Leaders of liver disease associations from Europe, the US, Latin America
and Asia released a Joint Society Statement on Elimination of Viral Hepatitis on
Thursday at the opening session of the International Liver Congress in
Barcelona, calling for enhanced efforts to diagnose and treat hepatitis B and
C, with the goal of eliminating viral hepatitis as a public health threat.
The statement – signed by Dr Laurent Castera
of the European Association for
the Study of the Liver (EASL), Prof. Keith Lindor of the American Association for the Study of Liver Diseases
(AASLD), Dr Javier Brahm of the Latin American Association for the Study of the Liver (ALEH) and
Prof. Jinlin Hou of the Asian
Pacific Association for the Study of the Liver (APASL) – was presented to Dr Gottfried Hirnschall, director of the HIV/AIDS Department and the Global
Hepatitis Programme of the World Health Organization (WHO).
"This conference in Barcelona will be remembered as when
elimination of viral hepatitis was first embraced," Hirnschall predicted.
The joint endorsement sends an "incredibly strong signal to the
world that leading scientists think elimination of viral hepatitis is
achievable," Hirnschall said, noting that WHO's first-ever global strategy on
viral hepatitis has as its vision a world where hepatitis B virus (HBV) and hepatitis C
virus (HCV) transmission are halted and viral hepatitis is eliminated as a major
public health threat by the year 2030.
We are still "far off from this aspiration" as access to
hepatitis C treatment remains limited and affordability is a barrier both in
wealthier and in resource-limited settings, but "momentum is building"
and some countries have demonstrated leadership in scaling-up their response,
he continued. "What we need now is increased advocacy to make sure plans
turn into real action."
Hirnschall's call for action was echoed by Tatjana Reic, president of the
European Liver Patients' Association and Raquel Peck, CEO of the World Hepatitis
"Let's not fool ourselves – the fight for political recognition of
viral hepatitis and the fight to eliminate it is not yet won," said Reic.
"We need to exploit synergies between prevention, diagnosis, and treatment
of viral hepatitis and other diseases" including HIV and tuberculosis.
"Elimination as a goal is only achievable if everyone in [the field
of] hepatitis speaks in same voice," added Peck. "As someone who went
through 60 weeks of ribavirin/interferon hell, I want no one else to go through
that. Rationing interventions will not deliver elimination – we need a whole
new mindset so that no one is left behind."
Below is the full
text of the joint statement.
Joint Society Statement for Elimination of Viral Hepatitis
Association for the Study of Liver Diseases
Association for the Study of the Liver
Association for the Study of the Liver
Association for the Study of the Liver
Burden of Viral
Hepatitis on Human Health
Compared to better-publicized infectious diseases such as HIV or
malaria, viral hepatitis is often referred to as a silent killer.
- Of the five
hepatitis viruses (A-E), hepatitis B, C, and D viruses cause chronic liver
disease leading to cirrhosis, liver failure and liver cancer. Hepatitis B, C
and D viruses, transmitted through blood and body fluids, may also cause
damages in organs other than the liver.
- Hepatitis A and E
viruses are transmitted orally and cause acute hepatitis, which may result in
acute liver failure and death.
The World Health Organization (WHO) estimates that as many as 400
million people worldwide are living with chronic hepatitis viral infection.
- Liver cirrhosis is
an important cause of mortality globally – more than 1 million people die of
cirrhosis, a majority due to viral hepatitis.
carcinoma, the most common form of liver cancer, is the third leading cause of
cancer deaths, claiming more than 500,000 lives each year.
The purpose of this statement is to highlight the need for public health
interventions to prevent, diagnose and treat viral hepatitis in a timely
fashion to reduce the burden of viral hepatitis.
- Despite the
enormous burden of viral hepatitis, patients with chronic viral hepatitis are
often without symptoms until they develop complications of cirrhosis or liver
- Once symptoms
occur, currently available interventions are often ineffective and/or
Highly accurate diagnostic tests are available for all hepatitis
- Simple inexpensive
blood tests are available in many, but not all countries, to screen and
identify patients with viral hepatitis infection.
- Confirmatory blood
tests and routine biochemical tests allow early diagnosis of chronic liver
disease due to hepatitis viruses before cirrhosis or hepatocellular carcinoma
For the majority of patients with chronic viral hepatitis, namely hepatitis
B and C, effective medications are available for treatment. Treatment of
chronic viral hepatitis B and C has been shown to reduce cirrhosis,
hepatocellular carcinoma and mortality.
The most remarkable recent advance is that the vast majority of patients
with chronic hepatitis C can be cured with 8-12 weeks of oral medications with
very few side-effects.
Chronic hepatitis B can also be effectively managed by long-term
suppression of the virus using safe oral medications, similar to HIV treatment.
The most impactful public health intervention for viral hepatitis is
- Effective vaccines
are available for hepatitis A, B and E. Of these, immunization against
hepatitis B virus is critically important – universal vaccination of infants
starting at birth has been shown to reduce not only the prevalence of the
infection of the birth cohort, but also its health consequences including
hepatocellular carcinoma later in life.
- Other important
public health measures include elimination of healthcare-related transmission
of hepatitis viruses by screening blood and blood products, proper
sterilization of dental, medical, and surgical equipment, and implementation of
safe injection practices.
- To reduce
transmission of viral hepatitis in injection drug users, harm reduction
programs such as needle exchange programs should be available.
Given the large burden of viral hepatitis, governments around the world,
although not universally, have made various efforts to mitigate its impact.
Furthermore, availability of effective means for prevention and treatment makes
it feasible to eliminate viral hepatitis.
- Recognition of
viral hepatitis as an important public health threat motivates implementation
of subsequent actions.
- Accurate data to
understand locale-specific information about viral hepatitis informs proper
allocation of resources.
- Screening for
undiagnosed chronic viral hepatitis in definable population subgroups has been
shown to be cost-effective.
treatment guidelines facilitate prioritization of delivery of antiviral
- National programs
for systematic immunization have resulted in demonstrable benefits on the
- The significant
recent progress made in the management of viral hepatitis is a result of
committed funding of research.
- WHO has set a goal
to eliminate viral hepatitis as a major public health threat by 2030.
The leading professional organizations in liver disease, AASLD, EASL,
APASL and ALEH, urge governments, healthcare organizations, and
non-governmental organizations to implement the following action plans:
- Recognize the
public health burden posed by viral hepatitis as a priority and establish plans
to curb its impact.
- Deploy data
infrastructure to assess the public health impact of viral hepatitis.
- Establish practice
guidelines which make recommendations for immunization, screening, diagnosis
- Develop and
implement comprehensive hepatitis prevention programs, including universal
vaccination of all newborns against HBV infection.
- Define at-risk
populations for screening for hepatitis B and C virus infection.
- Make accurate
screening and diagnostic tests available and affordable for public health
- Implement and
finance healthcare programs to diagnose and treat individuals with chronic HBV
and HCV infection according to the accepted practice guidelines with a goal to
minimize and, over time, eliminate the health burden of viral hepatitis.
- Support research
in the laboratory, in patients and in the population.