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Coverage of the 2015 AASLD Liver Meeting coverage of the 2015 American Association for the Study of Liver Diseases (AASLD) Liver Meeting in San Francisco, November 13-17, 2015.

Conference highlights include interferon-free therapy for hepatitis C, treatment for difficult-to-treat populations including people with HCV genotype 3 and liver  cirrhosis, hepatitis B prevention and treatment, and management of advanced liver disease.

Full listing by topic

Liver Meeting website



AASLD 2015: Tenofovir During Pregnancy Reduces Risk of Mother-to-Child Hepatitis B Transmission

Women with chronic hepatitis B and high viral load who were treated with tenofovir (Viread) during pregnancy were significantly less likely to transmit hepatitis B virus (HBV) to their babies, according to study findings presented this week at the AASLD Liver Meeting in San Francisco. Another study showed that women with hepatitis B often experience viral load or ALT "flares" during pregnancy or post-partum.


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Antiviral Treatment for Hepatitis B Improves Liver Function after Decompensation

Early treatment with antiviral therapy can restore liver function and increase survival in chronic hepatitis B patients with decompensated cirrhosis who might otherwise need a liver transplant, according to a Korean study published in the June 2015 issue of Hepatology.


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AASLD 2015: REP 2139 Shows Promise for People with Hepatitis B and Hepatitis Delta Coinfection

The nucleic acid-based polymer REP 2139, used first as monotherapy then combined with pegylated interferon, reduced hepatitis B surface antigen (HBsAg) levels, lowered hepatitis delta viral load, and increased anti-HBs antibody titers, according to findings from a small Phase 2 study presented at the AASLD Liver Meeting taking place this week in San Francisco. Participants fell into 2 distinct groups, with half being partial responders and half full responders.


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Telbivudine Prevents Mother-to-Child Hepatitis B Virus Transmission

Women with a high hepatitis B viral load who were treated with the antiviral drug telbivudine (Tyzeka) had a lower risk of transmitting the virus to their babies during pregnancy or birth -- in fact, none did so -- compared to untreated women whose infants only received standard immunoprophylaxis, according to a Chinese study reported in the June edition of Clinical Gastroenterology and Hepatology.


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Bone and Kidney Problems Uncommon Among Hepatitis B Patients on Long-term Antiviral Therapy

Long-term hepatitis B treatment using nucleoside/nucleotide antivirals appears safe over a follow-up period of 5 years, according to a large study from Hong Kong published in the September edition of Hepatology. Researchers saw no significant rise in the likelihood of kidney-related adverse events, and while nucleotide analogs were associated with an increased occurrence of hip fractures, the risk remained very low.


Antiviral therapy using nucleoside/nucleotide analogs such as lamivudine (Epivir), entecavir (Baraclude), adefovir (Hepsera), or tenofovir (Viread) is the mainstay of chronic hepatitis B treatment. While these antiviral drugs can effectively suppress hepatitis B virus (HBV) replication during treatment, they usually do not lead to a cure -- as indicated by HBsAg loss and HBs antibody seroconversion -- necessitating long-term therapy.

The nucleoside/nucleotide analogs commonly used for hepatitis B treatment are considered generally safe and well-tolerated. However, the nucleotides adefovir and tenofovir are associated with kidney toxicity (in fact, adefovir was never approved for HIV treatment for this reason). Used as a treatment for HIV, tenofovir can cause or worsen kidney impairment in susceptible individuals and often causes a small amount of bone loss after starting therapy. Long-term side effects have not been as extensively studied in people using it for hepatitis B.

Grace Lai-Hung Wong from the Chinese University of Hong Kong evaluated the risk of kidney and bone side effects in patients who received nucleoside/nucleotide analogs as hepatitis B treatment.

This cohort study used data from Hospital Authority, the major provider of medical services in Hong Kong, looking at more than 53,000 patients diagnosed with HBV infection between 2000 and 2012.

The primary events of interest were incident (new) kidney failure, renal replacement therapy or kidney dialysis, and incident fractures of the hip, vertebra, and all sites.

Among the 53,500 total hepatitis B patients, 7046 had been treated with nucleoside/nucleotide analogswhile 46,454 remained untreated. Those who were event-free for 3 years were included in the analysis.


  • After a median follow-up period of 4.9 years, adverse events occurred with the following frequencies in treated and untreated patients:

           o   Chronic kidney failure: 1.4% vs 0.6%;

           o   Renal replacement therapy: 0.7% vs 0.2%;

           o   All fractures: 1.3% vs 0.7%;

           o   Hip fractures: 0.2% vs 0.1%;

           o   Vertebra fractures: 0.2% vs 0.1%.

  • While adverse events occurred more often among treated people, nucleoside/nucleotide analog therapy was not associated with a significant increase in the risk of any of these events after propensity score weighting (hazard ratio [HR] 0.79 to 1.31; p= 0.225-0.887).
  • Looking only at nucleotide analogs (not nucleoside analogs), exposure was associated with a significantly increased risk of hip fractures (HR 5.69; 95% confidence interval 1.98-16.39; p=0.001), but not other events (HR 0.58-1.44; p=0.202-0.823).

"[Nucleoside/nucleotide analog]treatment does not increase the risk of renal and bone events in general," the study authors concluded. "Nucleotide analogs may increase the risk of hip fracture, but the overall event rate is low."

These findings provide reassuring evidence that the likelihood of serious kidney and bone side effects while using long-term antiviral therapy for hepatitis B is low. However, they suggest that ongoing kidney function and bone density monitoring is advisable during adefovir or tenofovir treatment, and that people with pre-existing kidney or bone problems should be treated cautiously or avoid these drugs.



GLH Wong, YK Tse, VWS Wong, et al. Long-term safety of oral nucleos(t)ide analogs for patients with chronic hepatitis B: A cohort study of 53,500 subjects. Hepatology 62(3):684-693. September 2015.

EASL 2015: Using Interferon with Hepatitis B Antivirals Raises Likelihood of HBsAg Loss

Treating chronic hepatitis B with tenofovir plus pegylated interferon for 48 weeks resulted in a higher rate of hepatitis B surface antigen (HBsAg) clearance than either drug taken alone, though the response rate was still just 9%, according to a study presented at the recent European Association for the Study of the Liver (EASL) 50th International Liver Congress in Vienna. Other researchers reported that adding 48 weeks of interferon to nucleoside/nucleotide therapy increased the rate of HBsAg loss to about the same level, and switching to interferon may be effective for selected patients.


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July 28 Is World Hepatitis Day

July 28 is World Hepatitis Day, an opportunity to raise awareness about viral hepatitis and its consequences. This year's theme is "4000 Voices," reflecting the estimated 4000 people who die from viral hepatitis -- primarily hepatitis B and C -- each day, out of the approximately 400 million thought to be infected worldwide.


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ASCO 2015: PD-1 Checkpoint Inhibitor Nivolumab Shows Promise against Liver Cancer

Bristol-Myers Squibb's PD-1 immune checkpoint inhibitor nivolumab (Opdivo) was a star of the show at the American Society of Clinical Oncology (ASCO) annual meeting this week in Chicago, with study results showing that the drug demonstrated anti-tumor activity against hepatocellular carcinoma in a Phase 1/2 study, along with further Phase 3 evidence of its effectiveness against lung cancer and melanoma.


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