News

Date Added: 15/11/17
Alcohol Health Alliance Response to Supreme Court Judgement on Minimum Unit Pricing
News Type: BASL News

Responding to the UK Supreme Court judgment that minimum unit pricing is legal, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:

“We are delighted with the Supreme Court’s judgement that minimum unit pricing is legal and can be implemented in Scotland. The decision today represents a great victory for the health of the public.

“Five years ago the legislation introducing MUP passed through the Scottish Parliament without opposition. It has taken five years to implement for the simple reason that the Scottish Whisky Association and others chose to challenge it in the courts. In that time many families have needlessly suffered the pain and heartache of losing a loved one.

“This decision has implications far beyond Scotland. Wales, Northern Ireland and the Republic of Ireland are now clear to progress their own plans for minimum unit pricing.

“The spotlight should now fall on England, where cheap alcohol is also causing considerable damage. Over 23,000 people in England die every year from alcohol-related causes, many of them coming from the poorest and most vulnerable sections of society. We urge the Westminster Government to act now and introduce the measure in England. A failure to do so will needlessly cost more lives.”

 

Information on the AHA’s campaign for minimum unit pricing, along with facts and figures on the estimated impacts of MUP, is available on the AHA website: http://ahauk.org/campaigning-minimum-unit-price-alcohol/ . 

About the Alcohol Health Alliance UK
The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
- Highlight the rising levels of alcohol-related health harm
- Propose evidence-based solutions to reduce this harm
- Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk  or on 0203 075 1726.

Date Added: 27/10/17
Change to the Definition of Alcohol Deaths
News Type: BASL News

Commenting on the editorial published in The Lancet Gastroenterology & Hepatology on the new definition of alcohol mortality proposed by Office for National Statistics (ONS), Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:

“We agree entirely with the concerns outlined in The Lancet Gastroenterology & Hepatology about the revised definition for alcohol deaths from the ONS.

“The new definition will mean that a high number of liver disease deaths where we know that alcohol is the cause will no longer be recorded as being linked to alcohol.

“This reduction will give the wrong impression to the public that alcohol deaths are going down, when in fact the burden of alcohol on our nation’s health and health service is growing, with alcohol-related hospital admissions going up, and liver disease rates on the rise.

“Medical experts across the country have warned that it is premature for the ONS to alter the definition in the way it has proposed. The reasons are technical, but it comes down to the fact that more research is needed on the exact link between alcohol and certain categories of liver disease deaths.

“We recommend that the ONS hits the pause button on the work it is doing to alter the definition of alcohol deaths, until the necessary research has been done. This research could be done quickly and cheaply, in a handful of liver centres across the country.”

The editorial is available by clicking > here.

About the Alcohol Health Alliance UK

The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
- Highlight the rising levels of alcohol-related health harm
- Propose evidence-based solutions to reduce this harm
- Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 27/10/17
Medical Research Foundation Funding for Viral Hepatitis Researchers - application deadline 10th November
News Type: BASL News

The Medical Research Foundation have recently launched a funding opportunity focused on Viral Hepatitis research. Due to overwhelming demand the deadline has been extended for applications to Friday 10th November 2017.

This funding is aimed at Mid-Career researchers, who are making the transition to independence, and will support research that will increase the understanding of the disease mechanisms underlying viral hepatitis.

This competition is open to all UK researchers at eligible institutions (UK HEIs, Research Council research institutes, hospitals, and other independent research organisations). Applicants must hold a PhD, DPhil or MD and be in the process of, or be ready for, transition to research independence.

There is up to £1.6 million available in this competition and applicants may apply for up to £300,000 to support their research, over a maximum of a three year period.

The application process is now open and the deadline has been extended to Friday 10th November 2017.

More information can be found on the Medical Research Foundation website > here.

Date Added: 25/10/17
IQILS Update
News Type: BASL News

Improving Quality in Liver Services (IQILS) is a new scheme based on the work of the LiverQuest project.

The project led by the RCP London and supported by BASL and the BSG supports the national strategy to improve medical liver services for patients.

IQILS is run by the Royal College of Physicians (RCP) working in partnership with the Liver community, the professional bodies, societies and patient groups.

IQILS is open to all liver services across the UK and currently 18 services have signed up and are working towards accreditation. A list of these services can be viewed on the RCP website here; https://www.iqils.org/Default.aspx?PageId=66 .

Should you have any questions about IQILS please contact Madeline Corrigan, IQILS Programme Manager at the RCP at madeline.corrigan@rcplondon.ac.uk .

Date Added: 22/09/17
Press Release - British Liver Nurses' Association (BLNA) Launch
News Type: Nurse News

We are pleased to announce the official launch of the British Liver Nurses Association (BLNA). As you may already be aware, the BLNA is the new national liver nurses group, founded following the merger of the British Liver Nurses Forum (BLNF) and the British Association for the Study of the Liver Nurses Forum (BASLNF). 

After 2-3 years of collaborative working, the BLNF and BASLNF members reached a stage where their aims and objectives for liver nursing were such that it was agreed to unite so as to provide one powerful voice to raise the profile of liver nursing, across the UK.

The BLNA is a professional nursing association run by its members for its members and promises to continue to offer professional support for nurses working within all fields of liver disease. The BLNA will take forward the shared values and strengths from both BASLNF and BLNF and together with and on behalf of its members, will ensure opportunities are available to share best practice, as well as attend educational meetings, with the ultimate aim of improving standards of liver care to all people affected by liver disease.

The BLNA, also promises to continue to maintain and develop strong links with all those professional and charitable groups, locally, nationally and internationally. We look forward to working with you all, in the future.

Kind regards,

Fiona Fry and Michelle Clayton.
Co-chairs BLNA

Date Added: 18/09/17
Apply for the role of health service representative or lay member of Technology Appraisal or Highly Specialised Technologies Appeal Panels
News Type: BASL News

The National Institute for Health and Care Excellence (NICE) is looking to appoint a number of people with the necessary experience and skills to fulfill the following roles:

• Health service representative – up to 3 people
• Lay member – 2 people

The appeal panel is responsible for hearing appeals against our draft final recommendations in the technology appraisal (new drugs and other technologies used in the NHS) and highly specialised technologies (the evaluation of technologies for treating patients with very rare diseases and very complex healthcare needs) programmes.

When an appeal is submitted an appeal panel comprising five members is drawn from those appointed to hear NICE appeals.

The health service representative must hold an active registration with the appropriate professional body (including for doctors, a licence to practise).

The lay representative must be a patient or carer, or a member of an organisation that represents patients or carers.

Appointees will need to have an ability to draw out and articulate a balanced view on the issues arising from an appeal that are relevant to patients, carers and/or members of the public, and an ability to critique and weigh up competing arguments and make decisions (sometimes difficult ones) in meetings that are open to the public. Appeal panels are established infrequently and appointees may only need to sit on a panel two to three times a year.

NICE welcome applicants from all interested parties. For further information on the role and how apply please refer to the NICE website: https://www.nice.org.uk/Get-Involved/join-a-committee . Alternatively you can contact Maria Pitan, Project Manager – Corporate Office by email maria.pitan@nice.org.uk .

Deadline for applications is midnight on Monday 2 October 2017.

Date Added: 15/09/17
PSC Support and UK-PSC are partnering on a funding call for UK projects using UK-PSC data
News Type: BASL News

PSC Support and UK-PSC are inviting applications from UK-based investigators to conduct, ethically approved, biomarker based, research using serum samples collected for the UK-PSC biobank during the recent re-consenting effort. Clinical data is available and ethics exist for the successful research teams to collect further data.

Grant Amount and Scope  - two grants of up to £15,000 each will be awarded.

Pilot and feasibility work to enable larger grant applications will be considered.

Your research project must address PSC Support Research Priorities and have anticipated clear patient benefit, as regards potential use of biomarkers in PSC management.

PSC Support is an NIHR non-commercial Partner. Appropriate research studies funded through 'PSC Support Research Project Grants' are now automatically eligible for NIHR Clinical Research Network (CRN) support and therefore entitled to access NHS support via the NIHR Clinical Research Network.

Applications
Applicants should send their completed PSC Support Application Form together with additional relevant study investigator CVs, ethics approval and letter of support from the relevant Head of Department to research@pscsupport.org.uk .

UK-PSC Biobank
At present we have just under 900 serum samples stored in the Cambridge Bioresource. Serum is aliquoted and just under 2/3rds of the samples come from pre-transplant patients with PSC.

Application Deadline - 31 October 2017

Expected Decision Date - 01 December 2017


For more details visit www.pscsupport.org.uk/2017ukpscfunding .  

Date Added: 14/09/17
Liver Disease Atlas - News Release
News Type: BASL News

Please find below the news release that has gone out today to coincide with the publication of PHE Liver Disease Atlas.

BASL has been involved in helping put this together.

Download Liver disease atlas press release v11 13092017.pdf

Date Added: 13/09/17
New Report - 'How alcohol industry organisations mislead the public about alcohol and cancer'
News Type: BASL News

A report has just launched in Drug and Alcohol Review about ' How alcohol industry organisations mislead the public about alcohol and cancer'.

The report produced by Professor Mark Petticrew, of the London School of Hygiene and Tropical Medicine, and colleagues is available to read here;  Download Report London School of Hygiene.pdf

Date Added: 31/08/17
NIHR Birmingham Biomedical Research Centre Clinical Research Fellows - 2 fixed term posts
News Type: BASL News

Fixed Term posts of 12 months

The National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre (BRC) opened on 1 April 2017 with the aim of using cutting edge experimental medicine to accelerate access to, and adoption of, drugs, devices and diagnostics tests for patients living with chronic inflammatory diseases. The NIHR Birmingham BRC brings together the expertise of University Hospitals Birmingham NHS Foundation Trust (UHB) and the University of Birmingham, both members of Birmingham Health Partners (BHP), and is one of 20 NHS and University partnerships across England that have been awarded funding through the National Institute for Health Research (NIHR).

We are seeking two highly motivated Clinical Research Fellows to undertake research into chronic inflammatory disease. The post-holders willbe based in the Institute of Immunology and Immunotherapy at the University of Birmingham in the Institute for Biomedical Research. One post will involve the delivery of the Primary Sclerosing Cholangitis–Inflammatory Bowel Disease research programme of the BRC, reporting to Professor Gideon Hirschfield. The second post will involve undertaking clinical trials and other studies in patients with chronic inflammatory disease including non-alcoholic fatty liver disease and autoimmune liver disease, and will report to Professor Philip Newsome.

BRIEF PERSON SPEC
We are looking for clinicians with MRCP or equivalent, a potential ability to conduct and publish their own research, strong communication skills and an ability and eagerness to work in a multi-disciplinary team. The successful candidates will have an enthusiasm to learn and will be expected to register for a higher degree.

The positions are available for 12 months with potential and expectation to extend for a higher degree and submission of a fellowship application. Salary will be at the appropriate point on the appropriate clinical scale, with placement according to qualifications and experience.

Closing date: 21st September Reference: POST NUMBERS 57808 and 57809

To apply for these jobs please visit the University of Birmingham vacancies website.

Date Added: 24/08/17
Alcohol Health Alliance Newsletter - August 2017
News Type: BASL News

Click here to view the Alcohol Health Alliance Newsletter - August 2017.

Date Added: 18/08/17
The fight against hepatitis C has not yet been won – here’s what we have to do
News Type: BASL News

Read an article by Professor Mark Thursz in the Huffington Post > here.

Professor Mark Thursz is professor of hepatology at Imperial College and consultant in hepatology at St Mary's Hospital, London. Professor Thursz is also the current Chair of the Hepatitis C Coalition.

Date Added: 17/08/17
Vacancy - Trust Clinical Fellow (Str Higher Non NTN) in Hepatology - Plymouth Hospital NHS Trust - closing date 24th September 2017
News Type: BASL News

Trust Clinical Fellow (Str Higher Non NTN) in Hepatology

Job Reference: 216-9645-HEP

Employer: Plymouth Hospitals NHS Trust

Department: 216 120698 Hepatology Medical Staff

Location: Plymouth

Salary: £30,605 to £48,123 pa

Closing date 24th September 2017

For further information about this vacancy click > here

Date Added: 09/08/17
PHE Notice - Re: Shortage of hepatitis B vaccines - recommendations for national clinical directors
News Type: BASL News

Dr. Mary Ramsay and Dr Sema Mandal

Immunisation, Hepatitis, Blood Safety and Countermeasures Response

There is a global shortage of hepatitis B vaccine which is currently impacting severely on the UK supply. The situation is particularly critical during August but limitations on supply are likely to continue until early 2018. To ensure that stock is available for those individuals at highest and most immediate risk of exposure to hepatitis B, Public Health England (PHE) has developed temporary recommendations to support clinicians undertaking an individual risk assessment.

PHE and Department of Health (DH) have been working with both vaccine manufacturers to institute ordering restrictions according to customer type. The allocation is based on an agreed assessment of the proportion of vaccines used by that provider type for individuals in the highest priority groups. As a consequence, some providers may not be able to order any stock and others will have limits applied to their orders. A mechanism will be in place, however, to allow for exceptional orders if there is an urgent and immediate need for an individual following an individual risk assessment.

NHS Hospital Trusts will get the highest allocation, but it has been agreed with the BMA's General Practitioners Committee that general practice will not be able to order any adult hepatitis B vaccine stock until further notice. Because of this, patients requiring post-exposure hepatitis B vaccination will be referred to urgent care or Accident and Emergency based in NHS trusts for an assessment. In addition, specialist services such as liver services, who may normally request that GPs offer hepatitis B vaccination to their patients should note that the GP may not be able to meet this request.

To sustain supply for those at greatest need, all services are being asked to:

  • ensure that clinicians are aware of the temporary recommendations on prioritising vaccines
  • only order essential vaccine stock (small amounts more frequently) and avoid stockpiling
  • coordinate and monitor stock usage across the service to ensure that scarce stock is being used responsibly
  • accept and use alternative products including combined hepatitis A and B vaccines, and other presentations (e.g. multi-dose packs)

Download the full list of recommendations here >  Download Hepatitis B vaccine shortage PHE letter.pdf

Date Added: 09/08/17
'Best of BASL’ papers feature in this months edition of the Clinical Liver Disease Journal
News Type: BASL News

Highlights from last year's BASL Annual Meeting can be found in this months edition of the Clinical Liver Disease (CLD) Journal. 

Read the 'Best of BASL’ papers, view video presentations of the articles and watch interviews with the Authors.

View the CLD Journal Volume here.    

Date Added: 01/08/17
Hepatitis C in the UK – Annual Report 2017
News Type: BASL News

Public Health England (PHE) has published its Hepatitis C in the UK Annual Report 2017 to coincide with World Hepatitis Day, 27th July 2017.

View the Annual Report > here

Date Added: 27/07/17
Royal College of Physician’s (RCP) Medical Care has been published today
News Type: BASL News

The latest version of the Royal College of Physician’s (RCP) Medical Care has been published today.

Medical Care is a web based planning resource produced by RCP in partnership with UK’s medical specialty societies. The updated version includes further information on workforce and medical specialty specific job planning and additional content on diabetes and endocrinology services.

Medical Care is a valuable resource for clinicians and managers working in the NHS. The resource provides support for:

· Designing services – this includes a short description of the specialty and the patient population, and a summary of the workforce needs to support service provision
· Developing physicians – which includes information on the education, training and continuing professional development, workforce and job planning for physicians
· Improving quality and medical leadership – By exploring the latest ideas on how to develop physicians and teams.

The resource can be found by clicking > here or at www.rcpmedicalcare.org.uk.  

For queries please contact medicalcare@rcplondon.ac.uk

Date Added: 26/07/17
The Financial Case for Action on Liver Disease - report
News Type: BASL News

The Lancet Commission into Liver Disease in the UK has published 'The Financial Case for Action on Liver Disease' report. 

Read the report here; Download Financialcaseforactiononliverdiseasepaper.pdf

The alcohol section contains new data on the impact of minimum unit pricing, outlining that within 5 years of introducing MUP in England there would be:
• 1,150 fewer alcohol-related deaths
• 74,500 fewer alcohol-related hospital admissions
• Savings of £325.7m in healthcare costs
• Savings of £710.9m in crime costs.

Date Added: 24/07/17
Information on Clinical Guidelines about PBC
News Type: BASL News

Read the advice for managing patients with PBC who are unresponsive to UDCA below.

Download Advice for second line therapy for PBC.pdf

Date Added: 20/07/17
BVHG/BASL/BSG/BHIVA/BIA/CVN Guidelines for management of chronic HCV infection
News Type: BASL News

Following the Clinical Consensus on HCV Therapies 2017 meeting held in Birmingham on 30th June 2017, the BVHG/BASL/BSG/BHIVA/BIA/CVN Guidelines for management of chronic HCV infection report is now available to download.

Download BVHG BASL BSG BHIVA BIA CVN Approved Guidelines Final For Publication.pdf

Date Added: 20/07/17
Pocket Money Prices For Alcohol Continue 1 Year On
News Type: BASL News

Just days before the UK Supreme Court hears a case to decide whether introducing a minimum unit price for alcohol is legal, a survey published today shows that cheap, strong alcohol continues to be sold for pocket money prices up and down the country.

One year ago, a survey of alcohol prices across the UK found an abundance of cheap drinks being sold in shops and supermarkets, with high-strength cider available at the lowest prices.

A follow up review carried out this month in England, Scotland and Wales has found that these cheap prices remain largely unchanged, with products across the market still falling well below the 50p per unit mark recommended by health and alcohol bodies.

Both price reviews were carried out by the Alcohol Health Alliance UK (AHA), a group of medical royal colleges, alcohol organisations and health bodies. In this year’s review, the AHA found that cider continued to be sold at the lowest prices overall, with 3-litre bottles of 7.5% ABV cider (containing the equivalent of 22 shots of vodka) moving from £3.49 in 2016 to just £3.59 in 2017 (or 16p per unit).

At that price, for the cost of a small latte in Starbucks it is possible to buy more alcohol than the weekly recommended limit of alcohol.

The cheapest wine surveyed in 2016 was found to be even cheaper in 2017, and available for just 31p per unit.

Cheap, high-strength alcohol is known to be predominantly drunk by the most vulnerable groups, including children and the homeless, and a minimum unit price for alcohol of 50p per unit was passed by the Scottish Parliament in 2012, only to be held up by a legal challenge from sections of the alcohol industry. The Welsh government recently announced it will legislate for minimum unit pricing, and the Northern Ireland Executive has also expressed its desire to implement the policy.

The AHA said that today’s figures provide yet more evidence for the need for minimum unit pricing to be introduced across the UK.

Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“It is frankly unacceptable that it is possible to buy enough alcohol to exceed the new recommended alcohol guidelines for the price of a high street coffee. We need minimum unit pricing for alcohol so that the damage being done by the cheapest products to the most vulnerable in society can be brought to an end. We hope and expect that following the hearing on minimum unit pricing next week, Scotland will be given the green light to introduce the policy.

“With the recent announcement that the Welsh government also intends to legislate for minimum pricing, and a previous commitment to MUP from the Northern Ireland Executive, it is imperative that the UK government now legislates for MUP, so that England does not get left behind the rest of the UK. The Westminster government expressed its intention to introduce minimum pricing five years ago, but has still not delivered on this commitment.

“The evidence is clear – minimum unit pricing would save lives, reduce hospital admissions and cut crime. In addition, it would disproportionately benefit the poorest groups. Studies show that 8 out of 10 lives saved through minimum pricing would come from the lowest income groups.

“With alcohol-related hospital admissions at record highs, and liver disease rates on the rise, we can’t afford for alcohol to remain at such low prices.”

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 20/07/17
NICE - Recruitment to the Quality Standard Advisory Committee for Black, Asian and other minority ethnic groups: promoting health and preventing premature mortality
News Type: BASL News

NICE are looking for experts on Black, Asian and other minority ethnic groups: promoting health and preventing premature mortality to join our Quality Standards Advisory Committee (QSAC).

• GP working with Black, Asian and other minority ethnic communities
• Health inequalities lead from Clinical Commissioning Group/Local Authority with a focus on ethnicity
• Community nurse working with Black, Asian and other minority ethnic communities
• Public Health consultant with a focus on ethnicity and health inequalities
• Local authority commissioner with experience of commissioning services for Black, Asian and other minority ethnic groups

Information on the posts is available on the NICE website here.

The deadline for applications is 4 August 2017 at 17.00.

Date Added: 05/07/17
Research for all: Sharing good practice in research management
News Type: BASL News

The Royal College of Physicians (RCP) and NHS R&D Forum launches its new report Research for all: Sharing good practice in research management.

Download RD good practice report_WEB_case-studies.pdf

Following the publication of Research for all by the RCP in 2016 this follow up report outlines the conditions needed to support research directors, managers, clinical and non-clinical staff and, ultimately, patients.

By way of over 50 case studies the report builds upon the recommendations for collaboration and provides real world examples of good practice to inspire both doctors and researchers alike.

The examples of good practice from NHS organisations around the country aim to help build the knowledge base for all involved in research. By recognising and addressing barriers to pursuing research, the report encourages both doctors and R&D departments to underpin research as a core activity and demonstrate how it is everyone’s responsibility.

For more information please the RCP https://www.rcplondon.ac.uk/ .

Date Added: 05/07/17
BASL Commitee Trainee Representative - Expressions of Interest
News Type: BASL News

The tenure of the current BASL Trainee Representative will come to an end in September 2017. As such, BASL are now seeking expressions of interest for the position.

To apply for the position you must be a BASL Medically Qualified Member in Training and hold a national training number (NTN). The position is open to all trainees who are at least 24 months pre-CCT from September 2017.

The Trainee Representative will serve on the BASL Committee for a maximum of 2 years. They are expected to comment on all issues pertaining to training to ensure that trainee views are heard, to ensure that the annual meeting and schools of Hepatology meet trainees needs and in addition to attend BASL Committee meetings (face to face or teleconference) as well as the Annual Meeting. A working knowledge of Twitter is desirable and a strong link with the BSG trainee representative is helpful.

Application Process

Please send your expressions of interest to the BASL Secretariat at Judith@execbs.com by the deadline of 17:00 Monday 17 July.

Emails should clearly have as the subject: BASL Trainee Representative Post 2017.

Candidates wishing to be considered for the post are required to provide a short personal statement containing no more than approx. 250 words explaining why you want to be the BASL Trainee Representative and what relevant skills or training you have. The personal statement should accompany your expressions of interest email where possible.

A panel comprising of three BASL committee members will review and score the applications to select the successful applicant.

The new Trainee Representative will take up their position at the next Business Meeting of the Association during the Annual Meeting in September 2017.

If you require any further information please contact Judith@execbs.com .

Date Added: 05/07/17
NICE Liver Disease Quality Standard
News Type: BASL News

NICE focuses on improving treatment and diagnosis of liver disease.

People who drink too much should be sent for scans to detect early liver disease, says NICE.

Almost 1.9 million harmful drinkers in England could be sent for scans for cirrhosis by their GPs to detect disease early so treatment and lifestyle changes are more effective.

The final quality standard advises GPs to send people for scans for cirrhosis if men are drinking more than 50 units per week or 22 pints and women are drinking more than 35 units per week or 3 ½ bottles of wine.

You can view the final quality standard by clicking > here.

Access to the two recommended tests, transient elastography and acoustic radiation force impulse imaging is currently varied across England, whilst the first is available in at least 120 UK hospitals, the latter is a newer technology that is not as widespread.

Since draft, NICE has updated this standard to reflect that significant changes are needed to implement this guidance, such as a redesign of services or buying new equipment.

Read the full article on the NICE website > here

Date Added: 04/07/17
NICE - Invitation to apply for the role of appeal panel chair or lay member of Technology Appraisal or Highly Specialised Technologies Appeal Panels
News Type: BASL News

The National Institute for Health and Care Excellence (NICE) is looking to appoint a number of people with the necessary experience and skills to fulfill the following roles:

• Appeal panel chair
• Lay member

The appeal panel is responsible for hearing appeals against our draft final recommendations in the technology appraisal (new drugs and other technologies used in the NHS) and highly specialised technologies (the evaluation of technologies for treating patients with very rare diseases and very complex healthcare needs) programmes. When an appeal is submitted an appeal panel comprising five members is drawn from those appointed to hear NICE appeals.

Appeal panel chairs must either:
• currently provide healthcare in the NHS or public health service, or
• be a patient or carer, or a member of an organisation that represents patients or carers.

The lay representative must be a patient or carer, or a member of an organisation that represents patients or carers.
Appointees will need to be able to understand the process and methods NICE uses to appraise new health technologies and to critically assess the arguments put forward by companies, professional groups and patient organisations appealing against our guidance. In addition, chairs must demonstrate the personal qualities necessary to organise, lead and control a setting in which sometimes complex arguments are presented and challenged. Appeal panels are established infrequently and appointees may only need to sit on a panel two to three times a year.

NICE would welcome applicants from all interested parties. For further information on the role and how apply please refer to the NICE website: https://www.nice.org.uk/Get-Involved/join-a-committee . Alternatively you can contact Maria Pitan, Project Manager – Corporate Office by email maria.pitan@nice.org.uk.

The deadline for applications is 5pm on Monday 17 July 2017.

Date Added: 04/07/17
Improving Quality in Liver Services (IQILS)
News Type: BASL News

The Royal College of Physicians (RCP) has officially launched its new exemplar liver accreditation programme, Improving Quality in Liver Services (IQILS), led by Dr James Ferguson, clinical lead for the programme.

Born out of the successful LiverQuest pilot project, IQILS is supported by the British Association for the Study of the Liver (BASL) and the British Society of Gastroenterology (BSG) and has been shaped in partnership with the wider liver community, professional bodies, societies and patient groups.
Having taken learning and recommendations from the original LiverQuest pilot, the new accreditation scheme, will support liver services to deliver high-quality care for patients.

IQILS is open to all liver services across the UK, enabling them invaluable access to a new online tool, expertise and up to date guidance on improving standards and enhancing patient experience.

Thanks to the kind support of BASL, some services may also be eligible for an early bird discount.

For more details regarding the scheme, how to sign up, and discount eligibility, information can be found at www.iqils.org .

Alternatively, contact Madeline Corrigan, IQILS Programme Manager at the RCP at madeline.corrigan@rcplondon.ac.uk .

Date Added: 29/06/17
Publication of NICE Liver Disease Quality Standard
News Type: BASL News

We are pleased to announce that the liver disease quality standard (QS152) has been published on the NICE website today.

You can view the quality standard by clicking > here. 

BASL has formally supported the liver disease quality standard.

Date Added: 29/06/17
Alcohol Related Liver Disease PSP Final Report
News Type: BASL News

The Alcohol-Related Liver Disease (ARLD) PSP has been set up to identify unanswered questions about alcohol-related liver disease treatments from the point of view of patients, carers and healthcare professionals.

The identified questions will be prioritised, resulting in a list of the Top 10 priorities for research.

The objectives of the ARLD PSP are to:

• work with patients and clinicians to identify uncertainties about the effects of alcohol-related liver disease prevention and treatments
• to agree by consensus a prioritised list of those uncertainties for research
• to publicise the results of the PSP and process to the research community
• to take the results to the research commissioning bodies to be considered for funding.

Formed by the James Lind Alliance and funded by the National Institute for Health Research (NIHR) and the British Society of Gastroenterology (BSG), the PSP is being guided by a steering group of patient, carer and clinical group representatives.

Download the report Alcohol Related Liver Disease PSP Final Report here:  Download Alcohol-related Liver Disease PSP final report.pdf

Or visit the website to view the report by clicking > here

Date Added: 29/06/17
AHA comment: Minimum pricing in Wales
News Type: BASL News

Responding to the announcement (below) that the Welsh government is set to legislate for a minimum price for alcohol, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

Download Welsh government announcement.pdf

“We welcome the Welsh government’s announcement today that it will introduce legislation to set a minimum price for alcohol.

“The cheaper alcohol is, the more alcohol-related harm is done, and at present there is a proliferation of cheap alcohol across the UK. Raising the price of the cheapest alcohol by setting a price below which it cannot be sold will save lives, reduce hospital admissions and cut crime.

“With Scotland also set to introduce minimum unit pricing, it is vital that the UK government now legislates for minimum unit pricing for England too, something it committed to doing five years ago but failed to follow through. With lives being lost as a direct result of freely available cheap alcohol, a decision to delay further will be in effect a death sentence for some of the most vulnerable in society.”

About the Alcohol Health Alliance UK

The Alcohol Health Alliance UK (AHA) is a group of 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies.The AHA works together to:
• Highlight the rising levels of alcohol-related health harm
• Propose evidence-based solutions to reduce this harm
• Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 27/06/17
Vacancy - Senior Clinical Fellow in Hepatology - QEH Birmingham
News Type: BASL News

To view the details of the Senior Clinical Fellow in Hepatology post click > here.

Date Added: 22/06/17
Dame Shelia Sherlock Research Prize 2017 - apply now - deadline 4th August 2017
News Type: BASL News

Deadline: Friday 4th August 2017

Each year BASL presents the Dame Sheila Sherlock research prize, one of the highlights of the annual meeting. This prize is awarded annually to recognise the enormous contribution of Dame Sheila Sherlock to the development of Hepatology as a discipline in its own right.

When Dr Sherlock started her medical career, little was known about liver disease. Her work helped to establish hepatology as a medical specialty. She pioneered the use of needle liver biopsy, which had been used purely as a research tool, based on the technique of Sir John McMichael; this improved understanding of the pathology of liver disease and is used in the diagnosis of liver diseases today. The liver unit that she set up at the Royal Free Hospital became the centre for both research into liver disease and the education of trainees in the specialty.

Dame Sheila was involved in the foundation of the British Liver Club in 1961, which subsequently evolved into The British Association for the Study of the Liver (BASL). She was one of our past presidents and the first recipient of The BASL Distinguished Service Award.

In keeping with Dame Sheila’s enthusiasm for fostering young researchers, this eponymous research prize is awarded to young investigators without substantive posts in either medicine or science for their research contributions in the field of Hepatology.

The winner of the award will deliver a lecture presenting their research during the Annual Meeting, 20-22 September 2017. This year the prize is free registration to the meeting, a place at the Annual Dinner at Warwick Castle and £1,000.

To apply, please send one A4 sheet outlining the research and another A4 sheet detailing the related publications.

Please send submissions to steve@basl.org.uk before the deadline of midday on Friday 4th August 2017. 

Date Added: 22/06/17
Andy Burroughs Young Investigator Award 2017 - apply now - deadline 4th August 2017
News Type: BASL News

Deadline: Friday 4th August 2017

The Andy Burroughs Young Investigator Award was set up in honour of the late Professor Andrew Burroughs, who sadly passed away in March 2014. Professor Burroughs was an eminent and world renowned Professor of Hepatology and Consultant Physician/Hepatologist and among his many achievements was his significant contribution to liver transplantation.

This year the award will take place during the BLTG Transplant Meeting at Warwick Conference Centre, 19-20 September 2017.

This prize is awarded to young investigators, scientific or clinical, who are in training or within 2 years of taking up consultant positions (or equivalent) and the winner will deliver the prize lecture at the Meeting which will be being held at 11.30-12.10 on Tuesday 19th September, and will also receive free registration to the meeting and £1,000.

To apply, please send one A4 sheet outlining the research and another A4 sheet listing up to 5 related publications.

Please send submissions to steve@basl.org.uk before the deadline of midday on Friday 4th August 2017.

Date Added: 22/06/17
BLTG Transplant Meeting - Warwick Conference Centre - 19th - 20th September 2017 - Registration now Open
News Type: Transplant News

REGISTRATION OPEN

The third meeting of the British Liver Transplant Group (BLTG) integrates the meetings previously organised by each individual transplant centre and will offer a platform for those operating in or with a strong interest in the field of liver transplantation.

BLTG as ever includes the ‘Williams-Calne Lecture’, given this year by Professor Peter Friend (Oxford). An additional highlight is the state of the art lecture by Professor Geoff McCaughan (Sydney).

There are considerable 'Early Bird' discounts available for BLTG members and the deadline for early bird registration is Monday 31st July 2017.

View the Programme and Register now on the BASL Annual Meeting website for both meetings by clicking > here.

Date Added: 22/06/17
BASL Annual Meeting - Warwick Conference Centre - 20th - 22nd September 2017 - Registration now Open
News Type: BASL News

Please join us at Warwick University for the BASL 2017 Annual Conference where all of us interested in liver disease will share time whether we are clinicians, nurses, basic scientists, pharmacists, working in industry or students.

BASL follows seamlessly from the third meeting of the British Liver Transplant Group (BLTG), making it easy for the many delegates who want to attend both conferences. BLTG as ever includes the ‘Williams-Calne Lecture’, given this year by Professor Peter Friend (Oxford). An additional highlight is the state of the art lecture by Professor Geoff McCaughan (Sydney).

The BASL conference opens after lunch on Wednesday and will explore clinical and liver related aspects of senescence with a distinguished international faculty. A highlight of the meeting will be the state of the art lecture by Professor Judith Campisi (Buck Institute, California).

The second day has two streams: first, the interaction between the Liver and the Gut and second, the named lectures. These include the Ralph Wright Lecture (Professor John O’Grady) the British Liver Trust Lecture (Dr. Mary Ramsay), the inaugural Alex Mowat Lecture (Dr. Sue Beath) and the annual Dame Sheila Sherlock Prize Lecture.

The main poster session is on Wednesday evening with supper provided and the conference dinner (supported by BASL) is at Warwick Castle, a stunning venue, on Thursday evening.

The Nurses Day runs in parallel to the BASL meeting on Thursday 21st September and this year has especial importance as it will be celebrating the launch of the newly formed British Liver Nurses Association following a merger of the BLNF & the BASLNF. This day promises to deliver exciting and inspiring sessions for all nurses working within Hepatology, with the programme including a wide range of topics relating to liver disease and its associated issues and challenges.

There are considerable 'Early Bird' discounts available for BASL and BASLNF members and the deadline for early bird registration is Monday 31st July 2017.

View the Programme and Register now on the BASL Annual Meeting website for both meetings by clicking > here.

Date Added: 22/06/17
Enough alcohol sold in England for every drinker to consume 50% more than guideline levels
News Type: BASL News

New figures published today reveal that enough alcohol is being sold in England and Wales for every drinker to consume 21 units of alcohol a week – far more than the low-risk level of 14 units per week for both men and women recommended by the UK's chief medical officers.

The figures reveal that the situation is even worse in Scotland, with enough alcohol being sold for every drinker to consume 24 units a week.

The data was released by NHS Health Scotland, who also looked at consumption in England and Wales in order to compare patterns across the UK.

Roughly speaking, a regular-strength pint of beer and a 175ml glass of wine both contain 2 units of alcohol.

To tackle high levels of alcohol-related deaths and illness, Scotland is set to introduce a minimum unit price for alcohol, which would raise the price of the cheapest alcohol products which do the most harm. The Scottish government passed minimum unit pricing over 5 years ago, though implementation of the measure has so far been delayed due to legal challenges from the alcohol industry.

Minimum unit pricing formed part of the Westminster government's alcohol strategy in 2012, though has yet to be implemented in England and Wales.

Responding to the publication of the figures, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

"These figures are shocking and show why minimum unit pricing is needed in Scotland, as well as in the rest of the UK.
As a result of the legal challenges from the alcohol industry, lives will undoubtedly have been lost in Scotland. We hope and expect minimum unit pricing to be ruled legal in the final court hearing in this case in July, so that implementation in Scotland can follow.
If minimum unit pricing is ruled legal in Scotland, a decision by Westminster to delay would be a death sentence for some, including many from the lowest income groups. The evidence is already clear - minimum unit pricing saves lives, prevents illness and lowers hospital admissions."

About the Alcohol Health Alliance UK
The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:

· Highlight the rising levels of alcohol-related health harm
· Propose evidence-based solutions to reduce this harm
· Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA's Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 16/06/17
NICE Committee member recruitment – Alcohol interventions in schools - deadline 17:00 23 June 2017
News Type: BASL News

NICE are recruiting members for one of their guideline Committees.

They are looking for experts on Alcohol to join their Public Health committee to update a guideline on Alcohol interventions in schools and need people with a professional or practitioner background in the topic.

Further details can be found on the NICE website;  https://www.nice.org.uk/get-involved/join-a-committee .

The deadline for applications has been extended to 17:00, Friday 23rd June 2017.

If you have any questions about Committee membership or the recruitment process, please contact PHMember@nice.org.uk .

Date Added: 15/06/17
BASL Nurse Travel Bursary - BASL Annual Meeting and Nurses Day - September 2017
News Type: Nurse News

There are 25 nurse travel bursaries available to attend the BASL Annual Meeting and Nurses Day which is taking place from 20th - 22nd September 2017 at Warwick University, Coventry. 

To apply for a bursary you must be a member of the BASL Nurse Forum and submit an electronic and a paper copy of the Application Form by 17:00 on Friday 30th June 2017.

Full details can be found in the Guidance Document below and you must apply on the Application Form, also downloadable below:

Download BASLNurseBursaryGuidanceDocument_2017.pdf

Download BASLNurseBursaryApplicationForm_2017.pdf

If you have any questions please contact judith@execbs.com .

Date Added: 15/06/17
NHS England - seeking an organisation to appoint as a patient/public member to its Specialised Commissioning: Hepatobiliary and Pancreas services Clinical Reference Group (CRG).
News Type: BASL News

NHS England is seeking an organisation to appoint as a patient / public member to its Specialised Commissioning: Hepatobiliary and Pancreas services Clinical Reference Group (CRG).

Scope of the Clinical Reference Group (CRG) covers: Hepatobiliary (HPB) services treat patients who have disorders of the liver, bile ducts and pancreas. A large volume of HPB services are delivered in local hospitals but, because of the complexity and high cost of care, delivery in conjunction with, or at, specialist tertiary centres is necessary.

This Clinical Reference Group (CRG) covers:
• the management of people with serious complications of cirrhosis (about 3,000 cases each year)
• services for people with complex liver, biliary and pancreatic surgery (about 5,000 cases each year), including surgery for HPB cancers
• this CRG works with the Infectious Diseases CRG on services for hepatitis C (about 2,000 new cases each year).

For more information click here - https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a02/

CRGs bring together groups of clinicians, commissioners, public health experts, patients and carers. They use their specific knowledge and expertise to advise NHS England on the best ways that specialised services should be provided. CRGs provide advice on the development of service specifications, commissioning policies, identifying innovation and improving quality.

There will be an honorarium of £75 per half day or £150 per day (for those people not representing or supported by an organisation). This is in line with the NHS England policy.

Recruitment is now live. If you are interested in applying for one of these roles, or to find out more, please email england.voice-crg@nhs.net and request an application pack.

More information about the different Clinical Reference Groups can be found on the NHS England website > here.

Date Added: 02/06/17
Europe and Canada Practice to Policy Health Awards Programme - Applications Now Open
News Type: BASL News

The Europe and Canada Practice to Policy Health Awards Programme is now open. 

More information can be found here; Download EUCA_Practice-to-Policy_website-link-card-revised-approved-UK.pdf .

APPLY ONLINE via www.interceptpracticetopolicy.com .

The closing date is 30th June 2017.

Date Added: 11/05/17
AHA comment: Poorest people at greater risk of harm from heavy drinking, study finds
News Type: BASL News

Responding to the University of Glasgow study published on Wednesday 10th May 2017 in The Lancet Public Health which found that drinking heavily is more harmful to the poorest people in society, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“The findings in this study are worrying if not altogether surprising. It is clear that the way alcohol is being sold and promoted in Scotland and elsewhere in the UK is harming some of the most vulnerable people in society.

“On the other hand, we know what needs to be done, in particular to tackle the scourge of cheap alcohol. In real terms, alcohol is 60% cheaper than it was in 1980 and measures like strength based pricing would disproportionately benefit the poorest groups, in terms of reduced deaths, illness and hospital admissions. Studies have shown that 82% of the lives saved through minimum unit pricing would come from the lowest income groups.

“Overall, in the first year alone minimum unit pricing in Scotland is expected to save 60 lives and lead to 1,600 fewer hospital admissions and 3,500 fewer crimes, yet its introduction has been held up for years by alcohol industry legal challenges.

“Importantly, minimum unit pricing would leave pub prices untouched, and moderate drinkers would spend only about £2.25 extra per year with a 50p minimum price.”

About the Alcohol Health Alliance UK

The Alcohol Health Alliance UK (AHA) is a group of over 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
- Highlight the rising levels of alcohol-related health harm
- Propose evidence-based solutions to reduce this harm
- Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 04/05/17
Alcohol-related Hospital Admissions at Record High
News Type: BASL News

New figures released today show that hospital admissions due to alcohol are at their highest ever levels.

The data, summarised in a release from NHS Digital, shows that alcohol-related hospital admissions in England have increased by 64% over the last decade, with an extra 430,000 people being admitted due to alcohol-related causes in 2015/16 compared with 2005/06.

This takes the total number of alcohol-related hospital admissions to over 1.1 million in 2015/16.

Alcohol is linked to over 60 illnesses and diseases, including heart disease, liver disease and cancer. Figures from the local alcohol profiles for England show that admissions due to liver disease have gone up 57% over the last decade, and that the number of people diagnosed with alcohol-related cancer has increased 8%.

In contrast, separate data released today by the Office of National Statistics shows that the proportion of adults drinking is at its lowest level since 2005, with younger people more likely to be abstaining from alcohol. However, 7.8 million people admit to binge drinking on their heaviest drinking day.

In response to the figures, alcohol health experts called for more to be done in the UK to tackle the health harm done by alcohol.

Liver doctor Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK (AHA), said:

“These figures show that the UK continues to have a dysfunctional relationship with alcohol."

"We know that over the long term, rates of binge drinking are falling, and more people are choosing to abstain from alcohol."

"Worryingly, however, these trends do not appear big enough to stop alcohol harm from continuing to rise, and the sharp increase in alcohol-related hospital admissions over the last few years means hundreds of thousands more people each year are experiencing the misery associated with harmful alcohol consumption."

"The data released today should be sobering reading for whoever wins the upcoming general election, and we would urge the next government to make tackling alcohol harm an immediate priority to save lives, reduce harm, and reduce the pressure on the NHS.”

The data is available via the following links.
NHS Digital: Statistics on alcohol – England, 2017
Office of National Statistics: Adult drinking habits in Great Britain 2005 to 2016
Local Alcohol Profiles for England

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 03/05/17
Vacancy for a National HCC-UK Cancer Analyst - closing date 8 May 2017
News Type: BASL News

National HCC-UK Cancer Analyst
Circa £35,000 per annum (London) or £33,000 (Regional).
Full time for 2 years, in the first instance.

We are seeking an experienced cancer analyst to join an exciting new partnership between HCC-UK, the British Association for the Study of the Liver (BASL) and Public Health England (PHE). In this key role, you will be working to improve the outcomes for patients diagnosed with hepatocellular carcinoma (HCC) – the most common type of liver cancer.

You must have demonstrable skills in gathering, understanding, managing, evaluating and manipulating large amounts of data from a range of sources. You will be an excellent communicator, building strong relationships and working collaboratively with key stakeholders in order to obtain vital data.

You will undertake a detailed review of at-risk HCC patients with regard to age, sex, cirrhosis, aetiology of the underlying liver injury (if any); a considered review of treatment effects on survival, adverse events and cost; and an overall examination of the relationship between these and the outcomes.

Based within the National Cancer Registration and Analysis Service (NCRAS) in PHE, you will work closely with a Clinical Research Fellow, representatives from BASL and HCC-UK, and other UK professionals with similar interests. You must be comfortable working in a remote-managed setting.

How to apply:
Please send your CV and a supporting statement together as one document of no more than five pages to Professor Graeme Alexander (g.alexander@ucl.ac.uk ) or Dr Aileen Marshall (aileen.marshall@nhs.net ). Your supporting statement should explain how you think you meet the requirements of the role and person specification in no more than one side of typed A4. If you require further information, please email Prof Alexander.

Download HCC PHE Cancer Analyst JD Final 210417.pdf

Closing Date: 8th May 2017
First Interview: To be held in May 2017

About the partnership
HCC-UK is a multidisciplinary UK-wide group interested in all facets of management and sits currently under the BASL umbrella. The collaboration between BASL, HCC-UK and PHE proposes to increase our understanding of HCC in England & Wales and to address many of the issues experienced by this patient group. The partnership aims to ensure that liver services in the UK deliver the best available therapy efficiently to all patients with HCC regardless of socioeconomic status or liver centre. The focus will be on extensive use of available retrospective data in the first instance, with prospective data collection a long term intention. The group will also include expertise in health economics for a cost evaluation of HCC, per se, and treatment of this condition in England & Wales.

Date Added: 27/04/17
NICE Final Guidance - Obeticholic acid for treating primary biliary cholangitis
News Type: BASL News

The Final Guidance was published on the NICE website on 26 April 2017.

Click here to read the final guidance.

Date Added: 27/04/17
Foul Play? New report highlights how Alcohol industry bent the rules on advertising during UEFA Euro 2016
News Type: BASL News

A new report highlights how alcohol producers worked to circumvent legislation designed to protect children during the UEFA Euro 2016 football tournament. Researchers at the Institute for Social Marketing, University of Stirling, found over 100 alcohol marketing references per televised match programme in three countries – France, the UK and Ireland. Most marketing appeared in highly visible places, such as pitch-side advertising during the matches. This was the case, despite the fact that the tournament was held in France, where alcohol TV advertising and sports sponsorship is banned under the ‘Loi Évin’.

The report, Foul Play? Alcohol marketing during UEFA Euro 2016, will be launched at the European Healthy Stadia conference at Emirates Stadium on Thursday 27th April.

An analysis of broadcast footage found that alcohol marketing appeared, on average, once every other minute. The majority took the form of ‘alibi’ marketing, whereby indirect brand references are used to promote a product, rather than a conventional logo or brand name. Carlsberg was the most featured brand, accounting for almost all references in each of the three countries, using their slogan ‘Probably the best in the world’ while avoiding the mentioning the product name. ‘Alibi’ marketing was a common practice of tobacco companies in sporting events when advertising restrictions were introduced.

Dr. Richard Purves, Principal Investigator, Institute for Social Marketing, University of Stirling said:

“Beamed to audiences across the world, major sporting events such as the UEFA EURO tournament, present a prime opportunity for alcohol companies to market directly to a global audience. In order to continue to protect children and young people from exposure to alcohol marketing, laws such as those in France need to be upheld and respected by all parties involved and not seen as something to be negotiated.”

Katherine Brown, Director of the Institute of Alcohol Studies said:

“There is strong evidence that exposure to alcohol marketing encourages children to drink earlier and in greater quantities. The findings of this report show that alcohol companies are following in the footsteps of their tobacco colleagues by bending the rules on marketing restrictions putting children’s health at risk.”

Eric Carlin, Director of Scottish Health Action on Alcohol Problems (SHAAP), said:

“Sport should be an alcohol-free space. The presence of alcohol marketing during UEFA EURO 2016 highlights that organisers of sporting events need to hold out against tactics of big alcohol companies to flout legal regulations designed to protect children.”

A copy of the full report is available here: https://bit.ly/alcfoulplay .

The research was carried out by the Institute for Social Marketing, University of Stirling, and funded by the Institute of Alcohol Studies (IAS), Scottish Health Action on Alcohol Problems (SHAAP), and Alcohol Action Ireland.

Interviews available on request in England, Scotland and Ireland. Please contact Habib Kadiri at hkadiri@ias.org.uk or 0207 222 4001.

Date Added: 21/04/17
NICE Press Release on testing for blood-borne viruses to people upon entry to prison
News Type: BASL News

NICE has published a press release announcing a draft quality standard which recommends that healthcare staff working in prisons should offer testing for blood-borne viruses like hepatitis B and C, and HIV to people upon entry to prison. It also recommends that they should also assess inmates for their risk of having a sexually transmitted infection (STI).

The press release can be read – here.

Date Added: 20/04/17
NICE addendum publication – Alcohol-use disorders: diagnosis and management of physical complications (CG100)
News Type: BASL News

The final version of the addendum to the Alcohol-use disorders: diagnosis and management of physical complications (CG100) guideline has now been published on the NICE website which can be read > here.

 If you have any queries, please contact AUDSCupdate@nice.org.uk .

Date Added: 07/04/17
Bursaries Available - Nonclinical Students to attend BSG 2017 Translational Science Masterclass - 22nd June
News Type: BASL News

Bursaries are available for nonclinical students to attend the BSG 2017 Translational Science Masterclass (Thursday 22 June 2017, Manchester).

A restricted education fund provided by MSD provides ten £50 bursaries to nonclinical scientists who are: 
(1) studying towards a higher degree in a gastroenterology-related area
(2) are not members of the BSG
(3) have registered to attend the Translational Science Masterclass only (Signalling in epithelial cancer and inflammation, Thursday 22 June 2017, Manchester)

Apply to the BSG Education Committee juliesolomon@bsg.org.uk  by Monday 22 May.
The bursaries are available on a first-come, first-served basis.

Date Added: 06/04/17
UK NSC Consultation: Screening for Alcohol Misuse
News Type: BASL News

The UK National Screening Committee (UK NSC) has carried out a national consultation on screening for Alcohol Misuse.

After reviewing comments from stakeholders (including BASL) and the consultation papers the UK NSC have made formal screening recommendations to the four UK countries.

The outcome of the consultation can be found on the UK NSC website here - http://screening.nhs.uk/alcohol .

Screening recommendations were made to the following conditions:
 Alcohol misuse
 Asymptomatic bacteriuria
 Fetomaternal alloimmune thrombocytopenia
 GBS

There is more information about the work and remit of the UK NSC at http://www.screening.nhs.uk/about

Date Added: 04/04/17
ACCEA 2017 Round Open - BASL support has now closed
News Type: BASL News

The Advisory Committee on Clinical Excellence Awards (ACCEA) opened the 2017 awards round on Tuesday 28th February. The final closing date for applications to the ACCEA is 17:00 on Tuesday 25th April 2017.

