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Review of the European Association for the Study of the Liver (EASL) International Liver Congress (ILC) 2019

| Hepatology
Location

Reed Messe Wien Congress and Exhibition Centre – Vienna, Austria

Date
10.04.19–14.04.19
Citation
EMJ Hepatol. ;7[1]:10-25.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

Vienna is often referred to as the ‘City of Dreams’ owing to it being the birthplace of psychoanalyst Sigmund Freud. Much in the way that Freud was a pioneer in the field of psychoanalysis, encouraging discussion across academia that continues to this day, this year’s International Liver Congress (ILC) held in this beautiful city garnered a large, international ensemble of hepatology experts, each of whom had inspiring aspirations for the field. Innovation is an essential facet of all medical research, and this was clearly on show across 5 engaging days in the Austrian capital.

Profs Dominique Valla and Tom Hemming Karlsen welcomed the approximately 9,000 delegates from 125 countries, with the former offering some sound advice to the audience: ‘‘Seek out knowledge that is missing in your everyday practice and understanding of liver disease, and have the curiosity to go beyond your individual field, as there is much to be learned at the meeting points between different disciplines.’’ This collaborative approach taken towards tackling problems in the hepatology field was emphasised across some of the key talking points broached at the congress, including the need for encouraging positive change in public health and also the partnership with international bodies and patient organisations.

With 2,500 abstracts and 1,500 poster presentations, there was a wealth of information for our team to absorb during our time in Vienna. As always, we have compiled some of the abstracts we were most impressed by and included them in this edition of EMJ Hepatology 7.1. Additionally to these sessions, various topics of discussion were appropriately divided into six specialities and presented throughout each day:

  1. Liver Tumours
  2. Cholestasis and Autoimmune
  3. Viral Hepatitis
  4. Metabolisms, Alcohol, and Toxicity
  5. General Hepatology
  6. Cirrhosis and Complications

The steps needed for eliminating hepatitis C virus infection by 2030 were reiterated in one
informative session, detailing the strategic approach needed regarding approaches to investment, screening and diagnosis, and prevention of reinfection. A further discussion revolved around how declining healthcare resource utilisation was leading to worse manifestations of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis in the USA and European populations, and how the development of tools to inform patients and help physician decision making could help with the short and long-term management of this life-threatening disease. Several of the sessions followed in this vein: firstly, by acknowledging our shortcomings in the field and the problems facing us,
before discussing proactive and implementable solutions that can potentially improve quality of life for countless patients.

There was an impressive variety in the types of session provided at ILC 2019, among which the educational sessions are worthy of particular recognition. There was clearly an emphasis on maximising the dissemination of ideas and information, as attendees were able to make the most of seminars on critical reflections on
landmark papers, ‘solve the case’ sessions,
research think tanks, basic science seminars, and meet the expert sessions. Targeted sessions were conducted to address some of the aforementioned key talking points, including those involving nurses and allied health professionals, as well as other public health sessions. Seeing first-hand experts from across the healthcare spectrum come together to discuss collaborative solutions to global problems was inspiring, and we are sure the optimism surrounding such discussions will carry on to ILC in the future.

There were several momentous developments in the field that were brought to our attention at the congress, which we have presented in this congress review for your reading pleasure. Perhaps the most exciting could be the
first findings from the clinical trials of two investigational drugs used for the treatment of acute hepatic porphyria and polycystic liver disease associated with autosomal dominant polycystic kidney disease, two rare and poorly managed liver diseases. It is encouraging to see equal attention given to rare conditions such as these and the more common hepatic diseases discussed at this congress, including nonalcoholic fatty liver disease and viral hepatitis: these conditions are a major burden on the healthcare system, and it is to all our betterments to develop effective therapeutic strategies together. Witnessing the innovation of potentially life-changing treatments is always exciting for the scientific and clinical community, making our attendance at this year’s ILC all the more worthwhile.

