Day 1 :
Keynote Forum
Hani Oweira
Hirslanden Hospital Group, Switzerland
Keynote: Surgery of the Liver and intraoperative interventional Therapies What is possible today?
Time : TBD
Biography:
Dr. med. Hani Oweira, is a visceral Surgeon working in the Hirslanden Hospital Group in Zurich and Cham in Switzerland. He was trained in Charite Berlin and the University Hospital in Heidelberg in Germany. His Research focused on the predictive markers for liver dysfunction after liver surgery and transplantation.
Abstract:
Liver resections are performed to manage Benign and Malignant focal lesions in the liver, and the post-operative outcome was improved over time due to improvement of surgical techniques which get benefit from understanding the liver anatomy and segmentation with improvement of hemostasis techniques. .Anatomy wise liver is divided to 2 lobes (Right and left) ant into 8 segments classified by Couinaud based on vascular inflow and outflow. There are many techniques for liver parenchymal transection started with clamp –crush technique and developed to ultrasonic vibration (harmonic shear), Cavitron Ultrasound Surgical Aspirator CUSA), hydro jet, radiofrequency dissector and recently staplers. There are numerous types of resection could be divided to major (>2 segments) and minor (<2 segments) and could be divided into anatomical (right and left hepatectomy, right anterior and posterior sectionectomy and left lateral sectionectomy), non-anatomical resection and individual segmentectomy. There are many other interventional procedures can be done during surgery for hepatic focal lesions rather than surgery as radiofrequency ablation (RFA), cryoablation or irreversible electroporation (IRE) which usually kept as combined intervention with surgery in deep parenchymal lesions which difficult to be removed without injuring or scarifying a major hepatic structure. Also one of the elegant technique in management of hepatic focal lesions especially Malignant one is adjuvant or pre operatiove angio-embolization or chemo/ radio embolization which deprive the lesion from its blood supply and supplying it with chemo or radiotherapy which may decrease the size of lesion and make it easier and accessible to be removed. In addition to that, systemic chemotherapy could have benefit in malignant lesions as it may decrease the size of the lesions and minimize the liver parenchyma needed to be resected to remove the whole lesion, and sometimes it changes non resectable liver lesions to resectable one.
Keynote Forum
Samson Michel
Univ Rennes, France
Keynote: Protective role of RIPK1 in hepatitis
Time : TBD
Biography:
Michel Samson has got his PhD in 1993 at University of Paris XI (France). He studied as postdoctoral scientist at Université Libre de Bruxelles (Brussels, Belgium) supported by prestigious fellowships (EMBO, European Community, etc..). He passed two years as visiting scientist at Genentech (California, USA). He is now team leader and director of research of Inserm at University of Rennes (France) in UMR 1085 Inserm, vice-director of Institut de Recherche en Santé, Environnement et Travail. He studies the inflammation, cell death and fibrosis in liver pathologies. He has published more than 90 papers in reputed journals (Nature, Cell, J Exp Med, Hepatology, J Hepatol., etc...), with already more than 8400 citations and H-index 37.
Abstract:
Hepatocyte death is a starting point of liver disease progression by promoting inflammatory and regenerative processes. The death of hepatocytes can be induced by the large variety of immune, infectious and toxic agents. When the hepatocyte death becomes chronic, a development of fibrosis, cirrhosis or hepatocellular carcinoma occur. The molecular mechanisms regulating these cell death pathways are poorly documented. Innate and acquired immune cells play key roles in the induction or amplification of hepatolysis, mainly mediated by expression and release of death ligands belonging to the TNF-superfamily including TNF-α, FasL and TRAIL. In this study, we investigated the role of RIPK1, a protein known to regulate cell fate decisions, in the death of hepatocytes using different in vivo models of hepatitis. Hepatitis was induced in mice by Concanavalin A (ConA), lipopolysaccharide (LPS), DNA-CpG, recombinant IFN-γ and TRAIL co-administration, FASL, Poly I:C, Murine-Hepatitis virus type 3, and high fat diet. Using specific conditional mice deficient in RIPK1 only in liver parenchymal cells (LPC) (Ripk1LPC-KO), we reveal its necessary function in the protection of hepatocyte during hepatitis. Administration of lipsome-encapsulated Cl2MBP served to investigate the role of Kupffer cells in the establishment of the disease. Moreover, Etanercept, a TNF-decoy receptor, was used to study the contribution of TNF-α during liver injury. All together, these works demonstrate that deletion of RIPK1 sensitizes hepatocytes to TNF-α-induced apoptosis. Thus RIPK1 plays a key role in the protection of hepatocytes during acute and chronic hepatitis.