Application for BASL support
BASL will need to complete the process of selecting applicants who will receive our support shortly. If you would like to apply for BASL support please complete and submit Application Form A to BASL along with any other supplementary CVQs available as detailed below:

Form A – Application Form
Form D – Supplementary CV Questionnaire: Research & Innovation Assessment
Form E – Supplementary CV Questionnaire: Teaching & Training Assessment
Form F – Supplementary CV Questionnaire: Leadership & Management Assessment

In addition BASL also requires a short piece with your application on why you feel you should be supported by BASL.

The deadline for applying for BASL support is 17:00 on Friday 31st March 2017.

All applications have to go through the ACCEA on line system, however downloadable forms to send to BASL can be found on the ACCEA website by clicking > here.

Please be aware that there is a maximum number of supplementary forms that can be completed at each National Level: Bronze and Silver applicants: 1 and Gold applicants: 2. These forms are optional and it is for the applicant to decide whether using them will increase chances of success.

(For use of the Supplementary Forms, please see 'Domains' within the Application form A). Full application guidance can be found on the ACCEA website by clicking > here.

Eligibility
As in previous years BASL would be able to support colleagues directly by nomination for national Gold, Silver and Bronze awards. As a specialist society, BASL cannot make nominations for Platinum awards; this must be done through the applicant’s University/Research Body and Universities UK. BASL can however provide a citation to support an application for a Platinum award.

As a rule, candidates for National Bronze (Level 9) should have a minimum of at least five local Clinical Excellence Awards. Award holders applying for higher level awards or a renewal must specify which achievements have been made after the date of their last award or renewal particularly concentrating on current activities and activities in the last 4 or 5 years, therefore you must date activities.

To apply for BASL support, please follow these steps:
1. Send a completed application form along with a short piece as to why you feel you should be supported to the BASL Secretariat, Judy.Hawksworth@execbs.com  by 17:00 on Friday 31st March 2017 for review.
Please understand that in fairness to all applicants, late submissions will not be considered.

2. All applicants will be asked to provide the name of an individual who could write a supporting citation upon submitting their application to BASL. ACCEA regard the citations provided in support of individuals as giving added value to the process. The citation MAY be stronger if it comes from outside ones institution.

3. You must submit your own application to ACCEA online by their deadline 17:00 on Tuesday 25th April. This is your own responsibility.

4. If you are in receipt of BASL support then BASL will upload your citation - please can you ensure your application is uploaded at least one week before the ACCEA deadline - before 17:00 on Tuesday 18th April 2017, so that we have sufficient time to upload your citations onto your application on the ACCEA website.

 

Date Added: 29/03/17
BJN Awards 2017 - Winners
News Type: Nurse News

Congratulations to the liver nurses who were shortlisted at the BJN Awards for the Hepatology/Liver Nurse Award:

1st place: Tara Rees
Tara developed a nurse-led paracentesis service for patients with advanced liver disease and has shared her protocols across Wales. 

2nd place: Linda Porter and Sarah Tarff
Linda and Sarah provide an innovative community HCV clinic that has allowed for contact and treatment of a large and hitherto poorly served and socially disadvantaged population with significant disease burden and largely preventable health-economic impact to the wider NHS.

3rd place: Michelle Clayton
Michelle has recently been approached as one of only seven nurses in Europe to set up a Concerted Action Group for the European Association of the Study of the Liver.

Photos of the event can be viewed > here.

Date Added: 22/03/17
BASLNF and BLNF Merger – Survey Results
News Type: Nurse News

BASLNF and BLNF Merger – Survey Results

A big thank you to all those who completed the recent survey regarding the proposed merger of the BASLNF with the BLNF. We now have the results and I can confirm that 100% of those who completed the survey support the merger.

In the next few weeks I will be back in touch with more details on the timelines for the merger, including the priorities for the new group; launch dates and membership details. I will ensure that this is all as seamless as possible.

The survey has given us a lot of ideas on areas where we need to be focusing on in the future and as always I welcome your input and suggestions.

 

Date Added: 16/03/17
Public Health England (PHE) - publishes their updated report on Hepatitis C in England
News Type: BASL News

Public Health England (PHE) has published its updated report on Hepatitis C in England, the documents for which can be found > here.

Additionally, Dr. Helen Harris from PHE has written a blog to mark the report’s publication. It states that they are on track to meet the new World Health Organisation’s target to reduce hepatitis C mortality by 10% by 2020, but stresses the need for improved diagnostics and case finding.

Date Added: 15/03/17
BASL Secretary Nominations 2017 - OPEN
News Type: BASL News

Overview

The tenure of the current BASL Secretary, Dr David Patch, will come to an end in September 2017. As such, BASL are now seeking expressions of interest for the position of BASL Secretary.

The Secretary is one of the three principal officers of the Association along with the President and Treasurer. The Secretary is the Chief Executive of the Association and serves for two years and may be re-elected once.

Nomination Process

Please send your nominations to the BASL Secretariat at judy.hawksworth@execbs.com by the deadline of 09:00 Monday 3rd April 2017.

Candidates wishing to be considered for election will require one BASL member to propose them and a second BASL member to confirm their suitability for the role in writing.

If more than one candidate is nominated, the Secretariat will arrange for an election of all members. He/she will be elected by simple majority of those members voting. A member cannot be re-elected more than once to the post of Secretary.

A personal statement, containing no more than approx. 300 words will be required from the candidates should an election need to take place.

The newly elected Secretary will be announced at the next Business Meeting of the Association during the Annual Meeting in September 2017. A handover period will follow leading up to the end of the tenure of the current Secretary.

If you require any further information please contact Judith@execbs.com .

Date Added: 15/03/17
BASL President Nominations 2017 - OPEN
News Type: BASL News

Overview

The tenure of the current BASL President, Professor Graeme Alexander, will come to an end in September 2017. As such, BASL are now seeking expressions of interest for the position of BASL President.

The President is one of the three principal officers of the Association along with the Secretary and Treasurer. The President is Chairman of the Association and serves for two years. The President will Chair the annual Scientific Meeting and the meetings of the Governing Board.

Nomination Process

Please send your nominations to the BASL Secretariat at Judith@execbs.com by the deadline of 09:00 Monday 3rd April 2017.

Candidates wishing to be considered for election will require one BASL member to propose them and a second BASL member to confirm their suitability for the role in writing.

If more than one candidate is nominated, the Secretariat will arrange for an election of all members. He/she will be elected by simple majority of those members voting. A member cannot be re-elected to the post of President.

A personal statement, containing no more than approx. 300 words, will be required from the candidate should an election need to take place.

The newly elected President will be announced at the next Business Meeting of the Association during the Annual Meeting in September 2017. A handover period will follow leading up to the end of the tenure of the current President.

If you require any further information please contact Judith@execbs.com .

Date Added: 09/03/17
NOW OPEN! Core-BSPGHAN Grant Round 2017 Deadline May 1st 2017
News Type: BASL News

Core and BSPGHAN are co-funding a scheme to provide financial support for the collection of pilot or proof-of-concept data that will enable a high-quality competitive application to be made subsequently to a research council or other large funder.

Applications are invited from established investigators planning research studies on any topic within paediatric gastroenterology, hepatology and nutrition. We aim to fund 2 projects with a maximum budget of £35,000 per project and particularly welcome applications in nutrition, obesity and the microbiome.

Further details and the application form can be found > here.

Date Added: 09/03/17
Professor Thomas E Starzl: Liver Transplant Pioneer and Distinguished University Professor of the School of Medicine, University of Pittsburgh (1926-2017)
News Type: Transplant News

Professor Thomas E Starzl, who passed away last weekend a few days short of his 91st birthday, is universally regarded as the father of liver transplantation and intestinal transplantation. His career defining work as young liver transplant surgeon in Denver, Colorado comprised exhaustive laboratory and human clinical endeavours to overcome the technical, physiological, preservation and immunological barriers that had daunted liver transplantation during an era of hopelessness for the entire field. He moved from Denver to Pittsburgh, setting up what was to develop into the largest liver and intestinal transplant programme in the world in the early 1990s. He converted what was considered an experimental procedure into a standard low risk operation that is currently performed around 25,000 times a year worldwide.

The first and second generation liver transplant surgeons around the world have almost all learnt their skills working with Professor Starzl. His protégés went on to lead a multitude of the worlds’ liver transplant programmes. The other area where Professor Starzl played a pioneering role was in the complex field of intestinal and multivisceral transplantation, where he introduced the use of Tacrolimus and Campath, to overcome the major barriers of rejection and infection.
Professor Starzl remains the most published, most read and most cited transplant researcher in the history of this challenging field, with almost 2500 peer reviewed publications. He held innumerable honours and given hundreds of distinguished orations/lectures worldwide. Of the five books he wrote, The Puzzle People published in 1996, narrates stories on the incredible and brave lives of transplant patients, and their impact on the doctors looking after them.

His work in the areas of organ preservation, host graft interactions, microchimerism, immunosuppression and tolerance were truly groundbreaking, much of which has contributed to the safe and routine practice of organ transplantation, and his work remains one of the main reasons why transplantation became one of the most successful health care development stories of the 20th Century.

Despite these incredible achievements, Professor Starzl remained a humble, resolute, much respected and tireless researcher well into his 90s. His only concern remained the wellbeing of his patients and his entire life was devoted to findings ways to overcome the challenges in delivering these complex treatments for their benefit.

An example of his ongoing contribution was the transmitted lecture on the challenges facing intestinal transplantation at the 14th World Small Bowel Transplant symposium in Buenos Aires, Argentina in June 2015. He trained several generations of surgeons, physicians, researchers and ethicists. Even for clinicians who never met or trained with him, he remained a source of guiding inspiration, and countless transplant surgeons around the world have been directly influenced by his achievements, for which they will always be grateful.


To follow is a copy of a report from Pittsburgh that shows how amazing Professor Starzl was with an incredible output for a very long duration of time;  Download Starzl_Thomas_PS_00_2016-02-04_1437_24449.pdf

Date Added: 08/03/17
Research - Role of primary care in PBC management: Clinician perspectives needed
News Type: BASL News

The University of Birmingham and NIHR Birmingham Liver BRU in conjunction with UK-PBC are conducting research into perspectives of patients, GPs and specialists around PBC care and potential future changes including an increased role for primary care.

We are looking for gastroenterologists and hepatologists in the West Midlands area to take part in qualitative interviews around the role of stratification.

Please see the advert to follow for further details;  Download Physician advert.pdf

Or contact the study team led by Gideon Hirschfield for more details contact Dr Margaret Corrigan (Clinical research fellow, NIHR Liver Biomedical Research Unit) at m.corrigan@bham.ac.uk.

Date Added: 08/03/17
Alcohol Health Alliance comment on the budget
News Type: BASL News

Responding to the Chancellor’s budget today, Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, said:

“Whilst we would have liked to see the Chancellor increase duty on the cheapest alcohol today, we are encouraged to see that the government will be consulting on introducing a new duty band for high-strength ciders, which would mean these ciders are taxed at a higher rate.

“At the moment, it is possible to buy a three-litre bottle of 7.5% ABV cider, containing the equivalent amount of alcohol as 22 shots of vodka, for just £3.50. As a result of these low prices, these drinks are a favourite among children and vulnerable groups like the homeless.

“High-strength cider currently receives the lowest duty per unit of any alcohol product, and the government clearly recognises the need to address the anomalies in the tax system which mean that these ciders can be taxed at such low rates. Dealing with these anomalies in the tax system would target those most in need, and would move the tax system towards a more sensible scheme where the stronger alcohol is, the more highly it is taxed.

“By taxing these drinks more strongly, the government will also encourage producers to lower the alcohol content in the drinks.”

 

The AHA is a group of 50 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:

- Highlight the rising levels of alcohol-related health harm
- Propose evidence-based solutions to reduce this harm
- Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, contact Matt Chorley, Policy and Communications Officer, Alcohol Health Alliance, at matt.chorley@rcplondon.ac.uk or 0203 075 1726.

 

Date Added: 23/02/17
"Little convincing evidence" of economic benefits from alcohol sales
News Type: BASL News

Report casts doubts on economic rationale for cuts to alcohol taxes.

A new report from the Institute of Alcohol Studies, Splitting the Bill: Alcohol's Impact on the UK Economy, argues that the economic benefits of the alcohol industry are overstated, undermining the economic case for cutting alcohol duty in next month's Budget.
The report draws on government and trade statistics, academic evidence and economic theory to challenge arguments that the health and social benefits of reducing alcohol consumption are likely to come at a cost to the economy, finding:

  • Any reduction in employment and income resulting from lower spending on alcohol would be offset by spending on other goods
  • Econometric analysis of US states suggests that a 10% decrease in alcohol consumption is associated with a 0.4% increase in per capita income growth
  • Lower alcohol consumption could also reduce the economic costs of impaired workplace productivity, alcohol-related sickness, unemployment and premature death, which are estimated to cost the UK £8-11 billion a year.

The analysis comes at a timely moment, with health groups urging the Chancellor to raise alcohol duty in next month's Budget. Earlier this month, the Alcohol Health Alliance called for higher tax on high strength ciders and the reintroduction of the duty escalator, which ensured that alcohol taxes rose above inflation each year. Public Health England also recently identified raising duty as one of the most cost-effective ways to reduce alcohol-related harm.

The report's author, Aveek Bhattacharya, Policy Analyst at the Institute of Alcohol Studies said:

"Economic arguments are regularly used to resist policies that tackle excessive alcohol consumption, such as raising duty. Yet raising the price of alcohol is more likely to benefit the economy than harm it, by reducing the productivity costs associated with workers' harmful alcohol consumption." 
"Cuts to alcohol duty impose a heavy toll on our health service and our public finances, with no clear corresponding benefit to the economy. The Government should reverse course, and undo the damage of four successive years of falling tax on alcohol duty."

Splitting the Bill: Alcohol's Impact on the UK Economy is available for download from the Institute of Alcohol Studies website > here.

Date Added: 07/02/17
Two new hepatitis C therapies fast-tracked in Europe
News Type: BASL News

PM Live is reporting that two new drug combinations for Hepatitis C are being fast-tracked for approval by the European Medicines Agency (EMA). 

Read the article > here. 

Date Added: 06/02/17
Developing national data standards for recording alcohol and tobacco use - participate in the survey here
News Type: BASL News

The University of Birmingham and Queen Elizabeth Hospital Birmingham, with support from the RCP HIU, are developing national data standards for recording alcohol and tobacco use in electronic patient records. Recording alcohol and tobacco use in health records is essential for identifying patients at high risk of future harm and for providing effective interventions.

The views of patients, carers, healthcare professionals, researchers, and clinical information system suppliers are currently being sought through two online surveys (one on alcohol and one on smoking) to inform the development of the proposed data standards to ensure that they are appropriate, acceptable, and implementable across the NHS.

Your views are important:

• To complete the alcohol survey please click > here
• To complete the tobacco survey please click > here

Closing date: 5pm, 17 February 2017

Date Added: 24/01/17
Local MP visits Edinburgh Royal Infirmary to raise awareness of excessive alcohol consumption
News Type: BASL News

On Friday 20th January, Ian Murray MP, the Member of Parliament for Edinburgh South, visited Edinburgh Royal Infirmary’s Gastroenterology Ward to discuss the effects of excessive alcohol consumption as part of the Alcohol Health Alliance’s (AHA) ‘Day of Action’.

This national initiative, instigated with the British Association for the Study of the Liver, sees the AHA working with doctors to raise awareness of alcohol-related liver disease.

The local MP met with Consultant Gastroenterologist Dr Alastair MacGilchrist to discuss his work and the impact that alcohol-related disease has on the lives of many of his constituents, and they met a number of Dr MacGilchrist’s patients to see first-hand the effect of cheap alcohol consumption on individuals.

Speaking at the visit, Ian Murray MP said:

“From my conversations with Dr MacGilchrist today it is clear that excessive alcohol consumption is having a devastating impact on the lives of too many people in my constituency and across Scotland. The ready availability of cheap alcohol is a huge part of this, and tackling the low cost of alcohol, as well as discouraging excessive consumption, should both be priorities for the Government. I welcome the work of the Alcohol Health Alliance on this, and I hope that their Day of Action is successful in raising awareness in communities across the country”.

Date Added: 17/01/17
Clinical Epidemiology Webinar – 26 January 2016 - PHE Action on Liver Disease & Preview of 2nd Atlas of Variation in Liver Disease
News Type: BASL News

This webinar is for anyone who wants to understand the challenges to reduce liver disease.

By joining the webinar participants will:
 Explore the variations in liver disease risk factors and outcomes
 Learn about PHEs programmes of action on liver disease
 Look at time series data to identify where variation has improved, stayed the same or got worse
 Explore the stories behind the data
 Have an opportunity to ask a question to the national team

Date
The webinar* will be held on Thursday 26 January 2016 - 2:00pm and 3:00pm.

Registration
Registration is FREE for this event and if you have already expressed an interest in attending this webinar, then we will have your details on our system. If you have not registered, please do so > Here:

If you have any questions about registration, please contact Kerry.archerdutton@phe.gov.uk . 

*Webinar details will be sent out prior to the session

Date Added: 09/01/17
Gilead UK and Ireland Fellowship Programme 2017 in viral hepatitis
News Type: BASL News

The Gilead UK and Ireland Fellowship Programme 2017 will open soon for grant applications in the therapy area of viral hepatitis. The aim of the programme is to support local innovation and best practice in patient care.

The programme invites applications from healthcare or allied professionals that:

1. Innovative local integrated initiatives to evaluate effectiveness of non-hospital based HCV treatment service models
2. Novel HCV care pathways using partnership models demonstrating measurable improvements in patient engagement

Projects which fall outside of this scope but which will add clinical value or which investigate an area of unmet need within viral hepatitis can also be submitted and will be reviewed for their merit.

The Gilead UK and Ireland Fellowship Programme started in 2009, and since its inception has supported over 150 projects in the areas of HIV, Viral Hepatitis, Respiratory, Invasive Fungal Disease and Oncology.

You can apply for a viral hepatitis grant by clicking > here 

Date Added: 19/12/16
BASL BVHG Secretary Post - nominations by Friday 6th January 2017, 17:00.
News Type: BASL News

Due to the current post holder having being elected as Chair of the British Viral Hepatitis Group (BVHG) the BVHG are seeking nominations / expressions of interest for the post of Secretary.

The British Viral Hepatitis Group aims to improve the management and study of patients with chronic viral liver disease, bringing together UK hepatologists, gastroenterologists, infectious disease physicians, virologists and interested epidemiologists.

BVHG Committee Secretary 
The BVHG Secretary is elected by the BASL / BVHG membership to serve for a period of up to three year’s and may be re-elected once. The Secretary is responsible for running the administrative tasks pertaining to his/her function and will work closely with the BASL Secretariat, which is appointed by the BASL Governing Board.

The BVHG is commissioned by the BASL Governing Board to:
• a) promote research and the exchange of scientific information concerning viral hepatitis;
• b) foster multicentre scientific studies pertaining to viral hepatitis within the UK;
• c) promote education of physicians, surgeons, clinical nurse specialists and scientists with regard to viral hepatitides and their management;
• d) Promote interaction between clinical disciplines to promote good care of patients and foster research and clinical trials.

Nomination Process
Candidates wishing to be considered for election will require one BASL member to propose them and a second BASL member to confirm their suitability for the role in writing.

Please email Judy Hawksworth at the BASL Secretariat Judith@execbs.com with your nominations by 17:00 on Friday 6th January 2017. Following this time candidate statements will be requested and voting will take place if necessary.

If you require any further information about this role please contact Dr Ahmed Elsharkawy at Ahmed.ElSharkawy@uhb.nhs.uk or contact Judy Hawksworth as above.

Date Added: 19/12/16
DAA-based therapies effective for HCV patients with chronic kidney disease
News Type: Clinical News

Direct-acting antiviral (DAA)-based therapies are effective and well-tolerated for HCV patients with stage four to five chronic kidney disease, a meta-analysis of published studies shows.

Reviewers at the Second Hospital of Shandong University in China found 11 studies involving a total of 264 patients. The pooled SVR12 rate was 93.2% for the total population, 89.4% for sofosbuvir-based therapies, and 94.7% for non-sofosbuvir-based therapies. For HCV genotype 1 patients, the pooled SVR12 rate was 93.1%.

The pooled incidence of serious adverse events was 12.1%, and the pooled discontinuation rate because of adverse events or serious adverse events was 2.2%.

Reference

Efficacy and safety of DAA-based antiviral therapies for HCV patients with stage  4-5 chronic kidney disease: a meta-analysis. Li T, Qu Y, Guo Y et al. Liver Int. 2016 Dec 10 [Epub ahead of print]

Date Added: 19/12/16
Haemophilia does not affect liver transplant outcomes in HCV patients
News Type: Clinical News

A large observational study in the USA confirmed haemophilia per se does not have a specific influence on transplant outcomes in HCV patients, but that HIV infection increases the risk of mortality in both haemophilic (H) and non-haemophilic (NH) patients.

Researchers identified 2,502 HCV-positive liver transplant candidates from eight US university-based transplant centres between 2004 and 2010, including 144 HIV-positive and 2,358 HIV-negative; 36 H and 2,466 NH; 1,213 transplanted and 1,289 not transplanted patients.

In univariate analysis, 90-day pre-transplant mortality was associated with higher baseline MELD (hazard ratio 1.15), lower baseline platelet count (hazard ratio 1.11 per 25k/µL), and having HIV/HCV-positive haemophilia.

In multivariate analysis, pre-transplant mortality was associated with higher MELD and was significantly greater in HIV-positive than HIV- groups, but did not differ between HIV-positive H and NH (hazard ratio 1.7). Among HIV/HCV-positive, post-transplant mortality was similar between H and NH, despite lower CD4 in H.

Reference

Haemophilia liver transplantation observational study (HOTS). Ragni MV, Humar A, Stock PG et al. Liver Transpl. 2016 Dec 9 [Epub ahead of print]

Date Added: 19/12/16
Mechanisms of IFN-α-induced depression in HCV are unclear
News Type: Clinical News

A significant number of HCV patients develop a major depressive episode (MDE) during interferon-alpha (IFN-α) based immunotherapy, and several mechanisms may be involved.

Authors of a new literature review found eight unique references which met their inclusion criteria, and which involved 826 people with HCV (37.3% females). The overall MDE incidence rate was 34.8%, with follow-up ranging between four and 48 weeks. The methodological quality varied across selected studies. It was found that Interleukin-6, salivary cortisol, arachidonic acid/eicosapentaenoicacid plus ocosahexaenoic acid ratio, and genetic polymorphisms may present variations which are linked to a predisposition to INF-α-induced depression.

However, a meta-analysis could not be performed because of the diverse biological mechanisms investigated and the lack of replicated evidence. The reviewers, therefore, concluded the mechanisms involved in IFN-α-induced depression in humans remained unclear.

Reference

Biological mechanisms of depression following treatment with interferon for chronic hepatitis C: a critical systematic review. Machado MO, Oriolo G, Bortolato B et al. J Affect Disord. 2016 Nov 27; 209:235-245 [Epub ahead of print]

Date Added: 19/12/16
New metrics for the Lancet Standing Commission on Liver Disease in the UK
News Type: BASL News

The third report of the Lancet Commission into Liver Disease in the UK was published online on Friday 16th December 2016.

Visit the Lancet website to read the report > click here

Date Added: 15/12/16
Alcohol Health Alliance responds to publication of 2015 Health Survey for England
News Type: BASL News

Responding to the release on 14 December 2016 of the 2015 Health Survey for England, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:

"We welcome the continuing downward trend in children aged 8-15 being exposed to alcohol.

However, the figures for adults are worrying as they reveal that in 2015, 31% of men and 16% of women in England drank more than the current low risk weekly guideline of 14 units a week spread out across 4-5 days.

Drinking above the low risk guideline places people at increased risk of illnesses like heart disease, liver disease and cancer.

The most recent UK guidelines on low-risk drinking, and the reasons behind them, have simply not been communicated adequately. The government needs to ensure the public are aware of the current drinking guidelines, as well as the harms associated with alcohol. The public have the right to know, so they can make informed choices about their drinking.

The government should communicate the risks in two ways.

Firstly, the government should develop mass media campaigns outlining the risks. These could include TV and radio advertisements, social media campaigns, and messages on public transport.

Second, the government should introduce mandatory labelling of all alcoholic products, containing clear and legible health information about the harms associated with drinking."

Date Added: 15/12/16
New toolkit will help commission HCV services
News Type: BASL News

HCV Action has produced a new resource, aimed at helping commissioners and service providers better understand hepatitis C treatment pathways.

The Hepatitis C Commissioning Toolkit, an update to the original toolkit published in September 2013, sets out key commissioning responsibilities, with the intention of bringing clarity to an often highly fragmented commissioning landscape.

In a foreword to the toolkit, Dr Steve Ryder, chairman of HCV Action and Consultant Hepatologist at, Nottingham University Hospitals NHS Trust, said: “With new treatments becoming available that can cure upwards of 95% of people, we now have the opportunity to eliminate this preventable and curable virus. “Commissioners have a major role to play. It is no exaggeration to say that commissioners, whether based in local authorities, CCGs or NHS England, will decide whether nor not we capitalise on the opportunity we now have to tackle this costly virus and ultimately eliminate it.”

To find out more > click here

Date Added: 15/12/16
Guidelines for Nurses - new free digital resource
News Type: Nurse News

A new free digital resource called Guidelines for Nurses is available and delivers content that includes guideline summaries, feature articles, and educational resources to help with CPD and revalidation. The resource is available as an app and online.

The app is available to download from the Guidelines for Nurses website for an annual subscription fee of £49.99 HOWEVER access to the content on the app is FREE to all UK-based nurses who register for free on the website first.

Guidelines for Nurses includes a resource centre focussed on liver disease, and one of our most popular pieces of content is the NICE guideline on non-alcoholic fatty liver disease.

To register on the Guidelines for Nurses website > click here.

Date Added: 12/12/16
Some NASH patients have recurring fibrosis shortly after transplant
News Type: Clinical News

Some patients with non-alcoholic steatohepatitis (NASH) show recurrence of fibrosis as early as six to 12 months following their transplant.

This emerged in a study at the Medical University of Vienna which compared the recurrence of liver fibrosis in 15 patients transplanted for NASH with 12 to cryptogenic cirrhosis (CC) patients after orthotopic liver transplantation (OLT) between 2004 and 2015.

The case load for OLT because of NASH was constantly increasing (two in 2004-2007 compared with nine in 2012-2015) whilst decreasing for CC (six in 2004-2007 compared with two in 2012-2015). Patient characteristics at OLT were similar, except for an older age and a higher BMI in the NASH patients.

Although post-OLT plasma lipid levels and the incidence of de-novo hypertension, diabetes, and hyperlipidemia were similar between groups, the post-transplant NAFLD fibrosis score (NFS) re-increased in the NASH group but not in the CC group (-0.1317 versus -1.3645 at 12 months post-OLT.

Reference

The post-transplant course of patients undergoing liver transplantation for nonalcoholic steatohepatitis versus cryptogenic cirrhosis: a retrospective case-control study. Unger LW, Herac M, Staufer K et al. Eur J Gastroenterol Hepatol. 2016 Dec 2 [Epub ahead of print]

 

Date Added: 12/12/16
New DAAs “a very important advance” for HCV in haemodialysis patients
News Type: Clinical News

A new study has concluded that the new direct-acting antivirals (DAAs) are highly effective with minimal adverse effects for the treatment of HCV in haemodialysis, and are a very important advance in HCV management.

In this retrospective study, HCV antibodies were analysed in 465 patients at two Madrid hospitals. Positive antibodies were found in 54, and, among these, 29 with genotypes 1 and 4 were treated with different DAA regimens, including combinations of paritaprevir/ritonavir, ombitasvir, dasabuvir, sofosbuvir, simeprevir, daclatasvir and ledipasvir, with/without ribavirin. The most important aetiology of chronic kidney disease involved glomerular abnormalities.

In all cases, a sustained viral response was achieved after 24 weeks, regardless of DAA regimen received. Adverse effects were not relevant and no case required stopping treatment. In 15 cases, ribavirin was combined with the DAA. In these cases, the most significant adverse effect was an anaemic tendency, which was reflected in the increase of the dose of erythropoietin stimulating agents, although none required transfusions.

Reference

Effectiveness of direct-acting antivirals in Hepatitis C virus infection in haemodialysis patients. Abad S, Vega A, Rincón D et al. Nefrologia. 2016 Nov 30 [Epub ahead of print]

Date Added: 12/12/16
Similar long-term efficacy between tenofovir and entecavir in HBV related cirrhosis
News Type: Clinical News

Although tenofovir (TDF) was more effective at three months, there was no significant difference between TDF and entecavir (ETV) in the long-term treatment of HBV related liver cirrhosis, a new meta-analysis of studies found.

A literature search, conducted by reviewers from Beijing You'an Hospital, found significant difference of ALT norm level at three months (RR 1.43) and six months (RR 0.89), and significant difference of undetectable HBV-DNA only at three months follow-up period (RR 1.59) between TDF and ETV, but no significant difference in the long-term period. There was a significant difference between TDF and ETV in eGFR level (RR 1.601) and hypophosphatemia incidence (RR 4.008).

Reference

The efficacy and safety comparison between tenofovir and entecavir in treatment of chronic hepatitis B and HBV related cirrhosis: a systematic review and meta-analysis. Han Y, Zeng A, Liao H et al. Int Immunopharmacol. 2016 Dec 1;42: 168-175 [Epub ahead of print]

Date Added: 07/12/16
Report - Impact of Alcohol on Emergency Services
News Type: BASL News

On 6th December the APPG on Alcohol Harm has launched its report on the Impact of alcohol on the emergency services.

The Frontline Battle report  Download Alcohol Health Alliance The Frontline Battle.pdf reveals the full extent of the pressures and dangers alcohol related problems place on our emergency services and the impact this has on the staff who serve on the frontline.

As part of the Inquiry, the group of parliamentarians took evidence from police officers, fire crew and paramedics, and also collected written evidence. 

A press release can be found below:

Abused, attacked and over stretched - Parliamentary report lays bare the impact of alcohol on our emergency services

At an event in Parliament on Tuesday 6th December a report from the All Party Parliamentary Group on Alcohol Harm revealed the full extent of the pressures and dangers alcohol related problems place on our front line emergency services.

The group of parliamentarians took evidence from police officers, fire crew and paramedics, and also collected written evidence, including extensive surveys of emergency service staff across England. Findings in the report include:

Police:
• Over 50% of police officers report that alcohol related incidents make up the majority of their workload.
• Surveys find that over 80% of police officers had been assaulted by people who had been drinking, and of those more than 20% had been assaulted six or more times.
• 59% of female police officers and 33% of male officers report sexual assault or harassment while on duty.

Ambulance and A&E departments:
• Over 70% of all attendances at A&E departments are alcohol related at weekends.
• Drunken patients regularly cause significant problems for clinical staff and other patients, with clinicians reporting that they face aggression, violence and being personally assaulted by drunken patients.

Fire Service:
• On average alcohol related fires cost almost five times as much as other fires, and are more likely to involve fatalities.
• Fire and rescue services now rescue more people from road traffic collisions than from house fires, with drink driving a continuing problem.

The group of Parliamentarians were also told that alcohol puts a significant and damaging strain on our emergency services, and that many of these incidents were avoidable if the right action was taken.

See the report introduction for quotes from emergency service personnel – Download Alcohol Health Alliance The Frontline Battle.pdf

Fiona Bruce MP, Chair of the All Party Parliamentary Group on Alcohol Harm, said: “It should be wholly unacceptable to hear of an A&E consultant being kicked in the face, medical staff having TV’s thrown at them, or female police officers being sexually assaulted. And it’s not just emergency staff who suffer; as this report describes many other people are impacted too, from taxpayers who foot the bill, to patients who can’t be seen promptly, or worse, those innocent people killed in avoidable drunk driving accidents.”

“Urgent action, as described in this report, is needed from Government at the highest level in order to address this.”

Steve Irving, Executive Officer of the Association of Ambulance Chief Executives, said: “The ambulance service attends too many patients suffering from alcohol-related injuries or illnesses, many of which would not occur without the consumption of excess alcohol. This takes valuable resources away from patients who may be seriously ill so it is clear that more widespread safe drinking, in moderation, would significantly relieve the pressure on ambulance services and the wider health economy, especially emergency departments of local hospitals.”

“ The ambulance service also attends many alcohol-related road traffic collisions each year, some of which result in death and serious injury to members of the public. This is why AACE is actually in favour of ultimately lowering the drink driving limit to zero.”

Amongst others, the report recommendations include:

• A Government-led, cross-departmental National Strategy, to engage all of the appropriate Government Departments on a strategic level.
• Lowering the drink drive limit in England and Wales from 80mg alcohol/100ml blood to 50mg/100ml. This would reduce drink driving fatalities by at least 10%, and   is supported by many motoring and roads safety charities, as well as 77% of the British public.
• Reducing the affordability of cheap and high-strength alcohol, by introducing a minimum unit price (MUP) for alcohol, and reinstating the alcohol duty escalator in order to ensure the tax system both addresses alcohol harm, and incentivises the development and sale of lower strength products.

Alcohol Concern provides the secretariat for the All Party Parliamentary Group on Alcohol Harm and welcomes the recommendations made by the report.

Joanna Simons, Chief Executive of Alcohol Concern, said: “The costs of alcohol harm to the UK are huge, not only in terms on lives lost but also through the significant impact on society and our emergency services. Alcohol costs us all, even when we’re not buying alcohol ourselves.”

“What this report highlights is the enormous pressure our emergency service staff face every day. We need the UK Government to act and take steps to implement the report’s recommendations, including lowering the drink drive limit and tackling cheap and high-strength alcohol, which we know will work in reducing alcohol-related harms and ease the strain on frontline staff.”

The report provides a full list of recommendations –  Download Alcohol Health Alliance The Frontline Battle.pdf

For more information, please contact: Office of Fiona Bruce MP: johnny.monro@parliament.uk  / Tel: 0207 219 2969

References:
(1) Institute of Alcohol Studies. Drink driving factsheet
(2) Allsop R, (2015)., ‘Saving Lives by Lowering the Legal Drink-Drive Limit’. PACTS

Date Added: 07/12/16
Testing Times: Maintaining and Improving Public Health Testing Services
News Type: BASL News

In October the Hepatitis C Coalition, Public Health England and Local Government Association held a workshop on ‘Testing Times: Maintaining and Improving Public Health Testing Services.’

To view a report of the event click > here.

Date Added: 07/12/16
Enter the 2017 BJN Awards today - nominations close on 12 December 2016
News Type: Nurse News

Enter the 2017 BJN Awards today!

The BJN Hepatology/Liver Nurse of the Year award will recognise nurses who care for and treat very unwell patients with a range of life-altering conditions and diseases. The important work within this specialty should be recognised and any nurse who has made a special impact on hepatology/liver nursing should apply or be nominated.

Many people's lives are touched by these conditions and diseases, and whether they practice in hospitals or the community, nurses will find themselves caring at some stage for such patients.

This Award will recognise an individual or team who have made a demonstrable improvement to the delivery of excellent patient care.

Entries close on 12 December 2016 so nominate a colleague today by visitng the BJN website by clicking here

Date Added: 07/12/16
Chancellor Urged to Tackle the Scourge of Cheap Alcohol - Report finds alcohol harm will cost UK up to £52 billion in 2016
News Type: BASL News

Leading representatives from the alcohol harm reduction, children's, homelessness and religious sectors have today called for action on the harm done by cheap alcohol.

43 organisations and experts have written to the Chancellor calling on him to implement targeted measures such as a minimum unit price for alcohol and increased taxes on high strength white cider, to lower the burden of cheap alcohol on our most vulnerable groups, our NHS and public services, and the economy.

Their call comes in response to a report released today by Public Health England, which finds that raising the price of the cheapest alcohol products is the most powerful tool at the Government's disposal to tackle the harm done by the cheapest alcohol.

The report, published in the Lancet, explains that alcohol is the leading cause of ill health, early death and disability amongst 15-49 year olds in England, and results in 167,000 years of working life lost. The report estimates the annual cost of alcohol harm to the UK in 2016 to be between 1.3% and 2.7% of GDP, which equates to £27billion and £52billion.

In October 2016, a review of alcohol prices by the Alcohol Health Alliance UK found an abundance of cheap, high strength drinks across the UK. Researchers were able to find products like high strength white ciders, which are predominantly drunk by dependent and underage drinkers, available for as little as 16p per unit. This means that for the cost of a standard off-peak cinema ticket it is possible to buy almost seven and a half litres of high strength white cider, containing as much alcohol as 53 shots of vodka.

Last month, a study found that, in England alone, the introduction of a 50p minimum unit price could reduce alcohol deaths by around 7,200, and reduce healthcare costs by £1.2 billion over 20 years.

Responding to the Public Health England report, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:

"This report provides yet more evidence of the effectiveness of raising the price of the cheapest alcohol to tackle alcohol-related harm.
Increased duty on the cheapest drinks, alongside minimum unit pricing, would make a real difference to the lives of some of our most vulnerable groups and ease the burden on our health service. These measures would also lower the burden of premature mortality due to alcohol, thereby increasing economic output.
At the same time, ordinary drinkers will not be penalised. Minimum unit pricing will leave pub prices untouched, and tax on the cheapest, strongest drinks will be targeted at those drinks which are preferentially consumed by harmful and dependent drinkers".

For further information, please contact Matt Chorley, the AHA's Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 07/12/16
Women with HBV lose anti-cirrhosis advantage as they get older
News Type: Clinical News

A new study of HBV patients shows that the protective effect against cirrhosis of being female is gradually lost with increasing age.

This multicentre study from China investigated the interaction of female gender and older age on the development of cirrhosis in patients recorded in the China Registry of HBV. A total of 17,809 chronic HBV patients were studied.

The prevalence of cirrhosis in the females increased faster than that in the males over 50 years old. Multivariate analysis showed that the increase of adjusted odds ratios for developing cirrhosis in females started to accelerate after 50 years of age: 11.19 in women versus 14.75 in men aged 50 to 59; 21.67 versus 24.4 at ages 60 to 69; and 18.78 versus 12.09 in those aged over 70.

The study authors suggest that disease progression should be monitored more closely in elderly women with chronic HBV.

Reference
Female gender lost protective effect against disease progression in elderly patients with chronic hepatitis B. You H, Kong Y, Hou J et al. Sci Rep. 2016 Nov 28;6: 37498

Date Added: 07/12/16
New studies show simeprevir plus sofosbuvir safe and effective in HCV
News Type: Clinical News

Two otherwise unrelated studies have testified to the efficacy and safety of the combination of simeprevir and sofosbuvir in patients with HCV.

In the US-based GALAXY study, the combination, with or without ribavirin, was efficacious and well tolerated in patients with recurrent HCV genotype 1 post-orthotopic liver transplant (1).

Thirty-three such patients without cirrhosis were randomised into three arms: Arm 1, received simeprevir+sofosbuvir+ribavirin for 12 weeks; Arm 2, received simeprevir+sofosbuvir for 12 weeks; Arm 3 received simeprevir+sofosbuvir for 24 weeks; 13 additional subjects (two with cirrhosis, 11 without cirrhosis) entered Arm 3.

Among the randomised subjects, SVR12 was achieved by 81.8% in Arm 1, 100% in Arm 2, and 93.9% in Arm 3; two subjects did not achieve SVR12: one viral relapse

(follow-up Week 4; Arm 1) and one missing follow-up Week 12 data. Five subjects had a serious adverse event, considered unrelated to treatment per investigator.

In Spain’s PLUTO study, the combination of simeprevir plus sofosbuvir for 12 weeks resulted in SVR12 rates of 100% in treatment-naïve and -experienced patients with HCV genotype 4 with or without compensated cirrhosis, and was well tolerated (2).

Forty patients received the combination for 12 weeks. Seven of the patients had compensated cirrhosis. All achieved SVR12. Adverse events, all Grade 1 or 2, were reported in 20 patients. No serious adverse events were reported and no patients discontinued study treatment. Grade 3 treatment-emergent laboratory abnormalities occurred in two patients.

References

Efficacy and safety of simeprevir and sofosbuvir with and without ribavirin in subjects with recurrent genotype 1 hepatitis C post-orthotopic liver transplant: the randomized GALAXY study. O'Leary JG, Fontana RJ, Brown K et al. Transpl Int. 2016 Nov 29 [Epub ahead of print]

Simeprevir in combination with sofosbuvir in treatment-naïve and -experienced patients with hepatitis C virus genotype 4 infection: a Phase III, open-label, single-arm study (PLUTO). Buti M, Calleja JL, Lens S et al. Aliment Pharmacol Ther. 2016 Nov 29 [Epub ahead of print]

Date Added: 05/12/16
Hepatocellular carcinoma increase rate slows in USA
News Type: Clinical News

The overall rate of increase in hepatocellular carcinoma (HCC) slowed between 2010 and 2012, found a nationwide US study. However, it did increase in some sub-groups such as men aged 55 to 64, and whites/Caucasians.

 

Researchers at Baylor College of Medicine in Texas analysed data from the US Cancer Statistics registry, which covers 97% of the population of all 50 states.

 

They found that the HCC incidence increased from 4.4/100,000 in 2000 to 6.7/100,000 in 2012, increasing by 4.5% annually between 2000 and 2009, but only by 0.7% annually between 2010 and 2012.

 

The average annual percentage change (AAPC) between 2000 and 2012 was higher in men (increase of 3.7%) than women (increase of 2.7%), and highest in 55 to 59-year-olds (AAPC 8.9%) and 60 to 64-year-olds (AAPC 6.4%).

 

By 2012, rates in Hispanics surpassed those in Asians, and rates in Texas surpassed those in Hawaii (9.71/100,000 vs 9.68/100,000). Geographic variation within individual race and ethnic groups was observed, but rates were highest in all major race and ethnic groups in Texas.

 

Reference

 

Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through

2012. White DL, Thrift AP, Kanwal F et al. Gastroenterology. 2016 Nov 23 [Epub ahead of print]

Date Added: 05/12/16
The UK NSC review of screening for hereditary haemochromatosis
News Type: BASL News

The UK NSC recommendation on Haemochromatosis screening in adults has now been published and be accessed > here

Date Added: 02/12/16
People in prison should receive the same level of care as those outside, says NICE
News Type: BASL News

New guidance from NICE will ensure that people in prison receive the same standard of healthcare as those in society.

To read the article click > HERE.

Date Added: 29/11/16
MPs query blood victim support plan 29/11/2016
News Type: BASL News

MPs have called for improved support for the hundreds of people living with illnesses derived from contaminated blood transfusions.

Voting in the House of Commons last week, MPs backed a call for funds to be used from the sale of Plasma Resources UK, a sum of £230 million.

The MPs also expressed concern at government plans to hand the management of the support scheme in England to the private sector.

In a vote backed by members of all parties, MPs stated that the "contaminated blood scandal was one of the biggest treatment disasters in the history of the NHS."

The government says it has already taken new steps to help those affected. There is to be a new payment of £3,500 a year for those newly diagnosed with stage 1 hepatitis C linked to contaminated blood.

But MPs voted that this was "not commensurate with the pain and suffering caused," calling for help for bereaved families. And they called for recipients to have the choice of taking lump sum compensation.

Introducing the debate, the Labour MP for Kingston upon Hull North, Diana Johnson, said: "Although we are all agreed on the need for a reformed scheme, I cannot agree with the Department of Health that its proposed settlement is sufficient."

Ms Johnson told MPs about Glen Wilkinson, diagnosed with hepatitis C after a dental procedure at the age of 19. She said: "He has had to live with the virus all his life and is still waiting for proper recognition of how it has affected him. I hope that the Minister and the Government will now work to ensure that Glen and others can live the rest of their lives in dignity."

Former Conservative health minister Alistair Burt raised the issue of people co-infected with HIV and hepatitis C. He said some 250 remain alive out of 1,200. Mr Burt said: "This is a collective shame, because Government after Government have not grasped that this just needs a final settlement. We can find the money for other things."

Health minister Nicola Blackwood rejected calls for a public inquiry, claiming it would not provide further information. She said: "I believe it is right that the Government’s focus is on considering how best to create and implement a system with the increased budget that is affordable, that redesigns the inconsistencies that we have heard about, and supports those most affected by these tragic events now and into the future."

 

Date Added: 29/11/16
Three anti-HCV regimens “highly effective” in achieving SVR
News Type: Clinical News

A comparison of three different anti-HCV regimens concluded that all of them appeared highly effective in achieving sustained virologic response (SVR).

A study at the University of Southern California compared the SVR rates achieved 12 weeks post-treatment in 11,464 patients treated with three such agents by the Veterans Health Administration.

Without controlling for other risk factors, a SVR at least 12 weeks post treatment was achieved in 92% of ledipasvir/ sofosbuvir, 86% of ombitasvir/paritaprevir/ritonavir/dasabuvir, and 83% of simeprevir/sofosbuvir patients.

After adjusting for patient characteristics, simeprevir/sofosbuvir (93.3%) and ledipasvir/sofosbuvir (96.2%) patients were statistically more likely than ombitasvir/paritaprevir/ritonavir/dasabuvir (91.8%) patients to demonstrate a SVR.

HIV, HBV, diabetes, obesity, previous treatment history and augmentation therapy using ribavirin did not impact the SVR rates. Sustained SVR rates were lower for patients under age 65, with cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, indications of fibrosis or a non-genotype 1 infection. Women and Caucasian patients were more likely to achieve a SVR.

 
Reference

Comparative treatment effectiveness of direct acting antiviral regimens for hepatitis C: data from the Veterans Administration. Fox DS, McGinnis JJ, Tonnu-Mihara I et al. J Gastroenterol Hepatol. 2016 Nov 21 [Epub ahead of print]

Date Added: 28/11/16
Hepatitis increases risk of uveitis
News Type: Clinical News

A new study finds that people with viral hepatitis are at an increased risk of uveitis, particularly those with both HBV and HCV.

Researchers at China Medical University, Taichung, used data from the Taiwan National Health Insurance system to identify 17,389 patients newly diagnosed with viral hepatitis between 2000 and 2011 and matched these with 34,778 controls.

The risk of uveitis in the hepatitis cohort was 1.30-fold. Those with HBV and HCV coinfection had the highest risk (hazard ratio = 2.88), followed by HCV only infection (hazard ratio 1.75). Patients with cirrhosis had a higher risk in the multivariable model but did not attach statistic difference.

Reference

Relationship between uveitis, different types of viral hepatitis, and liver cirrhosis: a 12-year nationwide population-based cohort study. Tien PT, Lin CJ, Tsai YY et al. Retina. 2016 Dec;36(12):2391-2398

Date Added: 28/11/16
Statins reduce HCC risk in people with type 2 diabetes
News Type: Clinical News

The use of statins by people with type 2 diabetes may help them avoid developing hepatocellular carcinoma (HCC), new evidence suggests.
 
Researchers at Yonsei University College of Medicine in Seoul, carried out a Korean nationwide population-based study involving 47,738 patients with type 2 diabetes.
 

After at least a five-year HCC-free period there were 229 incident HCC cases and 1,145 matched controls. Of these 229 incident HCC cases, 27 were statin users, whereas 378 were statin users among 1,145 controls.
 
Statin use was associated with a reduced risk of HCC development (adjusted odds ratio 0.36) after adjustment for chronic viral hepatitis, liver cirrhosis, alcoholic liver disease, previous cancer, aspirin use, insulin use, sulfonylurea use, metformin use, thiazolidinedione use, history of chronic obstructive pulmonary disease, Charlson comorbidity score, household income level, and residential area.
 
The risk reduction was accentuated with an increase of cumulative defined daily doses (cDDD) compared with non-users (adjusted odds ratios 0.53, 0.36, 0.32, and 0.26 in ≤60, 60-180, 181-365, and >365cDDD, respectively).
 
The risk reduction was apparent in the presence of liver disease (adjusted odds ratio 0.27), including heterogeneous groups of clinical diagnosis of liver disease, but not significant in the absence of liver disease (adjusted odds ratio 0.64).
 
Reference
 
Effect of statin on hepatocellular carcinoma in patients with type 2 diabetes: A
nationwide nested case-control study. Kim G, Jang SY, Han E et al. Int J Cancer. 2016 Nov 7 [Epub ahead of print]
 

Date Added: 21/11/16
Liver cancer risk reduced in patients cured of HCV
News Type: Clinical News

 A large study found that the risk of hepatocellular carcinoma was reduced by 80% in people cured of HCV compared to those who were not cured.

This was a study of the entire population of people treated for HCV in British Columbia province, Canada, between 1990 and 2013. The study identified 8147 people treated with interferon-based regimens, 57% of whom were cured. Treated individuals were followed for a median of 5.6 years.

The liver cancer incidence was highest among those with cirrhosis who did not achieve a SVR (21 cases per 1000 patient-years of follow-up). In comparison, the liver cancer incidence was 6.4 per 1000 patient-years in those with cirrhosis who achieved SVR, 7.2 in those without cirrhosis who did not achieve SVR12 and 1.1 per 1000 patient-years in those without cirrhosis who achieved SVR12.

In a multivariable analysis liver cancer was associated with cirrhosis, age over 50 years, genotype three infection versus genotype one, alcohol consumption and being male in those who were not cured. In those who were cured of hepatitis C, only cirrhosis, age over 50 and being male were associated with an increased risk of liver cancer.

The researchers concluded that although curing HCV greatly reduces the risk of developing liver cancer, it does not eliminate the risk entirely. Older people and those with cirrhosis are at higher risk than others, underlining the importance of early diagnosis and treatment.