It would appear that ILC 2019 was a resounding success, both for the research and medical communities, and indeed the European Medical Journal! Based on our experiences this year, we are very much looking forward to next year’s congress in our backyard of London, where we are certain that the hepatological advancements made this year will have developed even further to improve the overall management and treatment of liver disease. Until then, we hope you enjoy reading our review of this year’s congress highlights.

Encouraging Progress in the Treatment of Two Rare Liver Diseases

PROMISING findings have emerged from the clinical trials of two investigational agents regarding two rare and poorly managed liver diseases: acute hepatic porphyria (AHP) and polycystic liver disease (PLD) associated with autosomal dominant polycystic kidney disease (ADPKD). The results were presented in a EASL ILC press release at this year’s ILC.

The AHP study (ENVISION) involved the use of an RNA interference agent termed givosiran. Givosiran selectively knocks down the hepatic delta aminolevulinic synthase 1 (ALAS1) enzyme responsible for the accumulation of toxic intermediates characteristic of deficient heme synthesis. Heme is vital for haemoglobin function, and its inhibition can manifest into serious neurovisceral attacks and other chronic,
morbid symptoms.

In a cohort of patients experiencing these attacks, givosarin reduced the mean annualised rate of attacks by a significant 74% compared to placebo (p=6.04×109), and 50% of these patients remained attack-free compared to the control (16.3%). Accumulation of the prognostic toxic intermediates was also stifled.

Prof Manisha Balwani, Department of Genetics and Genomic Sciences and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA, and principal investigator of the study, commented: ‘‘Givosiran represents a novel approach to the treatment of this rare liver disease, for which there is a considerable unmet need.’’

The second study investigated the use of the somatostatin analogue lanreotide for treating ADPKD-associated PLD. This drug targets the characteristic enlargement of the liver caused by the formation and accumulation of
cysts. Previous studies had been unable to demonstrate long-term volume-reducing effects for lanreotide.

In the study cohort of 305 ADPKD patients (175 of which had PLD), the lanreotide-treated group exhibited a 1.99% decrease in height-adjusted total liver volume following 120 weeks, compared to a 3.92% increase in the control group. Importantly, this effect was still observed 4 months following the final injection, demonstrating the drug’s long-term effect.

Dr René van Aerts, Radboud University Medical Centre, Nijmegen, Netherlands, was enthusiastic about the findings: ‘‘This study has provided the robust evidence we needed that lanreotide is associated with sustained reductions in liver growth in patients with PLD due to ADPKD.’’

Considering the difficulties associated with facilitating clinical trials for rare genetic conditions, the significant findings presented here for both conditions could impact the field in ways that, although too early to ascertain their magnitude, could help improve the quality of life for countless people.

Real-World Studies Demonstrate Glecaprevir/Pibrentasvir Effectiveness for HCV Treatment

INFECTING an estimated 71 million people worldwide, hepatitis C virus (HCV) remains a serious problem for global healthcare; however, despite this the increased availability of direct-acting antivirals (DAA) has greatly improved the scope for therapeutic intervention. Glecaprevir/pibrentasvir (G/P) is one such DAA, a fixed-dose pan-genotypic combination tablet. Following its approval in July 2017, the results from two large real-world studies have emerged detailing high rates of sustained virological response (SVR) in HCV patients following G/P treatment. These observations were presented during a EASL ILC press release at this year’s ILC in Vienna, Austria.

The first study, carried out at Hannover Medical School, Hannover, Germany, included 1,698 HCV patients from the German Hepatitis C-Registry (DHC-R) who had received G/P treatment. Notable comorbidities that often lead to deferred HCV treatment were present in the cohort, including the receiving of opioid substitution therapy (26%), presence of psychiatric disease (15%), and significant alcohol (6%) and drug (3%) abuse. In the intent-to-treat population, there was a reported 97% SVR rate 12 weeks following treatment cessation (SVR12), and mental and physical component scores were greatly improved in the patients with comorbidities.

