World Hepatitis Day
28 July 2023
In Australia, World Hepatitis Day is coordinated by the national peak body Hepatitis Australia to raise awareness and promote action on viral hepatitis. Hepatitis Australia’s vision is to see an end to viral hepatitis in Australia. The aim for World Hepatitis Day 2023 in Australia is to mobilise action on the elimination of viral hepatitis in Australia supported by national coordination. Hepatitis Australia
UpToDate
General
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Cochrane library
Articles
Diagnosis
General
Screening and prevention
Treatment
E-books
E-journals
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Articles
Diagnosis
Overview of related features of Viral Hepatitis: from pathogenesis to prevention, treatment, and complications
Viral hepatitis is a significant global health issue with multiple aspects that re-quire attention. This article will provide anoverview of the discussions on viral hepatitis, including athogenesis, serologic markers, prevention and treatment strategies, and complications or sequelae associated with hepatitis A, B, C, D, and E. Formosa journal of multidisciplinary research 30 May 2023
Diagnosis and management of autoimmune hepatitis
Autoimmune hepatitis is an inflammatory disease of the liver of unknown cause that may progress to liver cirrhosis and end stage liver failure if diagnosis is overlooked and treatment delayed. The clinical presentation is often that of acute hepatitis, sometimes very severe; less frequently, it can be insidious or completely asymptomatic. The aims of treatment are to induce and maintain long term remission of liver inflammation. Treatment can often even reverse liver fibrosis, thus preventing progression to advanced cirrhosis and its complications. Most patients need lifelong maintenance therapy, and repeated follow-up in experienced hands improves the quality of care and quality of life for affected patients. BMJ 6 February 2023
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General
Hepatitis B virus persistence and reactivation
Hepatitis B virus (HBV) infection causes chronic hepatitis and has long term complications. Individuals ever infected with HBV are at risk of viral reactivation under certain circumstances. This review summarizes studies on HBV persistence and reactivation with a focus on the definitions and mechanisms. BMJ 1 September 2020
Reevaluating liver donor risk in the era of improved Hepatitis C virus treatment
There has been a significant increase in donors with Hepatitis C virus (HCV) in the context of the opioid epidemic and increased deaths among patients with prior injection drug use. Donors with HCV make up appoximately 5% of those considered for transplant. HCV-positive organs will therefore continue to be prevalent in our donor pools, and it remains essential to use them if safe to do so. The authors demonstrate that HCV-positive organs are no longer associated with higher risk of unadjusted graft failure in the direct-acting antiviral medications (DAAs) era. JAMA 5 October 2022
Injection partnership characteristics and HCV status associations with syringe and equipment sharing among people who inject drugs
People who inject drugs (PWID) regulate their syringe and other injection equipment sharing to some extent by sharing preferentially with injection partners with whom they have a close personal or intimate relationship, and whose HCV status they are more likely to know. These findings underscore the need for risk interventions and HCV treatment strategies to consider the social context of syringe and equipment sharing within partnerships. BMC public health 20 June 2023
Hepatitis D virus infection
The overall prevalence of Hepatitis D virus (HDV) infection is unknown; however, hepatitis B virus (HBV) vaccination is reducing the incidence of HDV infection worldwide. The risk of cirrhosis and hepatocellular carcinoma is higher among patients with HDV infection than among those with HBV monoinfection. NEJM 6 July 2023
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Screening and prevention
The cost‐effectiveness of universal hepatitis B screening for reaching WHO diagnosis targets in Australia by 2030
Universal screening for hepatitis B will be cost‐effective only if the cost of testing is kept low and people receive appropriate clinical management. MJA 30 January 2023
Eliminating hepatitis C in Australia: a novel model of hepatitis C testing and treatment for people who inject drugs at a medically supervised injecting facility
People who attend supervised injecting facilities can be tested and treated for hepatitis C on site. Models that provide streamlined, convenient hepatitis C care promote engagement with treatment in a group in which the prevalence of hepatitis C is high. MJA 20 March 2023
Australia needs to increase testing to achieve hepatitis C elimination
Hepatitis C elimination programs in Australia should focus on increasing testing rates and linkage with care to maintain adequate levels of treatment. MJA 30 March 2020
Is dual testing for hepatitis C necessary? Modelling the risk of removing hepatitis C antibody testing for Australian blood donations
Antibody testing in addition to nucleic acid testing (NAT) does not materially change the risk profile. Even conservative estimates for the cessation of anti-HCV predict an HCV transmission risk substantially below 1 in 1 million. Therefore, given that it is not contributing to blood safety in Australia but consuming resources, anti-HCV testing can safely be discontinued. Vox Sanguinis 14 May 2023