Reference

The impact of sustained virological response to HCV infection on long term risk of hepatocellular carcinoma: the BC Hepatitis Testers Cohort. Janjua NZ et al. The 67th Meeting of the American Association for the Study of Liver Diseases, Boston 2016. Abstract 175

 

 

Date Added: 21/11/16
Sofosbuvir plus velpatasvir “best options” for HCV G3
News Type: Clinical News

An analysis of published studies on direct acting antivirals (DAAs) found that regimens containing sofosbuvir and velpatasvir were the best option for patients with HCV genotype three (G3).

The analysis indicated that ribavirin significantly increased rates of SVR and should be considered if tolerated.

Researchers at Radboud University Medical Centre in the Netherlands performed a Bayesian network meta-analysis using a random effects model to indirectly compare DAA regimens in HCV G3 patients with and without cirrhosis. They found 27 appropriate studies involving 3,415 patients.

Among patients without cirrhosis, the greatest rates of SVR were estimated for those receiving sofosbuvir + velpatasvir with ribavirin (99%) and without ribavirin (97%), for sofosbuvir + daclatasvir + ribavirin (96%), and for sofosbuvir + peginterferon + ribavirin (95%), all for 12 weeks.

Among patients with cirrhosis, the highest rates of SVR were estimated for those receiving sofosbuvir + velpatasvir for 24 weeks (96%), for sofosbuvir + daclatasvir + ribavirin for 24 weeks (94%), and for sofosbuvir + velpatasvir + ribavirin for 12 weeks (94%).

Ribavirin increases efficacy in patients with and without cirrhosis (odds ratios 2.6 and 4.5).

Reference

Identification of the best direct-acting antiviral regimen for patients with hepatitis C virus genotype 3 infection: a systematic review and network meta-analysis. Berden FA, Aaldering BR, Groenewoud H et al. Clin Gastroenterol Hepatol. 2016 Nov 10 [Epub ahead of print]

Date Added: 21/11/16
Psychosocial distress worsens in families during HCV treatment
News Type: Clinical News

A new study suggests young people being treated for HCV and their families experience increasing psychosocial distress.

During the study period, 10 children with HCV and their families began treatment at New York’s Icahn School of Medicine. Each family was given a battery assessing patient quality of life, caregiver distress related to their child's illness and overall family functioning.

At baseline, the patients displayed a poorer quality of life than population norms, caregiver distress was elevated and family functioning was also in the "stressed" range. After treatment, all parameters worsened.

The researchers suggest caregivers may benefit from additional support given the implications of HCV and grueling nature of its treatment. Broadly, the impact of continuous intensive treatments on families perhaps should be monitored.

Reference

Children with hepatitis C: the impact of disease and treatment on patients, caregivers and families. Annunziato RA, Lee SG, Galici E et al. J Pediatr Nurs. 2016 Nov 8 [Epub ahead of print]

Date Added: 18/11/16
135,000 ALCOHOL RELATED CANCER DEATHS PREDICTED BY 2035
News Type: BASL News

ALCOHOL will cause around 135,000 cancer deaths over the next 20 years and will cost the NHS an estimated £2 billion in treatments, according to estimates from a new report* by Sheffield University, commissioned by Cancer Research UK**.

The new figures, published today reveal that by 2035 the UK could see around 7,100 cancer deaths every year that are associated with alcohol. Of the cancer types included in the report, oesophageal cancer is set to see the largest increase, followed by bowel cancer, mouth and throat cancer, breast cancer and liver cancer***.
The report also forecasts that there will be over 1.2 million hospital admissions for cancer over the 20 year period, which will cost the NHS £100 million, on average, every year.

The results were based on analyses that assume alcohol drinking trends will follow those seen over the last 40 years, and takes recent falls in alcohol consumption, including among young people, into account****.

Evidence suggests that the more alcohol you drink, the higher the risk of cancer. UK government guidelines, published earlier this year, advise that both men and women drink no more than 14 units of alcohol a week.

The latest figures follow a Cancer Research UK study published earlier in the year that showed 9 in 10 people are unaware of the link between alcohol and cancer *****.

The report also examined the impact of introducing a minimum unit price for alcohol in England. It found that over 20 years a 50p minimum price per units of alcohol could reduce deaths linked to alcohol by around 7,200, including around 670 cancer deaths. It would also reduce healthcare costs by £1.3 billion. This follows a recent court decision in Scotland which found that a minimum unit price would not break European law.

Alison Cox, the Director of Prevention at Cancer Research UK, said: "These new figures reveal the devastating impact alcohol will have over the coming years. That's why it's hugely important the public are aware of the link between alcohol and cancer, and what they can do to improve their risk. If we are to change the nation's drinking habits and try to mitigate the impact alcohol will have then national health campaigns are needed to provide clear information about the health risks of drinking alcohol."

Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, said: "These latest figures show the serious consequences for individuals, the NHS and society if the UK government continues to ignore the consequences of the nation's drinking. In particular they reinforce the need for a minimum unit price (MUP) for alcohol. It is clear from the report that MUP will save lives, including those lost to cancer, and ease the burden on our health service. Importantly, MUP will do this while leaving moderate drinkers and prices in pubs and bars unaffected.
In addition, we need mandatory health information on the labels of all alcoholic products, informing the public of the link between alcohol and cancer, and the new low-risk drinking guidelines.
The public have the right to know about how their drinking impacts their health, so that they are empowered to make informed choices."

 

* The report –'Alcohol and Cancer Trends: Intervention Scenarios'– is available upon request from the cancer research UK press office.
** Alcohol trends were estimated across the whole population for England in 2015-2035. Using a scenario that incorporates both the recent shifts in consumption alongside longer-term trends, the average consumption is estimated to be 14.6 units/week and the abstention rate 20.7%.
***
Scenario in 20 years with no change (baseline)

Health outcomes: mortality
All deaths from alcohol-related conditions - 12,778
All deaths from alcohol-related cancers - 7,097
Of which:
Oesophageal cancer - 3,674
Other head and neck cancer - 887
Colorectal cancer - 1369
Liver cancer - 333 
Breast cancer - 835

**** Smoking drinking and drug use among young people in England in 2014: Health and Social Care Information Centre, 2015. http://content.digital.nhs.uk/catalogue/PUB17879

*****Based on figures from a Cancer Research UK commissioned report 'An investigation of public knowledge of the link between alcohol and cancer', 2016.

For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1022 or visit www.cancerresearchuk.org .

Date Added: 14/11/16
Large gaps in HCV and HBV testing in Europe
News Type: Clinical News

There are large gaps in the quality and diversity of HCV and HBV testing in many European countries, a literature review suggests.
 
Reviewers from the University of Copenhagen found 136 English-language studies from 24 European countries published between January 2007 and June 2013. Most of the studies took place in six countries: France, Germany, Italy, the Netherlands and the United Kingdom.
 
Thirty-seven studies addressed HBV, 46 addressed HCV, and 53 addressed both diseases. The largest categories of study populations were people who use drugs (18%) and health care patient populations (17%). Far fewer studies focused on migrants, prison inmates, or men who have sex with men. The reviewers concluded that more research is needed throughout Europe to guide efforts to provide testing to certain key populations.
 

Reference
 
Are the testing needs of key European populations affected by hepatitis B and
hepatitis C being addressed? A scoping review of testing studies in Europe. Lazarus JV, Sperle I, Spina A et al. Croat Med J. 2016 Oct 31;57(5):442-456

Date Added: 14/11/16
Coffee may reduce risk of NAFLD
News Type: Clinical News

People who drink coffee are less likely to develop nonalcoholic fatty liver disease (NAFLD), a new literature review suggests. And people with NAFLD who drink coffee regularly are less likely to develop liver fibrosis.

Reviewers from the Bassett Medical Centre, New York, carried out two meta-analyses. The first included observational studies comparing the risk of NAFLD in patients who did and did not drink coffee. The second analysis included studies comparing the risk of liver fibrosis between NAFLD patients who did and did not drink coffee.

Out of 355 articles, five studies fulfilled the eligibility criteria and were included in the analysis. The risk of NAFLD in patients who drank coffee was significantly lower than that in patients who did not (pooled risk ratio 0.71). There was also a significantly decreased risk of liver fibrosis among NAFLD patients who drank coffee compared with those who did not, with a pooled risk ratio of 0.70.

However, say the reviewers, it should be noted that the definition of regular coffee consumption varied between studies, which is the main limitation of this meta-analysis. They add that whether consumption of coffee could be considered a preventative measure against NAFLD needs further investigation.

 

Reference

Coffee consumption and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Wijarnpreecha K, Thongprayoon C, Ungprasert P. Eur J Gastroenterol Hepatol. 2016 Nov 7. [Epub ahead of print]

 

 

 

Date Added: 14/11/16
Women who don’t drink have improved spontaneous HCV clearance
News Type: Clinical News

Abstaining from alcohol increases the likelihood of spontaneous HCV clearance among women, a new international study suggests.

The study involved pooled data from observational studies in Australia, the Netherlands and the USA and included 411 high risk persons (or 560.7 person-years of observation) with documented acute HCV infection and data regarding alcohol use. Their median age was 28.5 years, 30.4% were women, 87.2% were white, and 71.8% reported alcohol use at or after incident infection.

There were 89 (21.6%) cases of spontaneous clearance, 39 (31.2%) among women and 50 (17.5%) in men. Overall, spontaneous clearance occurred less frequently among participants who drank alcohol compared to those who did not drink (18.9% versus 28.5%). After adjustment for other covariates, alcohol was significantly and independently associated with lower relative hazards for spontaneous clearance of HCV in women (adjusted hazard ratio 0.35) but not in men (adjusted hazard ratio 0.63).

Reference

The effects of alcohol on spontaneous clearance of acute hepatitis C virus infection in females versus males. Tsui JI, Mirzazadeh A, Hahn JA et al. Drug Alcohol Depend. 2016 Oct 26; 169:156-162 [Epub ahead of print]

Date Added: 14/11/16
Alcohol Awareness Week starts on Monday 14th November
News Type: BASL News

The theme for the week for this year is Know The Risks and will focus on a different topic each day:

• Monday 14th November – Alcohol and cancer
• Tuesday 15th November – Alcohol and depression
• Wednesday 16th November – Alcohol and dementia
• Thursday 17th November – Alcohol and breast cancer
• Friday 18th November – Alcohol and diabetes
• Saturday 19th November - Alcohol and hypertension
• Sunday 20th November – Alcohol and brain damage

Alcohol Concern have an e-book available on their website ready for people to download, as well as some infographics. It includes information on the week and is available > here.

The hashtag for the week is #AAW2016.

Please do promote within your networks if possible. The Alcohol Health Alliance (AHA) as always are happy to support any work being doing throughout the week and should any assistance be required please contact Laura McLeod, Policy and Advocacy Manager - Alcohol Health Alliance at LMcLeod@alcoholconcern.org.uk or by telephone on: 0203 815 8930. 

Date Added: 08/11/16
Despite HBV vaccination programmes, vertical transmission still occurs at birth
News Type: Clinical News

Even in countries with a low HBV prevalence and a national vaccination programme, vertical HBV transmission can still occur amongst children born to HBV-infected mothers, new research suggests.

In Denmark, pregnant women have been screened for HBV since 2005, and children born to HBV-infected mothers offered HBV immunoglobulin at birth, vaccination against HBV at birth and after one, two and 12 months.

Through the Danish Database for HBV, researchers identified 589 HBV-infected women who had given birth to 686 children, of whom 370 children were born to 322 women referred to hospital. A total of 132 children born to 109 mothers, were included in the study; 128 children had blood samples tested for HBsAg, anti-HBc (total), anti-HBs and HBV-DNA and four children had saliva samples tested for anti-HBc.

There was a vertical HBV transmission of 2.3%, a high proportion of HBsAg-negative children with low levels of anti-HBs (18.4%) and a high proportion (15.2%) with resolved HBV infection. No maternal risk factor was statistically significantly associated with HBV vertical transmission.

Reference

Vertical transmission of hepatitis B virus during pregnancy and delivery in Denmark. Weis N, Cowan S, Hallager S et al. Scand J Gastroenterol. 2016 Oct 31:1-7 [Epub ahead of print]

 

Date Added: 08/11/16
NAFLD patients with advanced liver fibrosis have low vitamin D
News Type: Clinical News

New evidence shows that low vitamin D is associated with advanced liver fibrosis in nonalcoholic fatty liver disease (NAFLD) patients

In a study at Anhui Medical University in China, 219 NAFLD patients and 166 matched healthy controls had their serum 25(OH)D, serum interleukin-8, and transforming growth factor-β1 measured.

Serum 25(OH)D was only marginally decreased in the NAFLD patients. However, serum 25(OH)D was markedly reduced in those NAFLD patients with advanced liver fibrosis compared to those with indeterminate liver fibrosis and no advanced fibrosis.

Logistic regression analysis showed that there was an inverse association between serum 25(OH)D and the severity of liver fibrosis in the NAFLD patients.

Further analysis showed that serum interleukin-8 was elevated in the NAFLD patients, the highest interleukin-8 being in those with advanced fibrosis. An inverse correlation between serum 25(OH)D and interleukin-8 was seen in NAFLD patients with and without liver fibrosis.

Although serum transforming growth factor-β1 was slightly elevated in NAFLD patients, serum transforming growth factor-β1 was reduced in those with advanced fibrosis. Unexpectedly, a positive correlation between serum 25(OH)D and transforming growth factor-β1 was seen in NAFLD patients with advanced fibrosis. 

The researchers suggest that interleukin-8 may be an important mediator for hepatic fibrosis in NAFLD patients with low vitamin D status.

Reference

Low vitamin D status is associated with advanced liver fibrosis in patients with nonalcoholic fatty liver disease. Yang BB, Chen YH, Zhang C et al. Endocrine. 2016 Oct 31. [Epub ahead of print]

Date Added: 08/11/16
People with HCV are at risk of chronic kidney disease
News Type: Clinical News

Findings from a new literature review show that people with HCV are at a significant risk of experiencing chronic kidney disease (CKD).
 
The reviewers, from Binzhou Medical University in China, found 12 appropriate longitudinal studies involving 1,972,044 subjects, and 15 cross-sectional studies involving 937,607 people.
 
Overall effect estimate was remarkably significant in the longitudinal studies (hazard ratio 1.45) in contrast to that in the cross-sectional studies (odds ratio 1.25), with obvious heterogeneity.
 
HCV infection was also associated with a 1.54-fold increased risk of
having prevalent proteinuria. In longitudinal studies with estimated glomerular
filtration rate (eGFR) < 60, < 30 and < 15 ml/min/1.73m2, the corresponding hazard ratios were 1.39, 1.79 and 2.30, respectively.
 
Further grouping of the longitudinal studies by median follow-up time at five years revealed that the effect estimate was reinforced in long-term studies (hazard ratio 1.86) relative to that in short-term studies (1.21).
 
The reviewers summarized that their findings demonstrate the significant risk of experiencing incident CKD after HCV infection, with the lower eGFR and longer HCV exposure time entailing a greater risk.
 

Reference
 
A systematic review and meta-analysis: Does hepatitis C virus infection predispose to the development of chronic kidney disease?  Li M, Wang P, Yang C et al. Oncotarget. 2016 Oct 25 [Epub ahead of print]

Date Added: 04/11/16
Hepatitis C Coalition - October newsletter
News Type: BASL News

Read the October Quarterly edition of the Hepatitis C Coalition's newsletter > HERE . 

Date Added: 31/10/16
Evidence shows value of treating all stages of chronic HCV
News Type: Clinical News

Available evidence suggests that HCV treatment with the new direct-acting antivirals (DAAs) should not be limited to patients with advanced liver disease.

A new literature review has provided an overview of the clinical and economic benefits of achieving SVR and to better understand the full value of chronic HCV treatment in all stages of liver disease. Overall, the review identified 354 studies involving more than 500,000 chronic HCV patients worldwide.

Evidence from 38 studies, involving 73,861 patients, showed a significant mortality benefit of achieving SVR in patients with all stages of fibrosis. Long-term studies with follow-ups of five to 12 years suggested that, particularly among non-cirrhotic patients, there was a significant decrease in mortality in SVR versus non-SVR groups.

Ninety-nine studies conducted in 235,891 chronic HCV patients in all stages of fibrosis showed that SVR reduced liver-related mortality, the incidence of hepatocellular carcinoma, and decompensation.

A total of 233 studies showed that chronic HCV infection was associated with several serious extrahepatic manifestations, some of which can have high mortality. Evidence from four modeling studies showed that delaying treatment to chronic HCV patient populations could significantly increase mortality, morbidity, and medical costs.

The review concludes that there is a robust body of evidence demonstrating diverse sources of value from achieving SVR in all stages of liver disease. While access to treatment is generally limited to late-stage patients, less restrictive treatment strategies that target HCV eradication have the potential to abate the burdens of mortality, liver morbidity and extrahepatic manifestations, and the associated healthcare costs.

Reference

Value of treating all stages of chronic hepatitis C: a comprehensive review of clinical and economic evidence. Nuño Solinís R, Arratibel Ugarte P, Rojo A et al. Infect Dis Ther. 2016 Oct 25. [Epub ahead of print]

Date Added: 31/10/16
Old age not a barrier to major hepatectomy for colorectal liver metastases
News Type: Clinical News

Well-selected elderly patients with colorectal liver metastases should be considered for major hepatectomy, followed by adjuvant chemotherapy.

This was the recommendation of researchers from St James University, Leeds, and Auckland City Hospital, who reviewed 727 patients who underwent major hepatectomy for colorectal liver metastases between 1996 and 2011. Of these, 105 were aged ≥75.

Morbidity was greater in the ≥75 group (25% versus 34%) but there was no difference in mortality. There was no difference in disease-free survival (DFS) between the two groups at five years (16.8 months versus 18.9 months). Overall survival (OS) was longer in the <75 group (38.6 months versus 32.0 months). DFS was better in groups
receiving adjuvant chemotherapy than those who did not (<75, 24.2 months versus 12.2 months, and ≥75, 24 months versus 12.1 months).

OS in the ≥75 group was improved in the group receiving adjuvant chemotherapy compared to those who did not (41.1 months versus 16.6 months). Age ≥75 was not an independent risk factor for reduced DFS on multivariate analysis.


Reference

The impact of advancing age on recurrence and survival following major hepatectomy for colorectal liver metastases. Bell R, Pandanaboyana S, Nisar S et al. J Gastrointest Surg. 2016 Oct 21. [Epub ahead of print]

Date Added: 31/10/16
Less HDV progression with IFNα-based treatment
News Type: Clinical News

In patients with HDV, pegylated interferon alfa (IFNα)-based therapy was independently associated with a lower likelihood for clinical disease progression than nucleos(t)ide analogues (NA) only.
 
In a study at Hannover Medical School, 136 anti-HDV-positive patients were followed for a mean time of 5.2 years. Liver cirrhosis was already present in 62 patients at first presentation. Twenty-nine percent did not receive any antiviral treatment, 38% were treated with IFNα-based therapies and 33% received NAs only.
 
Clinical endpoints defined as hepatic decompensation (ascites, encephalopathy, variceal bleeding), hepatocellular carcinoma, liver transplantation and liver-related death developed in 55 patients.
 
The patients who received IFNα-based therapies developed clinical endpoints less frequently than those treated with NAs (hazard ratio 0.02) or untreated patients (hazard ratio 2.2), which was significant in both chi-square and Kaplan-Meier analysis. In addition, considering various clinical and virological parameters, IFNα therapy was independently associated with a more benign clinical long-term outcome in multivariate logistic regression analysis (odds ratio 0.25). Loss of HDV RNA during follow-up was more frequent in the IFNα-treated patients and strongly linked with a lower likelihood to
experience liver-related complications.
 
Reference


Antiviral treatment and liver-related complications in hepatitis delta. Wranke A, Calle Serrano B, Heidrich B et al. Hepatology. 2016 Oct 22 [Epub ahead of print]
 
 

Date Added: 27/10/16
Acute severe alcoholic hepatitis (AAH): survey of current clinical practice
News Type: BASL News

Alcoholic hepatitis remains a difficult condition to treat with conflicting evidence as to its best management.

The recent STOPAH trial results have had a mixed reception among the gastroenterology and hepatology community and there is a variation in clinical management across the country. We would like to document this variation and determine how to improve care for this group of patients.

This short survey will take 5 minutes of your time.

To participate in the survey click > HERE.

Thank you for your time.

Dr Ashwin Dhanda, NIHR Academic Clinical Lecturer, Plymouth Hospitals NHS Trust
Dr Stephen Atkinson, MRC Clinical Research Training Fellow, Imperial College London
Prof Mark Thursz, Professor of Hepatology, Imperial College NHS Trust

Date Added: 24/10/16
Sofosbuvir/ribavirin “effective and tolerable” in elderly HCV G2 patients
News Type: Clinical News

The combination of sofosbuvir plus ribavirin (RBV) is effective and tolerable in elderly HCV genotype two (G2) patients, a new Japanese study reported.

Thirty-seven HCV G2 patients aged 75 or older ,and 19 aged under 75 were treated with sofosbuvir and weight-based dose of RBV. The older group included more women, and had more history of hepatocellular carcinoma, lower serum albumin (ALB) level, lower haemoglobin (Hb) concentration, lower estimated glomerular filtration rate (eGFR), and a higher fibrosis-4 index.

Forty-one patients were evaluated for SVR at 12 weeks after the end of therapy (SVR12); of them, all but one completed the treatment scheduled for 12 weeks. The older group had a lower SVR12 rate than the younger group (81.3% versus 96.0%, respectively).

Although the Hb concentration and eGFR were significantly lower in the older group throughout the clinical course, all patients in this group completed the 12-week treatment with a gradual increase of serum ALB level.

The researchers noted that although the drug combination is tolerable and beneficial in patients aged over 75, intensive management of anaemia by dose reduction of RBV is necessary, which could lead to a low SVR12 rate compared to patients under 75.

Reference

Safety, tolerability, and efficacy of sofosbuvir plus ribavirin in elderly patients infected with hepatitis C virus genotype 2. Nishida N, Kono M, Minami T et al. Dig Dis. 2016;34(6):632-639 Epub 2016 Oct 17.

 

Date Added: 24/10/16
Increased risk of NHL in HCV/HBV co-infected HIV patients receiving ART
News Type: Clinical News

HIV patients co-infected with HBV or HCV and who are receiving anti-retroviral therapy (ART) are at an increased risk of non-Hodgkin lymphoma (NHL).

This was the conclusion by the Collaboration of Observational HIV Epidemiological Research Europe (COHERE), which studied 52,479 treatment-naive patients of whom 1,339 had chronic HBV and 7,506 had HCV. A total of 40,219 later started ART. The median follow-up was 13 months for treatment-naïve patients and 50 months for those receiving ART.

A total of 252 treatment-naïve patients and 310 ART treated patients developed NHL, with incidence rates of 219 and 168 cases per 100,000 person-years, respectively. The hazard ratios for NHL with HBV and HCV infection were 1.33 and 0.67, respectively, in treatment-naive patients and 1.74 and 1.73, respectively, in ART treated patients.

Reference

Chronic hepatitis B and C virus infection and risk for non-Hodgkin lymphoma in HIV-infected patients: a cohort study. Wang Q, De Luca A, Smith C et al. Ann Intern Med. 2016 Oct 18 [Epub ahead of print]

Date Added: 24/10/16
Comparing the relative renal safety of HBV drugs
News Type: Clinical News

A new animal study has looked at the relative safety of four anti-HBV drugs against HBV, with respect to kidney function and toxicity.

Researchers at Novartis Institutes for BioMedical Research, Basel, administered telbivudine, tenofovir, adefovir or entecavir to male Spraque-Dawley rats once daily for four weeks by oral gavage at about 10 and 25-40 times the human equivalent dose. Main assessments included markers of renal toxicity in urine, magnetic resonance imaging (MRI) of kidney function, histopathology and electron microscopic examination.

Administration of adefovir at 11 mg/kg and 28mg/kg for four weeks caused functional and morphological kidney alterations in a time- and dose-dependent manner, affecting mainly the proximal tubules and suggesting a mechanism of toxicity related to mitochondrial degeneration/depletion.

For the low dose of 300mg/kg of tenofovir, minor kidney effects such as nuclear enlargement in the tubular epithelium, and hyaline droplets accumulation were detected, which was also observed for the low dose (11mg/kg) of adefovir. No assessments could be done at the higher dose of 600/1,000mg/kg tenofovir due to gastrointestinal tract toxicity, which prevented treatment of the animals for longer than one week.

Entecavir at 1mg/kg and 3mg/kg and telbivudine at 600 mg/kg and 1,600mg/kg caused no toxicologically relevant effects on the kidney.

Reference

Comparative renal safety assessment of the hepatitis B drugs, adefovir, tenofovir, telbivudine and entecavir in rats. Uteng M, Mahl A, Beckmann N et al. Toxicol Sci. 2016 Oct 13 [Epub ahead of print]

Date Added: 24/10/16
Minimum unit pricing in Scotland is legal – AHA comment
News Type: BASL News

Responding to the ruling made today in the Scottish courts in relation to minimum unit pricing in Scotland, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, said:

"We welcome this court ruling, and hope to see minimum unit pricing speedily implemented in Scotland. Now is the time to act, even if the global alcohol producers, prioritising commercial interests over Scotland’s health, try to delay further by another appeal.

Now is also the time for England and Wales to follow suit and introduce MUP. The UK government committed to introducing MUP in 2012, and the public support the measure. Government-commissioned research estimates that in the first year following the implementation of MUP in England, there would be nearly 140 fewer crimes per day.

MUP leaves pub prices untouched, and targets the cheap alcohol which is preferentially consumed by children and dependent drinkers. Recent AHA research has found that alcohol is being sold for as little as 16p per unit, with 3 litre bottles of white cider, which contain the same amount of alcohol as 22 shots of vodka, available for just £3.49.

MUP would also be of greatest benefit to those on low income, with 8 out of 10 lives saved coming from the lowest income groups, and greater harm reductions felt by these groups. The government has spoken of its commitment to even out life chances, and MUP would go a long way in furthering this agenda."

For more information visit the AHA website > here.

Date Added: 24/10/16
BOOZE SOLD AT POCKET MONEY PRICES: COST OF CINEMA TICKET BUYS 7½ LITRES STRONG WHITE CIDER
News Type: BASL News

Research released today shows there is an abundance of high strength alcohol sold for pocket money prices in shops and supermarkets across the UK.

A review of alcohol prices in a range of retailers found products like high strength white ciders, which are predominantly drunk by dependent and underage drinkers, available for as little as 16p per unit.

This means that for the cost of a standard off-peak cinema ticket it is possible to buy almost seven and a half litres of high strength white cider, containing as much alcohol as 53 shots of vodka.

The findings are released today in a report by the Alcohol Health Alliance UK (AHA) (Download Cheap alcohol the price we pay AHA Oct 2016.pdf), a group of medical royal colleges, alcohol organisations and health bodies. The report argues that recent cuts in alcohol taxes allow supermarkets to sell alcohol at rock bottom prices, but have done little to benefit pubs and their customers.

Chair of the Alcohol Health Alliance (AHA), leading liver doctor and former President of the Royal College of Physicians, Professor Sir Ian Gilmore said:

"In spite of a government commitment to tackle cheap, high-strength alcohol, these products are still available at pocket money prices. Harmful drinkers and children are still choosing the cheapest products: predominantly white cider and cheap vodka." 

"We need to make excessively cheap alcohol less affordable through the tax system, including an increase in cider duty. It's not right that high strength white cider is taxed at a third of the rate for strong beer."

"In addition, we need minimum unit pricing. This would target the cheap, high strength products drunk by harmful drinkers whilst barely affecting moderate drinkers, and it would leave pub prices untouched. In fact, pubs could benefit from minimum unit pricing, as it would prevent the proliferation of cheap alcohol in our supermarkets." 

"It's time the government took action and made all high strength alcohol less attractive to vulnerable drinkers."

Each year there are almost 23,000 deaths and more than one million hospital admissions related to alcohol in England and Government figures estimate that alcohol harm costs UK society more than £21billion.

The report, Cheap alcohol: the price we pay, warns that, unless action is taken on the availability of cheap alcohol, harms associated with alcohol consumption will continue to rise, increasing the burden on the NHS and public services.

For further information, please contact Matt Chorley, the AHA's Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 17/10/16
People with mental disorders at increased risk of HIV/HCV co-infection
News Type: Clinical News

A new review suggests that people with psychiatric diseases may be at an increased risk of HIV/HCV co-infection

The authors, from the University of Barcelona, found that the prevalence of HCV infection among HIV-infected patients is high ranging from 50% to 90%. Patients with psychiatric diseases have also an increased risk for HIV/HCV co-infection.

The most effective strategy to decrease HCV-related morbidity and mortality in co-infection is to achieve viral eradication. Although psychiatric symptoms often appear during antiviral treatment and may be associated with the use of interferon-alpha, recent evidence suggests that many patients with comorbid mental and substance use disorders can be treated safely.

Recent data indicate that interferon-alpha-induced psychiatric side effects have a similar prevalence in HIV/HCV co-infected patients to mono-infected patients and they can be managed and even prevented successfully with psychopharmacological strategies in the frame of a multidisciplinary team. New antivirals offer interferon-free therapies for this specific population.

Reference

Mental disorders in HIV/HCV coinfected patients under antiviral treatment for hepatitis C. Martin-Subero M, Diez-Quevedo C. Psychiatry Res. 2016 Sep 26; 246:173-181 Epub ahead of print]

 

Date Added: 17/10/16
Elbasvir/grazoprevir tablet effective in previously failed HCV
News Type: Clinical News

The combination of elbasvir and grazoprevir, with or without ribavirin, was effective in HCV patients failed by previous treatment, a large international study reported.

The study, at 65 centres in Europe, Asia, and Central and North America, assessed the effects of 12 or 16 weeks of a once daily tablet of elbasvir plus grazoprevir, with or without twice-daily ribavirin, in patients with HCV genotype one, four or six. There were 420 patients, of whom 35% had cirrhosis and 64% had a null or partial response to peg-interferon and ribavirin.

With 12 weeks of treatment, an SVR12 was achieved by 92.4% of patients given elbasvir and grazoprevir and 94.2% of patients given elbasvir and grazoprevir with ribavirin.

With 16 weeks of treatment, SVR12 was achieved by 92.4% of patients given elbasvir and grazoprevir and 98.1% of patients given elbasvir and grazoprevir with ribavirin.

Among patients treated for 12 weeks without ribavirin, virologic failure occurred in 6.8%, none, and 12.5% of patients with HCV genotype 1a, 1b, or four infection, respectively.

Also among patients given elbasvir and grazoprevir for 12 weeks, virologic failure occurred in none of the patients infected with HCV genotype 1, and 7.5% of those with genotype 4.

Among patients treated for 16 weeks who received ribavirin, there were no incidences of virologic failure. The treatment was generally well tolerated.

Reference

Effectiveness of elbasvir and grazoprevir combination, with or without ribavirin, for treatment-experienced patients with chronic hepatitis C infection. Kwo P, Gane E, Peng CY et al. Gastroenterology. 2016 Oct 5 [Epub ahead of print]

 

Date Added: 17/10/16
Diet and exercise independently improve fat oxidation in NAFLD
News Type: Clinical News

New research shows diet and exercise training have specific benefits on fat metabolism in patients with non-alcoholic fatty liver disease (NAFLD).

In a study at the University of Queensland, 10 NAFLD patients were randomised to circuit exercise training (EX) for three hours a week, and six patients to dietary energy restriction (ER). Respiratory quotient (RQ) and whole-body fat oxidation rates (Fatox) were determined by indirect calorimetry under basal, insulin-stimulated and exercise conditions. Severity of disease and steatosis was determined by liver histology; hepatic Fatox was estimated from plasma β-hydroxybutyrate concentrations; cardiorespiratory fitness was expressed as VO2peak.

Hepatic steatosis and NAFLD activity scores decreased with ER but not with EX. β-hydroxybutyrate concentrations increased significantly in response to ER but remained unchanged in response to EX. Basal RQ decreased in response to EX, while this change was not significant after ER. Maximal Fatox during aerobic exercise improved with EX but not with ER. The increase in β-hydroxybutyrate concentrations was correlated with the reduction in hepatic steatosis.

Reference

Independent effects of diet and exercise training on fat oxidation in non-alcoholic fatty liver disease. Croci I, Byrne NM, Chachay VS et al. World J Hepatol. 2016 Sep 28;8(27):1137-1148

Date Added: 10/10/16
HBV may reduce risk of stroke
News Type: Clinical News

New evidence suggests people with HBV are less likely to develop acute ischaemic stroke (AIS).

Researchers at China Medical University Hospital used a Taiwan national insurance claims data set of 1m patients to study 22,303 patients with HBV and 89,212 matched controls from the beginning of 2000 to the end of 2006. Both groups were followed up until the appearance of AIS or the end of 2011.

After adjusting for the relevant covariates, the HBV group exhibited a lower AIS risk (adjusted hazard ratio 0.77) compared with the controls at the end of follow-up. Under the condition of no co-morbidities, patients with HBV had a lower AIS risk compared with the controls (adjusted hazard ratio 0.65). In three age-stratified subgroups, HBV was correlated with a significantly diminished risk of AIS (adjusted hazard ratios at age ≤ 49 years 0.57; at age 50-64 years 0.65; and at age ≥ 65 years 0.96).

The study authors suggest that although a decrease in AIS risk was noted in the patients with HBV, preventing the development of AIS in this population warrants further attention.

Reference

Association of hepatitis B virus infection with decreased ischemic stroke. Tseng CH, Muo CH, Hsu CY et al. Acta Neurol Scand. 2016 Nov; 143(5): 339-345

 

 

Date Added: 10/10/16
HCV patients have body composition changes
News Type: Clinical News

Chronic HCV patients have both an acquired type of lipodystrophy (particularly in the trunk region) and a reduced bone mineral density (BMD) compared to controls.

These were the findings of researchers at Bucharest’s Carol Davila University of Medicine and Pharmacy, who assessed 60 chronic HCV patients and 60 healthy controls by Dual Energy X-Ray Absorptiometry.

Total fat mass, trunk fat mass and per cent body fat were lower in the HCV patients. Several risk factors were associated with the reduced fat mass: low BMI, cigarette smoking and peg-interferon alpha 2a plus ribavirin treatment. Peg-interferon alpha 2a and ribavirin treatment negatively correlated with lean body parameters, especially in male patients. BMD was lower when compared to controls and was correlated with low body mass index, cigarette smoking and peg-interferon alpha 2a and ribavirin treatment.

Reference

Body composition changes in patients with chronic hepatitis C. Barbu EC, Chiţu-Tișu CE, Lazăr M et al. J Gastrointestin Liver Dis. 2016 Sep; 25(3):323-9

Date Added: 10/10/16
ElastPQ technique accurately assesses liver fibrosis in HCV
News Type: Clinical News

The ElastPQ technique is reliable and accurate for assessing liver fibrosis in HCV, a new study reported.

Researchers at Italy’s Medical School University of Pavia assessed the performance in staging liver fibrosis of the updated ElastPQ technique (EPIQ7 ultrasound system) in a "real life" setting. A total of 278 chronic HCV patients referred for liver stiffness measurement with the FibroScan 502 Touch device also underwent measurements with the ElastPQ technique.

For the assessment of significant fibrosis, advanced fibrosis and cirrhosis, respectively, the cutoffs of 7, 9.5 and 12kPa were used. The diagnostic performance of ElastPQ was assessed using the area under the ROC curve analysis and was evaluated overall and for cases with (a) 10 measurements and IQR/M</=30%, (b) five measurements and IQR/M </=30%, (c) 10 measurements and IQR/M>30%, (d) five measurements and IQR/M>30%.

The optimal cutoffs of ElastPQ for significant fibrosis, advanced fibrosis and cirrhosis were 6.43, 9.54 and 11.34 kPa, respectively. For measurements with an IQR/M</=30%, there was no statistically significant decrease in sensitivity between 10 and five measurements.

Reference

Accuracy of the ElastPQ technique for the assessment of liver fibrosis in patients with chronic hepatitis C: a "real life" single center study. Ferraioli G, Maiocchi L, Lissandrin R et al. J Gastrointestin Liver Dis. 2016 Sep; 25(3):331-5

Date Added: 03/10/16
Chemotherapy patients with HBV markers need prophylactic antiviral therapy
News Type: Clinical News

Patients receiving chemotherapy who have serological markers of previous HBV infection remain at risk for reactivation, and need effective pre-emptive antiviral prophylaxis.

This is suggested by the results of a study at Athens University which retrospectively evaluated the medical records of 55 HBsAg-negative, anti-HBc-positive patients with haematological diseases or solid tumours who underwent immunosuppressive therapies and were referred because of positive baseline HBV serology or HBV reactivation.

Of the 55 patients, 31 received antiviral prophylaxis (group one), whereas 24 patients did not receive any anti-HBV agent (group two). The majority of patients had haematological malignancies and most of them received rituximab-containing regimens.

Lamivudine was used as antiviral prophylaxis in 13 of the 31 patients in group one. One patient in this group experienced HBV reactivation and was treated successfully with tenofovir add-on therapy.

All patients in group two experienced HBV reactivation and most of them were treated with tenofovir or entecavir as rescue therapy. Two of these patients (one of the tenofovir/entecavir subgroup and one of the lamivudine subgroup) eventually died because of hepatic failure despite rescue treatment.

The researchers conclude that screening of both anti-HBs and anti-HBc is mandatory before chemotherapy. Pre-emptive antiviral prophylaxis, including lamivudine, is highly effective in all subgroups of such patients, whereas deferring treatment upon HBV reactivation is not enough to rescue all cases.

Reference

Efficacy of prophylactic antiviral therapy and outcomes in HBsAg-negative, anti-HBc-positive patients receiving chemotherapy: a real-life experience. Papadopoulos N, Deutsch M, Manolakopoulos S et al. Eur J Gastroenterol Hepatol. 2016 Sep 23 [Epub ahead of print]

Date Added: 03/10/16
Corticosteroids safe in rheumatologic patients with HBV markers
News Type: Clinical News

A new study suggests short episodes of corticosteroids seem to be safe in rheumatologic patients with markers of HBV.

The study followed 23 HBsAg or HBcore antibodies positive, anti-HBs negative patients who were hospitalised for a total of 73 times in the rheumatology department at Rambam Health Care Campus, Haifa, Israel, and who each received seven days’ treatment with IV corticosteroids. Eighteen were HBsAg positive. The mean methylprednisolone dose was 33.9 mg/day. Concomitant therapy included disease-modifying anti-rheumatic drugs (DMARDs) in 15, low-dose corticosteroids in eight, and biologicals in 10. Serum HBV DNA was detected at baseline in seven patients.

Three HBsAg-positive patients treated with cyclophosphamide had HBV hepatitis flare-ups with elevated alanine aminotransferase (ALT). Two HBsAg-positive patients had reappearance of HBV DNA in serum after treatment with azathioprine and infliximab, respectively, but the ALT levels remained normal. Lamivudine therapy reduced the serum HBV DNA and improved ALT levels in all patients. Corticosteroid therapy by itself did not trigger exacerbations of HBV. No HBV reactivation occurred in lamivudine-treated patients after recurrent exposure to biologicals or cyclophosphamide.

Reference

Safety of corticosteroid treatment in rheumatologic patients with markers of hepatitis B viral infection: pilot evaluation study. Braun-Moscovici Y, Braun M, Saadi T et al. J Clin Rheumatol. 2016 Oct; 22(7): 364-8

Date Added: 03/10/16
Injecting drug use is a major global risk factor for HCV, HBV and HIV
News Type: Clinical News

A new analysis of international data shows injecting drug use (IDU) is a major contributor to the global burden of HCV, HBV and HIV.

Previous estimates of the burden of these diseases among people who inject drugs have not included estimates of the burden attributable to the consequences of past injecting. Therefore, a team of researchers from Australia, the UK and the USA used the Global Burden of Disease Study and United Nations data to study this risk factor.

They estimated 10million disability-adjusted life-years (DALYs) were attributable to previous exposure to HIV, HBV, and HCV via IDU, a four-times increase since 1990.

In total, in 2013, IDU was estimated to cause 4% of DALYs due to HIV, 1.1% of DALYs due to HBV, and 39.1% of DALYs due to HCV. The IDU-attributable HIV burden was highest in low-to-middle-income countries, and the IDU-attributable HCV burden was highest in high-income countries.

The researchers suggest that effective interventions to prevent and treat these important causes of health burden need to be scaled up.

Reference

Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. Degenhardt L, Charlson F, Stanaway J et al. Lancet Infect Dis. 2016 Sep 21 [Epub ahead of print]

Date Added: 26/09/16
Hepatic amyloidosis as a rare differential diagnosis of progressive liver failure
News Type: Clinical News

German researchers have reported a case of hepatic amyloidosis as a rare differential diagnosis of progressive liver failure.

A 63-year-old man presented with newly diagnosed ascites to the researchers’ department. The patient reported occasional alcohol consumption. Viral hepatitis, genetic-metabolic causes as well as hepatic vascular disorders were excluded and ultrasound did not show any signs of liver cirrhosis or intraabdominal malignancy.

Initially, alcoholic hepatitis was suspected. Because of the rapid deterioration of liver function, however, transjugular liver biopsy was performed, showing light chain amyloidosis of kappa isotype.

The researchers suggest that, as the diagnosis of hepatic amyloidosis is challenging, early liver biopsy is mandatory in patients with unexplained acute or chronic liver disease to exclude rare diseases with high mortality.

Reference

Hepatic amyloidosis as a rare differential diagnosis of progressive liver failure. Bettinger D, Lutz L, Schultheiß M et al. Dtsch Med Wochenschr. 2016 Sep;141(19):1387-1389

Date Added: 26/09/16
Six weeks sofosbuvir plus ribavirin is not effective in HCV
News Type: Clinical News

While six weeks of sofosbuvir and ribavirin therapy was safe and well tolerated in HCV patients, its efficacy was sub-optimal, a study concluded.

In this open-label study conducted in Australia and New Zealand, 19 adults with recent HCV (68% genotype 1; duration of infection median 37 weeks) received sofosbuvir 400mg daily and weight-based ribavirin for six weeks.

Four reported a symptomatic HCV seroconversion illness, including two with jaundice. At baseline, the median HCV RNA was 5.4 log10 IU/mL and at the end-of-treatment, it was non-quantifiable in 89%. SVR4 and SVR12 were 42% and 32%, respectively.

Treatment failure was because of non-response in two, post-treatment relapse in nine, re-infection in one, and with one loss to follow up.

The regimen was well tolerated with minimal haematological toxicity. SVR12 was related to baseline HCV RNA (≤6 log10 IU/mL, p=0.018) and early on-treatment viral kinetics.

The researchers suggest that further research is needed to determine whether more potent interferon-free direct-acting antiviral regimens will allow treatment duration to be shortened in recent, predominantly asymptomatic, HCV infection.

Reference

Sofosbuvir and ribavirin for six weeks is not effective among people with recent HCV infection: The DARE-C II study. Martinello M, Gane E, Hellard M et al. Hepatology. 2016 Sep 17 [Epub ahead of print]

Date Added: 26/09/16
UK patients who have liver transplants abroad get poorer management
News Type: Clinical News

A small number of UK citizens are undergoing liver transplants abroad but their management is of a lower standard than in the UK.

These were the conclusions of researchers at Sheffield’s Royal Hallamshire Hospital, who sent questionnaires to all seven UK liver transplant units enquiring about liver patients receiving transplant abroad. Six of the seven centres responded.

A total of 12 patients were identified as having undergone liver transplantation overseas. The top destinations were India, China and Egypt.

Four units responded to questions regarding pre-transplant screening. One unit reported HBV and HCV screening not taking place. Four units responded to questions regarding post-transplant antimicrobial therapy. This revealed examples of patients inappropriately not receiving valganciclovir, co-trimoxazole, anti-fungal treatment and HBV immunoglobulins.

The researchers add that information transfer between overseas and UK based transplant teams is poor.

Reference

A questionnaire based assessment of numbers, motivation and medical care of UK patients undergoing liver transplant abroad. Winter BK, Odedra A, Green S. Travel Med Infect Dis. 2016 Sep 14 [Epub ahead of print]

Date Added: 23/09/16
RCP Dame Sheila Sherlock travelling fellowships in hepatology
News Type: BASL News

Applications are invited for these travelling fellowships, which are funded by a donation from Dr Geraint James in memory of his wife, Dame Sheila Sherlock.

The fellowships offer consultants and trainees the opportunity to learn new techniques and acquire new experiences, ideas and stimulation through travel and the exchange of ideas.

Two travelling fellowships are available, covering a period of 1 month each, and will be offered to one consultant and one trainee. Each fellowship will be for a maximum of £2,000, with the recipients being responsible for funding any additional costs.

Who can apply?
You must have current membership of the RCP.

Applications are open until 16 January 2017 and details on how to apply can be found the the RCP website > HERE.

Date Added: 21/09/16
Alcohol Health Alliance news – September 2016
News Type: BASL News

To view the Alcohol Health Alliance news – September 2016 click > HERE. 

Date Added: 21/09/16
Scottish-Irish Alcohol Policy Report
News Type: BASL News

SHAAP (Scottish Health Action on Alcohol Problems) has released a report that compares alcohol- related problems and welcomes innovative policy responses in Scotland and Ireland. 

Click > HERE to view the report. 

Date Added: 19/09/16
Many vulnerable people do not return for hep screening results
News Type: Clinical News

More than a third of vulnerable people screened for HBV, HCV, HIV and syphilis at out-of-hospital sites, did not return for result, a study in Paris has revealed.

Researchers at nine out-of-hospital screening mobile sites in Paris explored the rates of these infections amongst 341 vulnerable people who were mostly intravenous drug users, sex workers or homeless. 

The proportion of failure to return for results was 38.75%. In multivariate analysis, unemployment was significantly associated with failure to return (odds ratio 4.29), as well as having been screened in the past (odds ratio 4.32). And 18.03% of the patients had a false perception of an immunization against HBV.

In multivariate analysis, having a place of residence protected against a false perception (odds ratio 0.33), while being screened in the past enhanced the risk of a false perception (odds ratio 3.28).

The researchers suggest that using technologies, such as phone texting, might be a partial solution along with rapid diagnostic tests. More information and explanation of the results should be provided, along with specific anti-HBV vaccination campaigns targeting these specific populations.

Reference

Out-of-hospital screening for HIV, HBV, HCV and syphilis in a vulnerable population, a public health challenge. Legoupil C, Peltier A, Henry Kagan V et al. AIDS Care. 2016 Sep 14:1-3 [Epub ahead of print]

Date Added: 19/09/16
“Acceptable outcomes” for liver transplant patients who have cardiac surgery
News Type: Clinical News

Liver transplant patients who receive subsequent cardiac surgery have acceptable short-term and long-term outcomes, researchers have concluded.

The researchers, from the University of Alabama at Birmingham School of Medicine, analysed data on 43 patients (median age 60) who underwent cardiac operations at 63 months, on average, after their liver transplants.

There were three operative deaths and 24 late deaths. The patients with a preoperative Model for End-Stage Liver Disease (MELD) score of 13.8 or less had significantly greater survival rates than those with a MELD score greater than 13.8. Patients with a postoperative MELD score of 17 or less had significantly greater survival rates than those with a MELD score greater than 17.

Further analyses showed that postoperative peak creatinine levels were statistically significant predictors of death (relative risk 1.8). The one, five, and 10 year Kaplan-Meier survival rates were 90%, 51%, and 35%, respectively; postoperative mortality rates followed a constant phase model with a hazard of death of 10% per year.

Reference

Outcomes of patients who undergo cardiac surgical procedures after liver transplantation. Harrington PB, McAlexander WW, Bryant AS et al. Ann Thorac Surg. 2016 Sep 9 [Epub ahead of print]

 

Date Added: 19/09/16
No difference in efficacy/safety of sorafenib for elderly HCC patients
News Type: Clinical News

 Elderly patients with advanced hepatocellular carcinoma (HCC) who were treated with sorafenib had similar clinical outcomes and toxicity rates to their younger counterparts, according to a UK study.

A total of 190 HCC patients who were treated with sorafenib at King's College Hospital, London, were divided into two groups: (A) 151 patients aged up to 75 and (B) 39 patients older than 75.

There was no significant difference in overall survival (OS) and time to treatment failure (TTF) between the two groups (7.1 months versus 10.4 months; and 4.2 months versus 5.6 months, respectively). The incidence of toxicities at all grades and dose reductions were comparable between the two groups.

In a multivariate setting, patients with Child-Pugh B scores at baseline were associated with a higher risk of death (adjusted hazard ratio 2.17) and treatment failure (adjusted hazard ratio 4.64) and had shorter OS and TTF compared with patients with a Child-Pugh A.

The researchers concluded that age alone should not be a discriminating factor for the management of advanced HCC with sorafenib.

Reference

Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: age is not a problem. Ziogas DC, Papadatos-Pastos D, Thillai K et al. Eur J Gastroenterol Hepatol. 2016 Sep 10 [Epub ahead of print]

 

Date Added: 15/09/16
British Viral Hepatitis Group (BVHG) Committee Chair - Vacancy
News Type: BASL News

Due to the current post holder having served their tenure, BASL are seeking nominations/ expressions of interest for one Committee post. Please send your nominations by Monday 3rd October 2016, 17:00.

• British Viral Hepatitis Group (BVHG) Committee Chair
The BVHG Chair is elected by the BASL / BVHG membership to serve for a period of up to three years and may be re-elected once.

The BVHG is commissioned by the Governing Board to:
• a) promote research and the exchange of scientific information concerning viral hepatitis;
• b) foster multicentre scientific studies pertaining to viral hepatitis within the UK;
• c) promote education of physicians, surgeons, clinical nurse specialists and scientists
• with regard to viral hepatitides and their management;
• d) Promote interaction between clinical disciplines to promote good care of patients and foster research and clinical trials.