Prof Markus Cornberg, who presented the findings, commented: ‘‘We found G/P treatment to be safe and highly effective, and to lead to significant improvements in reported physical and mental wellbeing.’’

An additional study by researchers in the USA studied data from 1,131 patients who had started G/P treatment between August 2017–April 2018. A SVR12 rate of 93% was reported for the G/P group, with additional findings from a sofosbuvir/velpatasvir treated cohort showing a 90% SVR12 rate. These results appear to support the findings of the Hannover team, and collectively attest to the success of this particular DAA treatment regimen for tackling the problem of global HCV infection.

Hepatitis B Virus Treatment Tenofovir Could Lower Risk of Hepatocellular Carcinoma

TENOFOVIR could lower the risk of hepatocellular carcinoma (HCC) when used to treat hepatitis B virus (HBV), as found by a study presented at this year’s ILC and reported in an EASL ILC press release dated 13th April 2019. The study found that chronic HBV treated with tenofovir (TDF), as opposed to entecavir (ETV), lowers the risk of HCC by at least one third.

Approximately 290 million people worldwide are HBV-infected, which can lead to the development of HCC. TDF and ETV are recommended as first-line treatments for HBV, but current guidelines do not specify a preference between the two antiviral drugs.  A previous South Korean study found that HCC risk was lower in patients who received TDF as treatment rather than ETV. Following this, further research was required to explore these findings.

The observational study included 29,123 adults who had received initial treatment of ETV or TDF for chronic HBV for ≥6 months from 2008–2018. The participants were located using public hospital and clinic databases across Hong Kong. The sample had a mean age of 53.7±13.3 years and was 63.5% male. TDF was initially used to treat 1,227 of the patients (4.2%), whereas the remaining 27,896 (95.8%) initially received ETV.

At the study follow-up of 3.3 years (interquartile range of 1.6–5.0 years) 9 TDF-treated patients (0.7%) and 1,468 (5.3%) ETV-treated patients had developed HCC. The 5-year cumulative incidences were, for ETV-treated individuals,
7.5% (95% confidence interval: 7.1–7.9%) and, for TDF-treated individuals, 1.3% (95% confidence interval: 0.6–2.6%).

Dr Terry Yip, The Chinese University of Hong Kong, Hong Kong, China, presented the conclusion: “Tenofovir was associated with a significantly lower risk of HCC than entecavir in this large population of adults with chronic HBV infection.” The researchers did recognise the limitations of their study due to its observational nature, but found the results promising as they were consistent with the South Korean research findings.

Elafibranor Oral Treatment Decreases Primary Biliary Cholangitis Biomarkers

ELAFIBRANOR has significant anticholestatic efficacy in patients with primary biliary cholangitis (PBC), according to researchers who presented their findings at ILC 2019 in Vienna, Austria, as reported in a EASL ILC press release from 13th April 2019. Dr Velimir Luketic, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA, presented the study: “12 weeks of elafibranor treatment was well tolerated and produced marked improvements in alkaline phosphatase (ALP).”

The chronic autoimmune disease PBC causes destruction of the bile ducts, impeding bile flow, which leads to cirrhosis and liver disease. Elevated levels of liver enzymes such as ALP are a biomarker of PBC. There is a need to develop new treatments for PBC as the current options are limited and, when not intolerable, elicit a limited response in the patient.

The researchers studied 45 PBC patients without cirrhosis who had received the current recommended treatment, ursodeoxycholic acid, but had not demonstrated an adequate response. Elafibranor, an oral treatment with an anti-inflammatory effect, was used in this Phase II study. Participants were randomised to a 12-week period in one of three groups: add-on oral elafibranor at 80 mg per day, 120 mg per day, or placebo. At the end of Week 12, patients were reviewed for a change in ALP.

