T. Jake Liang
SAN FRANCISCO — The president of the American Association for the Study of Liver Diseases reviewed some of the 2,300 new research findings presented here at the association’s annual Liver Meeting.
T. Jake Liang, MD, first summarized a comprehensive study of viral hepatitis B and C showing that by 2007, hepatitis C had overtaken HIV as a cause of death in the United States. By that time, Liang said, more than 70% of HCV-infected individuals were between the ages of 45 and 70 (ie, baby boomers).
“Some of this is due to youthful indiscretions … but these are the people who are getting older and more likely to get in [health] trouble,” Liang said, noting Centers for Disease Control and Prevention research. “We really need to be more aggressive in determining who they are and trying to treat them.”
Liang also reviewed the following research findings:
The Cost-Effectiveness of a Telaprevir-Inclusive Regimen as Initial Therapy for Genotype 1 Hepatitis C Infection in Individuals with the CC IL-28B Polymorphism
Researchers at Duke University Medical Center concluded that further trials should examine protease inhibitor-free strategies as first-line therapy in individuals with favorable IL-28B genotype. The study found that initial therapy with a telaprevir-based regimen is unlikely to be cost-effective.
“[CC IL-28B polymorphism] is a great marker, I would say, probably the best genetic marker we have so far to predict how a person will respond to treatment,” Liang said. “The question is: Maybe we can preselect patients using this genetic marker who will respond better to just this conventional pegylated interferon treatment.”
But both Liang and the researchers emphasized that this finding is based on “current cost and efficacy conditions.”
Diagnosis and Clinical Consequences of Hepatitis E Virus Infection in Orthotopic Heart Transplant Recipients
Several recent studies have shown that swine carry the hepatitis E virus, but it can occasionally infect humans, Liang said, noting research in the Netherlands on the prevalence and clinical consequences of hepatitis E infection in heart transplant recipients.
The study found sporadic acute HEV infection with genotype 3 in 3% of the heart transplant population studied.
Researchers found that consequences of this infection vary from mild, transient viraemia to severe, potentially progressive hepatitis with a marked steatosis in the liver biopsy.
“As the majority of cases would not be detected by IgM-HEV serology, we advise [real-time polymerase chain reaction] as a preferred method to diagnose hepatitis E infection in immune-compromised patients,” the study authors wrote.
A Randomized, Placebo-Controlled Trial of Oral Silymarin (Milk Thistle) For Chronic Hepatitis C
This study, funded by the National Institutes of Health, evaluated the effect of high doses of a milk thistle supplement on disease activity in patients with chronic hepatitis C. The milk thistle was administered at higher than customary doses, but this “did not significantly alter biochemical markers of disease activity in patients with chronic hepatitis C who had failed prior treatment with interferon-based regimens,” the study authors reported.
“Herbal products and over-the-counter medications are big business in this country and really not well regulated,” Liang said. “I think this study very clearly shows that the use of milk thistle is not effective in treating patients with hepatitis C.”
The Mediterranean Diet: Improvement in Hepatic Steatosis and Insulin Sensitivity in Individuals with NAFLD
Researchers at St. Vincent’s Hospital in Melbourne, Australia, studied the impact of the Mediterranean diet, compared to current standard low-fat dietary advice, on hepatic steatosis and insulin sensitivity in individuals with nonalcoholic fatty liver disease. “Even without weight loss, the diet reduces liver steatosis and improves insulin sensitivity in the study population,” they concluded.
“I think further long-term study is warranted,” Liang said. “If we can prevent a disease with diet, that’s probably better than any drugs we can develop.”
Reactivation of Hepatitis B Infection Among Patients with Cancer
Researchers at the University of Texas MD Anderson Cancer Center in Houston found that although hepatitis B reactivation occurred in nearly one-quarter of cancer patients after receiving chemotherapy, hepatitis B screening prior to chemotherapy occurred in only a small percentage of patients.
“These individuals … have a very high likelihood of reactivation,” Liang said, adding that the researchers concluded that persons at risk for hepatitis B are not being adequately screened prior to chemotherapy. “This is a very simple solution to prevent potentially life-threatening complications,” he said.
The First New Monotherapy Therapeutic PBC Study in a Decade? An International Study Evaluating the Farnesoid X Receptor Agonist Obeticholic Acid in PBC
Liang highlighted this study based on obeticholic acid, the first rationally developed drug for cholestatic liver disease that has been shown as effective for treating primary biliary cirrhosis as a single agent.
Based on the findings, the researchers concluded that a direct comparison with ursodeoxycholic acid is merited.
“Unfortunately, 70% to 90% of the patients had significant pruritus,” Liang said. “So, it may not be tenable as a lifelong treatment.”
Enoxaparin Prevents PVT and Decompensation in Advanced Cirrhotic Patients: Final Report of a Prospective Randomized Controlled Study
Next Liang described a prospective, randomized, controlled study in advanced-stage cirrhotics that showed enoxaparin to be safe and effective in preventing portal vein thrombosis. Enoxaparin was associated with greatly reduced occurrence of decompensation both during the active treatment and follow-up periods.
“We can see that patients do better in all three categories with this particular anti-thrombotic therapy. It’s certainly something that’s exciting,” Liang said.
A Randomized Controlled Study of Radiofrequency Ablation and Surgical Resection for Early-Stage Hepatocellular Carcinomas less than 4 cm in Diameter
Researchers in China concluded that in early-stage hepatocellular carcinoma patients — with no more than two lesions smaller than 4 cm in diameter — there is no significant difference in the 3-year recurrence or survival rates between radio frequency ablation and surgical resection treatments.
“This is an important study in the management of liver cancer,” Liang said. “The problem is that the evidence … has not been very clear, so there are always arguments that maybe you should just do the surgery. I think this study shows that there’s no difference, so you should decide what is the most economical way to deal with this.”
Dr. Liang is a tenured senior investigator and chief of the Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, at the National Institutes of Health in Bethesda, Md.