4^th International Congress on Viral Hepatitis June 18-30, -0001 Dublin, Ireland

Biography:

André-Jean REMY is Head of Hepatology and Gastroenterology Unit & Social Medicine, Unit of Perpignan Hospital and he is one of 41 viral hepatitis experts unit in France. Social medicine include jailhouse medical unit, retention center medical and primary care access unit. He is also Medical coordinator of Mobile Hepatitis Team, a new concept of HCV/HBV patients care from diagnosis to treatment. He is a Member of French hepatitis B and C guidelines follow-up national staff, General Secretary of ANGH, Administrator of AFEF (French Liver Diseases Association) and a specialist of viral hepatitis in drug users, inmates and precarious populations. He has published more than 150 scientific articles.

Abstract:

Background: Prevalence of viral hepatitis C is higher in prison environment than in the general population and is estimated of 4,8% in France. Systematic HCV screening on all inmates has been recommended in France since 1999. The impact in prison environment is little-known as based only on local studies. Inmate health care falls under USMP (Prison Setting Medical Unit), hospital specific units as by 1994 law. Access to antiviral C treatment for inmates has always been difficult in France, would it be for interferon and ribavirin or use of protease inhibitors, with less than 20% of treated patients. Arrival of DAA is an opportunity to propose treatment and the patient to accept it. In 2014, French guidelines recommended HCV carriers in prison should systematically be treated independently of stage of fibrosis; AAD treatment was permitted in 2015 without additional costs for hospitals. For prisoners, short treatment could be better to be treated in prison. Objectives: 1/ Evaluate completion rate of an 8-week antiviral C treatment by ledipasvir/sofosbuvir association in non-

cirrhotic genotype 1 patients in deprivation of liberty and achieve sustained virological response (SVR) 2/ Measure effectiveness of 8-week treatment (by protocol analysis).

Methodology: prospective non-interventional multicenter trial among inmates with chronic hepatitis C genotype 1 with fibrosis score F0 to F2 and who will receive a daily combination of sofosbuvir / ledipasvir during 8 weeks.

Results: for 100 first included patients: 91% men, mean age 37 years, contamination mode : drug injection 72%, nasal drug 9%, unknown 19%; genotype 1a  90%, initial liver fibroscan score: F0 66% F1 24% F2 10%; 95% have finished their antiviral treatment; only 5% stopped before end of 8 weekend and 5% have been responder/relapse; 91% have sustained virological response at time of these abstract.

Conclusion: It was first study of 8 weeks HCV treatment in prison; Almost all included patients have completed their treatment and are cured. Five percent of patients stopped the treatment because of cell promiscuity giving

Biography:

Yuming Wang  M.D. Professor and Chief Physician   Institute for Infectious Diseases,  Southwest Hospital, Army Medical University, Chongqing. Currently serves as the vice president in Infectious Diseases Branch of Capacity Building and Continuing Education Center, National Health and Family Planning Commission. Current research fields include severe hepatitis/liver failure, pathogenesis and treatment of viral hepatitis. Chief editor of 23 monographs, associated editor for 31 monographs. He has  published more than 400 papers, including Gastroenterology, Hepatology and CGH, etc

Abstract:

40 kD PEG IFN α-2a and 12kD PEG IFN α-2b have demonstrated effective immune control and resulted in better response in HBeAg positive CHB patients compared to nucleos(t)ide drugs (NUCs), e.g. HBeAg seroconversion and HBsAg loss. ^[1,2]However, efficacy of another PEG IFN α, i.e. 40kD PEG IFN α-2b, has not been reported yet.

Aim

This study aimed to compare efficacy among three PEG IFNα monotherapies in antiviral treatment-naïve HBeAg-positive CHB patients.

Material and Methods

Total 117 antiviral treatment-naïve HBeAg-positive CHB patients were enrolled. Subjects were randomly to receive 24 weeks of 40kD PEG IFN-α-2a (180 μg/week, Group A, n=41), 12kD PEG IFN α-2b (80μg/week, Group B, n=41), or 40kD PEG IFN-α-2b (180 μg/week, Group C, n=52) monotherapy. Primary endpoint was defined as satisfactory response (virological and biochemical response, plus anti-HBe seroconversion) at week 24. Secondary endpoints included ideal response (HBsAg loss) and HBsAg decline at week 24. All patients were further followed up during treatment.

