Viral hepatitis in practice - 2016

The future role of GPs in managing hepatitis
Stuart Flanagan
pp 33-37
Over the last decade, a marked increase in morbidity and mortality due to viral liver disease has been observed. Those individuals who have been living with chronic hepatitis B virus and/or hepatitis C virus infection for many years have progressed to advanced liver disease, with limited access to effective therapies. However, access to new direct-acting antiviral therapies for hepatitis C, approved by the National Institute for Health and Care Excellence, along with better treatment and surveillance management for hepatitis B, offers an opportunity to reduce end-stage liver disease, hepatocellular carcinoma and mortality rates related to chronic infection with these viruses.
Comment: Time for the talking to stop
Ahmed Elsharkawy
pp 35-35
I would like to start by adding my thanks to those of Brendan Healey for Alastair Miller’s fantastic stewardship of Viral hepatitis in practice over the last six years. With its unique mix of practical articles along with state of the art reviews in the field, I have always found myself excited to see what each issue of the journal will bring when it lands on my desk.
The pros and cons of point-of-care testing for viral hepatitis
Owen Seddon and Susannah Froude
pp 38-39
Chronic viral hepatitis is a global problem that affects 400 million people worldwide. The World Hepatitis Alliance, along with the WHO, is part of a worldwide movement to eliminate viral hepatitis by 2030.1 Pivotal to achieving this is the triad of prevention, diagnosis and treatment. Diagnosis is important as it is estimated that 95% of those infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) are unaware of their condition. Without diagnosis, the impact of the recent advances in the treatment HCV infection and the effective and safe treatments already available for the suppression of HBV is negated.
Management of patients with chronic hepatitis C, end-stage renal disease and kidney transplantation
Geoffrey Dusheiko
pp 40-43
Hepatitis C virus (HCV) infection confers an independent risk of renal disease, and renal impairment is considered a common complication encountered in patients with chronic hepatitis C. The prevalence of hepatitis C in renal disease is high, ranging from 7% to 44%. Several diverse groups of patients with renal impairment require consideration, these include: patients with chronic kidney disease stage 4/5; those on haemodialysis; post-renal transplant patients; patients with cirrhosis and renal impairment (chronic renal disease; hepatorenal syndrome; acute kidney injury; acute chronic liver failure with organ damage); post-liver transplant patients with calcineurininduced renal impairment or, importantly, mixed essential cryoglobulinaemia with renal damage. Interferon and ribavirin treatment of patients with hepatitis C and chronic renal disease confer greater toxicity and have impaired efficacy compared with newer regimens/DAAs. Thus, a need exists to utilise improved direct-acting antiviral agent therapies for hepatitis C to improve the outlook for chronic renal disease.
Hepatitis C: is there a case for treating patients without evidence of advanced fibrosis?
Ian Blyth and Brendan Healy
pp 44-47
Robert* is a 41-year-old man with a past medical history of anti-thyroid peroxidase antibody-negative hypothyroidism, for which he is under follow-up in an endocrinology clinic and receives levothyroxine. In June 2015, he was incidentally found to have isolated transaminitis on routine blood tests taken as part of his follow-up, with alanine aminotransferase (ALT) levels of 80 u/l. On review, his ALT levels had been elevated since he began attending the clinic three years earlier. His team requested a viral hepatitis screen and Robert was found to be anti-hepatitis C antibody positive (screening tests for hepatitis B virus and HIV were both negative). On receipt of the positive antibody test, hepatitis C virus (HCV) RNA levels were measured and found to be 5x105 international unit (IU)/ml. Genotyping revealed that he was infected with HCV genotype 3.

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)