The BVHG Chair shall be registered with Companies House in the United Kingdom as a Director of BASL and registered with the Charities Commission as a Trustee.

If you need any more information about the post please contact the current BVHG Committee Chair Dr Andrew Ustianowski at Andrew.Ustianowski@pat.nhs.uk .

Nomination Process
Candidates wishing to be considered for election will require one BASL member to propose them and a second member to confirm their suitability for the role in writing.

Please email Judy Hawksworth at the Secretariat; Judith@execbs.com with your nominations by 17:00 on Monday 3rd October 2016. Following this time, candidate statements will be sought and voting will take place if necessary.

Date Added: 12/09/16
High rate of HBV breakthrough in elderly NHL patients on rituximab
News Type: Clinical News

Researchers have reported a high rate of HBV breakthrough amongst elderly non-Hodgkin lymphoma (NHL) patients receiving rituximab-based chemotherapy.

The researchers, at Milan’s Luigi Sacco Hospital, evaluated 85 newly diagnosed NHL patients aged over 65 with resolved HBV infection who received rituximab-containing chemotherapies. All received lamivudine. HBV DNA was checked at baseline, every four weeks, for one year after completing the rituximab containing regimens.

Nine patients had HBV reactivation and HBV-related hepatitis. All received entecavir and recovered without consequences. HBV reactivation was more likely to occur after an average of five R-CHOP cycles or during fludarabine.

The researchers concluded that the rate of viral breakthrough was high, considering that the patients were HBV DNA negative at baseline. They suggested that lamivudine prevention may not be sufficient in this population.

Reference

High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy. Castelli R, Ferraris L, Pantaleo G et al. Dig Liver Dis. 2016 Aug 20 [Epub ahead of print]

 

Date Added: 12/09/16
HCV patients satisfied with clinical pharmacists
News Type: Clinical News

A new US study suggests patients with HCV appear to be highly satisfied with the treatment provided by clinical pharmacists.

Researchers at the University of Massachusetts Medical School offered an anonymous patient satisfaction survey to patients who were initiating or receiving HCV treatment under the care of a clinical pharmacist.

Sixty-four patients completed 77 (24 pharmacist and 53 prescriber) patient satisfaction surveys. The patients reported high levels of satisfaction with the pharmacist and prescribers. All 24 patients ranked overall satisfaction with services provided by pharmacists as 'great', and 36 of 52 patients ranked overall satisfaction with services provided by prescribers as 'great'. Patients supported the inclusion of a clinical pharmacist on health care teams for other disease states.

Reference

Patient satisfaction with the clinical pharmacist and prescribers during hepatitis C virus management. Martin MT, Faber DM. J Clin Pharm Ther. 2016 Aug 31 [Epub ahead of print

]

Date Added: 12/09/16
No mother-to-child HCV transmission among dental patients
News Type: Clinical News

A new study has not found any mother-to-child transmission of HCV among patients attending a dental hospital in Scotland.

The study was undertaken among children, accompanying parents and household contacts attending a general anaesthetic assessment clinic at Glasgow Dental Hospital and School. Children were asked to provide an oral fluid specimen for HCV testing. Accompanying adults were asked to provide demographic data on the child and information on familial risk factors for HCV infection using a standardised questionnaire. Birth mothers were also asked to provide an oral fluid specimen.

Between June 2009 and December 2011, samples were collected from 2,141 children and 1,698 mothers. None of the samples from the children were HCV seropositive but 16 (0.9%) of the specimens from mothers were HCV antibody positive.

The researchers summarised that the prevalence of HCV seropositivity in the birth mothers of the children was similar to that estimated in the general population served by the hospital and showed no evidence of mother-to-child transmission of HCV.

Reference

The seroprevalence of hepatitis C virus infection among children and their mothers attending for dental care in Glasgow, Scotland, United Kingdom. O'Leary M, Bagg J, Welbury R et al. J Infect Public Health. 2016 Aug 24 [Epub ahead of print]

 

 

 

Date Added: 12/09/16
#BASL2016: Primary care in and out of hours ¬– the challenges of end-of-life care in liver disease
News Type: BASL News

More integration is needed between primary and secondary care, said Dr John O’Malley, GP and Medical Director at Mastercall, Stockport.

Mastercall is a NHS social enterprise providing out-of-hours services in the Stockport area. In his presentation, Dr O’Malley used findings from a survey of 150 doctors to support his call for more integration between primary and secondary care in providing palliative care for end-of-life liver disease patients.

Most GPs are good at palliative care and, together with others in the primary care team, give the continuity of care needed, he said. Sophisticated computer databases have been developed to help coordinate care and are used to track the trajectory of many organ failures. However, whilst renal, heart or lung failure may follow a predictable model, many GP’s feel “out of their comfort zone” when it comes to liver failure.

Liver disease presents many problems in primary care; often, patients are (or are seen to be) homeless, intravenous drug users or with alcohol problems, and many do not have contact with their GPs. There is an uncertain illness trajectory which does not fit well with the palliative care model: liver patients do not do behave as they should in the textbooks. Periods of relative wellness between decompensation can lull carers into a false sense of security. Furthermore, there is a problem with the pharmacology. Primary care providers are well versed in symptom control for cancer etc, and have strong evidence that they are using these drugs correctly. But when it comes to liver disease, there are no manuals.

Palliative care is often seen as a “last gasp” when everything else has been done. The default position was to send the end-of-life liver patients into hospital (although evidence shows that only three percent of patients would prefer to die in hospital). Specialist advice and support is often sadly lacking, and GPs would welcome the support of liver outreach teams which could make it possible to keep patients at home.

Dr O’Malley ended by pleading for more cooperation between specialist and primary care. True multidisciplinary work and integration is needed, he said. And GPs want more education, especially evidence based methods of identification for end of life in liver disease.

 

Date Added: 12/09/16
#BASL2016: GLP-1 analogues in NASH
News Type: BASL News

By 2020, it is estimated that non-alcoholic steatohepatitis (NASH) will be the leading indication for liver transplantation.

During the Sheila Sherlock Lecture, Dr Matthew Armstrong of Queen Elizabeth University Hospital Birmingham, reminded delegates NASH is the most common form of liver disease, especially in the Western world, and that up to 20% of cases progress to cirrhosis

So far, there have been no licensed therapies for NASH; Dr Armstrong’s presentation focused on research into the glucagon-like peptide-1 (GLP-1) analogues and their potential role in the management of the condition.

GLP-1 analogues were developed as treatments for type 2 diabetes, however, Trevaskis et al (2012) provided evidence to suggest that liver fibrosis had regressed on histological assessment and collagen-1 immunostaining (marker of fibrogenesis) with GLP-1.

A study in type 2 diabetes (Armstrong et al 2013) had demonstrated a dose -dependent improvement in liver enzymes. However, as Dr Armstrong pointed out, these findings were retrospective and the study was diabetes-focussed and not powered for liver endpoints.

However, the LEAN double-blinded, randomised, placebo-controlled phase 2 trial assessed the GLP-1 analogue, liraglutide, in overweight patients with clinical evidence of NASH (Armstrong et al 2016). The primary outcome measure was resolution of definite NASH with no worsening in fibrosis from baseline to end of treatment (48 weeks), as assessed by two independent pathologists.

Nine of 23 patients who received liraglutide and underwent end-of-treatment liver biopsy had resolution of definite NASH compared with two of 22 patients in the placebo group (relative risk 4·3). Two of 23 patients in the liraglutide group versus eight of 22 patients in the placebo group had progression of fibrosis.  Most adverse events were grade 1 or 2, and were self-limiting in the first 12 weeks with the exception of gastrointestinal disorders in 21 liraglutide patients and 17 placebo patients.

Dr Armstrong summarized that GLP-1 agonists achieve histological clearance of NASH, reduce fibrosis progression and improves key metabolic risk factors with a direct and indirect mechanism of action. And they are well tolerated with an acceptable safety profile.

Date Added: 09/09/16
#BASL2016: The politics of alcohol
News Type: BASL News

Binge drinking culture was created deliberately to aid falling profits and public health is picking up the bill.

In a blistering attack on the Government and the drinks industry, Professor Nick Sheron, a consultant hepatologist, traced the current “epidemic of liver disease” to the 1990s, when marketing campaigns targeted a generation that had shunned alcohol in favour of “party drugs”.

“The drinks industry got worried because young people stopped drinking, so they changed their marketing and targeted 18 year olds with a new type of drink: alco-pops.

“At the beginning of the 1990s, children did not drink any spirits at all. By the end, 10 to 15 year olds are drinking at last one double vodka a week.”

Talking at the annual meeting of the British Association for the Study of the Liver in Manchester this week, he used the Government’s own figures to slam the U-turn on introducing a minimum price per unit (MUP) in 2014. In the same year there were 8,697 alcohol-related deaths in the UK.

“If we are going to stop people dying of liver disease we have to stop people drinking alcohol,” he said.

Far from MUP penalising moderate drinkers, as critics of the policy claimed, it would disproportionally impact those drinking at harmful levels, he said.

“Back in the 1980s, a litre of spirits would have cost more than £90. Today, the equivalent price is £28. The mean consumption of one of my patients with cirrhosis is 150 units a week.

“People with cirrhosis spent 30p a unit, others, on average, spend £1 a unit. Patients with cirrhosis on the whole are not drinking frozen mojitos for £7 a go in a rooftop bar.”

Charging 70p a unit, Prof Sheron said, would take the average weekly alcohol bill of his caseload from £23.25 to £105.

There is a direct correlation between the price of alcohol and deaths from liver disease, Prof Sheron said.

In 2008 in the midst of the economic downturn and to the backdrop of rising deaths from liver disease, a 2% tax escalator policy was introduced by the then Chancellor Alistair Darling.

The policy, which saw duty on wine and spirits automatically rise by 2% above inflation each year, was hotly opposed by the drinks lobby, but Prof Sheron said the number of deaths started to level out.

The policy was dropped in 2014 following extensive lobbying from the Wine and Spirits Association.

“Everything was going in the right direction and now we are back to an 8% year-on-year increase in alcohol related deaths,” said Dr Sheron, adding there was a very simple reason the industry had been opposed to MUP.

Just 1.3% of the population, those who are consuming 75+ units a week, are drinking 16% of all alcohol – and accounting for more than 50% of all alcohol-related deaths.

“Quite simply, the drinks industry does not want to lose these customers,” said Prof Sheron.

And it is public health, not to mention the public purse, which is missing out.

In 1980, 4% of the Government’s income came from alcohol taxation, but that has halved – that equates to £3.55billion of lost tax revenue a year since 2013.

“Shall we compare that to the £4billion hole in NHS?,” Prof Sheron asked.

 

Date Added: 09/09/16
#BASL2016: Unclear picture of genetic indicators
News Type: BASL News

Not everyone who drinks will become dependent, not everyone who becomes dependent will get fibrosis and not everyone who gets fibrosis will progress to cirrhosis and liver disease.

During the BASL annual meeting, Dr Marsha Morgan looked at the genetic predisposition for becoming alcohol dependent "versus being susceptible to cirrhosis".

“Only 40-50% of alcohol misusers are going to develop dependence over time and less than 20% of misusers will develop cirrhosis,” she said.

“It is so complex – there is a genetic susceptibility for alcohol misuse and one for cirrhosis what is unclear is where they overlap.”

PNPLA3 has a confirmed pivotal role, said Dr Morgan: “It has got nothing to do with alcohol dependence but everything to do with alcohol-related cirrhosis.”

It is also a risk factor for HCC: the cancer tends to occur at an earlier age, lead to multiple lesions and a worse outcome.

“It carries a population attributable risk of 27%, meaning it could be giving us 200,00 more cases of alcohol-related cirrhosis,” said Dr Morgan.

 

Date Added: 09/09/16
#BASL2016: Moving from paediatric to adult services
News Type: BASL News

In her presentation “Improving outcomes following paediatric liver transplantation”, Professor Deidre Kelly (Birmingham) had stressed the importance of issues involved in the transition to adult services. These themes were expanded on by Dr Alison Darcy, Clinical Research Psychologist at Stanford University, and Dr Marianne Samyn, Consultant Paediatric Hepatologist at King’s College Hospital, in their joint presentation.

Dr Darcy specialises in developing models that specifically target individuals who are difficult to reach. In her presentation, which centred on adolescent neurocognitive development in the context of chronic Illness, she explained that neuroimaging studies have shown how adolescence is a distinct period. Higher-order cognitive functioning matures later than “primary” function regions and the development of subcortical regions is also pronounced at that age.

Adolescence is a turbulent period, with 75% of mental illnesses arising before age 24 and with 8% reporting a suicide attempt in the previous year. However, she noted, most adolescents do not get treated for mental illness problems.

Most adolescents exist on a different space-time continuum and experience danger differently. Most importantly, they value their peer groups very highly (this, she noted, has also been observed in some higher primates). As the quality of the peer group matters, this has implications for clinicians. She suggested that clinicians should not tell adolescents NOT what not to do: negative messages inhibit learning and messages should be framed positively. Clinicians could also adjust expectations around self-management, adherence and adaptability, and adopt a “growth mindset” rather than a “fixed mindset.

Dr Samyn is the Clinical Lead at King’s multidisciplinary liver transition service and, in her presentation “Looking after young people: getting it right”, she told delegates that a study by Sagar et al (2015) had concluded that the outcomes were good for young liver transplant patients who transferred to the adult services.

She reminded delegates that other transitions are occurring at the same time, such as leaving school, leaving home, or starting work or college. Furthermore, IMPARTS had shown that amongst young people attending a liver transition clinic, prevalent anxiety and depression were higher than in the general adolescent population (17.7% versus 4-6%) and were similar across liver transplant, AILD and other liver conditions. And they were likely to interact with treatment adherence.

Based on her experience at King’s, she stressed the importance of the multidisciplinary team. She emphasised the need to foster a positive patient/provider relationship, with collaborative decision-making. Therefore, the multidisciplinary transition team should adopt a proactive individualised and flexible approach and be aware of psychosocial, educational and vocational needs.

 

Date Added: 09/09/16
#BASL2016: Improving outcomes following paediatric transplantation
News Type: BASL News

Liver transplantation (OLT) in children is now highly successful, with a more than 80% 20-year survival.

Deidre Kelly, Professor of Paediatric Hepatology at Birmingham Children’s Hospital NHS Trust, explained that most paediatric liver diseases are potentially curable with OLT and that long-term (i.e. over 10 years) histological outcome of liver allografts is evolving. Innovative surgery has allowed the extension of transplantation to under one year and under 10kg and include split liver and living related transplantation.

These techniques have been matched by improved specialised medical and nursing care, pre-operative nutritional therapy and post-operative immunosuppression. There have been many advances in therapy including anti-oxidant cocktail and iron chelation, exchange transfusions and IV immunogloblulin, primary bile salt therapy and nitisinone.

An example of a major advance has been the centralization, at Birmingham, Leeds and London, of the diagnosis and management of biliary atresia, Kasai portoenterostomy and liver transplantation. From 15 centres (1993-1995) to the three centres (2009-2013), changes in the clearance of jaundice have been 55% to 64%, five-year native liver survival, 27% to 56%, and five-year overall survival, 84% to 93%, respectively.

Prof Kelly believes that current challenges in paediatric liver transplantation include long term outcomes, indeterminate graft hepatitis and fibrosis, the detection and prevention of adverse cognitive or psychological functioning, and adherence and transition to adult care. She stressed that future pre-plant initiatives should include the optimization of nutrition and the time of transplant to prevent neurocognitive damage. And further research was needed on the aetiology of graft hepatitis/fibrosis.

Prof Kelly emphasized the crucial role of managing the transition to adult care. Young people’s anxiety about transition to adult care related to difficulties forming new relationships once in adult care and a lack of continuity of care. A BSPGHAN research project had found that young people with a liver transplant diagnosis felt different from their peers. They adopt different coping strategies in order to manage and cope with their condition. And they identify building relationships with healthcare professionals and having continuity of care as being important for their transitional care.

 

 

Date Added: 08/09/16
#BASL2016: Immeasurable contributions to modern medicine recognised
News Type: BASL News

Three stalwarts of hepatology were presented with lifetime achievement awards at the BASL Conference Annual Dinner.

Dr Roger Chapman, consultant at the Oxford University Hospital, Dr James Dooley, consultant at the Royal Free Hospital, and Dr Alex Gimson, consultant at Cambridge University Hospital Trust, were presented with their awards at the Manchester Football Museum.

Dr Chapman, a founding member of the International Autoimmune Hepatitis Group and the International PSC Study Group, and a Fellow of the American Association for the Study of Liver Diseases, said: “It is a great honour and a great privilege.”

Congratulating BASL president, Dr Greame Alexander, and treasurer Dr David Patch, he said: “When I was secretary of BASL we got 90 people in 1991, and the meeting has grown into what it is today. It is a fantastic meeting and I am very grateful to Greame and David for taking it even further.”

Of Dr Dooley, who co-authored three editions of ‘Diseases of the Liver’ with Dame Sheila Sherlock, Dr Patch joked: “He is loved by all his patients and it’s very hard to see patients after they have seen James because they look crestfallen.”

Dr Dooley said he was moved by the award and the kind words.

“I have had hell of a career with a tremendous number of colleagues and friends in a wonderful speciality,” he said, adding that he had witnessed amazing progress.

“To witness the discovery to the cure of HCV in one career in stunning.”

Dr Alex Gimson, director of medicine at Cambridge from 2003 to 2013, and char of the NHS BT Liver Advisory Group from 2008 to 2013 was also recognised.

Accepting the accolade, he said: “This is a considerable surprise!

“It has been an honour and a privilege to work with these people who are far brighter and cleverer than me. They have taught me an incredible amount.”

Date Added: 08/09/16
#BASL2016: Small changes can help tackle growing NAFLD threat
News Type: BASL News

Nutrition is key to managing non-alcoholic fatty liver disease (NAFLD) and even a small amount of weight loss can help reverse steatosis and fibrosis.

Jill Johnson, a specialist dietitian in liver disease and hepatobiliary disease spoke about the rising prevalence of NAFLD during the BASL Nurse Forum meeting at conference today.

“We are getting a lot of patients coming through with cirrhosis and it is probably going to become the most frequent indication for transplant,”’ she said, citing a nationwide shift towards higher calorie intake and lower activity levels as the reason.

“Right up to cirrhosis, everything else is reversible. One of the things I do with patients is talk them through their place on the scale and explain they can reverse it.”

Studies have shown losing a relatively small amount of weight, around to 3-5% of body weight, lead to a loss of fat from the liver – though the optimum level was 7-10%.

“We aim for 5-10% of weight loss, but it’s important to break that down and show patients what that means,” said Jill, adding that a 5% reduction in BMI equates to a 28% reduction in liver fat.

Supporting people to lose weight was about motivation and individualisation, she told delegates.

She said: “It's not just trying to lose weight but about what's going on inside. It's motivating for patients to see their LFTs returning to normal.”

She recommended talking to patients about their daily lives and using that information to help them make one easy change at a time.

Jill used the example of a man who had two sugars in his coffee and 20 coffees a day – by losing the sugar, he cut 800 calories from his daily intake.

“Individualise your advice: it might just be parking the car a bit further away from the supermarket or getting off the bus a stop earlier: even exercise without losing weight can cut liver fat,” she said.

 

Date Added: 08/09/16
#BASL2016: Growing up with a chronic condition
News Type: BASL News

Around 10% of adolescents in the UK have a chronic illness, but they have all the same problems and worries as their peers.

Monica Smith asked delegates at the BASL Nurse Forum meeting to remember their duty of care to young people with liver conditions.

“It’s our job to give them all the information they need to be able to live a healthy and fulfilled life within the confines of the chronic illness they are living with,” she said.

Monica, clinical nurse specialist for liver transition at Birmingham Children’s Hospital, recommended all those in the audience get trained on using the HEADSS (Home Education/Employment Activities Drugs Sexuality Suicide) assessment.

“It’s a very good tool and gives you guidance on what questions to ask and how to go forward,” said Monica.

Young people with long-term conditions engage in all the same risk-taking behaviours as other teenagers, such as smoking, drinking, taking drugs and having sex, but might need a little more support.

Monica suggested asking the parents to leave, for at least a part of the consultation, to allow for a more open conversation. Confidentiality is extremely important, she added.

“We have a golden opportunity to utilise the HEADSS survey tool,” said Monica.

“Even if you can’t talk about all the topics, pick two or three that are particularly important to the young person.

“Young people often engage in risky behaviour so helping them to be safe while they assert their independence is our duty of care.”

Date Added: 08/09/16
#BASL2016: Dealing with substance misuse in pregnancy
News Type: BASL News

Pregnancy is a window of opportunity to help expectant mothers deal with substance and alcohol misuse.

Debbie Reid is a specialist substance misuse midwife and said she acted as a conduit between women and the various services they needed to access.

“Most women have never even considered trying to stop before they became pregnant, so it's an opportunity to get them thinking about making positive changes,” she said.

“We have to be optimistic that they can change.”

Of all the drugs she came across in pregnancy, Debbie said, alcohol was the biggest worry as the damage to babies could be irreversible.

“We try to get them through as much detox during the pregnancy as we can,” she said.

Reducing vertical transmission of HCV is a priority in her service and all women referred to her are screened with those testing positive being offered treatment after the birth.

Date Added: 08/09/16
#BASL2016: Turning written off lives around
News Type: BASL News

Working with people written off by the system not only helps them get their lives back on track, but saves the NHS hundreds of thousands of pounds.

Mark Holmes, team leader of the Long Term Condition nurses in Nottingham, told the BASL nurses that he and his colleagues had saved the NHS £360,000 in just one year by acting as a “life raft” for people who had “fallen through the cracks”.

“We work with people who have long-term conditions related to alcohol. People who have been written off by the doctors, and in many cases, themselves,” said Mark.

The team identifies “people in trouble” and works proactively with them in a way they are comfortable with.

One such service user shared his story of how Mark’s team had helped him after he had fallen into a spiral of depression and alcoholism following his wife’s death.

“I didn't care if I died, it didn't matter to me,” he said, adding he had tried to commit suicide a number of times.

He was drinking at least a bottle of vodka a day and was homeless by the time he started working with Mark’s team, which helped him access the care he needed.

Despite multiple relapses and hospital admissions, Mark never gave up on him, he said, and one day “it just clicked”.

Mark encouraged nurses in the audience to look into setting up similar services, adding it wasn't hard to find the people who would benefit.

“We know who these people are – they are the ones in our hospitals, they are the ones calling 999,” he said.

 

Date Added: 08/09/16
#BASL2016: HE – the Cinderella of liver disease
News Type: BASL News

There are next to no treatments for hepatic encephalopathy (HE), which can have a devastating impact on the sufferer and their family.

HE is a brain dysfunction caused by a liver insufficiency and/or porto-systemic shunting and it manifests as a wide spectrum of neurological or psychiatric abnormalities. These can range from subclinical alterations that can go unnoticed, to anxiety and confusion, all the way through to coma.

Lynda Greenslade, clinical nurse specialist in hepatology at the Royal Free, gave advice on managing the condition, which she called the “Cinderella of liver disease”, during the BASL Nurse Forum meeting.

“There are no studies on incidence or prevalence of HE in the UK, so we don't know how many people have it,” she said.

“No randomised controlled trials have been carried out in HE, and the first drug for it was only licensed in 2013.”

Unless the underlying liver disease is treated, HE, which is often hidden by other symptoms, carries a high risk of recurrence. Symptoms, which can be recurrent or persistent, include cognitive impairment, changes in personality, changes in consciousness and disruptions to the sleep/wake cycle.

“Even in its mildest form, it reduces health-related quality of life. There is a huge burden of care placed on the family carers, as it may mean giving up work and they often feel depressed about their situation,” said Lynda.

It’s important to treat patients in a safe environment, as they are as risk of falling. Lynda said they may need to be cared for on a high-dependency unit, as they were often disorientated, and nurses needed to be aware of the risk of unsafe airways.

“Nutrition is key, so use an early NG tube for patients with an unsafe airway. Keep family and carers up to date as HE stages two to four can be really distressing to watch,” Lynda added.

Patients are treated with lactulose which works by removing the toxins causing neurological symptoms from the gut, but over dosing can cause diarrhoea.

This can lead to adherence problems, but Lynda’s advice was to explain what the medication was doing and why it was so important.

Once discharged, follow up is important and recurrence is common.

Lynda concluded by saying there needed to be greater awareness of the condition among GPs and the community as a whole.

 

Date Added: 08/09/16
#BASL2016: Thinking the unthinkable
News Type: BASL News

Everyone dies, so what are we so afraid of? A nurse-led hepatology clinic in Devon is tackling that question head on and is about to be rolled out to other therapy areas.

Tony Moffat, nurse consultant at Derriford Hospital, runs the Thinking Ahead programme for people with end-stage liver disease, those who have had a diagnosis of HCC, and those who continue to drink.

“My view is we should prepare patients with uncertain, life-limiting conditions for potential demise. We should support them to reach a stage of acceptance. We should give them ownership of what happens to them,” said Tony during the BASL Nurse Forum stream at conference today.

His referrals, who are given one-hour slots, are asked to fill out a Thinking Ahead proforma, designed to help them approach the subject, start putting it into real terms and make real plans.

It asks questions like what makes you happy, what has been happening with your health, what would you like to happen in the future, and what kind of support do you have from your family?

“It’s working well. Our trust wants to use Thinking Ahead for cardiovascular disease, elderly care and renal patients,” Tony said.

He said it was a timely end-of-life intervention which empowered and enabled patients to think about the process.

“It takes away from the uncertainty and helps them to accept the unpredictability of their disease,” he added.

 

Date Added: 07/09/16
#BASL2016: Towards increasing uptake in live donor transplantation
News Type: BASL News

Live donor liver transplantation (LDLT) is a valuable treatment option and should be treated as such, delegates were told.

Speaking during the British Liver Transplant Group session at the BASL Annual Meeting today, Dr Krishna Menon, of King’s College Hospital, said it was time to rise to the challenge.

“We have the option of plodding along as we are or we can be calculated risk takers, and risk takers are achievers. There is no path; a path is made from walking,” he said.

He asked delegates if they were even telling people about the possibility of LDLT.

“Looking at LDLT between 2006 and 2016, early on, we did improve, but over the last five years there has o-[lbeen no significant change in the number that have been performed,” said Dr Menon.

This was set against a backdrop of a transplant list that has doubled between 2008 and 2016 and a change in the kind of organs becoming available from deceased donors – both of which make LDLT more useful than ever.

“Donor characteristics are continuing to change: donors are older, more obese, and less likely to have suffered a trauma-related death, all of which have adverse effects on transplant outcomes.

“Only 36% of organs get transplanted and that percentage is on the rise,” he said, adding this was despite age or BMI in themselves being contra-indications.

Referring to guidelines published in June by the International Liver Transplant Society, Dr Menon said they positioned LDLT as a less desirable alternative to deceased donor liver transplantation (DDLT).

“It is important that we offer LDLT as a treatment option that is equivalent to DDLT. The guidelines are trying to create a separate category of the waiting list,” he said.

A number of things needed to be done to increase the levels of LDLT in the UK, he went on.

These included the wide-scale collection of mortality and morbidity data so families could properly understand the risk/benefit profile and nationwide agreement on where and how these procedures should be taking place.

Liver donor transplant co-ordinators should be employed at all transplant centres, and comprehensive mentoring systems need to be put in place, Dr Menon added.

“There is a clear need to increase the numbers of LDLT, but there is a lack of infrastructure and there is a lack of agreement between units on the way forward,” he said, concluding by telling the conference that a meeting of key MDT members from across the country was planned for next month.

Date Added: 07/09/16
#BASL2016: Expand and embrace transplant criteria for severe AAH
News Type: BASL News

The UK protocol for liver transplant in patients with severe acute alcoholic hepatitis (SAAH) has failed because it is too restrictive.

That's the opinion of Dr Alex Gimson, consultant hepatologist at Cambridge, who told delegates at the BLTG session the criteria must be expanded and the protocol widely publicised.

“Some protocol criteria were introduced to address concerns about the validity of the proposal, not because they identified a cohort with a high short-term mortality and a low risk of recidivism,” he said.

The SAAH transplantation programme was established in 2014, and the criteria set as patients aged less than 40 at their first presentation with any form of alcoholic disorder, who have not previously been told to stop drinking. They should have a Maddrey DF of more than 32 and a Lille score of more than 0.45.

There should be no sepsis or GIT haemorrhage, and hepatologists, alcohol specialists and the surgical and transplant teams should all agree on the course of action.

Just two patients have been referred under these criteria, one in September, 2014, and the other in February, 2015, yet neither have been treated. The first, a 27-year-old woman, was removed from the list when her condition improved, and the second, a 38-year-old man, died 48 days after being placed on the list.

“I feel the protocol is too restrictive,” Dr Gimson said. “I do not feel age is a good predictor, and I do not than that is right that it is about first presentation – it should be about decompensation. I don’t see why co-morbidities should be an exclusion.

“Why should criteria for selection for SAAH be qualitatively different from other indications? If there is a need, we should be assessing that need in the same way as others with non-alcoholic liver diseases are being assessed.”

In conclusion, he said the current SAAH protocol and implementation had failed.

“Patients with SAAH and poor short- term mortality are not adequately identified by the current prognostic scores,” he said.

In his closing recommendations, which he emphasised were personal opinions, he said the protocol should be relaunched to concentrate on similar factors to inactive ALD, then publicised widely.

 

Date Added: 07/09/16
#BASL2016: Transplant isn’t a cure for addiction
News Type: BASL News

Alcoholic liver disease is a world health problem, causing 493,000 deaths in 2010 – 0.9% of the total – but are transplant criteria too tough on drinkers?

Almost half, 47.9%, of all cirrhotic deaths are caused by alcoholic liver disease (ALD), and ALD-related cancer caused 80,600 deaths in 2010.

The figures are of no surprise, said Professor Mike Lucey, of the University of Wisconsin, during the Williams-Caine Lecture at conference today, where he asked if liver transplantation should be reserved for the abstinent.

He said: “Is a liver transplant a success if the patient is saved but returns to drink? Are we setting a higher standard? Does it not just have to cure the liver disease, but the alcoholism as well?

“These patients go through a more rigorous assessment than those in other indications.”

The answer lies in the interpretation of drinking behaviour, Prof Lucey said, adding that addiction specialists and transplant clinicians and surgeons speak different languages – and that divides them.

To illustrate this, he cited the primary outcomes of the Project MATCH study, from 1997, which were the number of days abstinent and number of non-drinking days.

“In our world, we talk about drinking or not drinking. We take a binary view while addiction specialists take a quantitative view.”

The data does show that relapse in transplanted ALD patients causes more rapid fibrosis and shortens life span, but only in the long term.

Prof Lucey said: “In order to see the shortened life-span, you need long-term follow up: of 10 years in some studies. If you only find problems 10 years later, should we be restricting patient access to a life-saving treatment because of that?”

The six-month rule, in which patients are only listed for transplant if they have remained abstinent for half a year, is still “alive and well” in the USA, Prof Lucey said.

“Many patients will drink again. Some will start early and stop, some will start and continue, and some will not stop for more than 1,000 days post-transplant.

“The addiction is not going to go away because of the transplant,” he said.

Concluding his talk, Prof Lucey said a paradigm shift was well overdue, and the goal of treatment should not be inducing abstinence, but improving the lives of people with ALD.

He said: “Liver transplant is only one part of the answer. We need to learn from addiction medicine and from patient experience.”

  

 

Date Added: 05/09/16
NAFLD rates higher in people with metabolic abnormalities
News Type: Clinical News

The prevalence of non-alcoholic fatty liver disease (NAFLD) and the rate of advanced fibrosis are significantly high among individuals with metabolic abnormalities, a new study found.

Among 11,674 individuals in NHANES III, a large United States population database, the prevalence of NAFLD was 18.2%. Individuals with metabolic abnormalities demonstrated a higher prevalence. These included metabolic syndrome (43.2%), increased waist circumference (31.2%), impaired fasting glucose/diabetes (41.2%), high triglyceride level (34.7%), low high-density lipoprotein (27.8%), and high blood pressure (29.2%).

The individuals with metabolic syndrome had significantly higher NAFLD prevalence compared with controls (adjusted odds ratio 11.5). The severity of hepatic steatosis increased with higher number of metabolic abnormalities. Among individual metabolic abnormalities, increased waist circumference, impaired fasting glucose/diabetes, high triglyceride, and low high-density lipoprotein levels were found to be independently associated with NAFLD.

Individuals with impaired fasting glucose/diabetes and those with five metabolic abnormalities had higher rates of advanced fibrosis (18.6% and 30.3%, respectively). The prevalence of NAFLD among individuals without any metabolic abnormalities was 6.1%.

Reference

The association between nonalcoholic fatty liver disease and metabolic abnormalities in the United States population. Jinjuvadia R, Antaki F, Lohia P et al. J Clin Gastroenterol. 2016 Aug 31. [Epub ahead of print]

 

Date Added: 05/09/16
Managing HCV in a UK outreach DTU “feasible and cost effective”
News Type: Clinical News

A UK study showed outreach testing and treating HCV in a drug treatment unit (DTU) could be both feasible and cost effective.

All persons attending a London DTU were offered HCV testing, and where appropriate follow-up and treatment by a specialist nurse at the DTU. Of 321 persons eligible, 216 were screened, 89 were HCV positive and 66 had confirmatory evidence of viraemia. All were infected with either HCV genotype 1 or 3.

Treatment was initiated in 29 people, 22 with interferon-based regimens and seven with direct-acting antiviral only treatments. Following initial treatment 21 (72%) achieved SVR12.

The study authors, from Imperial College, London, estimated that the programme represented an average per-patient cost-saving of £2,498 and a quality-adjusted life year (QALY) gain of 4.10 over a lifetime. In a hypothetical scenario of all oral DAA treatment, an incremental cost per QALY of £1,029 was estimated.

Reference

The cost impact of outreach testing and treatment for hepatitis C in an urban drug treatment unit. Selvapatt N, Ward T, Harrison L et al. Liver Int. 2016 Aug 27 [Epub ahead of print]

 

Date Added: 05/09/16
HCV is associated with Sjögrens Syndrome
News Type: Clinical News

People with HCV are at a greater risk of the autoimmune disorder, Sjögrens Syndrome (SS), a large Taiwanese study has confirmed.

Researchers, who also found an association between HBV and SS in men, used data from the Taiwan National Health Insurance claims database, entered between 2000 and 2011.

They identified 9,629 SS patients without other concomitant autoimmune diseases and 38,516 sex- and age-matched controls without the condition.

The risk of SS was higher in patients with HCV than in those without chronic viral hepatitis (odds ratio 2.49). Conversely, HBV infection was not associated with SS (odds ratio1.10). Younger HCV patients were at a higher risk for SS (<55 years odds ratio 3.37; ≥55 years odds ratio 2.20).

Men with HCV were at a greater risk for SS (women odds ratio 2.26; men odds ratio 4.22). Only men with chronic HBV exhibited a higher risk of SS (odds ratio 1.61).

Reference

Association of Sjögrens Syndrome in patients with chronic hepatitis virus infection: a population-based analysis. Yeh CC, Wang WC, Wu CS et al. PLoS One. 2016 Aug 25;11(8): e0161958

 

Date Added: 02/09/16
Alcohol Health Alliance Statement on Alcohol Consumption Guidelines
News Type: BASL News

Responding to the government's statement on the alcohol consumption guidelines, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, said:

"We reiterate our support today for the alcohol consumption guidelines released in January 2016.

The public have the right to know about the harms associated with alcohol consumption, so that they can make informed choices about their drinking.

The latest evidence demonstrates that the risk associated with cancer increases with any amount of alcohol consumed, so there is no level of drinking which can be considered 'safe'. This evidence was not available when the guidelines were last reviewed and is partly why the low risk guidelines have been revised downwards by the four chief medical officers of England, Scotland, Wales and Northern Ireland.

I was part of the group advising the chief medical officers on the latest evidence, and can attest to the thoroughness and independence with which the guidelines were developed.

Thus far, the risks associated with alcohol consumption have been poorly communicated to the public. A study earlier this year, for example, demonstrated that nine in ten people are not aware of the link between alcohol and cancer.

To ensure the public has faith in these new guidelines, it is essential that the harms associated with alcohol are communicated clearly to healthcare professionals and consumers. This should be done via mandatory labelling of alcoholic products, and mass media campaigns developed by Public Health England."

Date Added: 30/08/16
More deaths than normal amongst cured HCV patients in Scotland
News Type: Clinical News

Scottish patients who were successfully treated for HCV had a higher mortality rate than the general population, driven by drug-and alcohol-related causes and liver cancer.

These were the conclusions of a group from Aberdeen, Dundee, Edinburgh and Glasgow who used a Scottish national database to identify 1824 individuals with HCV who attained a sustained viral response (SVR) between 1996 and 2011 and were followed for an average 5.2 years.

In total, there were 78 deaths. All-cause mortality was 1.9 times more frequent for SVR patients than the general population (standardised-mortality-ratio 1.86). 

Significant cause-specific elevations were seen for death due to primary liver cancer (standardised-mortality-ratio 23.50), and death due to drug-related causes (standardised-mortality-ratio 6.58). These two causes accounted for 66% of the total excess death observed.

All of the modifiable characteristics associated with increased mortality were markers either of heavy alcohol use or injecting drug use. Individuals without these behavioural markers (32.8% of cohort) experienced equivalent survival to the general population (standardised-mortality-ratio 0.70).

Reference

Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population. Innes H, McDonald S, Hayes P et al. J Hepatol. 2016 Aug 18 [Epub ahead of print]

 

 

 

 

Date Added: 30/08/16
HEV outbreaks remain a global health problem
News Type: Clinical News

A systematic review of published literature has concluded that whilst HEV outbreaks are not new, they remain a continuous global health problem.

An international team of reviewers found that HEV outbreaks have mainly been reported from Asian and African countries and only a few from European and American countries. India has the highest number.

HEV genotypes 1 and 2 were responsible for most large outbreaks in developing countries. During the outbreaks in developing countries, significantly more pregnant women died.

Outbreaks have occurred in open and closed populations. The control measures mainly depend on improvement of sanitation and hygiene.

Reference

The global burden of hepatitis E outbreaks: a systematic review. Hakim MS, Wang W, Bramer WM et al. Liver Int. 2016 Aug 20 [Epub ahead of print]

Date Added: 30/08/16
Limited HBV/HCV treatment access for vulnerable groups in Europe
News Type: Clinical News

Many vulnerable patients, including refugees, have limited access to HCV and HBV treatment across six major European countries (including the UK).

Researchers from the Netherlands investigated access to treatment for chronic HBV and HCV among six vulnerable patient/population groups at risk of infection:  undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs, and people abusing alcohol. The researchers sent an online survey to 235 experts in gastroenterology, hepatology and infectious diseases in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. The 64 responses showed differences in access between and within countries for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for people who inject drugs.

The majority in Hungary and Spain reported significant/complete treatment restriction for all groups, while in Italy there were no/few restrictions. In the UK and Spain, undocumented migrants and people without health insurance were significantly or completely restricted. Opinion about undocumented migrants in Germany and the Netherlands was divergent.

The researchers conclude that their findings suggest a low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality.

Reference

Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries. Falla AM, Veldhuijzen IK, Ahmad AA et al. Eur J Public Health. 2016 Aug 19 [Epub ahead of print]

Date Added: 22/08/16
Study questions isolation of HCV patients during haemodialysis
News Type: Clinical News

A literature review has cast doubt on whether isolating HCV-infected patients during haemodialysis has any effect on transmission rates.

The Universidad Peruana Cayetano Heredia, Lima, Peru, found only one appropriate study. It covered 12 centres:  four used dedicated haemodialysis machines for HCV-infected patients and eight used non-dedicated machines. There were 593 patients enrolled. One centre was excluded after randomisation. Random sequence generation was not described and allocation concealment was not performed. Participants and personnel were not blinded and blinding of outcome assessors was not reported.

Only 74.5% of the patients were followed for nine months; and 47.3% were followed for an additional nine months. The authors only reported one outcome, measuring the difference in incidence of HCV in both groups. The authors did not consider the exposure time, to determine the adjusted rate of seroconversion risk/patient-year.

The study reported that the incidence of HCV infection during the first follow-up period (nine months) was 1.6% in the dedicated group, and 4.7% in the non-dedicated group (risk ratio 0.34). During the second 18 month follow-up the incidence was 1.3% in the dedicated group and 5.8% in the control group (risk ratio 0.22).

The reviewers wrote, “we found no differences in terms of the number of participants developing HCV infection when comparing the dedicated group with the usual care. Moreover, the evidence was of very low quality, which means that we have very little confidence in the effect estimate”. They concluded that the benefits and harms of isolating HCV-infected patients from other patients during haemodialysis are uncertain.

Reference

Isolation as a strategy for controlling the transmission of hepatitis C virus (HCV) infection in haemodialysis units.Bravo Zuñiga JI, Loza Munárriz C, López-Alcalde J. Cochrane Database Syst Rev. 2016 Aug 11;8 [Epub ahead of print]

 

 

 

Date Added: 22/08/16
Successful responses with Peg-INF for HCV patients on haemodialysis
News Type: Clinical News

In a new study amongst haemodialysis patients with HCV, pegylated interferon (Peg-INF) monotherapy resulted in high virological responses and was well-tolerated.

Researchers at New Delhi’s All India Institute of Medical Sciences studied 80 patients on dialysis with HCV infection who were treated with Peg-INF monotherapy. Those with genotype 1 and 4 were given 12 months therapy while those with genotypes 2 and 3 had six months. Mean time from diagnosis of HCV infection and the treatment start was 10.7 months.

Of the 80 patients, 43 had rapid virological responses (RVRs), while 49 had early virological and end of treatment responses. There was no difference related to genotype and 54 percent had sustained virological responses.

All patients had mild flu-like symptoms, 64 required increases in erythropoietin doses, 28developed leukopenia (three treatment-limiting) and 16 developed thrombocytopenia (one treatment-limiting). Five developed tuberculosis, five bacterial pneumonia, and one bacterial knee monoarthritis. None of the patients developed depression.

Reference

Pegylated interferon monotherapy for hepatitis C virus infection in patients on hemodialysis: A single center study. Agarwal SK, Bhowmik D, Mahajan S et al. Indian J Nephrol. 2016 Jul-Aug;26(4):244-51 

 

Date Added: 22/08/16
Routine testing gives earlier HCV detection in HIV-positive gay men
News Type: Clinical News

Routine anti-HCV testing at a sexually transmitted infection (STI) outpatient clinic led to earlier HCV detection among HIV-positive men who have sex with men (MSM).

In 2007, routine HCV antibody testing was introduced for MSM with an HIV-positive or unknown status attending a Dutch STI outpatient clinic. Researchers evaluated whether this screening resulted in additional and earlier HCV diagnoses among MSM who also attend HIV clinics.

At first STI consultation, HIV-positive MSM and MSM opting-out of HIV testing (HIV-status-unknown) were tested for HCV antibodies (anti-HCV). During follow-up consultations, only previously HCV-negative men were tested. Retrospectively, STI clinic and HIV clinic HCV diagnosis dates were compared.

At first consultation, 112 of 1,742 HIV-positive and three of 446 HIV-status-unknown MSM tested anti-HCV-positive. On follow-up, 32 HIV-positive MSM became anti-HCV-positive. Four of 34 HIV-positive MSM notified by their sexual partner of HCV tested anti-HCV-positive. Of 163 HIV-positive MSM with HCV antibodies, 78 reported a history of HCV.

HCV diagnosis data at the HIV clinic was requested for the remaining 85 MSM and available for 54 MSM. Of these 54, 28 were diagnosed with HCV at the STI clinic and seven concurrently with HIV. At their next scheduled HIV clinic consultation, three HCV cases probably would have been missed, the researchers suggested.

Reference

Earlier detection of hepatitis C virus infection through routine hepatitis C virus antibody screening of human immunodeficiency virus-positive men who have sex with men attending a sexually transmitted infection outpatient clinic: a longitudinal study. van Rooijen M, Heijman T, de Vrieze N et al. Sex Transm Dis. 2016 Sep;43(9):560-5 

Date Added: 22/08/16
The PBC Foundation - Sunday 11th September is World PBC day
News Type: BASL News

For 20 years The PBC Foundation has been supporting people diagnosed and living with Primary Biliary Cholangitis.

On Sunday 11th September it is World PBC day when members and supporters will be involved in many charitable activities. One of these will start at the close of the BASL conference on the 9th of September as Robert Mitchell-Thain and colleagues start a 3 Peaks Walk to raise funds for the charity.

Robert would welcome the support of BASL members who would like to join them for any section of the walk, with Scafell on Friday 9th September, Snowdon on Saturday 10th September and finishing on World PBC day with Ben Nevis on Sunday 11th September.

If you want to join any leg of the event, contact Robert through robert@pbcfoundation.org.uk and if joining the event is not possible then please support their efforts through their Just Giving page; https://www.justgiving.com/fundraising/PBC-Foundation1 . ‎

Date Added: 19/08/16
Life Chances Strategy Briefing – AHA
News Type: BASL News

The Alcohol Health Alliance (AHA) campaigns for assurances that alcohol harm will be tackled in the government’s Life Chances Strategy.

August 2016: The AHA is working hard to ensure that the government’s forthcoming Life Chances Strategy will benefit all disadvantaged groups, including those suffering adverse consequences from alcohol, who make up a significant proportion of those needing support.

Click on the link > HERE to view their full briefing on the strategy.

If you have any questions please contact Laura McLeod, Policy and Advocacy Manager - Alcohol Health Alliance. Email - LMcLeod@alcoholconcern.org.uk or Tel: 0203 815 8930.

Date Added: 15/08/16
Anti-viral therapy may cut sexual desire in HCV patients
News Type: Clinical News

Many HCV patients – especially men – receiving some anti-viral therapies lose sexual desire.

A total of 181 HCV patients at Taiwan’s China Medical University Hospital tertiary medical centre received peg-interferon (PegIFN)α2a or PegIFNα2b plus ribavirin (RBV), according to response-guide therapy for 24 to 48 weeks. Those with decreased sexual desire before PegIFNα plus RBV were excluded.

All were evaluated using the Mini-International Neuropsychiatric Interview and the 21-item Beck Depression Inventory (BDI). The 21st item of the BDI was used to evaluate decreased sexual desire.

During therapy, 124 of the 181 patients had decreased sexual desire. The BDI score peaked at 14.8 weeks and the severity was greatest at 16 weeks. The average score of the 21st item of the BDI correlated with decreased sexual desire. Depression history and the prevalence of subsequent major depressive disorder after anti-viral therapy was correlated to reduced sexual desire. Male patients complained more significantly than females.

Reference

Anti-viral therapy and decreased sexual desire in patients with chronic hepatitis C. Hsiao PJ, Hsieh PF, Chou EC et al. PLoS One. 2016 Aug 9;11(8): e0160450 

Date Added: 15/08/16
No added benefit with nurse-led treatment for HCV drug injectors
News Type: Clinical News

Nurse-led initiations of antiviral therapy have not lead to an increased uptake or adherence with treatment among people with HCV who inject drugs.

A study involving UK community clinics in London and Surrey compared nurse- and physician-initiated antiviral therapy with pegylated interferon and ribavirin.

Despite easy access to antiviral therapy, treatment uptake was poor, with no significant difference between the groups. The proportion of participants initiating treatment during follow-up was 10% with nurse-initiated (6/62) and 9% with physician-initiated (6/76) therapy. Adherence was similar in both groups, with only one patient in each not adhering to therapy. There were no serious adverse events, but interferon-related side effects were common. Drug and alcohol use did not change during therapy.

Reference

Community nurse-led initiation of antiviral therapy for chronic hepatitis C in people who inject drugs does not increase uptake of or adherence to treatment. Lewis H, Kunkel J, Axten D et al. Eur J Gastroenterol Hepatol. 2016 Aug 3. [Epub ahead of print]

Date Added: 15/08/16
High prevalence of cirrhosis and fibrosis in type 2 diabetics
News Type: Clinical News

People with type 2 diabetes often have undiagnosed advanced fibrosis and cirrhosis, a new study suggests (1).

Researchers at Pontificia Universidad Católica de Chile, Santiago, studied 145 type 2 patients (median age 60, mean BMI 29.6 kg/m2 and mean diabetes duration 7.6 years). 

There was a high rate of liver steatosis (63.9%), advanced fibrosis assessed by NAFLD fibrosis score (12.8%) and evidence of liver cirrhosis assessed by MRI (6.0%). In a multivariate analysis GGT > 82 IU/L and no alcohol intake were independently associated to advanced fibrosis.

A literature review suggested that metformin may improve the survival of diabetic patients with liver cancer (2).

The reviewers, from Central South University, Changsha, China, found 11 studies involving 3,452 liver cancer patients. Metformin use was associated with better survival (hazard ratio 0.59) of liver cancer patients, and the beneficial effect persisted (hazard ratio 0.64) when the population was restricted to diabetic liver cancer patients. Adjusting for age, etiology, index of tumour severity and treatment of liver cancer, the association between metformin use and better survival of liver cancer patients was stable. Pooled hazard ratios ranged from 0.47 to 0.57.

The reviewers warned that the results should be interpreted with caution because of possible residual confounding.