Results

   There were no significant differences in sex, age, HBV genotype and ALT level among three monotherapy groups (P>0.05). After treatment of 24 weeks, satisfactory response rate in 40kD PEG IFN-α-2b group (30.77%,16/52) was higher than Group A (17.07%, 7/41, P=0.1285) and Group B (12.20%,5/41, P=0.0634), although with no statistically significant difference (P>0.05). Ideal response rates in 40kD PEG IFN-α-2b group (17.31%,9/52) was slightly higher than Group A (7.32%,3/41, P=0.1536)and Group B (4.87%,2/41, P=0.0653) . Partial response rates as HBsAg level decline from baseline were a bit higher in 40kD PEG IFN-α-2b group compared to 40kD PEG IFN-α-2a group (P>0.05)(Table). 

Conclusion

Compared to 40kD PEG IFN-α-2a and 12kD PEG IFN α-2b monotherapies, 40kD PEG IFN-α-2b monotherapy showed trends for better efficacy for antiviral treatment-naïve HBeAg positive patients at week 24. Meanwhile, 40kD PEG IFN-α-2b is at a much cheaper price, which exerts a better cost effects.

Table

Table.   Response after treatment of 12 weeks

Biography:

Yuming Wang  M.D. Professor and Chief Physician   Institute for Infectious Diseases,  Southwest Hospital, Army Medical University, Chongqing. Currently serves as the vice president in Infectious Diseases Branch of Capacity Building and Continuing Education Center, National Health and Family Planning Commission. Current research fields include severe hepatitis/liver failure, pathogenesis and treatment of viral hepatitis. Chief editor of 23 monographs, associated editor for 31 monographs. He has  published more than 400 papers, including Gastroenterology, Hepatology and CGH, etc. 

Abstract:

Adding pegylated interferon alfa in HBeAg-positive CHB patients treated with long-term nucleot(s)ide analogues (NUCs) therapy has demonstrated obvious improvement in HBeAg seroconversion ^[1,2] and HBsAg loss or seroconversion.^[3,4] Thus, it was reported to improve efficacy by adding PEG IFN α in NUC-treated patients.

Aim

This study was to compare response rates of three different pegylated interferon alfa combined with NUCs in NUC-treated HBeAg-positive patients.

Material and Methods

HBeAg-positive CHB patients that achieved HBsAg ≤1000IU/mL, HBeAg ≤5 S/COI and HBeAb ≤2 S/COI after a long-term NUCs treatment (≥2years), were randomized to receive combination therapies of PEG IFN α and NUCs for 24 weeks. Satisfactory response (virological and biochemical response, plus anti-HBe seroconversion) was defined as primary endpoint, ideal response (HBsAg loss) was defined as secondary endpoint. All patients with/without withdrawing drugs were keeping further followed up.

Results

Totally, 105 NUC-treated HBeAg-positive CHB patients with HBV markers fulfilling above-mentioned criteria were enrolled and randomized to receive 40kD PEG IFN-α-2a+NUCs combination therapy (180μg/week, Group A, n=38), 12kD PEG IFN-α-2b +NUCs combination therapy (80μg/week, Group B, n=35), or 40kD PEG IFN-α-2b +NUCs combination therapy (180μg/week, Group C, n=32). There were no significant differences in sex, age, HBV genotype and ALT level among the three groups (P>0.05). Satisfactory response rate in Group C (26.3%,10/38)was slightly higherthan in Group A (22.8%, 8/35, P=0.7320)and Group B (31.2%,  10/32, P=0.6489). 40kD PEG IFN-α-2b +NUCs combination therapy achieved significantly higher ideal response rates (18.8%, 6/32) than Group A (5.26%, 2/38, P=0.0773) and Group B (2.86%, 1/35,P=0.0336).(P<0.05).

Conclusion

In NUCs-treated HBeAg-positive CHB patients with low level of HBsAg and HBeAg/HBeAb, our result showed that ideal response rate in 40kD PEG IFN-α-2b +NUCs combination group was higher than in 40kD PEG IFN-α-2a +NUCs and 12kD PEG IFN-α-2b +NUCs combination therapies.

