liver disease

The healthiest amount of alcohol consumption is zero.

August 4, 2022 by Madeline Lucre Leave a Comment

Experts on liver disease advocate less consumption, less advertising and higher prices for alcoholic beverages.

If you want to look after your liver and you can’t completely abstain from alcohol, you need to have at least three consecutive days a week alcohol-free. Even then, only by taking alcohol in moderation for the other four days, combined with a healthy diet, will avoid damage to your liver.

That was the key message from a conference held by the European Association for the Study of the Liver (EASL) and The Lancet.

Prof. Nick Sheron, a clinical adviser to Public Health England, told the conference that in general, liver disease impacted on a younger demographic.

“In Europe, chronic liver disease has a substantial impact on young and middle-aged individuals in their prime working years, with the peak age of death occurring in the late 40s and early 50s. This contrasts with mortality from smoking-related and other obesity-related illnesses, such as lung cancer or type 2 diabetes, for which deaths typically occur in the 60s and 70s,” he said.

Experts were unanimous on the two key tools needed to reduce alcohol consumption: raise the price and reduce the marketing.

“It’s well documented that the price of alcohol matters. Wales and Scotland put a minimum price (on alcohol) and overnight it lowered consumption,” said Aleksander Krag, Vice-Secretary of EASL.

They also recommend a complete social and digital media ban on the marketing of alcohol.

In contrast to Australia’s success with hepatitis C, our response to hepatitis B is lagging

July 28, 2021 by Rayan Calimlim Leave a Comment

Around one-third of Australians living with hepatitis C have been cured in the last four years.

Hepatitis means inflammation of the liver. Hepatitis C is one of five varieties of viral hepatitis (A-E), and alongside hepatitis B, is responsible for the majority of illness caused by hepatitis.

Australia’s response to hepatitis C is seen as a leading example around the world, and the elimination of the disease as a major public health threat is looking like an increasingly achievable goal.

But the situation is much less promising for Australians living with hepatitis B, which is now the most common blood-borne viral infection in Australia. It affects more people than hepatitis C and HIV combined.

In our research published today, we show Australia is falling short of its targets to reduce the burden of hepatitis B. Looking to the way we’ve responded to hepatitis C may set us on a better path.

Hepatitis C treatment

There were an estimated 182,144 people living with chronic hepatitis C in Australia at the end of 2017.

A number of important drugs were listed on the Pharmaceutical Benefits Scheme (PBS) from 2016, making curative treatments available to nearly all Australians living with hepatitis C.

The number of treatments being initiated has fallen significantly since the early peak, and significant differences exist in who has accessed the treatments across Australia. Nonetheless, Australia’s response to hepatitis C is highly regarded as an example of how to rapidly scale up hepatitis C treatment in a population, including among people who inject drugs.

Recent data from New South Wales demonstrate access to hepatitis C cures has led to a drop in the number of people with hepatitis C dying from liver cancer, with the bend in the curve coinciding with listing of these new treatments on the PBS in 2016.

Hepatitis B treatment

There were an estimated 221,420 people living with chronic hepatitis B in Australia in 2017. Along the trajectory of the disease, those who have liver disease or are at risk of developing liver disease require treatment.

Unlike hepatitis C, hepatitis B cannot be cured with current treatments, so ongoing antiviral therapy is required. This is similar to the treatment received by someone with HIV.

Although not a cure, the available treatments are effective. Current hepatitis B treatments have been associated with reducing the risk of liver cancer by around 50% in the first five years of treatment.

Scaling up such treatment and care will be a critical element in reversing the increasing tide of liver cancer deaths in Australia.

Targets

By 2030, the World Health Organisation has set out that 90% of people with hepatitis B should be diagnosed, 80% of those who meet criteria for treatment should be treated, and deaths due to hepatitis B should be reduced by 65% relative to 2015 globally.

In Australia, our Third National Hepatitis B Strategy sets targets to be achieved by 2022, including diagnosing 80% of people, engaging 50% of people in care, treating 20% of people, and reducing deaths due to hepatitis B by 30%.

Measuring progress towards these targets is complicated and requires consideration of a range of demographic and other factors. Considering most people living with hepatitis B in Australia were born overseas or are Aboriginal or Torres Strait Islander peoples, up-to-date estimates of Indigenous status and migration flows into and out of Australia are essential. Estimates of the prevalence of hepatitis B in different groups and detailed information about the natural history of hepatitis B in individuals over time is also important.

Our research

Taking these complexities into account, we’ve constructed a mathematical model simulating the burden of hepatitis B in the Australian population from 1951 to 2030. We wanted to see how Australia is faring in terms of meeting national and international targets.

By 2022, if current trends continue, the proportion of people diagnosed will reach 71% (short of the 80% goal). Some 11.2% of Australians living with hepatitis B will be on treatment (short of the 20% target). But we estimate the proportion who actually need treatment is around 30%, so we have a long way to go.

In related work mapping the burden of hepatitis B and estimating differences in treatment and care nationally we estimate only 20% of people living with hepatitis B are engaged in care (either being appropriately monitored or receiving treatment). Again, this is well short of the 50% target.

So why aren’t we meeting these targets?

Broader inequities in health access and outcomes for culturally and linguistically diverse groups and Aboriginal and Torres Strait Islander peoples play a substantial role. Together they represent over two-thirds of Australians living with hepatitis B.

Current delivery of treatment and care differs across the country. The experience and strategies used in those areas with higher levels of treatment and care should be examined and shared to address the inequities observed across Australia.

Like hepatitis C, Australia’s response to the needs of people living with HIV is viewed as being of a high standard. Two elements central to our responses to hepatitis C and HIV are currently missing for hepatitis B.