Keynote Forum
Ken Sato
Gunma University Graduate School of Medicine, Japan
Keynote: The next stage strategy for Direct-acting antiviral failure in patients with chronic hepatitis C
Time : TBD
Biography:
Ken Sato is a Japanese, physician, hepatologist and gastroentelorogist, clinical and basic researcher in Gunma University Graduate School of Medicine in Japan; working for more than 20 years in this area. He started working as a physician at Gunma University and its affiliated hospitals in 1990. Some of Dr. Sato’s achievements in the field include researching tumors in the liver with non-alcoholic steatohepatitis. His research had lead in indentifying Werner Syndrome as a possible cause of the steatohepatitis. Additionally, Dr. Sato has researched carcinomas and hepatitis, especially pertaining to the liver.
Abstract:
Direct-acting antiviral (DAA)-based therapy has become 1st choice for patients with chronic hepatitis C. According to the guidelines or areas, DAA-based regimens that are approved varies. In Japan, sofosbuvir/ledipasvir (SOF/LDV), elbasvir/grazoprevir (EBR/GZR) or glecaprevir/pibrentasvir (GLE/PIB) and sofosbuvir/ribavirin (SOF/RBV) or GLE/PIB combination therapies are the 1st choice therapeutic options for patients with hepatitis C virus (HCV) genotype 1 and 2 according to the Japan Society of Hepatology (JSH) guideline for the management of HCV infection, respectively. The rate of sustained virological response is more than 90-95% in most of the regimens. Unfortunately, a small but certain portion of patients have to experience DAA failure. This is the unmet needs to be addressed for hepatologists. I will present the effects of the combination therapy with daclatasvir/asunaprevir/beclabuvir (DCV/ASV/BCV) and SOF/RBV for patients with treatment failure of DCV/ASV and ombitasvir/paritaprevir/ritonavir plus ribavirin (OBV/PTV/r+RBV) in patients with HCV genotype 1 and 2, respectively. The efficacy of DCV/ASV/BCV and SOF/RBV for treatment-naïve patients with HCV genotype 1 and 2 are reportedly 96% and 98%, respectively. However, there is no report showing the efficacy of each regimen for the corresponding previous DAA regimen failure to date. In Japan, the combination therapy with GLE/PIB has recently approved and are available. This therapy is a pan-genotype DAA regimen and is reportedly effective for patients with treatment failure of the combination therapy with DCV/ASV and SOF/RBV. I will also present the effects of the combination therapy with GLE/PIB for patients with treatment failure of DCV/ASV/BCV combination therapy, which have not been reported yet. The next stage strategy for DAA failure will be discussed. To elucidate HCV infection is also key to prevent new infection to HCV by decreasing HCV infected peoples.
- Hepatitis C
Session Introduction
REMY Andre-Jean
Perpignan Hospital, France
Title: PH8 a french national study of completion rate of HCV treatment in prison
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 signiï¬cant 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
|
HBsAg decline from baseline |
Group A 40kD PEG IFN-α-2a (n=41) |
Group B 12kD PEG IFN α-2b (n=41) |
Group C 40kD PEG IFN-α-2b (n=52) |
P |
|
1lg-2lg HBsAg decline from baseline |
7(17.1%) |
_ |
8(15.4%) |
0.8265 |
|
2lg-3lg HBsAg decline from baseline |
12 (29.2%) |
_ |
13(25.0%) |
0.6452 |
|
≥3lg HBsAg decline from baseline |
18(43.9%) |
_ |
29(55.8%) |
0.2558 |
- Hepatitis B | HCV/HIV Coinfection
Session Introduction
Yuming Wang
Southwest Hospital, China
Title: A randomly controlled study comparing efficacy among three combination therapies with different pegylated interferon alfa plus nucleot(s)ide analogues in NUCs-treated HBeAg-positive CHB patients
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 signiï¬cant 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
|
response |
Group A 40kD PEG IFN-α-2a+NUCs (n=38) |
Group B 12kD PEG IFN α-2b+NUCs(n=35) |
Group C 40kD PEG IFN-α-2b +NUCs (n=32) |
P value |
|
Satisfactory response |
10 (26.3%) |
8 (22.8%) |
10 (31.2%) |
C vs. A P=0.7320,C vs. B P=0.6489 |
|
Ideal response |
2 (5.26%) |
1 (2.86%) |
6 (18.8%) |
C vs. A P=0.0773, C vs.B P=0.0336 |
Braimah Salifu
Nizhny Novgorod State Medical Academy, Russia
Title: Some ways by which screening and prevention of hepatitis can be made aware to the people worldwide
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:
- 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.
- 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.
- 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.
Ruchi Sogarwal
PerkinElmer, Inc, India
Title: Prevention and Management of HCV-HIV co-infection in India: From Policy to Practice
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.