Results showed a significant decrease of ALP in both groups that received an elafibranor dose compared with placebo (p<0.001): 48% decrease in the 80 mg group, 41% decrease in the 120 mg group, and a 3% increase in the placebo group. Lipid and inflammatory markers also saw significant improvements, and pruritis was also decreased. Dr Luketic concluded: “These results suggest the treatment has substantial anticholestatic efficacy that we hope will translate into long-term benefits for patients.”

Nonalcoholic Steatohepatitis Could Be Treated with Obeticholic Acid

OBETICHOLIC acid is an effective treatment option for nonalcoholic steatohepatitis (NASH) with fibrosis, as seen in a study presented at ILC 2019 and reported in a EASL ILC press release dated 11th April 2019. The Phase III REGENERATE study showed that 25 mg per day of obeticholic acid (OCA) improved fibrosis in nearly 25%
of participants.

NASH has a global prevalence estimated to be from 1.50–6.45%, but there are no approved medications specifically for NASH treatment in Europe or the USA. Dr Zobair Younossi, Professor and Chairman of the Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA, presented the study and outlined its necessity: “There is an urgent need for effective treatment regimens for NASH, a common liver disease which can lead to cirrhosis, liver failure, and need for transplant.”

The researchers studied 931 individuals diagnosed with NASH and significant or severe fibrosis. These participants were randomised into three groups: 10 mg OCA per day (n=312), 25 mg OCA per day (n=308), and placebo (n=311). The primary endpoints were either improvement of fibrosis with no worsening of NASH or resolution of NASH without deterioration of fibrosis.

Results showed the 25 mg group to have been the most successful: they met the endpoint of improvement of fibrosis without worsening of NASH in 23.1% of participants (p=0.0002 versus placebo). NASH resolution was not achieved, but some symptoms were reduced in this group: hepatocellular ballooning by 35.1% (p=0.0011 versus placebo) and lobular inflammation in 44.2% (p=0.0322 versus placebo).

The most common adverse event, pruritus, was reported by 51% of the 25 mg OCA group, 28% of the 10 mg OCA group, and 19% of the placebo group. The 10 mg and placebo groups saw <1% withdrawal due to pruritus, compared
with 9% of the 25 mg group. Aside from this, the results are promising, as Dr Younossi concluded: “These first results from the REGENERATE study give us hope that a new targeted approach to NASH treatment may soon become available and potentially reverse some of the liver damage associated with this important liver disease.”

The Future of Liver Disease in People with HIV

A GLIMPSE into the potential future of liver disease in people living with HIV was provided by the results of two studies presented at ILC 2019. These studies suggested that nonalcoholic fatty liver disease (NAFLD) could eventually be the most common liver disease affecting people with HIV. Additionally, it was highlighted that there were: “…significant proportions of patients with HIV infection at risk of NAFLD and progressive liver disease,” according to Dr Sila Cocciolillo, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada, an author of one of the studies. The studies were reported in a EASL ILC press release dated 11th April.

These findings are of importance as they suggest that the healthcare system may need to adapt its practices. For instance, Dr Cocciolillo recommended that there should be dedicated monitoring of patients with HIV. In regard to
NAFLD becoming an increasingly common cause of liver disease in people with HIV, Prof Philip Newsome, Vice-Secretary, EASL declared: “This reinforces the need to study therapeutic agents in patients with NAFLD and HIV, an area which is seldom examined.”

The first study presented at ILC, which was USA-based, saw the examination of the records of >47,000 people with HIV. Of these people, approximately >10,000 had liver disease. Over a 10-year period ending in 2016, there were several headline findings:

  • The prevalence rates of viral hepatitis declined from 27.75 to 24.17 per 100,000 people (p=0.009).
  • Prevalence rates of NAFLD increased to 11.62 from 5.32 per 100,000 people (p<0.001).
  • Mortality rates related to viral hepatitis decreased from 3.78 to 2.58 per 100,000 people (p=0.006).
  • Mortality rates related to NAFLD increased from 0.18 to 0.80 per 100,000 people (p=0.041).