Removing hepatitis C antibody testing for Australian blood donations: A cost-effectiveness analysis
Highlights
Vox Sanguinis 14 May 2023
Randomized trial of a vaccine regimen to prevent chronic HCV infection
In this trial, the HCV vaccine regimen did not cause serious adverse events, produced HCV-specific T-cell responses, and lowered the peak HCV RNA level, but it did not prevent chronic HCV infection. NEJM 11 February 2021 __________________________________________________________________________________
Treatment
Australian consensus recommendations for the management of hepatitis B
This statement highlights important aspects of HBV infection management in Australia. There have been recent changes in nomenclature and understanding of natural history, as well as a newly defined upper limit of normal for liver tests that determine phase classification and threshold for antiviral treatment. As the main burden of hepatitis B in Australia is within migrant and Indigenous communities, early identification and management of people living with hepatitis B is essential to prevent adverse outcomes including liver cancer and cirrhosis. MJA 7 March 2022
Efficacy and safety of Bepirovirsen in chronic Hepatitis B infection
In this phase 2b trial, bepirovirsen at a dose of 300 mg per week for 24 weeks resulted in sustained HBsAg and HBV DNA loss in 9 to 10% of participants with chronic HBV infection. Larger and longer trials are required to assess the efficacy and safety of bepirovirsen. NEJM 24 November 2022
New approaches to chronic Hepatitis B
Prophylactic vaccination alone will not alleviate the burden of hepatitis B. HBV continues to be a widespread cause of death because of inadequate screening, testing, and treatment, as well as late presentation — a major global public health failing. It is critical for agencies to advance affordable diagnostics in order to identify pregnant women and other persons who qualify for treatment. The cost of generic antiviral agents is not a barrier. Lack of community access and referral presents a greater obstacle than the low cost of drugs. NEJM 5 January 2023
Direct‐acting antiviral treatments in Australia for children with chronic hepatitis C virus infection
The authors found that the benefits of Direct‐acting antiviral (DAA) therapy for children with hepatitis C virus (HCV) infection are now attainable in Australia in normal practice (ie, outside clinical trials). This can be achieved using standard oral preparations, as outlined in the recent Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine guidelines. MJA 20 March 2023
General practitioners’ perceptions of the provision of direct-acting antivirals for hepatitis C within Australian private general practice: an exploratory qualitative study
Providing direct-acting antiviral (DAA) training, skill development, support and resources to GPs is necessary, but may not ensure that individual private GPs will provide this care. Where GPs do not include DAA in their scope of clinical practice (SOCP), care pathways need to be developed for patients who will benefit from DAA, including GP-to-GP referral. These findings may be applicable to other areas of unmet need that rely on GPs including provision of care in their SOCP. Australian journal of primary health 5 June 2023
Health-related quality of life among people who inject drugs in Australia
The study findings provide important health-related quality of life (HRQoL) data for economic evaluations, useful for guiding the allocation of resources for HCV elimination strategies and interventions among people who inject drugs (PWID). Quality of life research 23 June 2023
Hepatitis C direct-acting antiviral treatment completion: comparison of geographic, demographic and clinical characteristics in Australia
This analysis suggests that people in very remote areas of Australia have the lowest hepatitis C treatment completion rate, particularly those accessing treatment through GPs. Further investigation into predictors of low treatment completion within these populations is required. AJGP 6 June 2023
Association of direct-acting antiviral therapy with liver and non-liver complications and long-term mortality in patients with Chronic Hepatitis C
These findings support the need for continued efforts to promote hepatitis C screening for diagnosis and treatment of CHC before onset of complications to prevent liver and nonliver complications and to lower all-cause mortality. JAMA 12 December 2022
Association between alcohol use disorder and receipt of direct-acting antiviral Hepatitis C virus treatment
This cohort study suggests that individuals with alcohol use disorder (AUD), regardless of abstinence, were less likely to receive Direct-acting antiviral (DAA) treatment. Improved access to DAA treatment for persons with AUD is needed. JAMA 12 December 2022
A Phase 3, randomized trial of Bulevirtide in Chronic Hepatitis D
After 48 weeks of bulevirtide treatment, hepatitis D virus (HDV) RNA and alanine aminotransferase (ALT) levels were reduced in patients with chronic hepatitis D. NEJM 6 July 2023
Effect of prophylactic antibiotics on mortality in severe alcohol-related Hepatitis: A randomized clinical trial
In patients hospitalized with severe alcohol-related hepatitis, amoxicillin-clavulanate combined with prednisolone did not improve 2-month survival compared with prednisolone alone. These results do not support prophylactic antibiotics to improve survival in patients hospitalized with severe alcohol-related hepatitis. JAMA 9 May 2023 __________________________________________________________________________________
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