The first is strong, ongoing community engagement and leadership of the response by those affected. While organisations representing people living with HIV have existed since the 1980s and for hepatitis C since the 1990s, engagement with people living with hepatitis B has lagged well behind.

The second is treatment and care primarily being delivered in the community by primary care clinicians (especially GPs) – rather than in hospitals and by specialists, as is the case for most people living with hepatitis B. Many patients prefer seeing GPs and find this more convenient than waiting for hospital appointments and seeing specialists. This can be especially true for people living far from major hospitals, reflected in the fact hepatitis B treatment uptake is much lower than average in regional and rural areas of Australia.

Making it happen

Although both factors are priorities for action in the National Hepatitis B Strategy, progress will require ongoing funding and coordinated efforts by the Commonwealth, state and territory governments, primary health networks, and other partners.

The impact will be measured, not just in modelled estimates, but in real lives saved. While we’re not yet on track to meet our targets for hepatitis B in Australia, our modelling suggests even with the relatively low current uptake of treatment and care, 2,300 Australian lives were saved between 2000 and 2017, which otherwise would have been lost to liver cancer and liver failure caused by hepatitis B.

If we can translate what has been learned in our HIV and hepatitis C responses to increase access to essential care for Australians living with hepatitis B, thousands more lives can be saved in the next decade and beyond.

Benjamin Cowie, Director, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity; Karen McCulloch, Research Fellow, University of Melbourne, and Nicole Romero, Epidemiologist, WHO Collaboating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Explainer: the A, B, C, D and E of hepatitis

July 8, 2021 by Rayan Calimlim Leave a Comment

Hepatitis means inflammation of the liver. While we usually think of hepatitis A to E viruses, anything that causes inflammation or damage to the liver can be considered as a form of hepatitis.

Hepatitis A, B, C, D and E are very different viruses. Hepatitis A is genetically closer to the common cold than it is to hepatitis B, for example. Hepatitis C is closer to the virus that causes dengue fever.

The thing all five have in common is they can cause mild to very severe liver damage.

Viral hepatitis caused around 1.45 million deaths in 2013, making it the seventh leading cause of death world-wide; 96% of these were due to hepatitis B and C.

Hepatitis A

Hepatitis A is spread by contaminated food and water, and from person to person via faecal transmission, particularly in household settings.

Hippocrates first described epidemics of diarrhoea and jaundice as far back as the fifth century BCE.

Although hepatitis A can cause significant illness, the body usually recovers without treatment and becomes immune to future infections.

Vaccines can prevent hepatitis A; these are recommended for travellers and other groups at particular risk of infection. Vaccination given early after exposure can also prevent hepatitis A from developing.

Hepatitis B

This is the most prevalent form of viral hepatitis worldwide. It’s also the leading cause of liver cancer.

An estimated 250 million people live with hepatitis B worldwide. Around 220,000 Australians are thought to be living with chronic hepatitis B.

Hepatitis B can be transmitted from person to person through sex or blood-to-blood contact. But most people living with chronic (long-term) hepatitis B acquired it at birth from their mother, or early in life. Following infection, the chance of developing chronic hepatitis B in infancy is around 90%, but falls to 5% among adults.

A safe and highly effective vaccine has been available for hepatitis B since the 1980s. It has been provided for all infants born in Australia since May 2000.

In China, the proportion of children aged under five who had chronic hepatitis B fell from 9.7% in 1992 to 1% in 2006 after a vaccination program was introduced. The program has prevented millions of deaths from liver cancer and liver cirrhosis in China alone.

Effective antiviral treatments are also available for chronic hepatitis B. These can prevent liver damage and liver cancer from occurring. But even in a well-resourced country such as Australia, only a minority of people needing treatment and care for hepatitis B are receiving it.

Hepatitis C

This is the most common cause of viral hepatitis in Australia; an estimated 230,000 people live with chronic infection.

Hepatitis C is the leading cause of liver cancer and liver transplants nationally.

Most hepatitis C infections in Australia were acquired through unsafe injecting drug use. But in some low-resource countries, ongoing transmission of hepatitis C in health care settings is a major problem.

Around 80% of people infected with hepatitis C develop chronic infection; those who do clear the infection naturally remain susceptible to future infections.

No vaccine for hepatitis C is available.

On March 1, new treatments were listed on the Pharmaceutical Benefits Scheme (PBS). Although expensive, these treatments represent a huge advance and are a cost-effective way to prevent both new infections and deaths due to existing hepatitis C infections. With cure rates of the order of 90% with 8-24 weeks of tablets, and minimal side effects, these agents have the potential to drastically reduce the impact of hepatitis C.

The real key to unlocking this potential is the very liberal access criteria the Commonwealth government has applied to these treatments. As a result, uptake of treatment for hepatitis C in Australia has risen more than 20-fold.

Hepatitis D

Hepatitis D is a satellite virus that can only infect people who also have hepatitis B.

It is estimated that approximately 5% of people living with hepatitis B globally also have hepatitis D, which can lead to more severe liver disease.

Hepatitis E

Hepatitis E, like hepatitis A, is spread through contaminated food and water.

The first outbreak of hepatitis E infection acquired in Australia was reported earlier this year.

While hepatitis E is usually relatively mild, it can cause serious illness late in pregnancy, with a death rate of up to 20% among pregnant women in their third trimester.

A vaccine against hepatitis E has been developed but is currently licensed only in China.

While viral hepatitis remains a substantial public health challenge in Australia and world-wide, with political will, adequate investment and global partnerships, the world can eliminate viral hepatitis by 2030.

Benjamin Cowie, Director, WHO Collaborating Centre for Viral Hepatitis, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.