References

1.    High prevalence of undiagnosed liver cirrhosis and advanced fibrosis in type 2 diabetic patients. Arab JP, Barrera F, Gallego C et al. Ann Hepatol. 2016 Sep-Oct;15(5):721-8

2.    Metformin use improves survival of diabetic liver cancer patients: systematic review and meta-analysis. Ma SJ, Zheng YX, Zhou PC et al. Oncotarget. 2016 Aug 2 [Epub ahead of print]

Date Added: 09/08/16
No progress on drink driving deaths - Institute of Alcohol Studies
News Type: BASL News

Statistics released by the Department for Transport today show that there has been no improvement in drink driving related deaths since 2010.

Campaigners, including the Campaign Against Drink Driving (CADD) and the Alcohol Health Alliance, are calling on the Government to lower the drink-drive limit in England and Wales in order to save lives and prevent serious injuries.

The statistics, published in a statistical release from the Department for Transport show that across the UK in 2014:

• Around 240 people were killed in drink driving related incidents, a figure unchanged since 2010.
• The number of drink driving casualties decreased slightly, as did the number of drink driving crashes.
• Only around 40% of the 1,310 people killed or seriously injured were drivers over the limit. Around 60% were other passengers, road users or pedestrians.

England and Wales currently have a high drink driving limit by international standards, set at 80mg alcohol/100ml blood. In December 2014, Scotland used its devolved powers to lower its limit to 50mg, and saw a 12.5% decrease in drink-drive offences in the first nine months of the new limit. The Northern Ireland Assembly is also in the process of lowering its drink driving limit too.

In June 2016, a Private Member’s Bill to lower the limit in England and Wales to 50mg, sponsored by Lord Brooke of Alverthorpe, successfully passed through all stages in the House of Lords, but ran out of parliamentary time to progress further. There are high levels of public support for this move, with a recent opinion poll citing 77% support for a lower legal limit.

There is also strong support from a wide range of high profile groups, including the police and emergency services, road safety charities, insurance firms and health bodies (see notes to editors for the full list of stakeholder supporters).

John Scruby, former police traffic officer and CADD campaigner commented:

“Drink driving has huge and life changing impacts, both for the individuals involved and their friends and families. The number of drink driving deaths on our roads has not reduced since 2010, the government needs to tackle this issue head on and lower the drink driving limit to make our roads safer.”

Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, commented:

“It is deeply disappointing to see that deaths from drink driving have not gone down since 2010. The government have committed to improving road safety, and it is now time they looked at the evidence from home and abroad and lowered our legal limit.

“Not only would lowering the drink driving limit save lives and prevent life changing injuries, but it is consistently supported by the general public. Now is not the time for complacency, the government must take action to make our roads safer.”

Groups supporting a lower drink driving limit include:

• RAC
• BRAKE, the road safety charity
• The Police Federation of England and Wales
• Fire Brigades Union
• College of Paramedics
• The Parliamentary Advisory Council for Transport Safety (PACTS)
• The Royal College of Physicians
• The Royal Society of Public Health
• Alcohol Concern

For any enquiries please contact: Laura McLeod | Policy and Advocacy Manager - Alcohol Health Alliance - LMcLeod@alcoholconcern.org.uk 

Date Added: 09/08/16
Hepatitis C in the UK 2016 report - working towards its elimination as a major public health threat
News Type: BASL News

To view the latest HCV report (published last week) click > HERE. 

Date Added: 08/08/16
Many liver disease patients use complementary/alternative medicines
News Type: Clinical News

Many patients with liver disease use complementary and alternative medicines (CAMs) despite some being potentially hepatotoxic, often don’t tell their healthcare providers.

These were the findings of researchers at Duke University School of Medicine who analysed data from the 2012 [US] National Health Interview Survey. Of 647 adults with liver disease, 41% reported using CAMs in the prior year, compared with 33% of adults without liver disease. The most common modality was herbs and supplements (23%), and 3% of respondents reported consumption of a potentially hepatotoxic substance in the previous 30 days. Only a small proportion of CAM therapies were used specifically for liver disease, with milk thistle being the most common. Among respondents with liver disease, CAMs were used more commonly for anxiety or depression, fatigue, and substance use. The majority believed that these therapies improved health. Nearly one-third of therapies were not reported to healthcare providers, mostly because they don’t ask.

Reference

Complementary and alternative medicine use in United States adults with liver disease. Henson JB, Brown CL, Chow SC et al. J Clin Gastroenterol. 2016 Jul 29. [Epub ahead of print]

 

Date Added: 08/08/16
Risk factors for PegIFN-induced depression in HCV
News Type: Clinical News

A new study has identified the risk factors for, and clinical characteristics of, depressive states induced by pegylated interferon (PegIFN) therapies for HCV

In this Japanese multicentre study, 69 people with HCV who received PegIFN therapy were evaluated before treatment, using the Neuroticism-Extraversion-Openness Five-Factor Inventory and the List of Threatening Events Questionnaire. The Beck Depression Inventory (BDI) was also evaluated at baseline, two to four weeks after initiating therapy, and every four weeks thereafter.

During the study, 18 of the 69 patients developed a depressive state (BDI ≥ 10). A bimodal peak of onset was seen during early (two to eight weeks) and late (after 20 weeks) therapy phases. Moreover, baseline BDI scores (odds ratio 1.40) and neuroticism (odds ratio 1.14) were significant risk factors for developing a depressive state.

To determine the specific characteristics of this condition, the study researchers compared the BDI subscales between the "PegIFN-induced" and "general" depressive state reported previously. They found that the score at "somatic symptoms" were higher in the "PegIFN-induced" group.

The reviewers concluded PegIFN-induced depressive states most frequently developed during the first eight weeks of therapy, and that baseline BDI and neuroticism scores are risk factors for PegIFN-induced depressive state. The core symptoms of PegIFN-induced depressive state are different from those of "general" depression, they added.

Reference

Risk factors and clinical characteristics of the depressive state induced by pegylated interferon therapy in patients with hepatitis C virus infection: a prospective study. Kawase K, Kondo K, Saito T et al. Psychiatry Clin Neurosci. 2016 Jul 29 [Epub ahead of print]

Date Added: 08/08/16
Ribavirin remains useful for some HCV patients
News Type: Clinical News

In the era of direct-acting antivirals (DAAs), ribavirin continues to provide clinical benefit for defined groups of patients with HCV, a review has concluded.

Over the past two decades, ribavirin has been an integral component of HCV treatment, where it has been shown to improve the efficacy of pegylated interferon. However, write an international group of reviewers, because of to its treatment-limiting side effects and additive toxicity with interferon, the search for interferon- and ribavirin-free regimens has been underway.

The recent approvals of all-oral DAAs have revolutionised the HCV therapeutic landscape, and initially it was expected that the role of ribavirin with DAA regimens would be eliminated.

Yet reviewers say we have witnessed ribavirin retaining an important role in the optimal treatment of some subgroups, particularly those that historically have been considered the most difficult to cure.

Fortunately, it has also been recognized that the safety profile , of ribavirin is improved when co-administered with all-oral DAA combinations in the absence of interferon.

The reviewers summarise that, despite the antiviral mechanism of action of ribavirin being poorly understood, we now have a range of novel insights into the potential role of ribavirin in all-oral DAA HCV treatment.

Reference

Ribavirin revisited in the era of direct-acting antiviral therapy for hepatitis C virus infection.  Feld JJ, Jacobson IM, Sulkowski MS et al. Liver Int. 2016 Jul 30 [Epub ahead of print]

Date Added: 04/08/16
Andy Burroughs Young Investigator Award - Applications now open
News Type: BASL News

Submit your application for the Andy Burroughs Young Investigator Award - Deadline Monday 8th August 2016

The Andy Burroughs Young Investigator Award will take place during the BLTG Transplant Day. The awardee will deliver a 30 minute lecture presenting their research on Tuesday 6th September.

This prize is awarded to young investigators, scientific or clinical, who are in training or within 2 years of taking up consultant positions (or equivalent).

The awardee will receive free registration to the meeting and £1,000.

To apply, please send one A4 sheet outlining the research and another A4 sheet listing up to 5 related publications.

Please send submissions to steve@basl.org.uk before the deadline of 09.00hrs Monday 8th August 2016

Date Added: 04/08/16
Parliamentary Constituency Liver Disease Profiles
News Type: BASL News

As part of its mission to increase awareness of liver disease amongst parliamentarians and policy makers the Lancet Commission for Liver Disease has been working with Incisive Health to produce profiles of the burden of liver disease across England. The profiles have been customised to show data including Years of Life Lost, Mortality Rate and Hospital Admissions that is specific to each of the 533 parliamentary constituencies in England.

To view the profiles for your area please visit the Foundation for Liver Research website > here for A - S and > here for T-Z.   

The details of your MP and name of their parliamentary constituency in your place of residence or work can be located here: http://www.parliament.uk/mps-lords-and-offices/mps .

BASL members are encouraged to use these profiles to secure a meeting with their local MP in order to continue to raise the profile of liver disease across parliament.

Date Added: 02/08/16
Liver transplant patients more likely to develop cerebrovascular events
News Type: Clinical News

People receiving liver transplants (LTs) seem to have a considerably increased risk of cerebrovascular events (CBVEs), a new study concluded.

A new score (PROCAM-Stroke) estimates the 10-year risk of cerebrovascular events (CBVE) in a German standard population. Researchers, from Berlin’s Virchow Klinikum and Aachen’s University Hospital, retrospectively studied 313 LT patients. Six months after LT (T1) and 10 years after LT (T2) CBVE risk factors were recorded and PROCAM-stroke was calculated. Ten (T2) and 20 years (T3) after LT, the recipients were screened regarding CBVE. PROCAM-stroke estimates of CBVE were compared with the incidence of observed CBVE.

In both ten-year time frames the incidence of observed CBVE was higher than expected based on the PROCAM-stroke estimates: Six months - 10 years after LT (T1-T2): observed: 11, expected: 3.2; Ten years - 20 years after LT (T2-T3): observed: 7, expected: 3.4.

The researchers suggest that the progressive impairment of renal function in the long-term LT survivors may be one reason for the underestimation of CBVE in this patient group.

Reference

Cerebrovascular events in 20-years of follow-up after liver transplantation. an underestimated issue? Schoening W, Buescher N, Neidel N et al. Clin Transplant. 2016 Jul 22 [Epub ahead of print]

 

Date Added: 02/08/16
HCV patients report greater efficacy with sofosbuvir plus velpatasvir
News Type: Clinical News

Patients with HCV genotypes 2 and 3 reported significantly better outcomes with sofosbuvir plus velpatasvir (SOF/VEL) compared with those receiving SOF and ribavirin (RBV).

Patient-reported outcome (PRO) data were collected from 818 participants in the multinational ASTRAL-2 and ASTRAL-3 studies before, during and after treatment using four PRO instruments (SF-36v2, FACIT-F, CLDQ-HCV, WPAI:SHP), and compared between the SOF/VEL and SOF+RBV groups.

The rates of nearly all adverse events were lower in the RBV-free SOF/VEL group. The SOF/VEL group also experienced improvement of their PROs by treatment week four (+1.8% on average across all PROs) which continued throughout treatment (+4.1%) and post-treatment (+5.5%).  In contrast, the SOF+RBV group had a modest decline in their PROs starting at treatment week four (up to -3.7%) which lasted until the end of treatment (up to -6.4%).

In multiple regression analysis, the association of a treatment regimen with end-of-treatment PROs was significant for nearly all PROs; the average beta was +5.0% for the use of the SOF/VEL (reference: SOF+RBV).

Reference

Ribavirin-free regimen with sofosbuvir and velpatasvir is associated with high efficacy and improvement of patient-reported outcomes in patients with genotypes 2 and 3 chronic hepatitis C: results from Astral-2 and 3 clinical trials. Younossi ZM, Stepanova M, Sulkowski M et al. Clin Infect Dis. 2016 Jul 20 [Epub ahead of print]

Date Added: 02/08/16
HCV increases risk of complications after total shoulder arthroplasty
News Type: Clinical News

Following total shoulder arthroplasty (TSA), patients with HCV are more likely to have such complications as infection, dislocation, fracture, revision TSA, systemic complications and blood transfusion.


These were the findings of US national data, compiled at the University of Virginia, and involving 1,466 HCV patients and 21,502 matched controls who underwent TSA.
The HCV patients, when compared with the controls, had greater odds of infection within three months (odds ratio 1.7), six months (odds ratio 1.7), and one year (odds ratio 2.1); revision TSA within one year (odds ratio 1.5) and two years (odds ratio 1.6); dislocation within one year (odds ratio 1.6); postoperative fracture within one year (odds ratio 1.8); systemic or medical complications within three months (odds ratio 1.3); and blood transfusion within three months (odds ratio 1.7).


The researchers say that although this study was able to identify increased odds of complications in patients with HCV, the mechanism by which these occur was likely not solely related to the virus, and was more likely related to a higher degree of case complexity in addition to other postoperative socioeconomic factors.


Reference
Is hepatitis C infection associated with a higher risk of complications after total shoulder arthroplasty? Cancienne JM, Dempsey IJ, Holzgrefe RE et al. Clin Orthop Relat Res. 2016 Jul 22 [Epub ahead of print]

Date Added: 28/07/16
NIHR Research funding opportunity
News Type: BASL News

Zoledronic acid to reduce fractures in patients with alcoholic liver disease

The NIHR Health Technology Assessment (HTA) programme has reviewed the research requirements for the above topic, which was being considered by one of their Advisory Panels. The panels help the HTA programme to decide on which research topics are the highest priorities for the NHS. 

The topic has been reviewed and discussed at a recent panel meeting and has been prioritised for funding. The topics prioritised for a call for applications are listed on the NIHR web site.

If you are interested in applying for funding, please visit the NIHR website > here .

Zoledronic acid to reduce fractures in patients with alcoholic liver disease - can be found in the list under HTA number 16/75.

The HTA programme encourages patients, the public, policy-makers and individuals working in the wider NHS to suggest topics for research. If you would like to submit a suggestion for research for consideration by the HTA programme or one of the other NIHR programmes managed by NETSCC, please go to our website http://www.nets.nihr.ac.uk/identifying-research .

Date Added: 25/07/16
HCV patients at increased risk of cardio-cerebrovascular disease
News Type: Clinical News

A large literature review and meta-analysis confirms that HCV-infected patients are at an increased risk of cardio-cerebrovascular disease (CCD).

Reviewers from three academic centres in Italy found 27 studies which showed a significantly increased CCD risk in 297,613 HCV patients as compared with 557,814 uninfected controls (odds ratio 1.428).

These results were confirmed when separately considering the risk of coronary artery disease (CAD, 20 studies, odds ratio 1.382) and of cerebrovascular disease (13 studies, odds ratio 1.485).

Similar results were confirmed when analyzing 21 studies reporting adjusted risk estimates (odds ratio 1.448) and when, after excluding studies defining CAD as positive angiographic or electrocardiographic evidence, the reviewers specifically included the 17 studies reporting on acute CCD-related events (odds ratio 1.357). Moreover, four studies evaluating CCD-related deaths showed a higher risk in HCV patients than controls (odds ratio 1.772).

Meta-regression models suggested a direct association between the prevalence of cirrhosis and difference in CCD risk between HCV patients and controls.

Reference

The risk of coronary artery disease and cerebrovascular disease in patients with hepatitis C: A systematic review and meta-analysis. Ambrosino P, Lupoli R, Di Minno A et al. Int J Cardiol. 2016 Jul 4; 221:746-754 [Epub ahead of print]

 

 

Date Added: 25/07/16
Sofosbuvir-based regimens successful in lung transplant HCV patients
News Type: Clinical News

Three HCV patients who underwent lung transplant have been safely treated with IFN-free sofosbuvir-based regimens.

They all received anti-HCV treatment after lung transplant with sofosbuvir-based regimens, and all achieved a SVR. No unexpected safety signals were observed and no modifications in immunosuppressants were required.

The authors of the case report, from the University of Milan, also carried out a literature review and found no other data on the safety and efficacy of IFN-free regimens in HCV patients who received lung transplants.

They suggested that their case report opens the door for refined clinical management of this category of patients.

Reference

Sofosbuvir-based regimens for the treatment of HCV in patients who underwent lung transplant: case series and review of the literature. D'Ambrosio R, Aghemo A, Rossetti V et al. Liver Int. 2016 Jul 18 [Epub ahead of print]

Date Added: 25/07/16
NAs after HBIG protect against HBV/HDV recurrence following transplant
News Type: Clinical News

After HB immunoglobulin (HBIG) was ended in liver transplant (LT) patients with HBV/HDV coinfection, maintenance therapy with nucleos(t)ide analogue(s) (NAs) prevented its recurrence.

In a study at Greece’s Medical School of Aristotle University, 34 patients transplanted for HBV/HDV cirrhosis were evaluated. After LT, each patient received HBIG + NAs and then continued with NAs prophylaxis. All patients were followed up with HBV serum markers and HBV DNA, while anti-HDV/HDV RNA was performed in those with HBV recurrence. After HBIG discontinuation, the NAs were received as monoprophylaxis (lamivudine, adefovir, entecavir or tenofovir; or dual prophylaxis (lamivudine plus adefovir or tenofovir)).

Two of the 34 patients had HBV/HDV recurrence after HBIG withdrawal at a median follow-up of 28 months. These two patients had undetectable HBV DNA at LT. Statistical analysis revealed those with recurrence had received HBIG for shorter periods, compared to those without recurrence (median nine months versus 28 months).

Reference

Nucleos(t)ide analogue(s) prophylaxis after hepatitis B immunoglobulin withdrawal against hepatitis B and D recurrence after liver transplantation. Cholongitas E, Goulis I, Antoniadis N et al. Transpl Infect Dis. 2016 Jul 15 [Epub ahead of print]

Date Added: 18/07/16
DAAs safe and effective in chronic HCV with cirrhosis
News Type: Clinical News

A large real world study has shown direct-acting antiviral (DAA)-based therapy is safe and effective in HCV patients with compensated Child-Pugh score (CP) A cirrhosis.

In this multi-national study, at centres in Canada, Germany and the Netherlands, 433 cirrhotic patients with chronic HCV infection started DAA-based treatment.

The SVR12 rate was similar among patients with CP A (85.9%) and CP B/C (82.2%). Baseline albumin <35 g/L (hazard ratio 3.11), baseline MELD score ≥14 (hazard ratio 1.63) and HCV genotype 3 (hazard ratio 2.05) were independently associated with hepatic decompensation during antiviral treatment among patients with CP B/C.

The researchers suggest that, for patients with decompensated (CP B/C) cirrhosis, albumin <35 g/L, MELD-score ≥14 and HCV genotype 3 are important risk factors for hepatic decompensation during DAA-based treatment. Therefore, these patients require close monitoring during antiviral therapy or treatment should be deferred until after transplantation.

Reference

Safety and effectiveness of DAA-based therapy in patients with chronic HCV infection and cirrhosis. Maan R, van Tilborg M, Deterding K et al. Clin Gastroenterol Hepatol. 2016 Jul 9 [Epub ahead of print]

Date Added: 18/07/16
Low HEV transfusion transmission risk from blood donors
News Type: Clinical News

Although HEV transfusion transmitted infection (TTI) has been reported in some European countries, a large Danish study found no evidence of it in blood donations.

In the study, by researchers from four university hospitals, samples from 25,637 consenting donors collected during one month in 2015 were screened retrospectively using an individual-donation HEV RNA nucleic acid test with a 95% detection probability of 7.9 IU/mL.

Eleven donations (0.04%) were confirmed as positive for HEV RNA (median HEV RNA level, 13 IU/mL). Two donations were successfully genotyped as HEV-gt-3. Only one donor had a travel history outside Europe. Nine of eleven donors were male, but the gender ratio was non-significant compared with the total donor population.

Seven available recipients tested negative for HEV RNA and anti-HEV immunoglobulin M in follow-up samples. One recipient was HEV RNA-negative but anti-HEV immunoglobulin G-positive. HEV TTI was considered unlikely, but a transfusion-induced secondary immune response could not be excluded. Phylogenetic analysis showed relatively large sequence differences between HEV from donors, symptomatic patients, and swine.

The researchers concluded that despite an HEV RNA prevalence of 0.04% in Danish blood donations, all HEV-positive donations carried low viral loads, and no evidence of TTI was found.

Reference

Low transfusion transmission of hepatitis E among 25,637 single-donation, nucleic acid-tested blood donors. Harritshøj LH, Holm DK, Saekmose SG et al. Transfusion. 2016 Jul 7 [Epub ahead of print]

Date Added: 18/07/16
Global burden of viral hepatitis increased over 23 years
News Type: Clinical News

New global data show the absolute burden and relative rank of viral hepatitis has increased over the past quarter of a century.

A multi-national team of researchers used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.

Global viral hepatitis deaths increased in that period, from 0.89m to 1.45m, and the sum of years lost went from 31m to 41.6m and years lived with disability from 0.65m to 0.87m. Disability-adjusted life-years increased from 31.7m to 42.5m. In 2013, viral hepatitis was the seventh leading cause of death worldwide, compared with tenth in 1990.

The researchers concluded that, unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. They suggest the enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, represents an important opportunity to improve public health.

Reference

The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Stanaway JD, Flaxman AD, Naghavi M et al. Lancet. 2016 Jul 6 [Epub ahead of print]

Date Added: 12/07/16
NICE guideline on Liver disease (non-alcoholic fatty [NAFLD])
News Type: BASL News

This final guideline has now been published on the NICE website.

You can also find the supporting evidence, as well as all the stakeholder comments that we received during consultation and the responses to these comments. The comments were invaluable in helping us to develop and refine the guideline. We have also produced an equality impact assessment to support the guideline.

The recommendations in the guideline have been included in a NICE Pathway, which is an online tool that brings together all related NICE guidance and associated products in a set of interactive, topic-based diagrams. There is a version of the guideline for people using services, carers and the public called 'Information for the public'

If you have any queries, please contact Jill Peacock at liverdisease@nice.org.uk.

Date Added: 12/07/16
NICE guideline on Assessment and management of cirrhosis
News Type: BASL News

This final guideline has now been published on the NICE website.

You can also find the supporting evidence, as well as all the stakeholder comments that we received during consultation and the responses to these comments.The comments were invaluable in helping NICE to develop and refine the guideline. Nice have also produced an equality impact assessment to support the guideline. 

The recommendations in the guideline have been included in a NICE Pathway, which is an online tool that brings together all related NICE guidance and associated products in a set of interactive, topic-based diagrams. There is a version of the guideline for people using services, carers and the public called 'Information for the public'.

If you have any queries, please contact Jill Peacock at cirrhosis@nice.org.uk .

Date Added: 11/07/16
People with HCV take more risks than those with other liver diseases
News Type: Clinical News

People with HCV appear to be more impulsive and take more risks than individuals with other liver diseases, a new study suggests.

In the study, at Brazil’s Federal University of Bahia, Brazil, 269 adults with liver diseases were divided into a viral group of 157 patients with HCV and a non-viral group of 112. Risk behaviours were evaluated by a socio-demographic questionnaire. Impulsivity was assessed through Barratt Impulsiveness Scale (BIS-11). Psychiatric comorbidities were investigated by the Mini International Neuropsychiatric Interview 5.0.0.

The viral group patients had higher impulsivity than the non-viral group in all domains: attentional impulsivity, motor impulsivity, and non-planning. Risk behaviours were also shown to be associated with impulsivity levels. The results suggest that HCV-infected patients are more impulsive than individuals with other liver diseases, even when analyses are controlled for the presence of comorbid mental disorders. In addition, at-risk behavior was significantly mediated by impulsivity.

Reference

Risk-taking behavior and impulsivity among HCV-infected patients. Dantas-Duarte A, Morais-de-Jesus M, Nunes AP et al. Psychiatry Res. 2016 Jun 22; 243:75-80 [Epub ahead of print]

Date Added: 11/07/16
Collaborative care improves depression in HCV clinics
News Type: Clinical News

Collaborative care modestly improved depression among patients treated at chronic HCV clinics, a new study found

Collaborative care models have been shown to improve depression outcomes in primary care settings. The new study was conducted at four chronic HCV clinics in US Veterans Affairs facilities by a collaborative depression care team consisting of a depression care manager, pharmacist and psychiatrist.

Baseline screening identified 263 HCV-infected patients with depression. In unadjusted analyses, intervention participants' reports trended toward more treatment response (19% versus 13%) and remission (12% versus 6%), but total number of depression-free days (50.9) was similar to that of usual care participants (50.7).

These trends did not reach statistical significance for the overall sample in the adjusted analyses: response (odds ratio 2.02), remission (odds ratio 2.63), and depression-free days (7.6). However, the intervention was effective in improving all three outcomes for patients who did not meet criteria for remission at baseline.

Reference

Collaborative care for depression in chronic hepatitis C clinics. Kanwal F, Pyne JM, Tavakoli-Tabasi S et al. Psychiatr Serv. 2016 Jul 1 [Epub ahead of print]

Date Added: 11/07/16
HBV non-immunity in liver transplant children is higher than expected
News Type: Clinical News

A new article reviews the significance of HBV infection and the vaccination and screening measures needed to achieve immunity in children receiving liver transplants.

The review found HBV non-immunity among transplant candidates is higher than expected, even after appropriate completion of the vaccine series. Annual measurement of quantifiable HBV surface antibody in this vulnerable group should guide administration of booster and/or re-vaccination, thus improving immunoprotection.

The authors point out the liver plays a vital role in immune regulation. It induces immune tolerance and competence, and both clears antigens from the circulation and generates liver-primed memory cells through antigen presentation via hepatic scavenger cells. Lymphocyte populations are depleted in patients with liver disease.

The reviewers summarise immunity provided during early childhood against HBV infection is important to both paediatric liver transplant candidates and aging recipients. The field of paediatric transplantation is ripe for further functional cellular and humoral immunity studies on childhood HBV vaccines.

Reference

Hepatitis B immunity in the pediatric liver transplant population. Patel SS, Leung DH. Curr Opin Pediatr. 2016 Jun 29 [Epub ahead of print]

Date Added: 06/07/16
Cancer Research UK - funding opportunities available to support clinical academic careers
News Type: BASL News

Cancer Research UK has a range of funding opportunities to support clinical academic careers. The upcoming deadlines are listed below against each scheme available:

Clinical Science Fellowship - offers excellent clinicians the opportunity to develop a research career through a period of postdoctoral training, including research abroad, over a period of 5 years. Next deadline: 24 October 2016.
For more information click > here.

Advanced Clinician Scientist Fellowship - allows clinicians to establish an independent research group alongside their clinical practice, over a period of 5 years. Next deadline: 24 October 2016.
For more information click > here.

Pre-doctoral Research Bursaries - provide short-term funding to allow clinicians and other health professionals to get involved in research projects early in their career. Next deadline: 6 September 2016.
For more information click here.

Postdoctoral Research Bursaries for Clinical Trainees - offer funding for clinical trainees to undertake a research project after completion of a PhD, during completion of their clinical specialty training. Next deadline: 6 September 2016.
For more information click here.

Please share the new details of these schemes with your networks or get in touch if you have any questions; rachael.panizzo@cancer.org.uk

Date Added: 04/07/16
HCV treatment adherence does not affect liver transplant risk
News Type: Clinical News

This observational, historical cohort study was conducted using administrative data from the [US] Humana Research Database amongst 43,046 appropriate HCV patients diagnosed between 2008, and 2013. Cox proportional hazards models were used to estimate the relative risk of liver transplant by level of treatment adherence (> 80%, 50%-79%, and < 50%) based on proportion of days covered.

Only 2,708 (6.29%) of the patients received HCV treatment, and 366 (<1%) received a liver transplant. Although there were no significant differences in the risk of liver transplant by adherence level, there was an upwards trend in the rate of liver transplant as adherence worsened (> 80%: 1.25%; 50%-79%: 1.30%; and <50%:1.99%), and the average days to liver transplant was longer with higher adherence (> 80%: 683; 50%-79%: 623; < 50%: 454). Only 48 (13.11%) patients who received a liver transplant were treated for HCV.

Adjusted median total and per patient per month health care costs measured from index date until end of the study period were significantly higher for patients who received HCV treatment compared with those who did not (US$231,139 versus US$86,167, and US$20,583 versus US$5,778, respectively), driven by HCV-related medical costs and total pharmacy costs.

Reference

Does hepatitis C treatment adherence affect risk of liver transplantation? A historical cohort study. Ems D, Racsa P, Anderson C et al. J Manag Care Spec Pharm. 2016 Jul;22(7):863-71 

Date Added: 04/07/16
Few treatment failures with oral HCVs in routine practice
News Type: Clinical News

A total of 363 chronic HCV patients treated outside clinical trials with all-oral DAA regimens at three hepatitis clinics in Spain were retrospectively examined. Host and viral factors were tested as predictors of treatment failure.

All but 14 (4%) patients achieved sustained virological responses. Ten failures occurred after 12 weeks of sofosbuvir-ledipasvir, despite five of them being on ribavirin. All failures but one were relapses. The only patient with viral breakthrough selected NS5B L159F and NS5A Y93H.

In multivariate analyses, only advanced liver fibrosis and HIV coinfection were significantly associated with treatment failure. A trend towards a lower response was seen for HCV genotype 4.

Reference

Rate and predictors of treatment failure to all-oral HCV regimens outside clinical trials. Arias A, Aguilera A, Soriano V et al. Antivir Ther. 2016 Jun 24 [Epub ahead of print]

Date Added: 04/07/16
HBV or HCV may increase risk of non-Hodgkin lymphoma
News Type: Clinical News

This case-control multicentre study in Italy enrolled 571 NHL patients and 1004 cancer-free matched controls.

Circulating HCV RNA was detected in 63 NHL cases and 35 controls (odds ratio 3.51). Chronic HBV infection was found in 3.7% of cases and 1.7% of controls (odds ratio 1.95). There was a significantly elevated odds ratio for B-cell NHL (odds ratio 2.11).

People with serological evidence of past HCV or HBV infection, vaccination against HBV, or detectable antibodies against HBV core antigen alone were not at increased NHL risk.

The researchers suggest that the prevention and treatment of HCV and HBV may diminish the NHL incidence, notably in areas with a high prevalence of hepatitis virus infection.

Reference

Hepatitis B and C viruses and risk of non-Hodgkin lymphoma: a case-control study in Italy. Taborelli M, Polesel J, Montella M et al. Infect Agent Cancer. 2016 Jun 23; 11: 27

Date Added: 01/07/16
Hepatitis C Coalition - June Quarterly Newsletter
News Type: BASL News

Read the June Quartery edition of the Hepatitis C Coalition's newsletter > here.

 

Date Added: 27/06/16
Longer sleep length may increase NAFLD risk
News Type: Clinical News

New evidence suggests that sleeping for a longer time at night may slightly increase the risk of non-alcoholic fatty liver disease (NAFLD) in middle-aged and elderly people.

A total of 8,965 NAFLD-free subjects with a mean age of 61.6 who had enrolled in the Chinese Dongfeng-Tongji cohort study at baseline were divided into five groups dependent on their sleep duration: under six hours, six to seven hours, seven to eight hours, eight to nine hours, and nine hours or more.

During five years of follow-up, 2,197 participants were newly diagnosed as NAFLD. Compared with those reported seven to eight hours of night-time sleep, the multivariable-adjusted odds ratios were 1.21 for those who slept eight to night hours and 1.31 for those who slept over nine hours. However, no significant association was found with short nightly sleep duration, i.e., under seven hours.

The effect of long night-time sleep on the risk of incident NAFLD was attenuated greatly by body mass index in men.

Reference

Night-time sleep duration and risk of nonalcoholic fatty liver disease: the Dongfeng-Tongji prospective study. Liu C, Zhong R, Lou J et al. Ann Med. 2016 Jun 21:1-9. [Epub ahead of print]

 

 

 

Date Added: 27/06/16
Better liver transplant outcomes with rabbit antithymocyte globulin
News Type: Clinical News

People who received rabbit antithymocyte globulin induction before liver transplantation had lower rejection rates and improved patient and graft survival than those receiving interleukin 2 receptor blocker.

This was the finding of a retrospective analyses using the University of Washington [Seattle] Transplant Database from 2005 to 2012 for adult primary liver transplant patients. Maintenance immunosuppressive agents were tacrolimus or tacrolimus-mycophenolate mofetil. Among 595 patients, 322 received rabbit antithymocyte globulin and 273 received interleukin 2 receptor blocker.

Acute cellular rejection was higher in those who received interleukin 2 receptor blocker than in those who received rabbit antithymocyte globulin (27% versus 18%).

Both patient survival at one year (95% versus 90%), three years (92% versus 87%), and five years (86% versus 80%) and graft survival at one year (93% versus 88%), three years (90% versus 86%), and five years (83% versus 78%) were superior with rabbit antithymocyte globulin than with the interleukin 2 receptor blocker.

In patients with HCV, the type of induction therapy did not have any effect on the timing of HCV recurrence. At one year after transplant, 33.3% in the rabbit antithymocyte globulin group had grade three to four inflammation and 10.2% had stage three to four fibrosis, compared with 16.8% and 4.8% in the interleukin 2 receptor blocker group.

Female recipient, Model for End-Stage Liver Disease score, hepatocellular carcinoma, and high preoperative serum creatinine levels were associated with less favourable patient and graft survival.

Reference

Superior patient and graft survival in adult liver transplant with rabbit antithymocyte globulin induction: experience with 595 patients. Montenovo MI, Jalikis FG, Li M et al. Exp Clin Transplant. 2016 Jun 15 [Epub ahead of print]



 

Date Added: 27/06/16
Warning on neurologic complications in liver disease
News Type: Clinical News

Several drugs used to treat liver disease, including classic and new direct-acting antivirals, may have neurologic complications.

This was the final conclusion of a review by neurologists from the University of Lisbon, who point out that type A hepatic encephalopathy (HE), which occurs in acute liver failure, is a neurologic emergency. They also said multiple measures should be taken to prevent and treat cerebral oedema.

In Type C HE, which occurs in chronic liver disease, management should be aimed at correcting precipitant factors and hyperammonemia. There is an increasing spectrum of drug treatments available to minimize ammonia toxicity.

Acquired hepatocerebral degeneration is a rare complication of the chronic form of HE, with typical clinical and brain MRI findings, whose most effective treatment is liver transplantation. Epilepsy is frequent and of multifactorial cause in patients with hepatic disease, and careful considerations should be made regarding choice of the appropriate anti-epileptic drugs.

Several mechanisms increase the risk of stroke in hepatic disease, but many of the drugs used to treat and prevent stroke are contraindicated in severe hepatic failure.

HCV increases the risk of ischemic stroke. Hemorrhagic stroke is more frequent in patients with liver disease of alcoholic etiology. Viral hepatitis is associated with a wide range of immune-mediated complications, mostly in the peripheral nervous system, which respond to different types of immunomodulatory treatment.

Reference

Management of neurologic manifestations in patients with liver disease. Ferro JM, Viana P, Santos P et al. Curr Treat Options Neurol. 2016 Aug;18(8):37 

Date Added: 23/06/16
NICE Clinical Guideline Updates Programme: Alcohol use disorder - Topic expert recruitment (22/06/16 - 20/07/16)
News Type: BASL News

NICE are looking for Topic experts to join their updates committee in updating the Alcohol use disorder: diagnosis and management of physical complications guideline.

They need both lay members (people using services, family members and carers, and members of the public and community or voluntary sector) and people with a professional or practitioner background in the topic.

The update will look at the following:
• In patients with acute alcohol-related hepatitis, what is the safety and efficacy of corticosteroids versus placebo?

They are therefore seeking to recruit the following experts:
• 3 x Hepatologists/Physicians
• 1 x Lay member
• 1 x Nurse specialist
• 1 x Pharmacist

To find out more visit the NICE website click > here to view the healthcare professional members advert and click > here to view the lay members advert. 

Both adverts will close 5pm on Wednesday 20th July 2016.

Please note that the key dates for meetings that must be attended are included in the advert – please take these into consideration when applying.

Date Added: 21/06/16
Dame Sheila Sherlock Research Prize – submit your application
News Type: BASL News

Submit your application for the Dame Sheila Sherlock Research Prize – deadline 09:00 hrs Monday 27th June 2016.

One of the highlights of the annual meeting this prize is awarded annually to recognise the enormous contribution of Dame Sheila Sherlock to the development of Hepatology as a discipline in its own right. In keeping with Dame Sheila’s enthusiasm for fostering young researchers, this eponymous research prize is awarded to young investigators without substantive posts in either medicine or science for their research contributions in the field of Hepatology.

The winner of the award will deliver a 20 minute lecture presenting their research during the Annual Meeting on Thursday 8th September 2016. This year the prize is free registration to the meeting, a place at the Annual Dinner and £1,000.

To apply, please send one A4 sheet outlining the research and another A4 sheet detailing the related publications.

Please send submissions to steve@basl.org.uk before the deadline of 09.00hrs Monday 27th June 2016.

Date Added: 20/06/16
Chronic liver disease increases risks after cervical spine trauma
News Type: Clinical News

Chronic liver disease patients who have suffered cervical spine trauma may have an increased risk of morbidity and mortality.

This was the novel finding by researchers at Brigham and Women's Hospital, Boston, who analysed patient records in the Massachusetts Statewide Inpatient Dataset (2003-2010).

Among 10,841 patients with cervical spine trauma, 117 had chronic liver disease. The rate of surgical intervention for cervical trauma was not significantly different between patients with and without chronic liver disease (odds ratio 0.82).

Mortality (odds ratio 2.12), failure to rescue (odds ratio 2.86), and complications (odds ratio 1.65) were all significantly increased for the patients with chronic liver disease in final adjusted models that controlled for differences in case-mix and whether a surgical procedure was performed. Final models explained approximately 72% of the variation in mortality and failure to rescue.

Reference

The effect of chronic liver disease on acute outcomes following cervical spine trauma. Bessey JT, Le H, Leonard DA et al. Spine J. 2016 Jun 8 [Epub ahead of print]

 

Date Added: 20/06/16
Risk factors for HCC include liver fibrosis, steatosis, diabetes and cirrhosis
News Type: Clinical News

Two new studies suggest risk factors for hepatocellular carcinoma (HCC) in hepatitis patients include liver fibrosis, steatosis, diabetes and cirrhosis.

Japanese researchers cited liver fibrosis and steatosis as risk factors, regardless of past HBV infection and alcohol consumption (1).

Among HCC patients who underwent surgical resection at Shinshu University Hospital, Japan, between 1996 and 2012, 77 were negative for serum anti-HBV core/surface antibodies in addition to HBV surface antigen and anti-HCV antibody.

Advanced fibrosis and steatosis were detected in 64% and 60% of all patients. Approximately 85% of alcohol intake-positive patients had advanced fibrosis. Non-alcoholic fatty liver patients had the highest body mass index and prevalence of diabetes, but between 30% and 40% had none-to-mild fibrosis.

Cryptogenic patients (i.e., no alcohol intake or steatosis) exhibited the lowest incidence of accompanying hepatic inflammation/fibrosis but the largest tumour size. Recurrence/survival rates were comparable among the groups.

Meanwhile, Swedish researchers cited diabetes and cirrhosis as strong risk factors following successful treatment of HCV (2).

Among 399 patients with advanced liver disease successfully treated for HCV at Karolinska University Hospital, 17 developed HCC during 3366 person-years follow-up. The HCC incidence rates were 0.95 and 0.15 per 100 person years for patients with pre-treatment METAVIR F4 and F3, respectively.

Patients with pre-treatment cirrhosis and diabetes had a hazard ratio to develop HCC of 6.3, and an incidence rate of 7.9/100 person-years during the first two years of follow-up. The risk for HCC decreased significantly two years after SVR had been achieved.

References

1.     Clinicopathological characteristics of non-B non-C hepatocellular carcinoma without past HBV infection. Kimura T, Kobayashi A, Tanaka N et al. Hepatol Res. 2016 Jun 11 [Epub ahead of print]

2.     Diabetes and cirrhosis are risk factors for hepatocellular carcinoma after successful treatment of chronic hepatitis C. Hedenstierna M, Nangarhari A, Weiland O et al. Clin Infect Dis. 2016 Jun 9 [Epub ahead of print]

Date Added: 20/06/16
Sofosbuvir plus daclatasvir “best option” for HCV g3
News Type: Clinical News

A literature review concluded the sofosbuvir (SOF) and daclatasvir (DCV) combination is the best oral therapy for HCV genotype three.

Moreover, the addition of ribavirin (RBV) does not appear to increase SVR rates substantially.

Authors from the University of Seville reviewed the therapeutic efficacy of various treatment regimens in HCV genotype three from randomised clinical trials and prospective National Cohort Studies. The options included PEG-INF-based therapy including SOF + RBV for 12 weeks versus SOF + RBV for 24 weeks; SOF + RBV therapy 12-16 weeks versus 24 weeks; and the role of RBV in SOF + daclatasvir (DCV) and SOF + ledipasvir (LDV) combinations.

The analysis found a combination treatment including SOF + RBV + PEG-IFN for 12 weeks produced a better SVR than SOF + RBV only for 12 weeks, although its association with more frequent adverse effects may be a limiting factor.

Longer duration therapy with SOF + RBV (24 weeks) has achieved higher SVR rates than shorter durations (12 or 16 weeks). The review suggests that SOF + LDV is not an ideal treatment for genotype three.

Reference

Hepatitis C virus genotype 3: Meta-analysis on sustained virologic response rates with currently available treatment options. Ampuero J, Reddy KR, Romero-Gomez M. World J Gastroenterol. 2016 Jun 14;22(22):5285-92 

Date Added: 14/06/16
HBV a risk factor for periprosthetic joint infection after TKA in men
News Type: Clinical News

HBV infection is a risk factor for periprosthetic joint infection (PJI) among males after total knee arthroplasty (TKA), a new study shows.

Researchers studied 4,619 patients (1184 male) undergoing primary TKA in Taiwan between 2001 and 2010. The incidence of PJI was 523 among the males with HBV infection and 110 among the males without HBV (per 10,000 person-years). The males with HBV infection had a 4.32-fold risk of PJI compared with the males without HBV. HBV infection and diabetes were the risk factors for PJI among males.

The incidence of PJI was 58.8 among the females with HBV infection and 75.2 among the females without HBV (per 10,000 person-years). The risk of PJI was higher for the males with HBV infection than for the males without 0.5 to one year after TKA (hazard ratio 18.7) and over one year after TKA (hazard ratio 4.80).

Reference

Hepatitis B virus infection is a risk factor for periprosthetic joint infection among males after total knee arthroplasty: a Taiwanese nationwide population-based study. Kuo SJ, Huang PH, Chang CC et al. Medicine (Baltimore). 2016 May; 95(22): e3806

Date Added: 14/06/16
Experts disagree on timing of HBV vaccination for young children
News Type: Clinical News

Researchers say a French survey suggesting children can wait until they are 11 years old before being vaccinated for HBV is unacceptable and potentially damaging.

The objective of the survey (1), conducted at the University of Lille, was to identify potentially dangerous vaccination delays for each dose of ten different vaccines in children younger than two years.

Sixteen experts in vaccines for children responded from the Infovac-France group and 21 responded from the French study group for pediatric infectious diseases. They identified maximum delays for all vaccine doses.

The group reached a 70% cut-off consensus for six of the 10 vaccines. They agreed delays of 15 days after the recommended date for the first two doses of the diphtheria-tetanus-acellular pertussis-inactivated polio vaccine/Haemophilus influenzae B vaccine and for the second dose of the pneumococcal conjugate vaccine, one month for the meningococcal C vaccine and for the first dose of the measles-mumps-rubella vaccine, and 11 years of age for completion of the HBV vaccination.

However, in the following issue of the same journal (2), experts from Belgium, France, Greece and the USA point out that control of HBV through routine infant immunization in more than 95% of countries has reduced chronic hepatitis carriers to less than 1%-2% in immunized cohorts of children even in countries where it is endemic.

They write: “large cohorts of French children and adolescents remain susceptible to HBV infection. Given the high rates of immigration to France from areas of higher endemicity, the higher birth rate and degree of integration of these groups into the health system, plus the lower age of sexual debut and the use of injectable drugs in the general population, we cannot agree that a delay of 11 years is acceptable. Rates of adolescent immunization are quite low so relying on protection at this age will yield little in terms of population protection”.

They add that allegations persisted in France that the HBV vaccine caused Multiple Sclerosis and conclude “the results of this paper sends a damaging message to health workers and parents in France and beyond”.

References

1.What timing of vaccination is potentially dangerous for children younger than 2 years? Gras P, Bailly AC, Lagrée M et al. Hum Vaccin Immunother. 2016 May 24:1-7 [Epub ahead of print]

2.Global progress in the control of viral hepatitis and acceptable delay in Hepatitis B immunization. Kane MA, Roudot-Thoraval F, Guerin N et al. Hum Vaccin Immunother. 2016 Jun 3:1-4 [Epub ahead of print]

Date Added: 14/06/16
More cirrhosis, worse outcomes, for patients with both AIH and NASH
News Type: Clinical News

Patients with both autoimmune hepatitis (AIH) and nonalcoholic steatohepatitis (NASH) are more likely to have cirrhosis and decreased survival compared to AIH-only patients, researchers reported.

The researchers, at the University of Vermont Medical Centre, studied 73 AIH patients; 14% were classified as AIH with simple steatosis (SS) and 16% had AIH and NASH.

Fifty percent of the AIH plus NASH patients had cirrhosis at index biopsy as compared to 18% of AIH-only patients. AIH/NASH patients had relative risks of 7.65 for liver-related mortality and 2.55 for liver-related adverse outcomes, as compared to the AIH-only cohort. No significant difference in outcome measures existed in comparing (AIH only) with (AIH and SS) cohorts.

The researchers say their findings suggest that simultaneous exposure confers a clinically significant increased risk, which may warrant closer follow-up and surveillance.

Reference

Natural history of patients presenting with autoimmune hepatitis and coincident nonalcoholic fatty liver disease. De Luca-Johnson J, Wangensteen KJ, Hanson J et al. Dig Dis Sci. 2016 Jun 4. [Epub ahead of print]

Date Added: 06/06/16
Multi-disciplinary approach improves HCV outcomes
News Type: Clinical News

A study at a Spanish hospital found that the multi-disciplinary management of chronic HCV improved outcomes in patients.

Researchers at the Hospital de Sabadell, Barcelona, compared 228 HCV patients treated with pegylated interferon plus ribavirin before the implementation of a multidisciplinary approach with 286 treated after the implementation of the approach.

Age, viral genotype, previous treatment, aspartate transaminase, ferritin, and triglyceride were prognostic factors of a sustained virological response. After adjusting for prognostic factors, a sustained virological response was higher in the multidisciplinary cohort (58% versus 48%).

Despite a higher psychiatric  co-morbidity and age in the multidisciplinary cohort, there was a trend toward a lower rate of treatment abandonment in this group (2.2% versus 4.9%).

Reference

Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C. Gallach M, Vergara M, Miquel M et al. Ann Hepatol. 2016 Jul-Aug;15(4):524-31

Date Added: 06/06/16
Chinese herbs improve interferon/ribavirin therapy in chronic HCV
News Type: Clinical News

A meta-analysis of clinical studies suggests adding a combination of Chinese herbs to interferon and ribavirin yields better outcomes, and fewer adverse events, in chronic HCV than interferon plus ribavirin alone.

Researchers at the International Centre for Diagnosis and Treatment of Liver Diseases in Beijing found 17 randomised controlled trials that evaluated biochemical responses, virological responses, histological responses, and/or adverse reactions to combination therapy of interferon and ribavirin with and without Chinese herbs.

Overall, combination therapies with Chinese herbs plus interferon and ribavirin achieved significantly higher alanine transaminase and end-of-treatment viral response, and significantly lower levels of hyaluronic acid, laminin, procollagen iii peptide, type IV collagen, decreased leukocyte count, abnormal thyroid function, psychosis, and anaemia in chronic HCV patients compared with those treated without Chinese herbs. Sensitivity analysis showed no changes and no potential publication bias was found.

Reference

Meta-analysis of combination therapy of Chinese herbs plus interferon and ribavirin in patients with chronic hepatitis C. Wang J, Xin S, Jin X et al. Med Sci Monit. 2016 May 30; 22:1817-1826

Date Added: 06/06/16
Inner-city prescription opioid injectors at greater risk of HCV
News Type: Clinical News

People who inject prescription opioids and who live in inner-city areas have a higher risk of HCV than those in the suburbs, a new Canadian study suggests.

The study researchers interviewed 854 people who inject drugs and who lived in the inner-city of Montreal or in the surrounding areas, every three to six months from 2004 to 2012. At baseline, 40% of inner-city participants were more likely to report prescription opioid injecting in the past month compared with 25% of suburban residents.

The association between prescription opioid injection and heroin injection, syringe sharing and sharing of injecting equipment varied according to place of residence and was greater in the inner city.

The hazard of HCV infection associated with prescription opioid injection was greater among inner-city participants compared to those in the surrounding areas (adjusted hazard ratios 3.19 versus 1.26).

Reference

The role of living context in prescription opioid injection and the associated risk of hepatitis C infection. Sacks-Davis R, Daniel M, Roy E et al. Addiction. 2016 May 30 [Epub ahead of print]

Date Added: 31/05/16
BASL Committee Post Vacancies
News Type: BASL News

BASL are seeking nominations/ expressions of interest for two Committee posts.

Services Committee Chair
The Services Committee Chair – the chair is commissioned by the Governing Board to support the development and implementation of Clinical Standards and the provision of Clinical Services, including preparation and delivery of advice to national health authorities concerning liver diseases. The Services Committee Chair is elected by the membership to serve for a period of up to three years and may be re-elected once.

Paediatric representative
The Paediatric representative is appointed to represent the Paediatric Hepatology community across clinical standards of care, education, training and research. A current interest in Hepatitis C would be advantageous for the new post holder. The representative is elected by the membership to service for a period of up to three years.

Both post holders may be re-elected if they should choose to stand again.

Nomination Process
Candidates wishing to be considered for election will require one BASL member to propose them and a second member to confirm their suitability for the role in writing.

