Treatment of viral hepatitis: a new era

Abstract

Dear Colleagues, We are pleased to present the supplement for the 6th Paris Hepatitis Conference (PHC). This supplement of Liver International includes review articles with the most up-to-date information on the clinical care of patients with hepatitis B and hepatitis C, which was presented at this meeting. This meeting will once again provide state of the art information on the management of patients with hepatitis B and hepatitis C by outstanding international experts who will present the most recent data as well as the clinical applications in this area. The PHC 2013 includes a full day dedicated to hepatitis C and a full day dedicated to hepatitis B. Approximately, 170 million people have been infected with HCV worldwide. There are about 350 million carriers of HBV. The goal of the PHC is to encourage interaction with the audience during the plenary sessions (round table discussions). In addition, several interactive luncheons are held every day for discussions between experts and participants. Since the first edition of the meeting in 2004, attendance has steadily increased. More than 1000 specialists (most of them key national opinion leaders) from more than 60 countries and all continents have participated in this year's PHC meeting. Rapid progress, the availability of many new drugs and new therapeutic strategies are increasing the complexity and individualizing the management of patients with viral hepatitis. Therefore it is extremely important to educate and advise clinicians, so that available information can be exploited to optimize management of these patients. Last year, the meeting was specifically devoted to hepatitis C and the recent spectacular innovations made in the management of this disease thanks to the development of new therapies. At present, the treatment for hepatitis C virus (HCV) genotype 1 chronic infection is the combination of direct-acting antivirals (DAA) with a protease inhibitor (telaprevir or boceprevir) with the pegylated interferon (PEG-IFN) plus ribavirin (RBV) regimen 1-3. The primary goal of treatment is to achieve a sustained virological response (SVR), which is usually defined as undetectable serum or plasma HCV RNA 24 weeks after the end of treatment. A SVR corresponds to a cure 4. Twelve weeks post-treatment follow-up appears to be as relevant as 24 weeks to determine SVR 5. Some IFN-stimulated genes have been shown to be highly expressed in non-responders; thus, pre-activation of the IFN system in patients appears to limit the effect of IFN antiviral therapy 6, 7. Hopefully, second-generation protease inhibitors (simeprevir and faldaprevir) once a day will soon be available with PEG-IFN and RBV, making treatment easier. Thus, DAA with different viral targets, including NS3 protease inhibitors, nucleoside/nucleotide analogues and non-nucleoside inhibitors of the RNA-dependent RNA polymerase, and NS5A inhibitors are under development 8-10. Early data have demonstrated that antiviral combinations with additive potency that lack cross-resistance and have a good safety profile may provide new regimens in the near future to make HCV the first chronic viral infection eradicated worldwide with a finite duration of combination DAA therapy without IFN 8. Thus, clinicians have turned their attention to an exciting new direction: finding interferon-free therapy that will be effective in all genotypes. This raises an important issue that will be at the heart of discussions during the PHC conference in 2013: which patients should be treated in 2013 and how can we increase their chance of a cure? Which patients can be treated later based on future options? At the same time, the PHC 2013 conference, as in the past, will address and focus upon Hepatitis B. We will spend a full day discussing results on the long-term outcome of patients receiving the most potent available antiviral drugs. We will also assess the issue of quantifying HBsAg and its role as a new tool for predicting the severity of disease and response to therapy. The optimal management of special populations and difficult situations will be extensively discussed: pregnancy, co-infections, cirrhosis. As in previous PHCs, we will privilege interactive discussions and many specific working luncheons addressing the management of real-life patients. Finally, the ultimate goal of PHC 2013 is to review the most current knowledge and discuss their therapeutic applications with the most experienced experts to provide optimal therapy and the best chance of cure to as many patients as possible, worldwide. All the reviews from these outstanding international experts have been published in this issue of Liver International, which is available during the meeting. This up-to-date issue covers every aspect of hepatitis C and hepatitis B management.