The second study presented, which was a multinational collaboration, focussed on two cohorts of adults with HIV who did not have viral hepatitis coinfection and were not heavy drinkers. The researchers used elevated alanine aminotransferase levels and/or significant fibrosis to identify those who were at risk of progressive liver disease. Based on this, they estimated that 25.2% of patients with NAFLD were at risk of progressive liver disease, whereas 18.4% of patients without NAFLD were at risk of progressive liver disease. As already discussed, these two studies in conjunction suggest a potential trend in the future of liver disease for those living with HIV. This suggests the need for healthcare systems to prepare for such a future, and also the need for further studies into this trend.

Could This Novel Molecule Be the Holy Grail for Hepatitis B Virus-Infected Livers?

COVALENTLY closed circular DNA (cccDNA) exhibits a mechanism in hepatitis B virus (HBV) infection that currently inhibits treatment of the infection. However, researchers from Shanghai, China, have discovered a new molecule that can be administered orally that, in their study, removed all traces of cccDNA in human hepatocytes and mouse models. The molecule, named ccc_R08, was evaluated by the researchers in two studies, the first on human hepatocytes and the second on mice that had been infected with circular DNA to mimic the mechanism of HBV infection in humans.

In the first study, the molecule was administered 2 days following infection in the hepatocytes. The researchers noted a significant drop in the levels of cccDNA in the cells, and simultaneously, there was no problematic effect on the mitochondrial DNA and cellular toxicity was not detected.

Following on from this, the researchers looked at the effect of the molecule on mouse models transduced with circular DNA that mimicked HBV infection in humans. Just like in the earlier study, treatment with ccc_R08 led to a drop in serum levels of HBV DNA, pre-genome RNA, hepatitis B surface antigen, and hepatitis B e-antigen which was maintained in the post treatment follow-up period. Following the end of this period, the levels of the circular DNA molecules in the liver sat below the lower limit of quantification in the subgroup that was treated. By comparison, the control group receiving entecavir showed no change on cccDNA levels.

Dr Lu Gao, Roche Innovation Centre, Shanghai, China, commented: “We were encouraged to see that this agent had the potential to reduce pre-existing cccDNA from the liver in this animal model of HBV replication, even to undetectable levels.” He added: “We think this type of molecule is well worth exploring further to evaluate its potential to cure chronic HBV infection in humans.”

Faecal Microbiota Transplant Reduces the Burden for Hepatic Encephalopathy Patients

HEPATIC encephalopathy (HE) is a burdensome neurological syndrome that affects up to 40% of people with cirrhosis. The standard of care for HE is treatment with lactulose, but this, along with the use of other antibiotics, can greatly impact the gut microbiota, disposing patients to additional incidents of HE, cognitive impairment, and systemic inflammation. Now, new research from a randomised, patient-blinded, placebo-controlled study, presented in a EASL ILC press release, has shown the use of oral capsule faecal microbiota transplantation (FMT) to be effective at reducing hospitalisations and dysbiosis, as well as improving cognitive function.

Researchers identified 20 patients with cirrhosis and recurrent HE who were already receiving lactulose plus rifaximin; these patients were then randomised 1:1 to receive either 15 FMT capsules (prepared from the same donor) or placebo. Duodenal/sigmoid biopsies, cognitive function assessment (with the EncephalApp and the psychometric hepatic encephalopathy score [PHES]), and stool analysis were performed both pre-treatment and 2–4 weeks post-treatment. Follow-up was 5 months.

Results were promising for this new treatment: 6 patients in the placebo group died versus one in the treatment group (p=0.05), and the placebo group also experienced more hospitalisations than the treatment group (9 versus 1, respectively; p=0.02). A significant increase in duodenal mucosal microbial diversity was reported in the FMT group after treatment, including an increase in Ruminococcaceae and Bifidobacteriaceae and a decrease in Streptococcaceae and Veillonellaceae. Cognitive function also showed a marked improvement versus placebo (p=0.02).