Please email Judy Hawksworth at the Secretariat admin@basl.org.uk with your nominations by 5 p.m. on Monday 20th June 2016. Following this time, candidate statements will be sought and voting will take place if necessary.

Date Added: 31/05/16
Simtuzumab well tolerated in HCV/HIV advanced liver fibrosis
News Type: Clinical News

Simtuzumab, a monoclonal antibody directed against lysyl oxidase-like 2 enzyme, has been shown to be well-tolerated in HCV- and HIV-infected subjects with advanced liver disease.

In an open-label, pilot multi-centre clinical trial, 18 patients with HCV, HIV or HCV-HIV co-infection and advanced liver fibrosis received simtuzumab 700mg intravenously every two weeks for 22 weeks. Transjugular liver biopsies were performed during screening and at the end of treatment to measure hepatic venous pressure gradient (HVPG) and to stage fibrosis.

The treatment was well-tolerated with no discontinuations because of adverse events. No significant changes were seen in HVPG or liver biopsy fibrosis score after treatment. Exploratory transcriptional and protein profiling using paired pre- and post-treatment liver biopsy and serum samples suggested up-regulation of TGF-β3 and IL-10 pathways with treatment.

The researchers suggest that putative modulation of TGF-β3 and IL-10 pathways during simtuzumab treatment merits investigation in future trials.

Reference

Simtuzumab treatment of advanced liver fibrosis in HIV and HCV-infected adults: results of a 6-month open-label safety trial. Meissner EG, McLaughlin M, Matthews L et al. Liver Int. 2016 May 27 [Epub ahead of print]

 

 

Date Added: 31/05/16
Clinicians wary of HCV treatment for people who inject drugs
News Type: Clinical News

A new survey has found a low rate of prescribing amongst physicians when treating HCV patients who inject drugs.

Researcher at the University of California, San Francisco surveyed clinicians attending the Liver Meeting in 2014 who reported prescribing HCV treatment in the past three years.

Among 108 clinicians completing the survey, 10% were willing to treat a person who injected drugs (last injection within 30 days) using interferon-containing regimens, and 15% with all-oral regimens.

For each increasing time interval of injection abstinence, there was an increase in the odds of a clinician reporting willingness to treat with direct-acting antivirals (odds ratio 2.57) and with interferon-based treatment (odds ratio 2.22), Reinfection and medication cost were cited as most important concerns when determining candidacy. 

The researchers concluded that a cure is now the norm in HCV treatment, and that there is an increasing need to address the barriers to treating people who inject drugs, the population with the highest burden of infection. Understanding treatment candidacy assessments is essential to improving uptake.

Reference

Clinicians' views of Hepatitis C Virus treatment candidacy with direct-acting antiviral regimens for people who inject drugs. Asher AK, Portillo CJ, Cooper BA et al. Subst Use Misuse. 2016 May 24:1-6 [Epub ahead of print]

Date Added: 31/05/16
Renal impairment common in HCV patients
News Type: Clinical News

Some degree of renal impairment is common in people with HCV, including those with advanced liver fibrosis, researchers have found.

In a population-based prospective, observational cohort study at four large US health systems, data on 5,772 HCV patients was analysed.

The prevalence of estimated glomerular filtration rate (eGFR) = 80 was 33% and eGFR < 30 was 2%, including among patients with hepatic fibrosis. Diagnosed extra hepatic renal manifestations were rare: vasculitis- 0.2%, nephrotic syndrome- 0.3%, and cryoglobulinemia- 0.9%.

The researchers concluded that, while the prevalence of severe renal impairment was low, mild-to-moderate renal impairment was common in HCV patients, including those with advanced liver fibrosis for whom treatment is urgent.

Reference

Prevalence of renal Impairment and associated conditions among HCV-infected persons in the Chronic Hepatitis Cohort Study (CHeCS). Moorman AC, Tong 

Date Added: 23/05/16
Single-tablet multi-drug regimen effective in HIV/HBV co-infection
News Type: Clinical News

A tablet containing elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide (E/C/F/TAF) was effective in HIV/HBV co-infected adults, a new study showed.

In this US multi-centre, open-label, non-comparative switch study, at week 48, 91.7% of the 72 participants maintained or achieved virologic suppression (HIV-1 RNA <50 c/mL; HBV DNA <29 IU/mL.)

Seroconversion occurred in 2.9% of HBsAg positive participants and 3.3% of HBeAg positive participants; 40% of those with abnormal ALT normalized. E/C/F/TAF was associated with improved renal function and reduced bone turnover.

Reference

Efficacy and safety of switching to a single-tablet regimen of elvitegravir/cobicistat/emtricitabine/tenofovir Aaafenamide (E/C/F/TAF) in HIV-1/Hepatitis B coinfected adults. Gallant J, Brunetta J, Crofoot G et al. J Acquir Immune Defic Syndr. 2016 May 11 [Epub ahead of print]

 

Date Added: 23/05/16
Chronic HBV infection may lessen risk of pre-eclampsia
News Type: Clinical News

Findings from a meta-analysis of published studies suggest chronic HBV may decrease the risk of pre-eclampsia.

The reviewers found three observational cohort studies and eight case-control studies, including 11,566 preeclampsia patients, conducted up to 1 January 2016 in Asian populations. A significant negative association between chronic HBV infection and pre-eclampsia was observed (odds ratio 0.77).

The reviewers suggest future prospective cohorts in different countries with larger sample sizes are warranted to ascertain the causality. Pathophysiological studies are required to explore the possible biological mechanisms involved, they added.

Reference

Chronic hepatitis B infection is associated with decreased risk of preeclampsia: a meta-analysis of observational studies. Huang QT, Chen JH, Zhong M et al. Cell Physiol Biochem. 2016 May 9;38(5):1860-1868 [Epub ahead of print]

 

Date Added: 23/05/16
HBV infection “possible” following haemodialysis
News Type: Clinical News

HBV infection is possible following hemodialysis, especially among severely immunosuppressed patients.

Following an investigation of a report made in March 2013, US public health authorities, from the Epidemic Intelligence Service, have warned of this possibility, and recommended stringent infection control.

They found that the patient's only identified HBV risk factor was hemodialysis treatment, and that the facility had no other patients with known active HBV infection.

An investigation of one patient with evidence of a resolved HBV infection indicated HBV reverse seroconversion and reactivation had occurred in the setting of HIV infection and a failed kidney transplant.

HBV whole genome sequences analysis from the index and source patients indicated 99.9% genetic homology. Facility observations revealed multiple infection control breaches. Inadequate dilution of the source patient's sample during HBV testing might have led to a false-negative result, delaying initiation of hemodialysis in isolation. 

Reference

Hepatitis B reverse seroconversion and transmission in a haemodialysis centre: a public health investigation and case report. Rhea S, Moorman A, Pace R et al. Am J Kidney Dis. 2016 May 7 [Epub ahead of print]

Date Added: 20/05/16
Article in Nature by AHA chair & colleagues - Alcohol: taking a population perspective
News Type: BASL News

 A paper has just been published in Nature by the chair of the Alcohol Health Alliance and colleagues making the case that improving public knowledge about alcohol harm will increase government appetite for regulation.

The paper, Alcohol: taking a population perspective, can be read in full > here

Date Added: 19/05/16
NURSES TRAVEL BURSARY 2016
News Type: Nurse News

NURSES TRAVEL BURSARY 2016

We are delighted to announce that AbbVie UK Ltd is offering 30 bursaries to support nurses attending the BASL Annual Meeting 2016. This will be open to all Nurses in the UK, both members and non-members of the BASL Nurse Forum.

The bursary application deadline is Friday 10th June 2016.

By Monday 27th June you will be advised of the status of your submission and the deadline for confirmation of acceptance is Monday 4th July.

To apply:

Please email a copy of your application form to jane.douthwaite@execbs.com AND post the original signed copy to: BASL Secretariat c/o Executive Business Support Ltd, City Wharf, Davidson Road, Lichfield, Staffordshire WS14 9DZ.

BASL must receive your application (both hardcopy and email) by the deadline of Friday 10th June. You can download further information below:

Download Nurse Travel Bursary Guidance Notes.pdf
Download AbbVie Nurses Bursary Application Form_2016.docx

This travel bursary is funded by AbbVie Ltd, however, AbbVie Ltd have no involvement in the selection of the recipients of the bursary. Details regarding the application and review process for the scholarships can be found as part of these Guidance Notes.

Date Added: 17/05/16
Join BASL Ward Membership Today
News Type: Nurse News

BASL Nurse Forum Ward Membership is here, join today:

  • £100 per annum for up to 5 members per ward
  • Names of up to 5 ward members can be added at any point in the same membership year, up to the max of 5
  • Ward member names can be updated annually
  • Ward member benefits include; access to the Nurse e-learning toolkits on the BASL website, reduced fees at BASL Events including the Nurses Day at the Annual Meeting in September, and BASL member e-newsletters
  • Payments can be made by invoice.  

Sign up your Ward today by sending an email to jane.douthwaite@execbs.com. A main point of contact for the Ward is required who will be contacted by the BASL Secretariat to obtain further details to set up the Ward Membership.

Date Added: 16/05/16
Managing HCV drug treatment failure
News Type: Clinical News

Although in HCV studies, SVRs above 90% have been achieved with direct-acting antiviral (DAA) combinations, outcomes in real-world patients are lower. In a review, authors from Spain and the UK have discussed the management of HCV treatment failure and the impact of resistance-associated variants (RAVs) on re-treatment strategies.

The authors say that failure to DAA combinations occurs more often in chronic HCV patients with baseline predictors of poor response, such as those with RAVs, genotypes 3 or 1a, advanced liver cirrhosis, elevated serum HCV-RNA and perhaps HIV coinfection. Impaired antiviral efficacy is more frequent when multiple factors are present. 

On-treatment predictors of DAA failure are poor drug adherence and development of side effects. Extending the length of therapy, adding ribavirin and/or using DAA from other drug families may allow successful re-treatment of most prior DAA failures.

Reference
Prevention and management of treatment failure to new oral hepatitis C drugs. Benítez-Gutiérz L, Barreiro P, Labarga P et al. Expert Opin Pharmacother. 2016 May 5. [Epub ahead of print]

Date Added: 16/05/16
Muscle weakness associated with hepatic encephalopathy in cirrhosis
News Type: Clinical News

Findings from a new study suggest a significant relationship between skeletal muscle weakness and neurological impairment in cirrhotic patients. 

This cross-sectional multi-centre study in Brazil included 54 cirrhotic outpatients with hepatic encephalopathy (HE) varying from subclinical to grade II, who were submitted to neuropsychometric tests, electroencephalogram, brain Single Photon Emission Computed Tomograph, anthropometric measurements, handgrip strength and dual energy X-ray absorptiometry exam. 

Analysis of the area under the receiver operator characteristic curve revealed the values related to neurological manifestations (HE grades I and II). Reductions in adductor pollicis muscle thickness and hand grip strength were associated with higher HE grades, suggesting a big impact caused by the loss of muscle mass and function on HE severity. 

Reference
Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients. Augusti L, Franzoni LC, Santos LA et al. Metab Brain Dis. 2016 Apr 30. [Epub ahead of print]

Date Added: 16/05/16
Race and gender differences in the use of anti-HCV drugs
News Type: Clinical News

New evidence from the USA has found “unexplained” race and gender differences in the use of new direct acting antiviral agents (DAAs) amongst people with HCV.

Researchers at Baylor College of Medicine, Houston, studied HCV patients who received care at Veterans Administration facilities nationwide. Those who were treated in the current DAA era were compared with those who were seen in the previous standard of care era.

Of the 145,596 patients seen in the current DAA era, 17,791 received treatment during the first 16 months of DAA approval. African American

(AA) patients had 21% lower odds of receiving DAA than whites (odds ratio 0.79). Overall, women were as likely to receive treatment as men (odds ratio 0.99). However, the odds of receiving DAAs were 29% lower for younger women compared with younger men (odds ratio 0.71).

In the previous era, similar to the DAA cohort, AA patients had significantly lower odds of receiving  treatment than whites (odds ratio 0.74). The racial difference between the two eras did not reach statistical significance. 

The researchers described their findings as “unexplained”

Reference
Race and gender differences in the use of direct acting antiviral agents for HCV. Kanwal F, Kramer JR, El-Serag HB et al. Clin Infect Dis. 2016 Apr 30 [Epub ahead of print]

Date Added: 09/05/16
Myrcludex B - an effective novel HBV/HDV treatment
News Type: Clinical News

Myrcludex B is a new drug to treat HBV and HDV. In a multi-centre German first-in-human study (1), single ascending doses of myrcludex B were administered up to 20 mg intravenously and 10 mg subcutaneously in 36 healthy volunteers.

Myrcludex B was well tolerated and no serious or relevant adverse events representing off-target effects, and no immunogenic effects were observed up to the highest applied dose. The pharmacokinetic model suggested that subcutaneous doses of 10 mg and above reach a target saturation of over 80% for at least 15 hours.

In a pilot trial conducted at centres in Russia and Germany, 24 patients with chronic HDV were equally randomized to myrcludex B, or pegylated interferon alpha (pegIFNα-2a) or their combination (2).

Interim results showed that, after 24 weeks of treatment, HDV RNA, a relevant marker for HDV infection, decreased in all patients. Two of eight patients who received either myrcludex B or pegINF2a became negative for HDV RNA, and five of seven patients who received both drugs at the same time became negative. The drug was well tolerated.

References

1. Myrcludex B: a first-in-human clinical study with a first-in-class hepatitis B and hepatitis D virus entry inhibitor. Blank A, Markert C, Hohmann N et al. J Hepatol. 2016 Apr 27 [Epub ahead of print] 

 

2. Interim results of a Phase Ib/IIa study of the entry inhibitor myrcludex B in chronic hepatitis D infected patients. Bogomolov P, Alexandrov A, Voronkova N et al. J Hepatol. 2016 Apr 27 [Epub ahead of print]

Date Added: 09/05/16
Stool could be a source of HCV infection
News Type: Clinical News

A new German study shows, for the first time, that HCV can often be detected in stool samples of chronically infected patients irrespective of occult bleeding. This, say the study authors, suggests that stool could be a potential source for HCV infection.

Researchers at Hannover Medical School retrospectively collected stool samples of 98 HCV patients. Specific HCV primers were used to identify samples positive for HCV RNA. HCV RNA-positive samples were tested for HCVcoreAg with the Architect HCVAg assay. Presence of occult blood was investigated by the hemoCARE guajak test. Viral stability and infectivity of recombinant HCV particles was investigated in vitro by incubation of genotype 2a chimeric virus Jc1 with bile and stool suspensions.

HCV RNA could be detected in 68 out of the 98 stool samples and and 16 samples also tested positive for HCVcoreAg. Presence of HCV RNA in stool was more frequent in male than in female and in patients with low platelet counts but was not associated with the detection of occult blood. Stool suspensions and to a lesser extent bile reduced the in vitro infectivity of genotype 2a chimeric Jc1 virus even though infection of Huh7 cells was not completely abrogated.

The researchers suggest that stool can be a potential source for HCV infection and thus unprotected anal intercourse should be avoided.

Reference

Frequent detection of HCV RNA and HCVcoreAg in stool of patients with chronic hepatitis C. Heidrich B, Steinmann E, Plumeier I et al. J Clin Virol. 2016 Apr 14;80:1-7 [Epub ahead of print]

Date Added: 09/05/16
Elastin fibre accumulation predicts hepatocellular carcinoma
News Type: Clinical News

Using a novel computational analysis, researchers found that elastin fibre was a predictor for the development of hepatocellular carcinoma (HCC), independently of collagen fibre and F stage.

The researchers, at Musashino Red Cross Hospital, Tokyo, enrolled 189 consecutive patients with HCV and advanced fibrosis. Using Elastica van Gieson-stained whole-slide images of pretreatment liver biopsies, collagen and elastin fibres were evaluated pixel by pixel (0.46 μm/pixel) and the cumulative incidences of HCC within three years were analyzed.

There was a significant correlation between collagen and elastin fibres, whereas variation in elastin fibre was greater than in collagen fibre. Both collagen fibre and elastin fibre were significantly correlated with F stage.

In total, 30 patients developed HCC during follow-up. Patients who had higher elastin fibre in addition to higher collagen fibre showed significantly higher incidences of HCC. With regard to elastin fibre, this difference remained significant in F3 patients. Furthermore, for patients with a higher collagen fibre amount, higher elastin was a significant predictor for HCC development.

Reference 

Elastin fibre accumulation in liver correlates with the development of hepatocellular carcinoma. Yasui Y, Abe T, Kurosaki M et al. PLoS One. 2016 Apr 29;11(4):e0154558 

Date Added: 09/05/16
What is Liver QuEST?
News Type: BASL News

What is Liver QuEST?

Liver QuEST is a project that aims to improve the care of patients with liver disease. The ultimate aim is to provide an improvement and accreditation scheme for all liver services in the United Kingdom that will improve the care for patients with liver disease.

It asks services to improve themselves against 6 core standards (include hyperlink to standards):

1 Leadership and Organisation
2 Service Planning and Definition
3 Safety
4 Clinical Effectiveness
5 Person Centred Care
6 Staffing a Clinical Service

Services undergo self-assessment followed by peer review visits during the improvement process. The team conducting these visits include a patient, doctor, nurse and a quality assurance specialist. Ultimately the aim is for liver services to be accredited against these standards.

The project is funded by the Royal College of Physicians of London and has the backing of the patient groups, the British Society of Gastroenterology, The British Association for the Study of the Liver and the Lancet Commission.

A number of services are involved in the project and so far have visited 6 sites in the pilot stage. Two key themes emerged from the visits. Firstly most services were poor at demonstrating what services they provided and how to access them via the internet. Secondly units struggled to measure key performance indicators linked to the recently published cirrhosis care bundle, click here to view. 

Key performance indicators:

Antibiotic prescription in acute variceal bleeding 24 hrs either side of the procedure
Ascitic tap in emergency admissions with ascites (within 12 hours).
Albumin and Antibiotic prescription in patients diagnosed with SBP within 12 hours of diagnosis.
% of acute admissions with decompensated liver disease seen by a gastroenterologist/Hepatologist within 24 hours of admission.

A recent national meeting reviewed the project’s progress so far and was a great success. The plan is to roll the project out to more sites and utilise regional networks to promote Liver QuEST. The ultimate aim is to provide an improvement and accreditation scheme for all liver services in the United Kingdom that will improve the care for patients with liver disease.

Date Added: 06/05/16
Hepatitis C Coalition Quarterly Newsletter
News Type: BASL News

Click here to read the first edition of the Hepatitis C Coalition's quarterly newsletter, which provides a concise summary of developments in hepatitis C. Updates will be included from the Coalition’s diverse membership, which includes patient organisations, professional bodies, clinicians, industry and other interested parties.The newsletter provides a concise summary of news and policy developments in hepatitis C. 

Date Added: 06/05/16
AHA statement - Drink drive bill completes passage through the House of Lords
News Type: BASL News

DRINK DRIVE BILL COMPLETES PASSAGE THROUGH THE HOUSE OF LORDS

Members of the House of Lords today passed a bill which would reduce the drink driving limit and save up to 100 lives a year – but it is unlikely to become law in the near future despite being supported by over 70% of the general public.

The Alcohol Health Alliance welcomed the vote to progress Lord Brooke’s drink driving bill beyond third reading. The vote means that the bill, which would amend the Road Traffic Act to lower the legal drink drive limit from 80mg alcohol per 100ml blood to 50mg/100ml, has now successfully completed all stages in the House of Lords.

Unfortunately, with little time remaining before the end of the Parliamentary term, there will not now be a chance for the bill to be considered on the floor of the House of Commons.

Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, said:
'We thank Lord Brooke for sponsoring this bill and for seeing its passage safely through the House of Lords. It is disappointing that there is no Parliamentary time for this bill to progress any further, but by championing this bill and making the evidence-based case for this change in the law, Lord Brooke has raised some very important issues, not least the fact that a reduction in the limit would save lives and prevent needless injury. We call on the government to now legislate to lower the drink drive limit'.

Lord Brooke or Alverthorpe, who won the Parliamentarian of the Month award in February by road safety charity Brake and Direct Line Group for his work on the bill, said:
'I welcome the support received from my Parliamentary colleagues in the Lords for this bill. Lowering the drink drive limit is consistently supported by the public, along with road traffic bodies, medical royal colleges and the emergency services, and all the evidence demonstrates that where the legal limit is lowered, deaths and casualties go down.

The only other country in Europe to have a drink drive limit as high as England and Wales is Malta, with every other European country setting the limit at 50mg or below. When Scotland lowered the limit, within the first nine months drink driving offences went down 12%, and Northern Ireland has just legislated to lower the limit. It can now only be a matter of time before the government takes notice of the evidence and levels of support for a lower legal limit, and legislates to lower the limit in England and Wales'.

About the Alcohol Health Alliance (AHA) - the AHA is a group of more than 40 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:

· Highlight the rising levels of alcohol-related health harm
· Propose evidence-based solutions to reduce this harm
· Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 03/05/16
HCV/HIV co-infection increases transplant waiting list mortality
News Type: Clinical News

HCV/HIV co-infection is a factor in mortality prior to liver transplantation and is associated with higher mortality on the waiting list, new evidence shows.

In a study at University Hospital Lozano Blesa, Zaragoza, Spain, among 199 patients with HCV enrolled for liver transplants between 1998 and 2015, 17 were also infected with HIV.

The patients with HCV/HIV co-infection had higher mortality on the waiting list than those with HCV monoinfection (35.3% versus 4.6%). The intention-to-treat survival analysis (ITTA) at one, three and five years was 75%, 64%, and 57% for HCV monoinfection and 52%, 47%, and 39% for HCV/HIV co-infection, respectively. The ITTA at one, three, six and 12 months was 96%, 91%, 87%, and 75% for HCV monoinfection and 76%, 70%, 64%, and 52% for HCV/HIV co-infection, respectively.

A Cox regression analysis was carried out including all variables with predictive value in the univariate analysis, showing that only donor age > 70 years (hazard ratio 3.12), UNOS 1 status (hazard ratio 10.1), MELD (hazard ratio 1.13), and HIV co-infection (hazard ratio 2.65) had independent negative predictive value for survival.

Reference

Intention-to-treat survival analysis of HCV/HIV co-infected liver transplant: Is it the waiting list? Araiz JJ, Serrano MT, García-Gil FA et al. Liver Transpl. 2016 Apr 26 [Epub ahead of print]

Date Added: 03/05/16
Prednisone/azathioprine effective in paediatric autoimmune hepatitis
News Type: Clinical News

In a new study, prednisone and azathioprine produced biochemical remission and significantly improved the prognosis of most children with autoimmune hepatitis (AIH), although there were significant side effects.

This was a retrospective analysis of the medical records of 15 patients with AIH, diagnosed before 18 years of age, treated in the Provincial Infectious Diseases Hospital in Bydgoszcz, Poland, between 2002 and 2013.

Biochemical remission of the disease was achieved on average after 36 days of treatment. Histopathological regression in the control liver biopsy was found in seven patients and progression in two patients.

Ten of the 15 patients experienced exacerbation of the disease from one to three times during observation, with an increase of ALT activity to greater than three norm, and the remaining five patients had no increase of ALT activity. In total, 10 patients in the study group experienced 17 exacerbations. In 13 cases of exacerbations, these were associated with a reduction in the dose of immunosuppressive drugs. There was no correlation between the biochemical exacerbation and changes in the histopathological image. Steroidside effects occurred in 14 patients.

The researchers suggest the significant side effects of treatment indicate the need for further exploration of effective and safe therapy, especially in the paediatric population.

Reference

Evaluation of the effectiveness of treatment with prednisone and azathioprine of autoimmune hepatitis in children. Pniewska A, Sobolewska-Pilarczyk M, Pawłowska M. Prz Gastroenterol. 2016;11(1):18-23 

Date Added: 03/05/16
Growth impairment warning for children treated with PEG/INF/R
News Type: Clinical News

Impairment of growth should be considered as part of the risk-benefit profile of peg-interferon/ribavirin therapy in children with HCV, say researchers.

In a global open-label study, the team assessed the five-year follow-up of 107 children and adolescents with HCV who received peg-interferon and ribavirin for 24 or 48 weeks. Ninety-four patients were enrolled in the long-term follow-up part of the study and the median duration of follow-up was 287 weeks.

Of 63 with sustained virologic response enrolled on the study, 54 completed five years of follow-up and none relapsed in this time. Significant decreases in height Z scores were observed during treatment. The impact of treatment on height Z score was larger in patients treated for 48 weeks compared with those treated for 24 weeks (mean change from baseline to the end of treatment was -0.13 and -0.44 in the 24-week and 48-week treatment groups, respectively).

Among patients treated for 24 weeks, full recovery of height Z scores to baseline was observed by year one of follow-up, whereas only partial recovery was observed during five years of follow up in patients treated for 48 weeks (mean change from baseline to the final follow-up visit was -0.16 and -0.32 in the 24-week and 48-week treatment groups, respectively). Similar patterns were observed for weight and body mass index Z scores.

The researchers concluded that considerations should include both deferring treatment in patients during optimal growth periods, and the possibility of interferon-free regimens being available to children in the next five to 10 years. 

Reference

Long-term follow-up of children treated with peginterferon and ribavirin for Hepatitis C virus infection. Haber B, Alonso E, Pedreira A et al. J Pediatr Gastroenterol Nutr. 2016 Apr 21 [Epub ahead of print]

 

Date Added: 25/04/16
Patients with autoimmune hepatitis may be at risk of diabetes
News Type: Clinical News

A new study suggests that many people with autoimmune hepatitis (AIH) may be at risk of diabetes mellitus (DM).

Researchers retrospectively analyzed 118 Japanese patients diagnosed with AIH from 1990 to 2014 at Nihon University School of Medicine. The prognosis of patients with and without DM was also compared.

Twenty-nine patients had DM and 21 received corticosteroids. The annual cumulative incidence rate of newly diagnosed DM was 1.2%. Multivariate analysis showed that DM occurred in older patients (odds ratio 6.290) and  with higher serum immunoglobulin G levels (odds ratio 12.400).

A Cox hazard regression analysis revealed that predictive factors for DM were absence of other autoimmune diseases (odds ratio 0.171), use of corticosteroids (odds ratio 6.693) and lower platelet counts (odds ratio 1.873).

The 10-year survival rates of the DM and non-DM groups were 94.1% and 94.6%, respectively. There was no significant difference between these groups.

Reference

Prevalence and risk factors of diabetes mellitus in patients with autoimmune hepatitis. Matsumoto N, Ogawa M, Matsuoka S et al. Intern Med. 2016;55(8):879-85 

Date Added: 25/04/16
Obesity epidemic linked to more childhood NAFLD
News Type: Clinical News

As a probable result of obesity, non-alcoholic fatty liver disease (NAFLD)  is the most common form of chronic liver disease seen in children today, say US reviewers.

The reviewers, from Alfred I duPont Hospital for Children, Wilmington and the Thomas Jefferson University, write that childhood obesity has reached epidemic proportions, and by 2012, more than one third of American children were overweight or obese. As a result, increasingly children are developing complications of obesity including liver disease. In fact, NAFLD disease is the most common form of chronic liver disease seen in children today.

Recently, there has been a burgeoning literature examining the pathogenesis, genetic markers, and role of the microbiome in this disease.

On the clinical front, new modalities of diagnosing hepatic steatosis and hepatic fibrosis are being developed to provide non-invasive methods of surveillance in children. Lastly, the mainstay of treatment of paediatric NAFLD has been largely through lifestyle interventions, namely, dieting and exercise. Currently, there are a number of clinical trials examining novel lifestyle and drug therapies for NAFLD that are registered with the US National Institutes of Health ClinicalTrials.gov website.

Reference 

Paediatric non-alcoholic fatty liver disease. Uppal V, Mansoor S, Furuya KN.Curr Gastroenterol Rep. 2016 May;18(5):24

Date Added: 25/04/16
Telbivudine versus entecavir in HBV patients receiving chemotherapy
News Type: Clinical News

In chronic HBV patients receiving cytotoxic chemotherapy, telbivudine (LdT) showed lower clinical efficacy in viral suppression than entecavir (ETV) but was associated with greater extent of improvement in liver and renal functions, a new study found.

A total of 290 treatment-naïve chronic HBV patients undergoing intense chemotherapy at Tuen Mun Hospital, Hong Kong received daily 600 mg of LdT or 0.5 mg of ETV as pre-emptive antiviral chemoprophylaxis.

The ETV group had significantly higher proportion of patients with undetectable HBV DNA load compared to LdTat week 24 (72.99% compared to 50.33%). The cumulative rates of virological breakthrough in the LdT and ETV groups were 9.15% and 3.65% at the second year, respectively; this was associated with undetectable HBV DNA at week 24.

Compared with the ETV group, Model for End-stage Liver Disease score (year one: 4.53 versus 7.53) and estimated glomerular filtration rates (eGFRs) (year one: 118.17 versus 91.79 mL/min; year two: 111.14 versus 76.45 ml/min) in the LdT group were significantly improved from baseline after the first year. Moreover, a significant number of patients with impaired renal function had improved eGFRs after LdT than ETV treatment (32.68% versus 8.76%).

Reference

Comparison of clinical efficacy and renal safety of telbivudine and entecavir in chronic hepatitis B patients receiving cytotoxic chemotherapy. Law ST, Lee MK, Lee AS et al. J Dig Dis. 2016 Apr 16 [Epub ahead of print]

Date Added: 25/04/16
Metabolic disorders biggest risk for hepatocellular carcinoma
News Type: Clinical News

Metabolic disorders appear to be the biggest risk factors for hepatocellular carcinoma (HCC) and have increased in the last decade, new US evidence suggests.

Researchers at the National Cancer Institute, Bethesda, used data from the Surveillance, Epidemiology, and End Results-Medicare linkage to calculate population attributable fractions (PAFs) for each risk factor over time. A total of 10, 708 patients with HCC who were diagnosed between 2000 and 2011 were compared with 332,107 cancer-free controls residing in the Surveillance, Epidemiology, and End Results areas.

Overall, the PAF was greatest for metabolic disorders (32%), followed by HCV (20.5%), alcohol (13.4%), smoking (9%), HBV (4.3%), and genetic disorders (1.5%). The PAF for all factors combined was 59.5%. PAFs differed by race/ethnicity and sex. Metabolic disorders had the largest PAF among Hispanics (PAF, 39.3%) and whites (PAF, 34.8%), whereas HCV had the largest PAF among blacks (PAF, 36.1%) and Asians (PAF, 29.7%).

Between 2000 and 2011, the PAF of metabolic disorders increased from 25.8% to 36%. In contrast, the PAFs of alcohol-related disorders and HCV remained stable. 

Reference

Population attributable fractions of risk factors for hepatocellular carcinoma in the United States. Makarova-Rusher OV, Altekruse SF, McNeel TS et al. Cancer.

Date Added: 22/04/16
The Institute of Alcohol Studies Budget 2016 Analysis
News Type: BASL News


The Institute of Alcohol Studies has put together a briefing that summarises the decisions taken on alcohol in this year's Budget, and evaluates their likely impact. It also sets these policies in the context of recent history- following four years of real term cuts to duty: cheaper alcohol, lower Treasury revenues, increased illness and death, and no demonstrable benefits for pubs or exports.

To download the briefing please click here:  Download IAS Budget 2016 Analysis.pdf

Date Added: 18/04/16
Smoking plus HCV may affect the atherosclerotic process
News Type: Clinical News

A study from the University of Athens suggests a potentially synergistic effect of smoking and chronic HCV on the atherosclerotic process.

Researchers evaluated platelet microparticle (PMP) levels before and after treatment with pegylated-interferon-alfa and ribavirin in 28 chronic HCV  patients compared with 20 non-alcoholic fatty liver disease (NAFLD) patients and 20 healthy volunteers.

Twenty-four of the HCV patients achieved sustained virological response (SVR). PMP levels were determined at baseline in HCV and NAFLD patients, and the volunteers, at end-of-treatment (EOT) and 24 weeks post-treatment (SVR24) in the HCV patients.

PMP levels at baseline were higher in the HCV than in the NAFLD patients and volunteers. Higher PMPs at baseline were observed in smokers than non-smokers with HCV. Among smokers from all groups, PMPs at baseline were higher in the HCV than the NAFLD patients or volunteers. 

In the HCV patients, PMPs declined from baseline to both EOT and SVR24. Only HCV patients with SVR had a significant decline in PMPs from baseline to SVR24. PMPs at ΕΟΤ and SVR24 in all HCV patients were similar to PMPs in NAFLD patients and volunteers.

The researchers concluded that PMP levels are increased in HCV patients, particularly smokers, which further supports the atherosclerotic potential of HCV and suggests a potentially synergistic effect of smoking and HCV on the atherosclerotic process. Since PMP levels in HCV patients with SVR were similar to NAFLD patients and volunteers, the atherosclerotic potential of HCV seems to be abolished by effective antiviral treatment.


Reference

The significance of platelet microparticles in patients with chronic hepatitis C and their association with antiviral treatment and smoking. Kanellopoulou T, Alexopoulou A, Kontopidou FN et al. Ann Gastroenterol. 2016 Apr-Jun;29(2):201-7

Date Added: 18/04/16
High survival rates in IFN-treated HCV cirrhosis patients with SVR
News Type: Clinical News

A study found that patients with compensated HCV cirrhosis who achieved a sustained virologic response (SVR) when treated with interferon (IFN) had a survival rate similar to the general population.

Researchers studied surveillance data from three cohorts of Italian patients with compensated HCV cirrhosis who achieved SVR on an IFN-based regimen, compared to simultaneously observed non-SVR, untreated and decompensated patients. Overall survival was calculated from the date of start of IFN to death. 

Overall, 28 of 181 patients followed-up for a median period of 9.6 years died. The 10 and 20-year overall survival rates for the whole series were 90.9% and 62.9%, respectively. The number of expected deaths in the corresponding age and sex matched general population was 28.1, corresponding to a standardized mortality ratio (SMR) of 1.00, with an SMR for non-SVR patients of 3.85, for untreated of 3.01 and for decompensated of 6.70.

Reference

Survival of patients with HCV cirrhosis and sustained virologic response is similar to the general population. Bruno S, Di Marco V, Lavarone M et al. J Hepatol. 2016 Mar 23 [Epub ahead of print]

 

Date Added: 18/04/16
Does arsenic in drinking water increase risk of hepatitis or cirrhosis?
News Type: Clinical News

A study in Taiwan found that high concentrations of arsenic in drinking water significantly increased the risk of hepatitis or cirrhosis in people without chronic viral hepatitis. However, the study also found that, in people with chronic viral hepatitis, lower levels significantly reduced the risk.

Researchers examined associations between exposure of arsenic in drinking water and risk of hepatitis and cirrhosis, and the interaction with chronic viral hepatitis, in 4,387 people living in the Lanyang Basin of northeastern Taiwan, where well water has an arsenic content that ranges from undetectable to 3590 μg/L.

The prevalence odds ratios in the overall study population for chronic hepatitis or cirrhosis for well water arsenic concentrations of =10 μg/L were 1.00 (reference), 0.93 for 10.1-49.9 μg/L, 1.24 for 50.0-99.9 μg/L, 0.98 for 100.0-299.9 and 1.86 for =300.0 μg/L.

Increasing levels of arsenic in drinking water were associated with increasing prevalence of chronic hepatitis or cirrhosis in residents who were seronegative for HBsAg and seronegative for anti-HCV, but not for seropositive for either HBsAg or anti-HCV.

In individuals who were seropositive for HBsAg or anti-HCV, there was an inverse association between hepatitis or cirrhosis and consumption of water with levels of arsenic =100.0μg/L. Among participants who were seropositive for HBsAg or anti-HCV, consumption of water with levels of arsenic =100.0 μg/L was associated with a reduced risk of liver cancer (multivariate-adjusted hazard ratio, 0.29). A higher proportion of individuals exposed to cumulative arsenic level >14,000μg/L× year were carriers of inactive HBV and were positive for HBsAg (60%) than individuals exposed to water below this arsenic level (35%).

 

Reference

Effects of arsenic in drinking water on risk of hepatitis or cirrhosis in persons with and without chronic viral hepatitis. Hsu LI, Wang YH, Hsieh FI et al. Clin Gastroenterol Hepatol. 2016 Apr 6 [Epub ahead of print]

 

Date Added: 15/04/16
Funding opportunities that are available from Cancer Research UK
News Type: BASL News

Cancer Research UK has a range of funding opportunities for fellowship and bursary schemes, please find below the upcoming deadlines and schemes that are available: 

Clinical Science Fellowship - offers excellent clinicians the opportunity to develop a research career through a period of postdoctoral training, including research abroad, over a period of 5 years. Next deadline: 23 May 2016.
For more information click here.

Advanced Clinician Scientist Fellowship - allows clinicians to establish an independent research group alongside their clinical practice, over a period of 5 years. Next deadline: 23 May 2016.
For more information click here.

Pre-doctoral Research Bursaries - provide short-term funding to allow clinicians and other health professionals to get involved in research projects early in their career. Next deadline: 6 September 2016.
For more information click here.

Postdoctoral Research Bursaries for Clinical Trainees - offer funding for clinical trainees to undertake a research project after completion of a PhD, during completion of their clinical specialty training. Next deadline: 6 September 2016.
For more information click here.

Date Added: 15/04/16
NICE guideline CG100 Alcohol-use disorders: diagnosis and management of physical complications
News Type: BASL News

NICE have conducted an exceptional surveillance review of corticosteroid treatment for alcohol-related hepatitis to consider the impact of the NIHR funded STOPAH trial on the recommendations for corticosteroid treatment.

After considering the new evidence on the safety and efficacy of corticosteroids for people with acute alcohol-related hepatitis and consulting with experts, NICE has decided to update this guideline.

Information about the decision has been published on the NICE website, click here to view.

Date Added: 11/04/16
No link between smoking and liver disease in HIV/HCV coinfection
News Type: Clinical News

A new study suggests tobacco smoking is not associated with accelerated progression of liver disease in HIV-HCV co-infected individuals.

This is despite it being shown to be an independent risk factor for liver fibrosis in people with HCV.

The study population consisted of participants from the Canadian Co-infection Cohort multi-centre study of HIV/HCV co-infected individuals from 2003 to 2014. Data were analyzed for all participants who did not have significant fibrosis or end-stage liver disease (ESLD) at baseline. Of 1,072 participants, 978 had never smoked, 817 were current smokers, and 161 were previous smokers.

Tobacco exposure was not associated with accelerated progression to significant liver fibrosis nor with ESLD when comparing ever versus never smokers (odds ratios 1.06 and 1.20, respectively) or increases in pack-years smoked (odds ratios 1.05 and 0.94, respectively).

However, the study found that both time-updated alcohol use in the previous six months and presence of detectable HCV ribonucleic acid were associated with aspartate-to-platelet ratio index (APRI) score =1.5.

Reference

Tobacco smoking is not associated with accelerated liver disease in human immunodeficiency virus-hepatitis C coinfection: a longitudinal cohort analysis. Costiniuk CT, Brunet L, Rollet-Kurhajec KC et al. Open Forum Infect Dis. 2016 Mar 7;3(2):ofw050 .

 

Date Added: 11/04/16
HRQoL in Asians with hepatocellular carcinoma
News Type: Clinical News

Asians with hepatocellular carcinoma (HCC) appear to have a better health-related quality of life (HRQoL) than Europeans with the same condition, new evidence suggests. 

In a multinational study, 227 patients with HCC from Asian and European countries completed the EORTC QLQ-C30 and the EORTC QLQ-HCC18 questionnaires.

After adjusting for demographic and clinical characteristics, Asian patients still had significantly better HRQoL scores in emotional functioning, insomnia, (QLQ-C30) and in sexual interest (QLQ-HCC18). Researchers also found an interaction in physical functioning (QLQ-C30) and fatigue (QLQ-HCC18) between geographic region and marital status; married Europeans having worse HRQoL scores than Asian singles.

 

The researchers suggest cultural differences, as well as clinical differences in the pattern of disease owing to active surveillance of Asian countries may explain the results.

 

Reference

Differences in health-related quality of life between European and Asian patients with hepatocellular carcinoma. Chie WC, Blazeby JM, Hsiao CF et al. Asia Pac J Clin Oncol. 2016 Apr 1 [Epub ahead of print]

 

Date Added: 11/04/16
NAFLD becoming global principal cause of chronic liver disease
News Type: Clinical News

Non-alcoholic fatty liver disease (NAFLD) is becoming the principal cause of chronic liver disease across the world and disproportionately affects different ethnic groups in the USA.

That’s according to a literature review of NAFLD and its subtype non-alcoholic steatohepatitis (NASH) from Howard University, Washington, DC.

It also found that, in the US, Hispanics are the most disproportionately affected ethnic group with hepatic steatosis, and elevated aminotransferase levels, whereas African-Americans are the least affected.

Genetic disparities involved in lipid metabolism seem to be the leading explanation for the lowest incidence and prevalence of both NAFLD and NASH in African-Americans.

The reviewers suggest this unprecedented rise requires an initiation of population cohort studies with long-term follow-up to determine the incidence and natural history of NAFLD and it’s under representation in African-Americans. Future studies should also focus on the delineation of the interplay between genetic and environmental factors that trigger the development of NAFLD and NASH.

Reference

Global epidemiology of nonalcoholic fatty liver disease and perspectives on US minority populations. Sherif ZA, Saeed A, Ghavimi S et al. Dig Dis Sci. 2016 Apr 1. [Epub ahead of print]

Date Added: 04/04/16
Benefits of sofosbuvir-based combinations in HCV
News Type: Clinical News

In a study at the Cleveland Clinic (1) the combination of sofosbuvir (SOF) and simeprevir (SIM) without riba virin (R) was well tolerated and resulted in high virological response rates in recurrent HCV GT1 infection after liver transplantation (LT).

Sixty-seven patients with HCV GT1 have received SOF+SIM following LT to date: 39% with HCV RNA >6,000,000 IU/mL, 22% with advanced hepatic fibrosis (stage 3-4), 6% with homeostatic recurrence and 58% had previously failed or did not tolerate interferon-based treatments. Mean time from LT to treatment was 6.1 years. All patients had estimated GFR >30 mL/min. Tacrolimus was primary immunosuppression in 84% of patients and minimal immunosuppression dose adjustments were required during treatment. 

In intention to treat analysis, 90% achieved end of treatment virologic response and 88% achieved sustained virologic response.

And in a review from the Université Paris Descartes (2), authors wrote that results from clinical studies as well as preliminary real-life data regarding the combination of SOF (a nucleotide polymerase inhibitor) and daclatasvir, a first-in-class NS5A replication complex inhibitor, demonstrate that it is one of the most promising antiviral therapies for HCV, with once-daily oral dosing, a low pill burden, good tolerability, and limited drug-drug interactions, in addition to high antiviral potency, with over 90% sustained virologic response rates. 

This combination has high pangenotypic antiviral potency regardless of the severity and patient characteristics. The combination of SOF and an NS5A inhibitor with R for 12 weeks appears to be a very good further treatment option in both cirrhotic and treatment-experienced patients whatever the stage of fibrosis.


References

Sofosbuvir and simeprevir without ribavirin effectively treat Hepatitis C Virus Genotype 1 infection after liver transplantation in a two-center experience. Jackson WE, Hanouneh M, Apfel T et al.Clin Transplant. 2016 Mar 28 [Epub ahead of print]

Daclatasvir-sofosbuvir combination therapy with or without ribavirin for hepatitis C virus infection: from the clinical trials to real life. Pol S, Corouge M, Vallet-Pichard A. Hepat Med. 2016 Mar 4;8:21-26.

Date Added: 04/04/16
High-fat, high-fructose diet may increase risk of NAFLD
News Type: Clinical News

New animal research suggests that a high-fat, high-fructose diet may increase the risk and progression of nonalcoholic fatty liver disease (NAFLD).

In a study at Khon Kaen University, Thailand, the effects of a high-fat, high-fructose diet (HFFD) on mRNA levels and activities of the antioxidant enzymes, including superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), were determined in mouse livers and brains. 

Histopathology of the liver showed that fat accumulation and inflammation depended on the period of the HFFD-consumption. The levels of mRNA and enzymatic activities of SOD, CAT, and GPx were raised, followed by the increases in malondialdehyde levels in livers and brains of the HFFD mice. The oxidized GSSG content was increased while the total GSH and the reduced GSH were decreased, resulting in the increase in the GSH/GSSG ratio in both livers and brains of the HFFD mice. 


Reference

A high-fat, high-fructose diet induces antioxidant imbalance and increases the risk and progression of nonalcoholic fatty liver disease in mice. Jarukamjorn K, Jearapong N, Pimson C et al. Scientifica (Cairo) ;2016:5029414

Date Added: 04/04/16
Sequential ETV/PEG-IFN “promising” in HBV
News Type: Clinical News

Researchers claimed “promising results” using a sequential combined therapy with entecavir (ETV) and pegylated interferon (PEG-IFN) in young patients with active chronic HBV. 

In a study at the University of Turin, 39 patients with different HBV genotypes, HBeAg-positive/negative received a sequential therapy with ETV 0.5 mg/day monotherapy for 12 weeks followed by combination of ETV and PEG-IFN α-2a 180µg/week for 12 weeks, then PEG-IFN monotherapy for 36 weeks. 

HBeAg seroconversion rate was 68.2%; HBsAg loss was 33.3%; sustained virological response was 64.1%; primary non-response was observed in eight patients after 12 weeks of PEG-IFN therapy; virological relapse was reported in six patients.  Viral genotype and HBsAg decline were the most important predictive factor for PEG-IFN response. 

The researchers commented that the stopping rule after 12 weeks of PEG-IFN therapy was useful for identify the non-responders. They added that their results should not be generalized, as further investigations were required for the confirmation of this combination approach. 


Reference

Sequential therapy with entecavir and pegylated interferon in a cohort of young patients affected by chronic hepatitis B. Boglione L, Cariti G, Di Perri G et al. J Med Virol. 2016 Mar 27 [Epub ahead of print]

Date Added: 01/04/16
Clinical Research Fellow in Hepatology – 2 Posts - Derriford Hospital, Plymouth
News Type: BASL News

Applications are invited for two Clinical Research Fellows in Hepatology posts. 

Location: South West Liver Unit, Derriford Hospital and Plymouth University Peninsula Schools of Medicine & Dentistry

Job Reference: 216-9367-CFHE

Closing Date: 1st May 2016

Further details can be found on the NHS Jobs Website www.jobs.nhs.uk  or by clicking here. 

Should you require more information, please contact Prof Matthew Cramp, Lead Consultant Hepatologist on telephone 01752 432722 or email matthew.cramp@nhs.net

Date Added: 30/03/16
RCGP Clinical Champion for Liver Disease Post - closing date 3rd April 2016
News Type: BASL News

The British Liver Trust has been successful in its application to the RCGP to make liver disease a clinical priority for the next three years. This means that the RCGP and the British Liver Trust will work in partnership to:

• Improve the number of patients who are a) detected with liver disease at early stage and b) receiving appropriate treatment to potentially reverse some if not all of the damage and prevent more serious illness
• Raise awareness of the key risk factors for the 90% of preventable liver disease
• Develop and encourage the use of clear early identification, management and treatment pathways and common GP systems for viral hepatitis, non-alcohol related fatty liver disease and alcohol related liver disease (taking into account forthcoming NICE and BSG guidance) to prevent unnecessary hospital referral
• Disseminate clear guidelines, toolkits, resources and learning materials to GPs and provide e learning and workshops
• Review current GP curricula and make appropriate revisions

The initial goal is to appoint a clinical champion who will be responsible for clinical leadership of the project and to scope what is currently available, conduct a baseline ‘knowledge and attitude survey’ and develop appropriate impact measurement approaches for the three year project, identify key partners/stakeholders and then develop a detailed work plan and marketing, communication and engagement plan with clear deliverables/timeline etc.

The call for applications for this crucial role of RCGP Clinical Champion Liver Disease post is now open – with a tight closing date of 3rd April.

To find out more and to apply click here.

Although the advert says funding will be for only 2 sessions a month, the British Liver Trust believes they will secure funding for 4 sessions a month. They have also developed a good network of GPs to support the person who takes it on – hopefully that means the work can be shared out and not fall onto one lap only.

Date Added: 30/03/16
New BASL Treasurer - September 2016
News Type: BASL News

On behalf of all BASL members I would like to welcome Dr James Ferguson who will take on the role of Treasurer from September 2016 after the annual meeting in Manchester. This is a challenging post and one that needs the strong personal commitment that I know James will provide.

He has a hard act to follow. Prof Matthew Cramp has been an exemplary BASL Treasurer for over 5 years and while welcoming James to his new post I would be remiss in not thanking Matthew on behalf of BASL and the BASL secretariat for his wholehearted commitment.

BASL President, Prof Graeme Alexander

Date Added: 29/03/16
ACCEA 2016 Round Open
News Type: BASL News

Advisory Committee on Clinical Excellence Awards (ACCEA) opened the 2016 awards round on Friday 11th March. The final closing date for applications to the ACCEA is 17:00 on Monday 16th May 2016. 

Application for BASL support
BASL will need to complete the process of selecting applicants who will receive our support shortly. If you would like to apply for BASL support please complete and submit Application Form A to BASL along with any other supplementary CVQs available as detailed below:

Form A – Application Form
Form D – Supplementary CV Questionnaire: Research & Innovation Assessment
Form E – Supplementary CV Questionnaire: Teaching & Training Assessment
Form F – Supplementary CV Questionnaire: Leadership & Management Assessment

A short piece as to why you feel you should be supported is also required.

The deadline for applying for BASL support is 09:00 on Monday 18th April 2016

All applications have to go through the ACCEA on line system, however downloadable forms to send to BASL can be found on the ACCEA website by clicking here. 