Table.  Responses in three groups after treatment for 24 weeks

Biography:

Braimah Salifu has completed a degree in Biological Sciences from University of Cape Cost, Ghana and currently a medical student in Nizhny Novgorod State Medical Academy, Russia.

Abstract:

Liver diseases are factors that cause damage to the liver, such as viruses, some drugs and alcohol use, but can also be genetically inherited. Obesity is also associated with liver damage. Over time, damage to the liver results in scarring (cirrhosis), which can lead to liver failure, a life-threatening condition.

Hepatitis is inflammation of the liver tissue – which is one of the most serious liver problems. The most common cause worldwide is viruses. Other causes include heavy alcohol use, certain medications, toxins, other infections, autoimmune diseases, and non-alcoholic steatohepatitis (NASH). There are five main types of viral hepatitis: type A, B, C, D, and E. Hepatitis A and E are mainly spread by contaminated food and water. Hepatitis B is mainly sexually transmitted, but may also be passed from mother to baby during pregnancy or childbirth. Both hepatitis B and hepatitis C are commonly spread through infected blood – these may occur during needle sharing by intravenous drug users. Hepatitis D can only infect people already infected with hepatitis B.

It’s necessary, therefore, to make screening in order to evaluate the kind of liver disease (hepatitis) a patient is suffering in order to administer the patient with the appropriate treatment or to prevent any kind of liver disease (hepatitis) after screening.

Ways by which screening and prevention awareness can be made worldwide are:

1. Education: global education programs about hepatitis should be held twice of thrice annually. These programs should highlight on the dangers and effects of hepatitis. These programs can be held in schools and other institutions. The government together with the health sector has a role to play.

2. Social Media: awareness of screening and prevention of hepatitis and liver diseases can be made through the media such TV show, Radio programs, Facebook, WhatsApp, VK, Instagram, YouTube, Internet, etc. At least, every human being on earth uses one of these platforms. For example, WhatsApp is almost everywhere and if we do have a popping messages about the screening and prevention of hepatitis and liver diseases through this medium, it will be a help to get people aware.

3. Door-to-door: awareness can be made worldwide by door-to-door interactions with  people. This can be done by coordination of organisations around the world and sending of workers or volunteers from these organisations to educate the people about the screening and prevention of hepatitis. 

Biography:

Ruchi Sogarwal, a professional in health and development sector for more than a decade, having a special focus on HIV/AIDS, hepatitis. She is currently working as Deputy General Manager-South Asia, PerkinElmer, leads public policy matters of the company. In the past, she served the Ministry of Health & Family Welfare, Government of India in various capacities. During tenure with NGOs, she led CSR/philanthropy supported projects focused to prevent and manage infectious diseases, mhealth interventions, etc.  She has published more than 40 papers in indexed Journals and has been serving as a member of various editorial and scientific committees of repute.

Abstract:

About 12 million people are reported to be suffering from Hepatitis C in India — six times the number of HIV/AIDS patients. Indian studies have reported that People who inject drugs (PWID) have disproportionately high HCV prevalence (20–90 %) in comparison to the general population. In light of overlapping risk factors for transmission of viral hepatitis and HIV infection, as well as limited public health resources in many settings, the World Health Organization has recommended integrating HCV and HIV services for prevention and management of co-infections. Pilot interventions have indicated that safe injecting and sexual practices, adherence to OST and frequent mobility customized for PWID by ‘age’ should be prioritized for HCV risk reduction.

During the 12th Five Year Plan (2012-17), Government of India launched the National Programme for prevention and control of viral Hepatitis. Further, it instituted the National Viral Hepatitis Surveillance Programme, which aimed at capacity building of health care functionaries with special emphasis on ‘community’ centric education. It also has focused strategies to increase ‘case finding’ and utmost safety during injection/blood transfusion practices for prevention of co-infections.

Though these policy initiatives are timely since recent treatment advances have resulted in most cases of chronic HCV being curable with the use of direct-acting antiviral regimens. However, translating these advances into declines in co-infections are currently limited by the fact that 50 to 75% of infected individuals are unaware of their sero-status and young individuals (<30 years of age) are likely to be undiagnosed or late diagnosed. Thus, continue to spread the infection for decades and eventually contributing to the health care burden. Therefore, a coordinated implementation practices for expanded access to prevention services addressing an unmet need of high risk individuals would surely help in making India a free nation from HCV and HIV.