While further studies are needed to verify these findings in a larger cohort, the future is bright for this exciting treatment modality. Discussing the study, Annalisa Berzigotti, University of Berne, Switzerland, and EASL governing board member, concluded: “Oral faecal microbiota capsules are an interesting innovation to modulate the gut microbiota in cirrhosis and could represent a novel treatment strategy to reduce the burden of recurrent hepatic encephalopathy.”

Large Numbers of Teenagers and Young People are at Risk of Undiagnosed Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD), the accumulation of lipids in the liver (steatosis) unrelated to alcohol consumption, is the most common form of chronic liver disease among both adults and children with a global prevalence of 20–30%. Large numbers of young adults have features suggestive of NAFLD, and 1 in 40 have already developed fibrosis. These findings were presented by Dr Kushala Abeysekera to attendees of the ILC and reported in a EASL ILC press release dated 12th April 2019.

A team of researchers from Bristol, UK, analysed the ultrasound scans of 4,021 young adults from the Avon Longitudinal Study of Parents and Children (ALSPAC). Prevalence of NAFLD in the cohort was 2.5%. These individuals were revisited as young adults (mean age: 24 years) to assess steatosis and fibrosis using transient elastography.

After excluding those with excessive alcohol consumption, 76 (2.4%) of the 3,128 individuals had some degree of fibrosis and 8 (0.3%) had fibrosis evaluations equivalent to stage 4 (F4) fibrosis. Steatosis (indicative of NAFLD) was identified in 680 (20.8%) individuals, with half of them (331) staged as severe (S3). Furthermore, when liver enzymes (alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase) were analysed, a positive correlation with their increase and the increase of fibrosis (F) (p≤0.002) and controlled attenuated parameter (CAP) scores (p<0.001) was observed, indicative of liver damage. Finally, BMI rose significantly with both F and CAP scores (p<0.001 for both).

Prof Phillip Newsome, Vice-Secretary, EASL, said: “These data highlight the impact of the obesogenic environment, and in particular, its role in the development of NAFLD in a much younger sector of the population. This requires swift changes in public policy if we are to defuse the ticking time bomb of obesity and NAFLD.”

Environmental Exposure and the Risk of Autoimmune Liver Disease Development

ENVIRONMENTAL exposure could be contributing to the development of certain autoimmune liver diseases, as shown by a study presented at the ILC and reported in a EASL ILC press release from 11th April 2019. The study, carried out in northern England, found significant clustered cases of primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC), which are relatively rare conditions, pointing to the involvement of an environmental agent.

The study was carried out by a group of researchers from Newcastle, UK and was supported by the National Institute for Health Research Newcastle Biomedical Research Centre. Participants were from the north-east of England and north Cumbria and had one of the three autoimmune liver diseases: PBC (n=2,150), AIH (n=963), and PSC (n=472).  Postal addresses were used to carry out spatial point analysis to investigate clustering, along with
spatio-temporal analyses.

Higher than expected prevalence of the three autoimmune diseases were found at approximately 1.0–2.0 km. Extra clusters appeared for AIH and PSC at approximately 10 km and for PBC at approximately 7.5 km. Dr Jessica Dyson, Associate Clinical Lecturer at Newcastle University and Consultant Hepatologist, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK, discussed the findings: “This study suggests that exposure to a persistent, low-level environmental agent may have played a role in the pathogenesis of all three autoimmune liver diseases studied, not just PBC.”

While the study did identify clusters of these diseases, the environmental trigger is still unknown and further research is needed. Prof Marco Marzioni, Università Politecnica delle Marche, Ancona, Italy, and an EASL Governing Board Member discussed the research: “Triggers are as yet unknown. Environmental factors have been considered, but no solid data have emerged so far. The study presented today has sufficient scientific rigour to reinforce the idea that environmental exposure may play a major role in triggering autoimmune diseases of the liver.”

