This week the 51st Congress of the Spanish Association for the Study of the Liver (AEEH) took place. During it, Gilead organized various activities reaffirming its present and future commitment to liver diseases.
Among them, a symposium focused on primary biliary cholangitis (PBC) and the opportunities available to patients who suffer from it, and in which doctors Rosa Morillas, from the Germans Trías i Pujol Hospital, Barcelona, Javier Ampuero, from Virgen del Rocío, in Seville, María Pilar Ballester Ferré, from the Clínico de Valencia, and Montserrat García Retortillo, from the Hospital del Mar, in Barcelona, participated. During it, the need to continue advancing in PBC, a chronic immune-mediated liver disease that It causes inflammation and gradual destruction of the small intrahepatic bile ducts. This leads to an alteration of bile flow and the accumulation of toxic bile acids that cause damage to the liver, leading to cirrhosis, decompensation or the need for a liver transplant if not managed correctly.
Its most common symptoms are pruritus (chronic itching) and fatigue (referring to tiredness), which in some cases can be debilitating. Currently, there is no cure for PBC, so treatments focus on slowing the progression of the disease and reducing symptoms associated with cholestasis (impaired bile flow), such as cholestatic pruritus. The effectiveness of the treatment is evaluated comprehensively, taking into account both the evolution of the biochemical parameters of liver function and the clinical and symptomatic impact of the pathology in the patients.
The experts highlighted that, although rare, it is the most common liver disease associated with chronic cholestasis in adults, mainly affecting women, with a ratio of 9:1 between women and men. Most are diagnosed between 30 and 65 years of age. Nowadays its management and treatment are constantly evolving. This symposium has been an opportunity to discuss the current challenges in the management of these patients, as well as to offer an update on new approaches and treatments to achieve not only biochemical, but also symptomatological improvement.
viral hepatitis
By 2030, the WHO has set the goal of eliminating viral hepatitis as a threat to public health. And this has been reflected in the conference organized by Gilead during the congress “Diagnostic and clinical approach to viral hepatitis”, in which doctors María Buti, from the Vall d’Hebron Hospital, in Barcelona, Beatriz Mateos, from the Ramón y Cajal, in Madrid, and Professor Pietro Lampertico, from the Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlínic, in Milan (Italy), participated.
During her intervention, Dr. Buti recalled that the hepatitis B virus (HBV) is the second most relevant carcinogen in the world, only behind tobacco. Infection with hepatitis Delta virus, which requires the presence of HBV to infect and complete its replication, significantly increases the risk of developing hepatocellular carcinoma (HCC) and other liver events.
In the case of the patients coinfected by HDV and HIVthe risk of developing hepatocellular carcinoma is up to six times higher compared to patients monoinfected by HBV. The International Agency for Research on Cancer has classified HDV as a carcinogen and cirrhosis is the most important risk factor for the development of HCC. In this context, HDV promotes the infiltration of inflammatory cells and accelerates the progression of liver fibrosis, which contributes to the development of cirrhosis. It should be noted that, according to the AEEH registry, the 43% of hepatitis D patients had cirrhosis in the diagnosis.
Therefore, early diagnosis and early treatment of people infected with HDV is important. The guidelines recommend screening HBV+ patients and repeating the quantification of viremia at least twice to rule out active infection. These cost-effective strategies such as double reflex testing increase the identification of VHD patients. Additionally, early treatment has benefits for hepatitis D patients.
That is why there is still a long way to go and, along these lines, Dr. Mateos recalled that the new strategies to increase diagnosis –such as those based on elevation of transaminases or strategies such as Prolink– and the linking of people with viral hepatitis are very necessary, focusing on the pending challenges to advance in the elimination of these infections as a public health problem. He also stressed that there is still a relevant number of undiagnosed patients who could be in advanced stages of the disease, which shows the need to reinforce these screening and early detection strategies.
8th edition of the Gilead-AEEH Scholarships
►As part of its support for scientific innovation, Gilead presented the 8th edition of the Gilead-AEEH Scholarships during the congress, reaffirming its commitment to research in hepatology. Since its launch in 2018, they have financed 90 projects in 16 CC AA, with aid of more than 2.2 million euros. Initiatives that have contributed significantly to the elimination of hepatitis C in Spain and to the improvement in the diagnosis of hepatitis D, addressing different populations and healthcare environments.
In Spain, more than 172,000 patients with hepatitis C have been treated. However, of them, more than 30% had advanced liver disease. Therefore, it is important to continue with elimination strategies that allow diagnoses to be made before it is so advanced.
