Viral hepatitis in practice - 2016


Hepatitis E: meeting the challenges
Glynn W Webb and Harry R Dalton
pp 17-23
First identified in the early 1980s, the hepatitis E virus (HEV) is now recognised as a major cause of acute viral hepatitis globally. HEV is a small, non-enveloped RNA virus with four genotypes. Genotypes 1 and 2 are obligate human pathogens and are endemic in developing countries, where large outbreaks of hepatitis E are often seen. By contrast, genotypes 3 and 4 are zoonoses with a porcine primary host and are responsible for sporadic cases, found mainly in developed countries.
Comment: The golden age?
Alastair Miller
pp 18-18
When I was a medical student there were only two forms of viral hepatitis: hepatitis A virus and hepatitis B virus. Other forms of acute hepatitis that were thought to be viral in origin were, therefore, referred to generically as non-A, non-B hepatitis. None of them were really amenable to treatment, although there was some interest already in the use of interferon.
Comment: Thanks Alastair!
Brendan Healy
pp 19-19
It is a great privilege to provide the editorial comment for this edition of Viral hepatitis in practice and, in particular, a privilege to follow in the footsteps of Alastair Miller. Those of you who know Alastair will know that he is both a great physician and a gentleman who is a great inspiration to younger doctors. As readers, you will also fully appreciate the amazing job he has done in editing this journal over the last six years. One of the strengths of Viral hepatitis in practice is the applicability of the topics covered to every day practice. Over the years, Alastair has done a great job in delivering very practical articles that have been a pleasure to read. I know that he is highly respected among the other members of the journal team, the editorial board and within the viral hepatitis community in general. So thanks Alastair for all of your hard work in this regard over the years and I only hope that my colleagues Ahmed Elsharkway, David Bell and I who are taking over the editorial role (three of us are sharing what Alastair did on his own, a measure of something surely!) continue to do as good a job as him.
Practical support services for people living with hepatitis C: an Edinburgh-based initiative
Shona Wells
pp 24-25
It is estimated that 39,000 people are living with chronic hepatitis C in Scotland, 50% of who are thought to be undiagnosed. Positive Help is an Edinburgh-based charity that provides practical support to those living with HIV and hepatitis C in the city and surrounding areas. Its work was recognised as a finalist of ‘Best Patient Support Programme’ in the Quality in Care (Hepatitis C) Awards 2015.
Viral hepatitis outreach clinic with Addaction
Quality in Care Hepatitis C
pp 26-26
Quality in Care Hepatitis C recognises, rewards and shares good practice in prevention, diagnosis and testing, treatment pathways and patient support throughout the UK.
Drug–drug interactions: what remains relevant in HCV treatment?
Omar El Sherif and David Back
pp 27-29
The development of highly effective direct-acting antivirals (DAA) represents the biggest advance in the treatment of hepatitis C. DAAs are associated with significantly higher sustained virology response rates (SVR), shorter therapy and fewer side effects compared to interferon-based therapy. However, the potential for drug–drug interactions (DDIs) between DAAs and other comedications has become an important consideration. The DAA era has seen an increase in the proportion of patients eligible for HCV therapy and a greater number of patients with multiple comorbidities undergoing treatment. These patients frequently receive a number of other medications, and require careful consideration for DDIs. Patients with HIV–HCV co-infection are another population where potential interactions between DAAs and anti-retroviral therapy remain highly relevant. A number of other potential DDIs have come to light with greater use of DDAs in clinical practice.
The development of a nurse-led hepatitis B service
Sara Stevenson
pp 30-31
There are an estimated 300 million people worldwide living with chronic hepatitis B (CHB). It is a leading cause of cirrhosis and hepatocellular carcinoma (HCC) with cirrhosis developing in 8–20% of patients with CHB. The majority of around half a million annual deaths due to HCC are related to CHB and cirrhosis. As well as being a significant global problem, data from Public Health England indicates that the frequency of CHB in the UK is increasing due to migration from areas of high prevalence, such as southeast Asia and sub-Saharan Africa, where 8–20% of the population are infected.

Viral hepatitis in practice was previously supported by Gilead Sciences from 2015 to 2016, by Gilead Sciences and Janssen in 2014, by Gilead Sciences and Roche Products in 2013 and by Gilead Sciences from 2009 to 2012.


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ISSN 2041-1162 (Print)  ISSN 2045-7863 (Online)