Georgia’s Road to Hepatitis C Virus Elimination

On the morning of Saturday 13th April in Vienna, Austria, the EASL International Liver Foundation (EILF) declared the accreditation of the first Centre of Excellence in Viral Hepatitis Elimination in Georgia for the country’s leading work in hepatitis C virus (HCV) eradication.

The centre’s objectives were clear: “To build and showcase the exemplary efforts of national viral hepatitis programmes, creating a technical assistance hub for other countries, and, in addition, to act as a catalyst for continued excellence and necessary expansion within the country,” as Jeffrey Lazarus, Vice Chairman of the Board, EASL International Liver Foundation, explained.

Globally, it is estimated that 71 million individuals live with HCV and, despite having the biomedical tools available to eliminate the disease, nearly 400,000 affected individuals die each year, mostly from cirrhosis and hepatocellular carcinoma.1 At the World Health Assembly in 2016, 194 countries pledged to eliminate the threat of viral hepatitis by 2030, but only 12 of those countries are currently on track towards this target.2 New initiatives are clearly needed to achieve this lofty goal and engage the global community.

One of the countries to embrace this project was Georgia. In 2015, 7.7% of the Georgian population were positive for HCV, with 5.4% needing treatment (around 150,000 people);2 Georgia recognised the unmet need and embarked on the world’s first national HCV elimination programme, which entailed improving the surveillance, prevention, screening, and treatment of the disease.

Georgia set itself a 90-95-95 target for 2020: to diagnose 90% of those living with HCV, to treat 95% of those diagnosed, and to cure 95% of those treated.2 “We are already exceeding targets with our treatment and cure rates hitting 98.2%,” said Dr David Sergeenko, Minister for the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health, and Social Affairs of Georgia, who was present in Vienna to accept recognition of behalf of Georgia’s exemplary centre. To date through the programme, >1.4 million adults have been screened for the virus and >55,000 are currently in treatment or have been treated.2

Dr Sergeenko announced: “It is a great pleasure and honour for us to be granted the status of the first EILF Centre of Excellence in Viral Hepatitis Elimination. Our unprecedented HCV Elimination Programme in Georgia is a direct result of a successful public–private partnership, which originated from our close co-operation with the U.S. Centers for Disease Control (CDC) and Prevention and the pharmaceutical company Gilead Sciences.”

Having support from a strong network of stakeholders was a main driver behind the ambitious goals set by the country and a key to their success; working with the CDC has provided scientific support, and partnership with Gilead meant Georgia has received donations of direct-acting antiviral HCV medications. In addition to these collaborations, the country’s experience in the diagnoses of other diseases, such as HIV, and the government’s strong commitment to healthcare has made Georgia an ideal place for launching the programme.

“Our public health stands on three pillars: quality, access, and cost. We are very fortunate that our partnerships handled our quality and cost. Our focus was access: improving access by location, by quality, and by capacity,” explained Dr Sergeenko.

Additional findings and improvements in healthcare were experienced as a result of this elimination programme, including safer blood transfusions and improved infection control.2

Georgia’s commitment to HCV elimination will surely kick-start and enhance other programmes. These centres of excellence are in place to represent distinguished places of thought leadership and act as a hub of knowledge to nurture exchanges of research, training, good practices, and lessons learnt.

“Through universal access to HCV diagnostics and treatment, HCV burden in Georgia is being gradually eliminated. Beyond its immediate public health impact at national level, the programme could serve as a model for other countries by generating valuable data and sharing best practices to support
implementation of elimination programs in different parts of the world,” said Dr Sergeenko.

References
World Health Organization (WHO). Hepatitis C: Key Facts. 2018. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. Last accessed: 26 April 2019. EASL International Liver Congress. Launch of EASL International Liver Foundation (EILF) centre of excellence in viral hepatitis elimination in Georgia. 2019. Available at: https://easl.meta-dcr.com/ilc2019/crs/the-road-to-elimination-in-georgia. Last accessed: 26 April 2019.