Please be aware that there is a maximum number of supplementary forms that can be completed at each National Level: Bronze and Silver applicants: 1 and Gold applicants: 2. These forms are optional and it is for the applicant to decide whether using them will increase chances of success.

(For use of the Supplementary Forms, please see 'Domains' within the Application form A). Full application guidance can be found on the ACCEA website by clicking here

Eligibility
As in previous years BASL would be able to support colleagues directly by nomination for national Gold, Silver and Bronze awards. As a specialist society, BASL cannot make nominations for Platinum awards; this must be done through the applicant’s University/Research Body and Universities UK. BASL can however provide a citation to support an application for a Platinum award.

As a rule, candidates for National Bronze (Level 9) should have a minimum of at least five local Clinical Excellence Awards. Award holders applying for higher level awards or a renewal must specify which achievements have been made after the date of their last award or renewal particularly concentrating on current activities and activities in the last 4 or 5 years, therefore you must date activities.

To apply for BASL support, please follow these steps:
1. Send a completed application form along with a short piece as to why you feel you should be supported to the BASL Secretariat (Judith@execbs.com) by 09:00 on Monday 18th April 2016 for review. Please understand that in fairness to all applicants, late submissions will not be considered.
2. All applicants will be asked to provide the name of an individual who could write a supporting citation upon submitting their application to BASL. ACCEA regard the citations provided in support of individuals as giving added value to the process.
3. You must submit your own application to ACCEA online by their deadline Monday 16th May 2016, 17:00. This is your own responsibility.
4. If you are in receipt of BASL support then BASL will upload your citation - please can you ensure your application is uploaded at least one week before the ACCEA deadline - before 09:00 on Monday 9th May 2016, so that we have sufficient time to upload your citations onto your application on the ACCEA website.

Date Added: 29/03/16
High prevalence of hepatitis in African immigrants
News Type: Clinical News

The high prevalence of viral hepatitis, particularly HBV, in immigrants from Africa represents a challenge for healthcare systems.

The Spanish study highlighted that viral hepatitis is a significant health problem in African countries, from which there has been an increase in the immigrant population. 

Researchers at the Hospital de Poniente, El Ejido, studied 2,518 immigrant patients (87.7% Sub-Saharan natives), with a mean age of 31.3 years.

Some 78.8% of the patients had a positive infection marker for HBV, and 638 (25.3%) were diagnosed with active HBV. In 19 cases, antibodies against HDV were detected (four cases with detection of the viral genome). Sixty-eight patients had antibodies against HCV, 26 of whom had a positive viral load.

The researchers concluded this high prevalence of viral hepatitis represent a significant change in the profile of patients treated in Spain, and requires measures aimed at early diagnosis and transmission prevention.

Reference

Viral hepatitis and immigration: a challenge for the healthcare system. Cuenca-Gómez JA, Salas-Coronas J, Soriano-Pérez MJ et al. Rev Clin Esp. 2016 Mar 16 [Epub ahead of print]

 

Date Added: 29/03/16
Chloroquine has potential for HCV non-responders
News Type: Clinical News

A pilot study suggests chloroquine (CQ), an autophagy inhibitor used to treat malaria, may be a treatment option for HCV non-responders.

Researchers from Iran and the USA studied 10 patients with chronic HCV genotype 1 who were unresponsive to a combination of pegylated interferon alpha and ribavirin. They were randomized to CQ (150 mg daily for eight weeks) or placebo, and were followed for four weeks after CQ therapy. HCV RNA load and plasma alanine transaminase (ALT) levels were measured at baseline, week four (initial response), week eight (end-of-treatment response), and at the end of 12 weeks.

A significant decrease in HCV RNA after the treatments (week eight) was seen in all patients in the CQ group. However, HCV RNA levels increased within four weeks after discontinuation of CQ treatment although they were still lower than baseline. In addition, the ALT normalised during treatment in the CQ group. However, this response was also lost after treatment cessation.

Reference

New use of an old drug: chloroquine reduces viral and ALT levels in HCV non-responders (a randomized, triple-blind, placebo-controlled pilot trial). Peymani P, Yeganeh B, Sabour S et al. Can J Physiol Pharmacol. 2016 Jan 15:1-7 [Epub ahead of print]

 

Date Added: 29/03/16
Metabolic disorders biggest risk for hepatocellular carcinoma
News Type: Clinical News

Metabolic disorders appear to be the biggest risk factors for hepatocellular carcinoma (HCC) and have increased in the last decade, new US evidence suggests.

Researchers at the National Cancer Institute, Bethesda, used data from the Surveillance, Epidemiology, and End Results-Medicare linkage to calculate population attributable fractions (PAFs) for each risk factor over time. A total of 10, 708 patients with HCC who were diagnosed between 2000 and 2011 were compared with 332,107 cancer-free controls residing in the Surveillance, Epidemiology, and End Results areas.

Overall, the PAF was greatest for metabolic disorders (32%), followed by HCV (20.5%), alcohol (13.4%), smoking (9%), HBV (4.3%), and genetic disorders (1.5%). The PAF for all factors combined was 59.5%. PAFs differed by race/ethnicity and sex. Metabolic disorders had the largest PAF among Hispanics (PAF, 39.3%) and whites (PAF, 34.8%), whereas HCV had the largest PAF among black people (PAF, 36.1%) and Asians (PAF, 29.7%).

Between 2000 and 2011, the PAF of metabolic disorders increased from 25.8% to 36%. In contrast, the PAFs of alcohol-related disorders and HCV remained stable.

Reference

Population attributable fractions of risk factors for hepatocellular carcinoma in the United States. Makarova-Rusher OV, Altekruse SF, McNeel TS et al. Cancer. 2016 Mar 21 [Epub ahead of print]

Date Added: 22/03/16
High-dose atorvastatin increases risk of hepatotoxicity
News Type: Clinical News

A UK study suggests an increased risk of hepatotoxicity with high doses of the statin atorvastatin when compared to sim vastatin.

Researchers at the University of Glasgow used the UK General Practice Research Database (GPRD) to identify 164,407 patients with a first prescription for sim vastatin and 76,411 with atorvastatin between 1997 and 2006. None of the patients had a prior record of liver disease, alcohol-related diagnosis, or liver dysfunction.

Moderate to severe hepatotoxicity developed in 71 patients on atorvastatin versus 101 on simvastatin. Adjusted hazard ratio for all atorvastatin relative to simvastatin was 1.9.

High dose was classified as 40-80mg daily and low dose 10-20mg daily. Hepatotoxicity occurred in 0.44% of 4,075 patients on high dose atorvastatin [HDA], 0.07% of 72,336 on low dose atorvastatin [LDA], 0.09% of 44,675 on high dose simvastatin [HDS] and 0.05% of 119,732 on low dose simvastatin [LDS].

Adjusted hazard ratios compared to LDS were 7.3 for HDA, 1.4 for LDA and 1.5 for HDS.

Reference

High dose atorvastatin associated with increased risk of significant
hepatotoxicity in comparison to simvastatin in UK GPRD cohort. Clarke AT, Johnson PC, Hall GC et al. PLoS One. 2016 Mar 16;11(3):e0151587

Date Added: 22/03/16
Green tea component may have anti-HBV properties
News Type: Clinical News

New research suggests epigallocatechin-3-gallate (EGCG), a major component of green tea, could be an effective anti-HBV agent.

Using fluorescence quenching and affinity binding, researchers at Henan Agricultural University, Zengzhou, China, showed EGCG to be an important transcriptional regulator of the HBV genome. It achieves this by interacting with farnesoid X receptor alpha (FXRα).

Luciferase assay showed that EGCG effectively inhibited the transcription of the HBV promoter dose-dependently when expression plasmids of FXRα and retinoid X receptor α (RXRα) were co-transfected into HEK293 cells.

These results indicated the down-regulation of the HBV antigen and the decrease in the transcriptional activation of the HBV EnhII/core promoter by FXRα/RXRα are mainly because of the interaction between EGCG and FXRα. Therefore, say the researchers, EGCG, an antagonist of FXRα in liver cells, has the potential to be employed as an effective anti-HBV agent.

Reference

Epigallocatechin gallate inhibits hepatitis B virus via farnesoid X receptor alpha. Xu J, Gu W, Li C et al. J Nat Med. 2016 Mar 11. [Epub ahead of print]

Date Added: 22/03/16
Identifying and staging HCV and fibrosis with common electronic medical record systems
News Type: Clinical News

HCV infections can be identified and fibrosis staged using commonly available electronic medical record (EMR)-based algorithms.

So say researchers at the NorthShore University Health System, Portland, USA. The team performed a pilot study to identify all HCV-infected patients in a large healthcare system, and predict their fibrosis stage on the basis of demographic and laboratory data from their EMRs.

The liver biopsies of 191 HCV patients were graded using the Ishak and Metavir scoring systems. Demographic and laboratory data were extracted from the EMR and used to calculate the aminotransferase to platelet ratio index, Fib-4, Fibrosis Index, Forns, Göteborg University Cirrhosis Index, Lok Index and Vira-HepC.

In total, 869 HCV-infected patients were identified from a population of more than 1m. In the subgroup of patients with liver biopsies, all seven algorithms were significantly correlated with the fibrosis stage. The degree of correlation was moderate, with correlation coefficients ranging from 0.22 to 0.60.

For the detection of advanced fibrosis (Metavir three or four), the areas under the receiver operating characteristic cure ranged from 0.71 to 0.84, with no significant differences between the individual scores. Sensitivities, specificities, and positive and negative predictive values were within the previously reported range. All scores tended to perform better for higher fibrosis stages.

Reference

Identification and fibrosis staging of Hepatitis C patients using the electronic medical record system. Anand V, Hyun C, Khan QM et al. J Clin Gastroenterol. 2016 Mar 11. [Epub ahead of print]

 

Date Added: 22/03/16
Children's Liver Disease Foundation - PhD Student Fellowship 2016
News Type: BASL News

Applying for a Children’s Liver Disease Foundation (CLDF) PhD Student Fellowship 2016

***APPLICATIONS ARE NOW OPEN***

Visit the CLDF website to find out all of the information and to find out how to apply by clicking here.

The closing date for applications sent by email to info@childliverdisease.org is before 5.00pm on Tuesday 31st May 2016.

The latest date for acceptance of the hard copy of the application (containing original signatures from all parties) is 5.00pm on Tuesday 7th June 2016.
Applications should be sent to: Office Manager, CLDF PhD Student Fellowship Award, Children’s Liver Disease Foundation, 36 Great Charles Street, Birmingham B3 3JY.

Date Added: 16/03/16
Simple changes to Alcohol Policy could dramatically reduce EU death rates
News Type: BASL News

Alcohol Health Alliance Statement

New analysis published today in the Journal of Hepatology demonstrates that simple and cheap changes to alcohol policy at European Union level would, if implemented, dramatically reduce liver mortality across Europe.

In the World Health Organisation European Region, more than 2,370,000 years of life are lost from liver disease before the age of 50. Between 60–80% of these deaths are alcohol-related.

Yet the analysis published today explains that we already know exactly what to do to tackle this problem. The most effective and cost-effective measures have been summarised by the OECD and World Health Organisation, with the most effective and cost effective policy being increased alcohol taxation and the introduction of a minimum unit price for alcohol. These measures would reduce overall consumption of alcohol in the population, thereby reducing the number of cases of liver mortality.

Dr Nick Sheron, author of the analysis published today, and Professor and Head of Clinical Hepatology at the University of Southampton, and the Royal College of Physicians’ Representative for European Union Alcohol Policies, said:

'The link between alcohol consumption and liver mortality is clear cut, as is the evidence linking effective alcohol policy to liver mortality. Were the liver mortality in the worst member states to be brought down to the EU average 14,000 deaths could be prevented each year. Were liver mortality rates in the EU to be brought in line with the EU minimum then around 46,000 liver deaths would be prevented each year. The case for action on alcohol related harm could not possibly be clearer. The most effective and cost effective interventions actually raise money for hard pressed governments and are more likely to increase rather than decrease productivity'.

Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, said:

'This analysis is further evidence of the need for the European Union, and governments across Europe, to introduce measures that reduce alcohol consumption and the number of deaths from liver disease. The problem is the drinks industry – despite the evidence for the effectiveness of these policies, the drinks industry has thus far been able to lobby effectively to protect their market access and profits. If we are to reduce the cases of liver mortality in Europe, the health and social needs of Europe’s populations need to be put ahead of the interests of the drinks industry'.

 

The Alcohol Health Alliance UK (AHA) is a group of more than 40 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:

· Highlight the rising levels of alcohol-related health harm
· Propose evidence-based solutions to reduce this harm
· Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 14/03/16
Obesity a major risk factor for cirrhosis and advanced fibrosis
News Type: Clinical News

Obesity has been shown to be the major risk factor for cirrhosis and advanced fibrosis in young Hispanic males.

Researchers studied 2,466 participants in the community-based Cameron County Hispanic Cohort in South Texas. Aspartate transaminase to Platelet Ratio Index (APRI) was used to predict cirrhosis.

The prevalence of cirrhosis using APRI=2 was 0.94%, which is nearly four-fold higher than the national USA prevalence. Using APRI=1, the overall prevalence of cirrhosis/advanced fibrosis was 3.54%. In both analyses, the highest prevalence was in males, specifically in the 25-34 age group.

Risk factors independently associated with APRI=2 and APRI=1 included HCV, diabetes and central obesity with a remarkable population attributable fraction of 52.5% and 65.3% from central obesity, respectively.

Excess alcohol consumption was also independently associated with APRI=2. The presence of patatin-like phospholipase domain-containing-3 gene variants was independently associated with APRI=1 in participants over 50 years of age. 

Reference

Cirrhosis and advanced fibrosis in Hispanics in Texas: the dominant contribution of central obesity. Jiao J, Watt GP, Lee M et al. PLoS One. 2016 Mar 7;11(3):e0150978

 

 

Date Added: 14/03/16
Care for HBV mothers is inadequate following pregnancy
News Type: Clinical News

New evidence from the USA suggests HBV care for chronically infected mothers may be inadequate following pregnancy.

Researchers assessed the quality of HBV care in 243 HBsAg-positive mothers who had sought pre-natal care at Massachusetts General Hospital.

More than a third of the women were first diagnosed with HBV infection at a pre-natal visit, and one third did not undergo timely liver function test measurements. HBV DNA was never measured in 26% and was untimely in 34% of patients.

One were at high-risk for HCC based on American Association for the Study of Liver Diseases (AASLD) criteria, yet only 33% of these women underwent timely imaging. Nearly half never saw a liver specialist for their HBV care.

In multivariate analysis, women were 3.7 times more likely to have a timely ALT and 8.1 times more likely to have a timely HBV DNA if they were followed by a liver specialist.

The researchers say the HBV care was remarkably inadequate and discontinuous. They suggest that, as HBV infection is already being

identified pre-natally, quality improvement measures encompassing obstetricians, primary care providers and hepatologists are needed to ensure that HBV-infected women are linked to care post-pregnancy.

Reference

Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy. Rajbhandari R, Barton K, Juncadella AC et al. J Viral Hepat. 2016 Mar 4 [Epub ahead of print]

 

Date Added: 14/03/16
Daclatasvir/peginterferon-ribavirin most effective regimen in HCVg1
News Type: Clinical News

Daclatasvir plus peginterferon-ribavirin (PR) was the most effective direct-acting antiviral agent regimen in SVR12 and SVR24, but carried an increased adverse events profile in HCV genotype one.

Researchers at Wenzhou Medical University, China, conducting a literature review found 22 eligible randomised controlled trials. Compared with PR, daclatasvir plus PR (odds ratio 8.90), faldaprevir plus PR (odds ratio 3.72), simeprevir plus PR (odds ratio 3.59) and sofosbuvir plus PR (odds ratio 4.69) yielded a significant effect in improving SVR12. Consistently, simeprevir plus PR (odds ratio 3.49), sofosbuvir plus PR (odds ratio 4.51) and daclatasvir plus PR (odds ratio 4.77) also improved the rates of SVR24.

With respect to adverse events, compared with PR, ledipasvir plus sofosbuvir plus PR (odds ratio 2.13) conferred a significant advent event in nausea, whereas daclatasvir plus PR (odds ratio 0.20 and 0.18, respectively) lowered the incidence of fatigue and nausea significantly when compared with ledipasvir plus sofosbuvir plus PR. 

Reference

Systematic review and network meta-analysis of randomised controlled trials: comparative effectiveness and safety of direct-acting antiviral agents for treatment-naive Hepatitis C Genotype 1. Zhu GQ, Zou ZL, Zheng JN et al. Medicine (Baltimore). 2016 Mar;95(9):e3004

Date Added: 11/03/16
Alcohol Health Alliance and Road Safety Bodies Welcome Drink Drive Vote in the House of Lords
News Type: BASL News

Health and road safety campaign groups have welcomed a House of Lords vote which brings a lowering of the drink drive limit in England and Wales one step closer.

According to the Alcohol Health Alliance, the RAC and BRAKE, the road safety charity, the measure, should it be introduced, will improve road safety and save lives.

The purpose of the bill is to lower the drink drive limit in England and Wales from 80mg/100ml blood to 50mg/100ml blood, a measure which is supported by 77% of the general public, recent AHA polling has found. Every other country in Europe, with the exception of Malta, has a legal drink drive limit at 50mg/100ml blood or below. The change would bring the rest of the UK into line with Scotland. In the first nine months following the introduction of the new limit in Scotland, drink driving offences fell by 12.5%.

Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, said:
It is greatly encouraging that the House of Lords has progressed the bill to lower the legal drink drive limit today which would bring road safety standards in England and Wales in line with Scotland. This vote is in line with public opinion, and in step with the existing evidence that a lower drink drive limit prevents unnecessary deaths and injuries. We will continue to campaign to see this bill put onto the statute book as it progresses through Parliament, and we urge the House of Lords to support this bill at the next stage.

Gary Rae, campaigns director for Brake, the road safety charity, said
This is a great step forward by the Lords in the fight to make our roads safer. One in seven UK road deaths result from crashes where the driver was over the drink-drive limit and Brake sees the devastation this leaves behind, through our work supporting bereaved families. We would urge all MPs and Lords to now back the bill, which is supported by both the police and general public. Brake will continue to campaign for a zero drink driving limit, as our roads will not be as safe as they can be until that happens.

Nicholas Lyes, Public Affairs Manager for the RAC, said:
The RAC welcomes the progress Lord Brooke's Bill is making through the House of Lords. The RAC's Report on Motoring last year showed that a majority of motorists support a reduction in the legal drink drive limit. Studies have demonstrated that lowering the drink drive limit in line with the proposals outlined in the Bill could save lives and improve road safety, so we urge Peers and MPs across the House to get behind it.
Note to editors

The Alcohol Health Alliance UK (AHA) is a group of 45 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:
• Highlight the rising levels of alcohol-related health harm
• Propose evidence-based solutions to reduce this harm
• Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information contact Matt Chorley, Policy and Communications Officer for the Alcohol Health Alliance, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Date Added: 08/03/16
High global prevalence of HCV in people with HIV
News Type: Clinical News

There is a high global prevalence of HCV in all people with HIV, particularly those who inject drugs.

A global systematic review and meta-analysis carried out by an international team of researchers found 783 studies published between 2002 and 2015, resulting in 902 estimates of the prevalence of HIV/HCV co-infection.

The analysis showed co-infection was present in 2.4% of those with HIV within general population samples, 4.0% within pregnant or heterosexually exposed samples, 6.4% in men who have sex with men, and 82.4% in people who inject drugs.

The odds of HCV infection were six times higher in people living with HIV (5.8) than their HIV-negative counterparts.

Worldwide, there were 37million people infected with HIV and 115million people with antibodies to HCV. The study found approximately 2,278,400 HIV/HCV co-infections, of which 1,362,700 were in people who inject drugs, equalling an overall co-infection prevalence in HIV-infected individuals of 6.2%.

The research, which was funded by the World Health Organization, highlighted the importance of routine HCV testing in all HIV-infected individuals, but especially in people who inject drugs. It also identified a need to improve country-level surveillance of HCV prevalence across different population groups in all regions.

Reference

Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis. Platt L, Easterbrook P, Gower E et al. Lancet Infect Dis. 2016 Feb 24 [Epub ahead of print]

 

Date Added: 08/03/16
Success of a UK campaign in identifying new hepatitis cases
News Type: Clinical News

Offering routine blood-borne virus (BBV) screening in emergency departments (EDs) uncovered a high number of hepatitis, particularly HCV, infections.

 During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in Glasgow, Leeds, Leicester and London offered adults having blood taken as part of routine care HIV, HBV and HCV tests. The areas involved all have high HIV prevalence and patients who tested positive were linked to care.

A total of 7,807 patients had blood taken during their ED visit and 2,118 were tested for BBVs. In all, 71 tests were positive, with 32 resulting in a new diagnosis. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed).  Those aged between 25 and 54 had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV.

The study authors calculated that, assuming the cost per diagnosis was £7, the cost per new case detected would be £988 for HCV, £1,351 for HBV and £2,478 for HIV. The authors also concluded that testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.

Reference

Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign. Orkin C, Flanagan S, Wallis E et al. HIV Med. 2016 Mar;17(3):222-30 

Date Added: 08/03/16
Telbivudine superior to other NAs in HBV outcomes
News Type: Clinical News

At one year, telbivudine was superior to other nucleos(t)ide analogues (NAs) in HBeAg seroconversion, among other outcomes, in chronic HBV.

Researchers at Nanfang Hospital, Guangzhou, China, conducted a comprehensive and up-to-date network meta-analysis comparing the efficacy of NAs in patients with chronic HBV. A total of 75 randomised controlled trials (RCTs) were included in the systematic review, which was funded by Novartis.

At one year, telbivudine was associated with significantly higher rates of HBeAg seroconversion than adefovir (odds ratio 1.99), entecavir (odds ratio 2.00) and limivudine (odds ratio 1.49). It was linked to with significantly higher HBeAg loss than entecavir (odds ratio 1.85) and limivudine (odds ratio 1.62), with significantly higher aminotransferase (ALT) normalisation than limivudine (odds ratio 1.50), and with significantly higher rates of HBV DNA suppression than adefovir (odds ratio 2.77) and limivudine (odds ratio 2.97).

At two years, however, the relative efficacy outcomes were not statistically significant.

Reference

Effect of telbivudine versus other nucleos(t)ide analogs on HBeAg seroconversion and other outcomes in patients with chronic Hepatitis B: a network meta-analysis. Liang X, Fan R, Sun J et al. Adv Ther. 2016 Feb 26. [Epub ahead of print]

 

Date Added: 29/02/16
UK Somali population ‘needs HBV education’
News Type: Clinical News

Promoting HBV testing and contact tracing and countering misconceptions of the virus among migrant Somali populations in the UK, should be a priority.

Researchers at the University of Bristol canvassed the views of 30 people with Somali ethnicity living in the area through focus groups and semi-structured interviews.

Most participants lacked awareness of HBV and often identified it with 'jaundice'. There were frequent misconceptions regarding transmission, natural history and diagnosis, with the infection commonly viewed as a relatively trivial, short lived, symptomatic disease. HBV was generally not stigmatised. Lack of understanding of the disease was cited as the major barrier to targeted testing and contact tracing.

Reference

Barriers and opportunities for hepatitis B testing and contact tracing in a UK Somali population: a qualitative study. Cochrane A, Collins P, Horwood JP. Eur J Public Health. 2016 Feb 15 [Epub ahead of print]

Date Added: 29/02/16
Chinese and western medicine can cause DILI
News Type: Clinical News

Both Chinese herbal medicine (CHM) and Western medicine (WM) can lead to drug-induced liver injury (DILI), but with different clinical characteristics, say researchers. 

Overall, 1,985 DILI cases were retrospectively collected from 96,857 patients hospitalised because of liver dysfunction in Beijing’s 302 Military Hospital between January 2009 and January 2014.

In the DILI patients, CHM was implicated in 563 cases, 870 cases were caused by WM. In the remaining patients, accounting for 27.8% of the cohort, the combination of WM and CHM was blamed. Polygonum multiflorum was the major implicated CHM.

The cases caused by CHM were more female (51% versus 71%) and positive rechallenge (6.1% versus 8.9%), a much greater proportion of hepatocellular injury (62.2% versus 88.5%), and a higher mortality (2.8% versus 4.8%). However, no differences in the rates of chronic DILI and ALF were found (12.9% versus 12.4%; 7.6% versus 7.6%, respectively).

Based on Roussel Uclaf Causality Assessment Method, 75.6% of cases caused by CHM were classified as probable and only 16.6% as highly probable, significantly different from WM (38.4% and 60.3%).

 

Reference

Comparison between Chinese herbal medicine and western medicine-induced liver injury of 1985 patients. Zhu Y, Niu M, Chen J et al. J Gastroenterol Hepatol. 2016 Feb 20 [Epub ahead of print]

Date Added: 29/02/16
Statins reduce cirrhosis and HCC in HCV patients
News Type: Clinical News

Statins have been associated with a dose-dependent reduction in incident cirrhosis and hepatocellular carcinoma (HCC) among patients with HCV (1).

In the ERCHIVES study, among 9,135 HCV patients, 1,649 developed cirrhosis, and 239 developed incident HCC. Statin use was associated with a 44% reduction in development of cirrhosis (adjusted hazard ratio 0.6). The adjusted hazard ratios of fibrosis progression with statin cumulative defined daily dose (cDDD) 28-89, 89-180, and >180, were 0.74, 0.71, and 0.6 (0.53,0.68), respectively.

Mean change in FIB-4 score with atorvastatin (944) and fluvastatin (34) was -0.17 and -0.13 respectively after adjustment for baseline FIB-4 score and established predictors of cirrhosis. Statin use was also associated with a 49% reduction in incident HCC (adjusted hazard ratio 0.51). A similar dose-response relationship was observed.

However, a US study found statins were used less frequently in patients with HCV compared to those without (2).

In the study of 157 people at W. G. Hefner Veterans Affairs Medical Centre, , a significant difference in statin use was seen between those with and without HCV (54% versus 83%). Although there were a greater number of subjects on statins in the non-HCV group, there was not a significant difference in the proportion of subjects reaching their LDL goal between the two groups.

 

References

1) Atorvastatin and fluvastatin are associated with dose-dependent reductions in cirrhosis and HCC, among patients with HCV. Results from ERCHIVES. Simon TG, Bonilla H, Yan P et al. Hepatology. 2016 Feb 18 [Epub ahead of print]

2) Treatment of dyslipidemia with statins by primary care providers in Veterans with and without chronic Hepatitis C. Chandra R, Dolder NM, Dolder CR et al.Am J Health Syst Pharm. 2016 Mar 1;73(5 Suppl 1) 

Date Added: 29/02/16
Budget 2016 - the AHA are calling on the government to tackle cheap alcohol
News Type: BASL News

The Alcohol Health Alliance (AHA) asks if you could take one minute to contact your MP to ask them to tackle cheap alcohol?

Ahead of the budget on 16 March, the AHA has been lobbying the government and Treasury civil servants calling on them to increase duty on high strength ciders and white spirits. Their submission to the Treasury ahead of the budget can be found here.

They are now encouraging as many members as possible to contact their MPs, to ask them to call on the government to take these measures.

The AHA have also just published a page on the AHA with full details of their submission to the Treasury ahead of the budget. You can view the page here.

To contact your MP all you need to do is as follows: 

- Find out your MP’s email address using the postcode search here
- Use the template email below to send the message on
- Insert the name of your MP at the top of the e-mail
- Insert your name and address at the bottom (your MP will need your address so they know you live in their constituency)

Dear [NAME OF MP]

Re: Help us to tackle cheap alcohol

Cheap alcohol is a huge problem, and it’s not just adults with a drinking problem who favour own brand vodka and three litre bottles of high strength cider at pocket money prices.

Large bottles of cheap, sweet cider are often the drink of choice for under-15s receiving help for alcohol addiction. These bottles often contain around twice the recommended low risk weekly allowance for an adult, all for under £3.

For older children white spirits are becoming more popular, with own-brand vodka now the number one drink of choice amongst adolescent girls accessing treatment, followed by Smirnoff vodka.

These cheap drinks make children hugely vulnerable, and have been linked with a range of poor short and long term outcomes, including issues such as Child Sexual Exploitation (CSE).

We can’t afford for cheap alcohol to get even cheaper, but this is what’s happened over the last 3 budgets, with successive duty cuts and the removal of the alcohol duty escalator. These cuts don’t get passed on to pub drinkers, but have helped supermarkets to drop their alcohol prices even further.

Tackling affordability is one of the best evidenced and most powerful tools for reducing harmful drinking, whatever the age of the drinker. The Institute of Fiscal Studies (IFS) recently called for an increase in duty on these products. We support this, as do the Alcohol Health Alliance, a coalition of over 70 groups and charities. For very similar reasons action is also needed on taxation for spirits, and the reintroduction of the alcohol duty escalator.

There is a pressing need for the Government to increase the duty on cheap, high strength cider and white spirits, products which make these children extremely vulnerable and open to the most serious forms of exploitation and harm.

Please highlight these concerns in your work as an MP, and lobby the Government for action in the run up to the budget. More information on this important issue can be found by clicking here.

Kind regards,

[YOUR NAME]
[YOUR ADDRESS]

Date Added: 29/02/16
Drink Driving Bill 11th March 2016 - save the date
News Type: BASL News

The Alcohol Health Alliance (AHA) has just heard that the committee stage of the Drink Driving Bill in the House of Lords will take place on Friday 11th March 2016. 

More information will follow. 

Date Added: 29/02/16
Treatment Recommendations for the management of patients with Chronic HCV Infection – February 2016
News Type: BASL News

The link below contains recommendations for treatment based on a consensus meeting of experienced treating physicians held in London in January 2016. The most appropriate management of the individual patient is a matter for individual clinical judgement based on patient need taking due account of the evidence base, the NICE completed cost effectiveness analyses and the overall cost of the medication.

To read more click here;  Download Treatment recommendations FINAL Feb 2016.pdf

Date Added: 22/02/16
High adherence to ribavirin during PEG-interferon in chronic HCV
News Type: Clinical News

A real time study in the Netherlands found that adherence to ribavirin during PEG-interferon containing therapy in chronic HCV was high.

In this randomized controlled trial at the University Medical Centre of Utrecht, 35 patients (the intervention group) received a medication dispenser that monitored ribavirin intake real-time during 24 weeks of PEG-interferon/ribavirin±boceprevir or telaprevir. Thirty-seven patients in a control group received standard-of-care. Adherence was also measured by pill count.

Median adherence by pill count was 96% with 30 (94%) of patients exhibiting 80% adherence. Perfect adherence (i.e. 100%) was similar in intervention and control groups: 22 (85%) versus 15 (75%). Adherences by real-time medication monitoring and by pill count did not correlate. No predictors of poor adherence could be identified.

Ribavirin trough levels after eight weeks (median: 2.4mg/L versus 2.7mg/L) and 24 weeks (median: 3.0mg/L versus 3.0mg/L), and virological responses did not differ between the intervention and control groups.

Reference

Adherence to ribavirin in chronic hepatitis C patients on antiviral treatment: results from a randomized controlled trial using real-time medication monitoring. van Vlerken LG, Lieveld FI, van Meer S et al. Clin Res Hepatol Gastroenterol. 2016 Feb 8 [Epub ahead of print]

Date Added: 22/02/16
Ezetimibe/peg-IFN/RBV benefits obese HCV patients
News Type: Clinical News

Adding ezetimibe to pegylated interferon and ribavirin (peg-IFN/RBV) significantly improved early virological response rates in obese chronic HCV patients.

In a study at Al-Azhar University, Cairo, 144 chronic HCV genotype four patients were divided into two groups; group 1 included 76 non-obese patients and group two 68 obese patients. Each group was further sub-classified into equal control and treated groups. The control groups received peg-IFN/RBV combination for 24 weeks, and the treated groups received peg-IFN/RBV plus ezetimibe for 12 weeks and then only peg-IFN/RBV for the remaining 12 weeks

Early virological response significantly improved in the obese patients (85.3% versus 64.7% in the treated and control groups, respectively) without any significant improvement in the non-obese patients. Biochemical responses (defined as normalisation of alanine aminotransferase at week 12) were markedly improved in the treated groups in both the non-obese and obese groups compared with their respective controls.

Reference

Coadministration of ezetimibe with pegylated interferon plus ribavirin could improve early virological response in chronic hepatitis C obese Egyptian patients. Helal GK, Gad MA, Abd-Ellah MF et al. Eur J Gastroenterol Hepatol. 2016 Feb 11. [Epub ahead of print]

Date Added: 22/02/16
Diabetes, smoking and alcohol increase risk of hepatocellular carcinoma
News Type: Clinical News

Two studies have found diabetes, smoking, alcohol and HBV to be among the main risk factors for hepatocellular carcinoma (HCC) and its mortality.

Researchers from the National Taiwan University College of Medicine followed up 51,164 participants. They were aged 44 to 94, did not have chronic HBV or HCV, and were enrolled from nationwide health screening units (1) . Between 1998 and 2008 there were 253 deaths from HCC. A history of diabetes was associated with deaths from HCC for both total participants (adjusted hazard ratio 2.97 ) and ever smokers with current or past smoking habits (hazard ratio 1.92).

Both never smokers (hazard ratio 0.46) and quitters (hazard ratio 0.62) had a lower adjusted risk of HCC deaths compared with current smokers. Among all ever smokers with current or past smoking habits, as compared with diabetic smokers, only quitters without diabetes had a lower adjusted risk of HCC deaths (hazard ratio 0.37). However, quitters with diabetes had a similar risk of deaths from HCC when compared with smokers with diabetes.

The researchers concluded that clinicians should promote diabetes and smoking prevention in order to reduce subsequent HCC mortality, even in adults without chronic viral hepatitis.

Another study, from China, concluded HBV and alcohol intake were still the major risk factors for HCC (2).

Researchers at Xiamen University conducted a case-control study of 314 HCC cases and 346 controls was conducted in Xiamen, which is an epidemic area in China for both HBV and HCC. Face-to-face interviews were conducted and enzyme-linked immunosorbent assay kits were used to determine the status of serological markers of HBV infection.

As expected, HBV and alcohol intake remained the major risk factors of HCC. Liver disease history and passive smoking are also associated with elevated HCC risk. Indoor air pollution and pesticide exposure were newly identified as risk factors. The researchers suggested alcohol prevention should be promoted and that the consumption of fruit and tea intake could significantly lower the HCC risk .

References

1) The relationship of diabetes and smoking status to hepatocellular carcinoma mortality. Chiang CH, Lu CW, Han HC et al. Medicine (Baltimore). 2016 Feb;95(6):e2699

2) The epidemiological investigation on the risk factors of hepatocellular carcinoma: a case-control study in Southeast China. Niu J, Lin Y, Guo Z et al. Medicine (Baltimore). 2016 Feb;95(6):e2758 

Date Added: 18/02/16
Gilead UK and Ireland Fellowship Programme 2016 in Viral Hepatitis
News Type: BASL News

The Gilead UK and Ireland Fellowship Programme 2016 is now open for grant applications in the therapy area of Viral Hepatitis. The aim of the programme is to support local innovation and best practice in patient care.

The programme invites applications from healthcare or allied professionals who are seeking funding for a project in Viral Hepatitis that relates to community based HCV specialist treatment service models or the integration of HCV testing into routine healthcare delivery.

The Gilead UK and Ireland Fellowship Programme started in 2009, and since its inception has supported over 130 projects in the areas of HIV, Viral Hepatitis, Respiratory, Invasive Fungal Disease and Oncology.

To view the detailed criteria and to apply please click here.

The closing date for applications is the 31st March.

Date Added: 15/02/16
HBV patients live longer with simultaneous liver-kidney transplants
News Type: Clinical News

Although HBV patients who received simultaneous liver-kidney transplant (SLKT) had higher early-stage infection rates, they had higher long-term survival rates than those who received liver transplant (LT) alone.

In a study at the Organ Transplant Centre of the Shanghai First People's Hospital, 21 patients with HBV and renal failure (any degree) underwent SLKT and 25 underwent LT alone.

The one, three and five year survival rates of the SLKT recipients were 90.5%, 81.0%, and 81.0%, respectively. The incidence of acute hepatic allograft rejection between SLKT recipients and LT recipients (33% versus 16%) did not reach significance. Despite higher infection rate, more prevalent HBV relapse, and longer stays in the intensive care unit, the SLKT recipients experienced 90.5% one-year survival rates compared with 60% amongst the LT recipients.

Multivariate regression analysis revealed that post-operative renal failure (odds ratio 48) and Risk/Injury/Failure/Loss/End-stage (RIFLE) stage (odds ratio 8) were independent risk factors for postoperative death after LT.

The researchers suggest that SLKT might be a better choice for RIFLE stage 2 or 3 patients than LT alone.

Reference

Long-term outcomes of simultaneous liver-kidney transplant patients with Hepatitis B compared to liver transplant alone. Li H, Fan MQ, Men TY et al. Med Sci Monit. 2016 Feb 1;22:332-340

Date Added: 15/02/16
Novel HCV inhibitors interfere with viral entry
News Type: Clinical News

Novel benzothiazepinecarboxamide (BTC) inhibitors that interfere with early and late steps of the HCV viral life cycle have been identified.

Upon screening synthetic small molecule libraries with the infectious HCV cell culture system, researchers at the Korean Pasteur Institute identified a BTC scaffold that inhibits HCV. A structure-activity relationship (SAR) study with BTCs was performed, and modifications that led to nanomolar antiviral activity and improved the selective index (CC50/EC50) by more than 1,000-fold were identified. In addition, a pharmacophore modeling study determined that the tricyclic core and positive charge on the piperidine moiety were essential for antiviral activity.

Furthermore, the researchers demonstrated that BTC interferes with HCV glycoprotein E1/E2-mediated viral entry and the generation of infectious virions by using HCV pseudoparticle and cell culture supernatant transfer assays, respectively. BTC showed potent antiviral activity against HCV genotype 2 but was less potent against a genotype 1/2 chimeric virus, which expressed the structural proteins of HCV genotype 1.

Reference

Benzothiazepinecarboxamides: Novel hepatitis C virus inhibitors that interfere with viral entry and the generation of infectious virions. Kim HY, Kong S, Oh S et al. Antiviral Res. 2016 Feb 2 [Epub ahead of print]

Date Added: 15/02/16
Improved HCV outcomes with interferon/ribavirin-free regimens
News Type: Clinical News

In an analysis of studies, the use of interferon (IFN)- and ribavirin (RBV)-free regimens in older adults with HCV resulted in significant improvement of patient-reported outcomes (PROs).

Researchers at Inova Fairfax Hospital, Falls Church, USA, assessed the effect of different treatment regimens for chronic HCV on the PROs of patients aged 65 and older. PRO data from eight multinational phase two and three clinical trials were included.

Of 3,120 participants in these clinical trials, 229 had a mean age of 67.8. Of these, 75% were treatment-naïve, and 22% were cirrhotic. Ninety of these received ledipasvir plus sofosbuvir (LDV + SOF), 119 received SOF plus ribavirin (SOF + RBV), and 20 received pegylated IFN, SOF, and RBV (IFN + SOF + RBV).

The participants aged 65 and older had slightly more pretreatment PRO impairment in their physical functioning than younger individuals (-3.1% on a normalised 0-100% PRO scale).

Despite this, these participants experienced significant PRO improvement during treatment with IFN-free RBV-free regimens (up to +8.0%), similar to improvements in younger participants. In contrast, participants aged 65 and older experienced substantial decline in PROs while receiving IFN- or RBV-containing regimens (up to -18.9% in IFN + SOF + RBV, -10.4% in IFN-free SOF+RBV), and some were greater than in the younger group.

Nevertheless, after achieving sustained viral clearance at post-treatment week 12, PROs in participants aged 65 and older improved regardless of the regimen (up to +10.4%). In multivariate analysis of the cohort aged 65 and older, the use of IFN and RBV was consistently associated with PRO impairment during treatment.

Reference

Patient-reported outcomes of elderly adults with chronic Hepatitis C treated with interferon- and ribavirin-free regimens. Younossi ZM, Stepanova M, Nader F et al. J Am Geriatr Soc. 2016 Jan 30 [Epub ahead of print]

Date Added: 10/02/16
CORE BSG Trainee Research Grants
News Type: BASL News

Core and the British Society of Gastroenterology are inviting applications under this new research programme which is open to UK-based trainees.

There are two confirmed deadlines in 2016. Up to two awards of up to £5,000 each will be made per funding round.

The deadlines are:
• March 31
• July 29

The research project must address an area of clinical need within gastroenterology and have clear patient benefit. The project must be entirely based within the UK.

It is possible to apply as an individual or as a group (for example as collaborators within a Trainee Research Network) but you must have the agreement of a supervisor who must sign your application.

All relevant non-capital project costs can be funded under this award. This can include, for example, project-related travel or volunteers expenses but excludes conference attendance. Core supported projects are eligible for CRN support.

The successful project should be able to start promptly and a final report should be available to Core within three months of completion. In order to assist with project start-up up to 20% of the grant award can be made in advance. The final 20% of the award will be paid upon receipt of a satisfactory final report and invoice detailing expenditure.

For more information and to download an application form click here

Date Added: 10/02/16
AHA release: Fall in drink driving death rate stalls, new DfT figures reveal
News Type: BASL News

Fall in drink driving death rate stalls, new Department for Transport Figures reveals.

On the 4th February the Department for Transport released provisional estimates on the number of casualties arising from drink driving accidents in the UK in 2014, and the figures demonstrate that the decline in the number of drink driving deaths has stalled, with no reduction in the number of those killed since 2010.

The figures show that in 2014, 240 people died in drink driving accidents, with 8,220 injured.

Commenting on the figures, Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, said:

These figures show the significant harm done, both in terms of deaths and injuries, by drink driving in the UK.

It is worrying that the fall in the number of drink drive deaths has stalled, particularly when we know exactly what we need to do in order to reduce the number of fatalities. A large part of the solution is to reduce the drink driving limit from 80mg alcohol/100ml blood to 50mg/100ml, something which Scotland has already done. Every other country in Europe, except Malta, has a limit at this level or lower and by reducing the limit in this way, over a hundred lives would be saved each year, and many more injuries would be prevented. While a small fall in non-fatal alcohol-related injuries is welcome, we cannot be complacent when we know that a simple measure that would bring us into line with the rest of Europe would prevent many more.

A bill which has just progressed past second reading in the House of Lords aims to lower the drink drive limit in England, Wales and Northern Ireland to 50mg/100ml, and the AHA has called for this bill to be supported.

Drinking and driving, no matter how much alcohol is consumed, can never be justified. These figures relate to those drivers who are found to be over the legal drink driving limit, but we know that, even when drivers are within the limits, their driving is still affected: even at low levels of alcohol consumption, steering problems, difficulty judging distances and delayed reaction times are common.

We call on the government to take notice of the figures released today, and to lower the drink drive limit to prevent further casualties.

The Alcohol Health Alliance UK (AHA) is a group of more than 40 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:

· Highlight the rising levels of alcohol-related health harm
· Propose evidence-based solutions to reduce this harm
· Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information, please contact Matt Chorley, the AHA’s Policy and Communications Officer, at matt.chorley@rcplondon.ac.uk or on 0203 075 1726.

Statistics on drink driving
· The provisional figures released today show that in 2014 there were 240 deaths and 8,220 injuries due to drink driving accidents
· England, Wales and Northern Ireland have the highest drink drive limit in Europe with the exception of Malta
· Reducing the legal Blood Alcohol Content limit to 50mg alcohol/100ml blood would save over 100 lives a year
· Reducing the drink drive limit would not only have a greater impact on fatalities, but would save £300 million each year in costs to emergency services
· There is overwhelming public support for lowering the legal drink drive limit – our recent poll showed 77% of people favoured a 50mg limit
· At the current limit of 80mg, drivers are six times more likely to die in a road traffic accident than those who have not drunk alcohol
· Self-reported drink driving appears to be on the rise: a 2015 survey found one third of drivers who drink regularly drive whilst over the limit.

Date Added: 08/02/16
Short-term entecavir safe and effective in paediatric HBV
News Type: Clinical News

Entecavir in children and adolescents with chronic HBV is safe and shows clinical benefits in short-term biochemical and virologic responses, a new study concluded.

In the study, at the National Taiwan University Hospital, group one comprised nine treatment-naïve patients (median aged 12.2 years) who had been HBeAg seropositive for more than six months, and had alanine aminotransferase (ALT) of more than two times the upper limit of normal value (30 IU/L). They received entecavir at a dose of 0.015 mg/kg/d, with a maximal dose of 0.5 mg daily, for at least 52 weeks. Another 27 untreated chronic HBV patients matched for age, sex, ALT levels, and HBeAg status were recruited as the control group.

The entecavir-treated patients achieved rapid ALT normalisation (all before eight months of treatment) compared with the control group and had a greater chance of achieving undetectable HBV DNA levels at Week 52 after treatment (55.6% versus 11.1%).

The cumulative incidence rates of HBeAg seroconversion were similarly high in both groups (entecavir group 44% at one year and 78% at two years; control group 37% and 63%, respectively). The entecavir group also had a trend of better complete response than the control group (22.2% versus 0%). None of the entecavir-treated patients reported significant adverse effects.

Reference

Entecavir treatment in children and adolescents with chronic hepatitis B virus infection. Chang KC, Wu JF, Hsu HY et al. Pediatr Neonatol. 2015 Dec 23 [Epub ahead of print]

 

Date Added: 08/02/16
Tacrolimus plus entecavir improves remission of HBV-associated glomerulonephritis
News Type: Clinical News

Tacrolimus with entecavir was fast and effective at inducing remission of HBV-associated glomerulonephritis in adults, a Chinese study reported.

The study authors have suggested the two may have a synergistic antiviral effect used together.

In the study, at Guangdong General Hospital, 23 HBV patients with biopsy-proven membranous nephropathy received tacrolimus (0.05mg/kg/day) in combination with entecavir over 24 weeks, whereas 19 received entecavir monotherapy.

The probability of proteinuria remission in the combination group was 69% after 12 weeks and 87% after 24, while in the monotherapy group it was 26% and 42%, respectively.

The mean time to partial or complete remission was 18.6 weeks in the combination patients and 34.3 weeks in the monotherapy group. There was a decrease in the HBV DNA titre in all patients with active HBV replication. None of the HBV carriers in the combination group showed evidence of HBV reactivation. The serum creatinine and alanine aminotransferase levels remained stable in both groups. The tacrolimus target trough concentration was 5-10ng/ml.

Reference

The combination of tacrolimus and entecavir improves the remission of HBV-associated glomerulonephritis without enhancing viral replication. Wang L, Ye Z, Liang H et al. Clin Chim Acta. 2016 Jan 22 [Epub ahead of print]

Date Added: 08/02/16
Increasing prevalence of cirrhosis among US adults with HCV
News Type: Clinical News

The proportion of HCV-infected Americans with cirrhosis increased from 6.6% to 17.0% over the past two decades.

A new study found the prevalence of cirrhosis was highest among individuals who were unaware of their HCV infection.

Researchers at Stanford University School of Medicine used National Health and Nutrition Examination Survey (NHANES) data to identify adults with detectable serum HCV RNA. The prevalence of advanced fibrosis and cirrhosis was determined for Eras 1 (1988-94), 2 (1999-2006) and 3 (2007-12) by using FIB-4 > 3.25 and APRI > 2.0, respectively.

Out of 52,644 NHANES examinees, 49,429 were tested for HCV, of whom 725 met the inclusion criteria (positive HCV RNA with available data for FIB-4 and APRI). Based on APRI, 6.6% of HCV-infected adults in Era One, 7.6% in Era Two and 17.0% in Era Three had cirrhosis.

In the multivariable regression analysis, this era effect was attributable to increasing age (odds ratio 1.04), diabetes (odds ratio 2.33) and obesity (odds ratio 2.96). Cirrhosis was as common among respondents who were unaware of their infection as those who were aware (both 11%). Results were identical when FIB-4 was used.

The researchers say these data highlight the urgency for HCV screening regardless of symptoms, systematic assessment for liver fibrosis in those with HCV infection and institution of antivirals to prevent advanced liver disease.

Reference

Increasing prevalence of cirrhosis among US adults aware or unaware of their chronic hepatitis C virus infection. Udompap P, Mannalithara A, Heo N et al. J Hepatol. 2016 Jan 22 [Epub ahead of print]

Date Added: 03/02/16
Treatment Recommendations for the management of patients with Chronic HCV Infection – for consultation
News Type: BASL News

Recommendations were developed at a consensus meeting of clinicians and interested parties on 5 January 2016.

To view the recommendations please click here -   Download Treatment Recommendations for the management of patients with Chronic HCV Infection - for consultation.pdf

Therapies that are NICE approved are presented in bold and those that are NICE unapproved are italicised. The prices of the different regimens vary considerably. Clinicians should use the most cost effective treatment option taking account of the individual patient’s requirements.

The anticipation is that NHSE will adopt these recommendations for the networks and commission in line with our recommendations.

If you are interested in commenting please send your comments directly to Professor Graham Foster at g.r.foster@qmul.ac.uk before midday on 10th February 2016.

Date Added: 01/02/16
Entecavir can be genotoxic
News Type: Clinical News

New genetic studies show that the anti-HBV nucleotide analogue, entecavir, has a genotoxic effect. 

To evaluate its genotoxic mechanisms, researchers at Sichuan University, China, analysed the effect of entecavir on a panel of chicken DT40 B-lymphocyte isogenic mutant cell line deficient in DNA repair and damage tolerance pathways.

The results showed that Parp1-/- mutant cells defective in single-strand break (SSB) repair were the most sensitive to entecavir. Brca1-/-, Ubc13-/- and translesion-DNA-synthesis deficient cells including Rad18-/- and Rev3-/- were hypersensitive to entecavir.

XPA-/- mutant deficient in nucleotide excision repair was also slightly sensitive to entecavir. γ-H2AX foci forming assay confirmed the existence of DNA damage by  entecavir in Parp1-/-, Rad18-/- and Brca1-/- mutants. Karyotype assay further showed entecavir-induced chromosomal aberrations, especially the chromosome gaps in Parp1-/-, Brca1-/-, Rad18-/- and Rev3-/- cells when compared with wild-type cells.

The researchers concluded these genetic comprehensive studies clearly identified the genotoxic potentials of entecavir and suggested that SSB and postreplication repair pathways may suppress entecavir-induced genotoxicity.

Reference

Genetic evidence for genotoxic effect of entecavir, an anti-hepatitis B virus nucleotide analogue. Jiang L, Wu X, He F et al. PLoS One. 2016 Jan 22;11(1):e0147440

 

Date Added: 01/02/16
Impaired glucose metabolism increases death risk in HCV patients with cirrhosis
News Type: Clinical News

In compensated HCV-related cirrhotic patients, diabetes and marked insulin resistance are independently associated with poorer overall survival.

A new multicentre study also found an increased risk of hepatic decompensation in these patients.

A total of 250 subjects in Australia, Cuba and Spain, with compensated HCV-related cirrhosis and without known diabetes, underwent an oral glucose tolerance test and were subsequently followed for a median 201 weeks.

At baseline, 67 had Type 2 diabetes. During follow-up, 28 deaths and 55 first events of decompensation occurred. After adjustment for potential confounding covariates, overall mortality/liver transplant (hazard ratio 2.2) and hepatic decompensation events (hazard ratio 1.9) were significantly higher in those with diabetes.

Patients with a HOMA-IR >5 showed higher rates of mortality (hazard ratio 2.2). The rates of hepatic decompensation were higher in patients with HOMA-IR >3 (hazard ratio 1.7).

Overall, two-hour plasma glucose was the most robust predictor of overall mortality (hazard ratio 2.5) and decompensation (hazard ratio 2.7).

Reference

Impaired glucose metabolism increases risk of hepatic decompensation and death in patients with compensated hepatitis C virus-related cirrhosis. Calzadilla-Bertot L, Vilar-Gomez E, Torres-Gonzalez A et al. Dig Liver Dis. 2015 Dec 25 [Epub ahead of print]

Date Added: 01/02/16
Alpha-fetoprotein as a biomarker for HCC in hepatitis patients
News Type: Clinical News

Two new studies demonstrate how alpha-fetoprotein (AFP) remains a valuable biomarker for predicting hepatocellular carcinoma (HCC) in hepatitis patients.

A Chinese study concluded that serum AFP was of diagnosis and prognostic predicting value for HCC with chronic HBV infection, and suggests its use as a biomarker in HBV endemic area like south east Asia (1).

Researchers from Peking University Health Science Centre studied 318 HBV patients, 731 cirrhosis patients and 796 HCC patients. Using 11.62ng/mL as a cut-off value, the positive rate of AFP test among serum HBsAg positive HCC patients was significantly higher than that in HBsAg negative HCC patients (79.55% versus 56.49%). Similarly, the median serum AFP level in HCC patients with serum HBsAg positive was significantly higher than that in those HBsAg negative HCC patients (423.89ng/ml versus 40.82ng/ml).

In addition, Kaplan-Meier curve analysis revealed that lower pre-operative AFP level implicated a much higher overall survival rate. Of note, such prognosis predicting value was only seen in those chronic HBV infection-related HCC patients, but not among the HCC patients aetiologically irrelevant to HBV infection.

A Brazilian study has suggested AFP could be used to distinguish between patients with HCC and cirrhosis or HCV, and that vascular endothelial growth factor (VEGF) could be a potential biomarker for HCC (2).

Researchers at Faculdade de Medicina de São José do Rio Preto evaluated the influence of the VEGF-C936T polymorphism on the prognosis of HCC, cirrhosis and HCV infection. A total of 285 subjects were studied: 68 HCC, 118 cirrhosis, 43 HCV, and 56 healthy controls.

The genotype CC (frequencies between 63.24% and 76.79%) and the C allele (absolute frequencies from 0.816 to 0.884) were prevalent in all groups. Higher VEGF levels in HCC patients (588.0 pg/mL) were observed, particularly in patients with the T allele in VEGF -C936T (764.4 pg/mL) compared to those in the other groups.

The same trend occurred with AFP levels (HCC 8.522; cirrhosis 12.7; HCV 4.6; control 2.7 ng/mL). Levels of VEGF and AFP showed sensitivity of 65% and 28% and specificity of 85 and 99%, respectively, for HCC patients.

References

1.          Alpha-fetoprotein still is a valuable diagnostic and prognosis predicting biomarker in hepatitis B virus infection-related hepatocellular carcinoma. Yao M, Zhao J, Lu F. Oncotarget. 2016 Jan 13.[Epub ahead of print]

2.          Influence of vascular endothelial growth factor and alpha-fetoprotein on hepatocellular carcinoma. Yvamoto EY, Ferreira RF, Nogueira V et al. Genet Mol Res. 2015 Dec 21;14(4):17453-62 

Date Added: 01/02/16
New Recommended drinking guidelines welcomed by NICE
News Type: BASL News

NICE has welcomed proposed new guidelines on alcohol which aim to limit the health risks that result from drinking. The proposed guidelines, published by the Department of Health and out for consultation, make 3 main recommendations on safe levels of alcohol consumption".

Click here to read the article. 
 

Date Added: 01/02/16
Lower Drink Drive Limit Moves One Step Closer In Parliament
News Type: BASL News

The Alcohol Health Alliance (AHA), the RAC and BRAKE, the road safety charity, welcome the progression of Lord Brooke of Alverthorpe's private members bill on drink driving in the House of Lords today. The bill will now move on to committee stage in the House of Lords, where the full details of the bill will be considered.

This brings us one step closer to saving lives and safer roads for all.

The AHA had previously called on the Lords to support the bill which would bring England and Wales in line with Scotland and the European Union. The most recent figures show that in 2013, there were 240 deaths on our roads due to drink driving, and 8270 injuries.

Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, said:

We welcome the progress in the House of Lords earlier today in support of lowering the drink drive limit. We're pleased the House has considered this important issue. The strong evidence and public opinion clearly demonstrate to the government there is a need for the limit to be lowered.There is now more work to do to keep the pressure on the government, and make sure that they pay attention to the overwhelming evidence in support of this move, and the overwhelming public support.

Simon Richardson MBE, a Gold medal-winning cyclist at the 2008 Beijing Paralympic Games, who has twice been struck by drunk drivers, said:

I'm pleased the Lords have passed this bill to committee stage. My injuries from being knocked off my bike by a drunk driver were life-threatening; I had to be kept in an induced coma for fifteen days, and recovery is very slow, long and painful. This is the real impact of drunk driving, beyond the statistics and figures: there were over 8000 casualties from drink drive accidents in 2013 – all of us have had our lives altered, often irrevocably. The vote today means we are now closer to preventing more deaths and injuries on our roads.

Gary Rae, campaigns director for BRAKE, the road safety charity, said:

Reducing the drink drive limit in England and Wales is long overdue. The House of Lords has shown today it is in step with public opinion, with 77% of the public supporting a lower limit, according to Alcohol Health Alliance UK. Along with Malta, we have the highest limit in Europe, and this is costing lives. We urge the government to do the right thing, save lives, and lower the limit.

RAC public affairs manager Nicholas Lyes said:

Although still a long way from becoming law, the progression of Lord Brooke's Bill is a promising early step for an amendment to the Road Traffic Act that would lead to a lower drink-drive limit across England and Wales. The RAC urges the Government to consider a legal threshold of 50mg/100ml, which should not only make roads safer, but, according to our own data, would also have the support of the majority of motorists.

The Alcohol Health Alliance UK (AHA) is a group of 45 organisations including the Royal College of Physicians, Royal College of GPs, British Medical Association, Alcohol Concern and the Institute of Alcohol Studies. The AHA works together to:

• Highlight the rising levels of alcohol-related health harm
• Propose evidence-based solutions to reduce this harm
• Influence decision makers to take positive action to address the damage caused by alcohol misuse

For further information contact Matt Chorley, Policy and Communications Officer for the Alcohol Health Alliance, at matt.chorley@rcplondon.ac.uK or on 0203 075 1726.

Statistics on drink driving

• The latest available figures show that in 2013 there were 240 deaths and 8,270 injuries due to drink driving accidents
• England, Wales and Northern Ireland have the highest drink drive limit in Europe with the exception of Malta
• Reducing the legal Blood Alcohol Content limit to 50mg alcohol/100ml blood would save over 100 lives a year
• Enforcement is part of the solution, but cuts to police numbers are making this more difficult. Reducing the drink drive limit would not only have a greater impact on fatalities, but would save £300 million each year in costs to emergency services
• There is overwhelming public support for lowering the legal drink drive limit – our recent poll showed 77% of people favoured a 50mg limit
• At the current limit of 80mg, drivers are six times more likely to die in a road traffic accident than those who have not drunk alcohol
• Self-reported drink driving appears to be on the rise: a 2015 survey found one third of drivers who drink regularly drive whilst over the limit

Date Added: 25/01/16
Aspirin may protect against liver fibrosis in adults
News Type: Clinical News

Aspirin may play a role in the prevention and treatment of fibrosis among adults with suspected chronic liver diseases, a US study suggests.

The study, at Harvard Medical School, Boston, used data from the National Health and Nutrition Examination Survey III to identify 1,856 individuals with suspected chronic liver disease.

The use of aspirin was associated with a significantly lower composite liver fibrosis index calculated from FIB4, APRI, Forns and NFS. The association of aspirin with lower fibrosis scores was significantly larger among those with suspected chronic liver disease compared to those without. The negative association between aspirin use and lower fibrosis index was consistent across all four fibrosis indices in individuals with chronic viral hepatitis, suspected alcoholic liver disease and NASH. In comparison, no negative associations with liver fibrosis were seen with ibuprofen in parallel analyses.

The researchers suggest aspirin and other anti-platelet drugs warrant further investigation for the prevention and treatment of liver fibrosis.

Reference

Aspirin use is associated with lower indices of liver fibrosis among adults in the United States. Jiang ZG, Feldbrügge L, Tapper EB et al. Aliment Pharmacol Ther. 2016 Jan 7 [Epub ahead of print]

Date Added: 25/01/16
Low cardiovascular risk in children receiving liver transplants
News Type: Clinical News

Children receiving liver transplants (LTs) do not present with significant cardiovascular risk factors (CVRF), a new French study suggests.

Researchers at Lyon University retrospectively assessed CVRF, lipid abnormalities, and atherosclerosis (appraised by c-IMT) in 31 children who underwent LTs between 1990 and 2000.  Their median age at LT was 14 months and the median follow-up after LT was 11.9 years.

In these children, obesity (9.7%) and treated hypertension (9.7%) were rare. None of the patients were smokers or diabetic. High TC and TG were both observed in 6.5%. The mean c-IMT for male patients was 1.22mm and for female patients,1.58 mm.

Seven patients (22%) had a mean c-IMT above +2 s.d. Values below the fifth percentile were noted for LDL-cholesterol (58.1%), HDL-cholesterol (25.8%), apolipoprotein B (40%), and apolipoprotein A1 (20%). LDL-cholesterol and apolipoprotein B levels were significantly lower in patients treated by tacrolimus in comparison with CsA (p < 0.05).

Reference

Lipid profile and cardiovascular risk factors in paediatric liver transplant recipients. Roblin E, Dumortier J, Di Filippo M et al. Pediatr Transplant. 2016 Jan 11 [Epub ahead of print]

Date Added: 25/01/16
Benefit of adding mericitabine to protease inhibitor regimens in HCVg1
News Type: Clinical News

Adding a nucleoside polymerase inhibitor with intermediate antiviral potency to regimens containing a first-generation protease inhibitor (PI) may benefit difficult-to-treat HCV g1 patients.

Two studies have demonstrated the approach increased sustained virological response (SVR) rates and reduced relapse rates in this group.

Researchers studied the incremental benefits associated with adding mericitabine (nucleoside analogue inhibitor of HCV polymerase) to a PI plus PegIFN alfa-2a/RBV-based therapy in two double-blind randomised multicentre phase two trials. DYNAMO 1 used boceprevir and DYNAMO 2, telaprevir.

Overall, the addition of mericitabine to PI plus PegIFN alfa-2a/RBV therapy resulted in SVR12 rates of 60% to 70% in DYNAMO 1 and of 71% to 96% in DYNAMO 2. SVR12 rates were similar in patients infected with HCV genotype 1a and 1b in both trials.

The placebo control arms in both studies were stopped because of high rates of virological failure. Numerically lower relapse rates were associated with longer treatment with mericitabine (24 versus 12 weeks), telaprevir-containing regimens, and regimens that included 48 weeks of PegIFN alfa-2a/RBV therapy. No mericitabine resistance mutations were identified in any patient in either trial.

Reference

Mericitabine and either boceprevir or telaprevir in combination with peginterferon alfa-2a plus ribavirin for patients with chronic hepatitis C genotype 1 infection and prior null response: the randomized DYNAMO 1 and DYNAMO 2 studies. Wedemeyer H, Forns X, Hézode C et al. PLoS One. 2016 Jan 11;11(1):e0145409 

Date Added: 22/01/16
Alcohol may be involved in majority of weekend A&E caseloads.
News Type: BASL News

Date Added: 22/01/16
Fiona Fry - Chair of the BASL Nurse Forum has been awarded the BEM
News Type: BASL News

Congratulations to Fiona Fry - Chair of the BASL Nurse Forum and lead specialist nurse in hepatology at the Royal Devon and Exeter NHS Foundation Trust.

Fiona has been recognised in the New Year’s Honours for 2016 with a British Empire Medal for her services to nursing. Fiona has worked at the Royal Devon and Exeter NHS Foundation Trust since 1993, and has been in her current hepatology nurse specialist role since 2001. In the past 14 years she has developed liver nursing services in Exeter and Mid and East Devon.

As well as her positon as Chair of the BASL Nurse Forum she is a facilitator of a local patient support group and passes on her knowledge to others with courses and placements for medical and nursing students.

Date Added: 20/01/16
BASL Treasurer Post
News Type: BASL News

Due to the current post holder having served their tenure, BASL are seeking nominations / expressions of interest for one Committee post.

Please send your nominations by Monday 8th February, 17:00

The Treasurer
The Treasurer is elected by the membership and can serve for up to three years and may be re-elected once. The newly elected Treasurer will work alongside the current Treasurer and take over the role at the end of the next Business Meeting of the Association.

The Treasurer is a member of the Governing Board and shall be registered with Companies House in the United Kingdom as a Trustee (Director) of BASL. They are one of three Principal Officers of the association.

The Treasurer has the following duties:
 To represent the Association in financial negotiations with third parties together with the Secretary or any other person designated for the task by the Governing Board
 To oversee the collection and distribution of money on behalf of the Association and keep records of all transactions
 To engage and supervise an accountant who will keep the books of the Association
 To present the annual accounts, consisting of the profit and loss statement and balance sheet, to the Business Meeting
 To present the current accounts to the Governing Board.

Nomination Process
Candidates wishing to be considered for election will require one BASL member to propose them and a second member to confirm their suitability for the role in writing.

Please email Judy Hawksworth at the Secretariat Judith@execbs.com with your nominations by Monday 8th February 2016. Following this time, candidate statements will be sought and voting will take place if necessary.

Date Added: 18/01/16
Higher rates of infections among HCV patients in a surgical intensive care unit
News Type: Clinical News

In a US surgical intensive care unit (SICU), patients with HCV had an increased incidence of infectious complications compared with non-HCV patients.

A total of 1,941 patients admitted to the SICU at Houston’s Baylor College of Medicine between 2008 and 2012 were studied. Those who were HCV-positive had a higher overall incidence of infectious complications (25% versus 18%), particularly ventilator-associated pneumonia (VAP) and bacteraemia. The increased incidences of VAP and bacteraemia persisted when cirrhotic patients were excluded.

Prolonged intubation (odds ratio 2.1), abdominal surgery (odds ratio 1.6), and model for end-stage liver disease ≥ 15 (odds ratio 1.4) were independent predictors of SICU infectious complications.

Reference

Hepatitis C status and infectious complications in the surgical intensive care unit: a retrospective analysis of 1,941 consecutive patients. Kueht M, Bebko S, Helmick R et al. Am J Surg. 2015 Dec 13 [Epub ahead of print]

Date Added: 18/01/16
Gender influences HCV outcomes
News Type: Clinical News

Gender influences fibrosis progression, likelihood of initiating HCV antiviral therapy, and treatment outcomes, a new Canadian study suggests.

Among 1,978 chronic HCV-infected patients followed at The Ottawa Hospital and Regional Viral Hepatitis Programme, 630 were women. Compared to the men, they who had lower weight as well as liver enzyme and HCV RNA levels.

They were more likely to have non-genotype-1, black or Asian, and immigrants from Africa and Asia. Women aged under 50, on average, had lower fibrosis scores than men. Beyond the age of 50 years, the mean fibrosis scores were similar, suggesting a “catch-up” phase.

Women were less likely to have initiated interferon-based HCV antiviral therapy. Their crude sustained virological responses (SVR) were higher, but, when determined by multivariable analysis, were similar to men (odds ratio 0.92).

Women of low socioeconomic status were more likely to be HIV co-infected and had higher rates of fibrosis progression. Women living in low-income neighbourhoods were less likely to achieve SVR (odds ratio 0.50) compared with women in higher income regions.

Reference

Influence of female sex on hepatitis C virus infection progression and treatment outcomes. Corsi DJ, Karges W, Thavorn K et al. Eur J Gastroenterol Hepatol. 2016 Jan 7. [Epub ahead of print]

Date Added: 18/01/16
Tenofovir fails to prevent HIV in men who have sex with men
News Type: Clinical News

The use of single agent, tenofovir disoproxil fumarate (TDF), failed to prevent HIV acquisition or the establishment of a viral reservoir in two men who have sex with men.

The World Health Organization recently recommended Truvada (tenofovir disoproxil/emtricitabine) or TDF for high-risk individuals, with limited data for single-agent TDF pre-exposure prophylaxis in men who have sex with men.

Researchers from Guys and St Thomas' NHS Trust, London, reported two cases of TDF pre-exposure prophylaxis failure in men who had sex with men and who had received long-term TDF for HBV infection and who had therapeutic levels of drug immediately after HIV acquisition.

Rapid antiretroviral intensification at the diagnosis of acute HIV infection failed to limit immune dysfunction or prevent the establishment of a viral reservoir.

Reference

Tenofovir disoproxil fumarate fails to prevent HIV acquisition or the establishment of a viral reservoir: two case reports. Fox J, Brady M, Alexander H et al. Infect Dis Ther. 2016 Jan 9. [Epub ahead of print]

Date Added: 11/01/16
Reduced prophylactic antiviral therapy in patients with DLBCL
News Type: Clinical News

Prophylactic antiviral therapy could be withdrawn six months after ending chemotherapy in HBsAg-negative/anti-HBc-positive patients with diffuse large B cell lymphoma (DLBCL).

This was the conclusion of researchers at Peking University Cancer Hospital and Institute who retrospectively analysed 107 newly diagnosed DLBCL patients with HBV who received chemotherapy.

The median time from the cessation of anti-tumor therapy to the withdrawal of prophylactic antiviral therapy was 6.1 months. The incidence of delayed HBV reactivation was 21.7% in the HBsAg-positive group and none in the HBsAg-negative/anti-HBc-positive group. No HBV-related fulminant hepatitis or hepatitis-related deaths occurred.

The multivariate analysis showed that female gender and more than eight cycles of chemotherapy were independent risk factors of HBV reactivation in HBsAg-positive patients.

The researchers suggest a longer course (i.e. over six months) of prophylactic antiviral drug administration may be an optimal option to prevent delayed HBV reactivation for HBsAg-positive patients.

Reference

Hepatitis B virus reactivation after withdrawal of prophylactic antiviral therapy in patients with diffuse large B cell lymphoma. Liu WP, Wang XP, Zheng W et al. Leuk Lymphoma. 2016 Jan 4:1-8. [Epub ahead of print]

Date Added: 11/01/16
Efficacy of second generation DAAs for treatment-naïve HCV g1B
News Type: Clinical News

Second generation direct-acting antiviral agents (DAAs) with pegylated interferon and ribavirin (PR) and dual DAA regimens should become first line treatments for naïve HCV genotype 1.

Authors from Mahidol University, Bangkok, have performed a literature review and network meta-analysis and concluded the DAAs offer significant clinical benefits over PR alone.

They compared the treatment efficacy of the second generation DAAs, simeprevir (SMV), sofosbuvir (SOF), daclatasvir (DCV), ledipasvir (LDV), and paritaprevir/ritonavir/ombitasvir plus dasabuvir (PrOD) for naïve HCV genotype 1. Primary outcomes were sustained virological response at weeks 12 (SVR12) and 24 (SVR24) after the end of treatment and adverse drug events. Sixteen studies were included in the analysis.

Compared with the PR regimen, SOF plus PR, SMV plus PR, and DVC plus PR regimens yielded significantly higher probability of SVR24 with pooled risk ratios of 1.98, 1.46 and 1.68, respectively.

Pooled incidence rates of SVR12 and SVR24 in all treatment regimens without PR (pooled incidence of SVR12 ranging from 93% to 100%, and pooled incidence of SVR24 ranging from 89% to 96%) were much higher than the pooled incidence rates of SVR12 (51%) and SVR24 (48%) in PR alone.

In comparing SOF plus LDV with ribavirin and SOF plus LDV without ribavirin, the chance of SVR12 was not significantly different between these two regimens, with the pooled risk ratio of 0.99.

The risks of serious adverse drug events, anaemia and fatigue were relatively higher in treatment regimens with PR than in the treatment regimens without PR.

Reference

Efficacy of second generation direct-acting antiviral agents for treatment naïve hepatitis C genotype 1: a systematic review and network meta-analysis. Suwanthawornkul T, Anothaisintawee T, Sobhonslidsuk A et al. PLoS One. 2015 Dec 31;10(12):e0145953

Date Added: 11/01/16
Increased glucose metabolism/insulin secretion in cirrhotic HBV patients
News Type: Clinical News

HBV patients with liver cirrhosis may be at an increased risk of insulin resistance and abnormal glucose metabolism, new evidence suggests.

In a study at China’s Affiliated Jiangyin Hospital of Southeast University Medical College, 106 HBV positive subjects with liver cirrhosis as well as with different grade of Child-Pugh and 37 healthy subjects had the oral glucose tolerance test (OGTT), C-peptide and insulin release test. Plasma glucose and insulin levels were analysed periodically for two hours after oral glucose loading.

There was no significant difference in the level of fasting plasma glucose and C-peptide between the two groups. However, the levels of OGTT two-hour glucose, insulin and C peptide were significantly higher in the cirrhosis group than in the controls.

The peak insulin and C-peptide response occurred at 60 minutes in the controls but was delayed to 120 minutes in the cirrhosis group. There was a significant difference between the two groups in the pattern of plasma glucose levels at corresponding time points. The OGTT two hour glucose and insulin levels were positively correlated with Child-Pugh Scores.

Reference

The investigation of glucose metabolism and insulin secretion in subjects of chronic hepatitis B with cirrhosis. Guo CH, Sun TT, Weng XD et al. Int J Clin Exp Pathol. 2015 Oct 1; 8(10):  13381-6

Date Added: 11/01/16
BASL welcomes new drinking guidelines
News Type: Clinical News

BASL has welcomed new Government guidelines, which state there is no safe level of drinking.

In a report published today (Friday, 8 January), the UK’s Chief Medical Officer warns any level of alcohol consumption increases the risk of a range of cancers. It also states men should have no more than 14 units a week, bringing the limit in line with the recommended maximum for women.

It says the oft-reported heart health benefits of alcohol only apply for women 55 and over, and concluded that there is no justification for drinking for health reasons. It also recommends pregnant women avoid alcohol altogether.

A BASL spokesman said it was an important report that enabled the public to make informed choices about the graduated risks of drinking alcohol.

“It tackles the increasingly tenuous myth that alcohol could be in any way beneficial for cardiovascular health, and reverses the unhelpful 'daily drinking' guideline in favour of a sensible weekly total - the equivalent of two bottles of wine shared with a partner plus a couple of pints at the weekend,” he added.

Dame Sally Davies, Chief Medical Officer for England, said any level of regular drinking carried a health risk, but sticking to the weekly limit would keep the risk of cancer and liver disease low.

“I want pregnant women to be very clear that they should avoid alcohol as a precaution. Although the risk of harm to the baby is low if they have drunk small amounts of alcohol before becoming aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant,” she added.

“What we are aiming to do with these guidelines is give the public the latest and most up to date scientific information so that they can make informed decisions about their own drinking and the level of risk they are prepared to take.”

 

Date Added: 08/01/16
Intercept PBC Practice to Policy now accepting applications
News Type: BASL News

The Practice to Policy(tm) Health Award Program is currently open and accepting applications in the U.S., Europe and Canada. Applications are being sought from academic institutions, healthcare, policy and patient organizations, for creating innovative models of care or support to enable or improve diagnosis and/or patient experience for people living with primary biliary cholangitis (PBC).


These programs offer Intercept and the award recipients the opportunity to create momentum for long-term change by bringing together new ideas and evaluating successful and reproducible concepts.


The Practice to Policy™ Health Awards Program will provide financial support to award recipients. Applications close January 31, 2016.


To apply in Europe or Canada, applicants must be from: Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Luxembourg, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland or United Kingdom.


For more information, please visit: www.interceptpracticetopolicy.com

Date Added: 07/01/16
Parliamentary reception on hepatitis C and associated diseases calls for a national improvement framework for hepatitis C
News Type: BASL News

BASL members have joined patients, parliamentarians and other organisations from across several associated disease areas at a parliamentary reception calling for action to release an improvement framework for hepatitis C.

In late-November, The Hepatitis C Coalition, the Hepatitis C Trust and the All-Party Parliamentary Hepatology Group organised a parliamentary reception on hepatitis C and associated diseases. The event highlighted the opportunity for elimination of hepatitis C presented by effective curative medicines available on the NHS and how in doing so, patients from associated diseases and conditions including HIV, TB, haemophilia, thalassaemia and alcohol-related liver disease, also stand to benefit.

The event was organised following the development of a series of factsheets on the above conditions and how they relate to hepatitis C, with recommendations on how policy can be shaped to deliver mutual benefit across services.

These factsheets are available online by clicking here

Date Added: 06/01/16
Professor Deirdre Kelly awarded CBE in New Year's Honours
News Type: BASL News

A pioneering professor at Birmingham Children’s Hospital who set up its world renowned Liver Unit and helped save thousands of lives has been honoured with a CBE in the New Year’s Honours list.

Professor Deirdre Kelly set up the specialist paediatric liver unit in 1989. Since then it has grown from just two beds to one of the busiest units in the world.

Full Story CLICK HERE

Date Added: 04/01/16
HCV g4 more common in black Africans in Belgium
News Type: Clinical News

In a Belgian study, patients with HCV genotype 4 (HCV-4) were more frequently of black African origin than of any other origin.

This multicentre study selected 473 HCV-4 patients from seven Belgian hospital databases and compared them according to ethnic origin, i.e., black African (331) or not (142), for epidemiological, clinical, biological and histological characteristics. Interleukin 28B polymorphism (CC-genotype) was evaluated in a second cohort of 69 black African and 30 non-black African patients.

Compared to other patients, the black African patients were more likely to be female and were older, commonly overweight, frequently had abnormal glucose metabolism and arterial hypertension. They were less likely to have dyslipidemia, a history of alcohol consumption or ALT elevation. The route of infection was more frequently unknown in these patients.

Black African patients had more HCV-4 subtypes, were less frequently of IL28B CC-genotype and had less severe liver fibrosis. The proportion of patients who received antiviral treatment was similar in the two groups.

Reference

Ethnic epidemiological profiles and antiviral therapy among patients infected with hepatitis C virus genotype 4: a multicentre study from Belgium. Nkuize M, Mulkay JP, Moreno C et al. Acta Gastroenterol Belg. 2015 Oct-Dec; 78(4):365-72

Date Added: 04/01/16
Chronic HBV with spontaneous severe acute exacerbation – a review
News Type: Clinical News

A new review summarises our current knowledge regarding chronic HBV with severe spontaneous acute exacerbation.

The reviewers, from Kaohsiung Veterans General Hospital in Taiwan, explain that spontaneous acute exacerbation is not uncommon in the natural history of chronic HBV, with a cumulative incidence of 10% to 30% every year. While exacerbations can be mild, some patients may develop hepatic decompensation and even die.

The underlying pathogenesis is possibly related to the activation of cytotoxic T lymphocyte-mediated immune response against HBV. An upsurge of serum HBV DNA usually precedes the rise of alanine aminotransferase and bilirubin.

Whether antiviral treatment can benefit in this condition remains controversial, early nucleos(t)ide analogue (NA) treatment seemed to be associated with an improved outcome. There has been no randomized study that has compared the effects of different NAs in this setting. However, potent NAs with good resistance profiles are recommended.

Reference

Chronic hepatitis B with spontaneous severe acute exacerbation. Tsai WL, Sun WC, Cheng JS. Int J Mol Sci. 2015 Nov 26; 16(12):28126-28145

 

Date Added: 04/01/16
Ledipasvir/sofosbuvir highly effective for older genotype 1 HCV patients
News Type: Clinical News

Ledipasvir/sofosbuvir (LDV/SOF), with or without ribavirin (RBV) has been shown to be highly effective for the treatment of genotype 1 chronic HCV in patients aged 65-plus.

Among 2,293 patients with genotype 1 chronic HCV enrolled in four multi-national phase three trials, 264 were aged 65 or older and 24 were over 75. All were treated with LDV/SOF, and 1,042 also received RBV.

Sustained virological response at 12 weeks (SVR12) was achieved by 97% of 2,029 patients aged under 65, and 98% of the 264 aged 65 or older.

The most common adverse events (AEs) in both LDV/SOF groups, occurring in ≥ 10% of subjects, were headache and fatigue. The rate of study discontinuation due to AE was similar in the two age cohorts. The addition of RBV increased the number of AEs, treatment-related AEs, and AEs leading to study drug modification/interruption, particularly among elderly subjects.

Reference

Safety and efficacy of ledipasvir/sofosbuvir for the treatment of genotype 1 hepatitis C in subjects aged 65 years or older. Saab S, Park SH, Mizokami M et al. Hepatology. 2015 Dec 24 [Epub ahead of print]

Date Added: 04/01/16
HEV genotype 3 viremia mainly presents in underlying chronic liver diseases
News Type: Clinical News

HEV genotype 3 (HEV-3) viremia mainly presents in patients with underlying chronic liver diseases or an impaired immune system, Dutch investigators reported.

The investigators, from the Erasmus MC, University Medical Centre Rotterdam studied 79 patients with HEV-3 infections diagnosed by means of quantitative real-time reverse transcription-polymerase chain reaction test (RT-PCR).

Sixty-one patients were immunocompromised. Three had only transient viremia, 43 cleared the infection within six months and 26 developed chronic infection. Five patients were lost to follow-up.

All patients developing chronic infection were immunocompromised. Overall, 13 patients within this cohort died. Three patients had pre-existent liver diseases and died of liver-related causes. Time between diagnosis and death was shorter for patients with pre-existent liver diseases

Twenty-eight per cent of patients on immunosuppressive medication achieved viral clearance after reducing the dose of immunosuppressive therapy. Thirty patients were treated with off-label ribavirin, of whom 25 demonstrated a sustained viral response was documented.

Reference

Hepatitis E virus genotype 3 infection in a tertiary referral centre in the Netherlands: Clinical relevance and impact on patient morbidity. Nijskens CM, Pas SD, Cornelissen J et al. J Clin Virol. 2015 Dec 2; 74:82-87 [Epub ahead of print]

Date Added: 04/01/16
HBV increases risk of osteoporosis
News Type: Clinical News

People with HBV are at an increased risk of osteoporosis, a new Taiwanese study shows.

Using a nationwide Longitudinal Health Insurance Database 2000, the study compared 36,146 adult HBV patients with 144,584 patients without advanced liver disease

Compared with the comparison cohort, the HBV patients had a higher risk of osteoporosis (adjusted hazard ratio 1.14) after adjusting for age, sex, frequency of medical visits, and comorbidities of diabetes, hypertension, hyperlipidemia, heart failure, cirrhosis, chronic kidney disease, thyroid diseases, medication of steroid, PPI, warfarin, aspirin, and oestrogen replacement therapy.

The HBV patients exhibited a 1.13-fold higher risk of developing osteoporosis, but the risk of osteoporotic fracture was comparable between patients with HBV and the comparison cohort (adjusted hazard ratio 1.20). The incidence of osteoporosis increased with the increment of age (age ≤ 49, adjusted hazard ratio 1; age 50-64,  5.67,age ≧ 65, 13.3) and coexisting cirrhosis (adjusted hazard ratio 1.62).

However, the osteoporosis risk contributed by HBV decreased with age and the age-specific risk analyses showed that patients with HBV exhibited the highest risk of osteoporosis than patients without HBV for the patients aged ≤49 (adjusted hazard ratio 1.42). Furthermore, the osteoporosis risk contributed by HBV decreased with the presence of comorbidities (adjusted hazard ratio 1.27 versus 1.04).

Reference

Association between chronic hepatitis B virus infection and risk of osteoporosis: a nationwide population-based study. Chen CH, Lin CL, Kao CH. Medicine (Baltimore). 2015 Dec; 94(50): e2276 

Date Added: 04/01/16
A new predictive score for HCC associated with HCV
News Type: Clinical News

A new easy-to-use, non-invasive score can help predict patients with hepatocellular carcinoma (HCC) associated with HCV.

Researchers from three Egyptian universities measured α-1-acid glycoprotein (AGP) and C-reactive protein (CRP) in the serum of 53 HCC patients, 20 liver cirrhosis patients and 15 healthy individuals. Area under receiver operating characteristic curves (AUCs) was used to create a predictive score comprising AGP, CRP, alpha fetoprotein (AFP) and albumin. The diagnostic performances of score was determined and compared with AFP alone for the diagnosis of HCC.

The combination of AGP, albumin, CRP and AFP had AUC 0.92 and sensitivity 85% which was higher than AFP alone. The odds ratio of having HCC was 8.4 for AGP, 5.8 for CRP, 12.5 for AFP and 6.5 for albumin.

The score predicted HCC with an odds ratio of 50.6 for HCC. The AUC of score in HCC with single tumour, absent vascular invasion and CLIP score (0-1) were 0.9, 0.9, 0.82, respectively, compared with 0.71, 0.71, 0.68 respectively, for AFP.

Reference

An easy and useful noninvasive score based on α-1-acid glycoprotein and C-reactive protein for diagnosis of patients with hepatocellular carcinoma associated with hepatitis C virus infection. Omran MM, Emran TM, Farid K et al. J Immunoassay Immunochem. 2015 Dec 18. [Epub ahead of print] 

Date Added: 21/12/15
Entecavir plus tenofovir superior to entecavir alone in HBV
News Type: Clinical News

New data suggest that the combination of entecavir (ETV) and tenofovir (TDF) is superior for HBV suppression and ALT normalisation in partial responders to ETV monotherapy.

This was a retrospective cohort study consisting of 86 consecutive treatment-naive, ETV 0.5mg partial responders who maintained ETV 0.5mg daily or switched to either ETV 1.0mg daily or ETV/TDF 0.5mg/300mg in three US hospitals between 2005 and 2012.

In all therapy groups, the majority of patients were HBV e antigen-positive and had similar baseline alanine aminotransferase (ALT) levels. However, baseline HBV DNA and HBV DNA at regimen switch points were lower in the ETV 0.5mg cohort compared with those switched to ETV 1.0mg or ETV/TDF, respectively. The ETV 0.5 mg cohort also had the shortest duration of ETV 0.5mg therapy before switch.

After the switch point, more patients on the combination achieved complete viral suppression (CVS) compared with those on either ETV monotherapy at months six, 12 and 18. Compared with the ETV monotherapy groups, the ETV/TDF group also had higher rates of ALT normalisation at the three time points. 

The multivariate analyses,inclusive of baseline age and treatment duration on initial therapy with ETV 0.5mg, indicated that the ETV/TDF combination (hazard ratio 12.19) was independently and positively associated with CVS, whereas high HBV DNA levels at baseline (hazard ratio 0.77) and at switch point (hazard ratio 0.46) were negatively associated with CVS. ETV 1.0mg dose was not a predictor for CVS compared with ETV 0.5mg.

Reference

Alternative therapies for chronic hepatitis B patients with partial virological response to standard entecavir monotherapy. Chaung KT, O'Brien C, Ha NB et al. J Clin Gastroenterol. 2015 Dec 5. [Epub ahead of print]

Date Added: 21/12/15
High rise in HCV among men who have sex with men
News Type: Clinical News

The incidence of HCV infection in HIV-positive men who have sex with men (MSM) rose 18-fold between 1998 and 2011 in Switzerland.

In a new study of predominantly HIV-negative MSM, half the participants were aware of their HCV. However, high rates of unprotected anal intercourse (UAI) and of UAI without HIV serosorting were reported.

Between 2011 and 2012, trained health care professionals in southwest Switzerland invited individuals attending (1) MSM screening clinics and (2) indoor and outdoor meeting areas to complete an anonymous questionnaire. Consenting participants were rapid tested for HCV (OraQuick HCV Rapid Antibody Test).

Of 918 MSM approached, 654 agreed to participate, most of whom were enrolled via MSM screening clinics. Of 654 participants, 21 disclosed being HIV positive and 140 had unknown HIV status.

In the preceding 12 months, 357 participants reported UAI and 321 reported UAI with partners of different/unknown HIV status. Not HIV serosorting was reported more frequently among HIV-positive individuals (76%). Three hundred and two participants were aware of their HCV, awareness being higher among clinic than meeting area participants. One individual with a negative HIV test result 18 months previously was newly diagnosed as being HCV positive on rapid testing.

The study authors suggest that, given the increasing incidence of HCV amongst MSM, counselling should be offered regardless of HIV status, with testing offered to those at high risk.

Reference

Hepatitis C virus awareness among men who have sex with men in southwest Switzerland. Clerc O, Darling K, Calmy A et al. Sex Transm Dis. 2016 Jan; 43(1):44-48

Date Added: 21/12/15
HCV eradication leads to reduced portal pressure
News Type: Clinical News

Among chronic HCV-infected patients with advanced hepatic fibrosis, platelet counts improved following sustained viral response (SVR).

Also, the change in platelets correlated with the change in spleen size following antiviral therapy.

These were the findings of an international retrospective study and, say the researchers, their results suggest that HCV eradication leads to reduced portal pressure.

In the study, platelet counts and spleen sizes were recorded in chronic HBV patients with Ishak four to six fibrosis who started antiviral therapy between 1990 and 2003. Last measured platelet counts and spleen sizes were compared to their pre-treatment values (within six months prior to the start of therapy).

Amongst 464 patients, 353 had cirrhosis and 187 attained a SVR. Among patients with SVR, median platelet count, increased by 35 x109/L. In comparison, patients without SVR showed a median decline of 17 x109/L.

In a subgroup of 209 patients, median decrease in spleen size was 1.0 cm for patients with SVR, while median spleen size increased with 0.6 cm among those without SVR. The changes in spleen size and platelet count were significantly correlated.

Reference

Improvement of platelets after SVR among patients with chronic HCV infection and advanced hepatic fibrosis. van der Meer AJ, Maan R, Veldt BJ et al. J Gastroenterol Hepatol. 2015 Dec 8 [Epub ahead of print]

Date Added: 18/12/15
Guidance to DVLA regarding Patients with Liver Disease
News Type: BASL News

The DVLA have sought guidance from BASL on whether patients with Liver Disease should be allowed to drive. The following recommendations were made:
Overt Encephalopathy – patients with a history of overt hepatic encephalopathy should be advised not to drive.
Minimal hepatic encephalopathy can be diagnosed by neuropsychometric tests which are not widely available. However, if a patient with known cirrhosis of the liver has evidence of neuropsychometric impairment, or where there is high clinical suspicion of minimal or covert hepatic encephalopathy (i.e short term memory loss, difficulty concentrating, sleep-wake reversal) then they should not be driving.

Date Added: 18/12/15
Senior & Junior Clinical Fellow Posts at the Royal Free London
News Type: BASL News

Junior Clinical Fellow in Hepatology - Applications are invited for Junior Clinical Fellow posts working within the Royal Free Hospital Liver unit. The Royal Free provides secondary and tertiary Hepatology services, including liver transplantation, management of complex portal hypertension and management of complex pancreatic and biliary diseases. For further details please click here 

Senior Clinical Fellow in Hepatology x 2 - Applications are invited for 2 Senior Clinical Fellow posts working within the Royal Free Hospital Liver unit. The Royal Free provides secondary and tertiary Hepatology services, including liver transplantation, management of complex portal hypertension and management of complex pancreatic and biliary diseases. For further details please click here 

Senior Clinical Fellow in Pancreatobiliary Medicine - Applicants are invited to apply for the post of senior clinical fellow in Pancreaticobiliary Medicine based at the Royal Free Hospital Hampstead site. The post supports the expanded hepato-pancreatico-biliary (HPB) Medicine service at the Royal Free Hospital which now comprises of 10 regular ERCP/EUS fluoroscopy lists per week with more than 800 ERCP and 400 EUS performed each year. For further details please click here

Date Added: 18/12/15
Organ donation is changing in Wales
News Type: BASL News

On 1 December 2015 Wales will be the first UK country to introduce a soft opt-out system for organ and tissue donation. Click here to find out more.

Date Added: 17/12/15
Successful treatment of HCV in renal transplant recipients with DAAs
News Type: Clinical News

HCV eradication with direct-acting antiviral agents (DAAs) has been found to be successful after kidney transplantation, with few treatment-related side effects.

Researchers at the University of Pennsylvania collected data from 20 consecutive kidney recipients treated with interferon-free regimens for HCV; 88% were infected with genotype 1 and 50% had biopsy-proven advanced hepatic fibrosis on their most recent liver biopsy preceding treatment; 60% had failed treatment pre-transplant with interferon-based therapy. DAA treatment was initiated a median of 888 days after renal transplantation.

All patients cleared the virus while on therapy and 100% achieved a sustained virologic response at 12 weeks after completion of DAA therapy. The most commonly used regimen was sofosbuvir 400 mg daily in combination with simeprevir 150 mg daily. However, four different treatment approaches were employed, with comparable results. The DAAs were well tolerated and less than half of patients required calcineurin inhibitor dose adjustment during treatment.

Reference

Successful treatment of Hepatitis C in renal transplant recipients with direct-acting antiviral agents. Sawinski D, Kaur N, Ajeti A et al. Am J Transplant. 2015 Nov 25 [Epub ahead of print]

Date Added: 17/12/15
Why some HCV patients relapse after DAAs
News Type: Clinical News

A new study has identified risk factors associated with HCV treatment failure after direct acting antivirals (DAAs) in patients with complex treatment histories.

Amongst 35 HCV mono-infected patients at Mount Sinai Medical Centre, New York who were treated with boceprevir (BOC) or telaprevir (TVR), eight subsequently relapsed and were treated with simeprevir (SMV) and sofosbuvir (SOF) ± ribavirin (RBV) for 12 weeks.

All eight patients had an end of treatment response, but later relapsed. All had previously failed PEG/RBV dual therapy at least once in addition to prior failure with triple therapy. Total number of times treated ranged from three to six. All eight had liver cirrhosis and seven had genotype 1a HCV. Seven had over 1 million IU/mL HCV RNA at the time of re-treatment.

The authors concluded that twelve weeks of SMV/SOF/RBV is insufficient in cirrhotics with high-titre genotype 1a HCV.

Reference

Re-re-treatment of hepatitis C virus: Eight patients who relapsed twice after direct-acting-antiviral drugs. Hartman J, Bichoupan K, Patel N et al. World J Gastroenterol. 2015 Nov 21;21(43):12430-8 

Date Added: 17/12/15
Limited role for pentoxifylline in the treatment of alcoholic hepatitis
News Type: Clinical News

Pentoxifylline is a phosphodiesterase inhibitor with an anti-TNF effect and has been reported to reduce mortality and the incidence of hepatorenal syndrome in severe alcoholic hepatitis (AH). However, a review of recent evidence concludes that it has no clear beneficial effects in severe AH but could perhaps be used in patients with a contraindication to corticosteroids.

The reviewer, from Hospital Clínic, IDIBAPS, Barcelona, points out that corticosteroids are still the treatment recommended by clinical guidelines, pentoxifylline being the second-line option for non-responders to corticosteroids and for patients with contraindications.

Several studies, of distinct quality, have tested the efficacy of pentoxifylline in different scenarios. The conclusions of these studies are that pentoxifylline seems to improve survival in comparison to placebo but has lower efficacy than corticosteroids, with no improvement in survival when added to corticosteroids or in non-responders to steroid therapy.

The role of pentoxifylline in severe AH is even more doubtful after the results of a very recent controlled study that showed no beneficial effect on survival at one, three and 12 months of follow up, although a very recent network meta-analysis reported a beneficial effect of pentoxifylline alone or with corticosteroids on short-term survival.

Reference

Is there a role for pentoxifylline in the treatment of alcoholic hepatitis? Caballeria J. Gastroenterol Hepatol. 2015 Nov 14 [Epub ahead of print]

Date Added: 17/12/15
Liver viral load correlates with liver damage in chronic HBV
News Type: Clinical News

The results of a new study show a strong correlation between liver viral load and liver damage in patients with chronic HBV.

Researchers at Babol University of Medical Sciences, Iran, studied 30 patients with chronic anti-Hbe positive HBV, with liver enzymes two or more times the upper limit of normal and positive HBV DNA of any amount.

The mean age of the patients was 32 and 24 were males. Ten patients had HBV viral load levels less than 20000 IU/mL. There was a significant correlation between liver viral load levels with staging or grading of liver damage.

Reference

Relationship between hepatitis B DNA viral load in the liver and its histology in patients with chronic hepatitis B. Biazar T, Yahyapour Y, Hasanjani Roushan MR et al. Caspian J Intern Med. 2015 Fall;6(4):209-212

Date Added: 17/12/15
Nucleoside analogues prevent HBV transmission from father to infant
News Type: Clinical News

Nucleoside analogues are effective and safe for the prevention of vertical transmission of HBV from father to infant, a new study shows.

Researchers at the third Hospital Liver Disease Centre of Qinhuangdao, China, studied 201 patients who were positive for HBV surface antigen (HBsAg), HBeAg, anti-HBc, and HBV DNA; of these, 189 had abnormal liver function. In all couples, the fathers were HBV DNA-negative and had normal liver function, and the mothers were anti-HB-positive before pregnancy. The control group comprised of 188 couples that visited the hospital during the same time period. The fathers in the control group were positive for HBsAg, HBeAg, anti-HBc, and HBV DNA. The mothers were HBsAg-negative and anti-HBs-positive.

No infants in the case group were HBsAg-positive and HBV DNA-positive, and all were anti-HBs-positive, indicating that father to infant HBV vertical transmission was prevented in the case group.

In the control group, 147 of 188 newborns were anti-HBs-positive at birth, 28 were HBV DNA-positive, and 19 were HBsAg-positive. A significant difference was observed between the two groups. No statistically significant difference was observed in the gestational age, birth weight, birth length, one-minute and eight-minute Apgar score. Nor in jaundice, other internal and surgical diseases, delivery mode, and other birth information between the neonates born to couples in the case and control groups; there were no foetal malformations and stillbirths in the two groups.

Reference

Efficacy and safety of nucleoside analogues in preventing vertical transmission of the hepatitis B virus from father to infant. Cao LH, Zhao PL, Liu ZM et al. Genet Mol Res. 2015 Dec 2;14(4):15539-46

Date Added: 17/12/15
Efficacy of nucleotide/nucleoside analogues in HBV-associated glomerulonephritis
News Type: Clinical News

A new meta-analysis of studies shows the efficacy of nucleotide/nucleoside analogue (NA) monotherapy for treating HBV-associated glomerulonephritis (HBV-GN).

Researchers found ten trials involving 325 patients – four randomised controlled trials, two cohort clinical trials, and four self-controlled studies.

Based on the fixed-effects model, the reviewers found significant proteinuria remission rate improvement in the NA group (relative risk 3.60), a negative conversion rate of HBV-DNA (relative risk 2.20), and clearance of HBeAg (relative risk 4.49).

Improvement in ALT (mean difference 56.60) was found with the fixed effects model, and a slight decrease in serum creatinine (mean difference 25.25) was shown.

Reference

Meta-analysis of the efficacy and safety of nucleotide/nucleoside analog monotherapy for hepatitis B virus-associated glomerulonephritis. Wang WN, Wu MY, Ma FZ, et al. Clin Nephrol. 2015 Dec 4. [Epub ahead of print]

 

Date Added: 17/12/15
HCV patients with high healthcare resource utilisation have more comorbidities
News Type: Clinical News

New data shows chronic HCV patients with high healthcare resource utilisation (HRU) have a high level of comorbidity at baseline, it also suggests non-HCV comorbidities and conditions are strong predictors of high HRU.

Using North American health insurance claims for 2001-2013, researchers studied 4,898 adult patients with two or more chronic HCV claims and six or more months of continuous insurance coverage before and more than 36 months after the first diagnosis.

Liver disease severity and both chronic HCV and non-HCV-related comorbidities and conditions were strong predictors of high healthcare costs, with odds ratios for ≥2 chronic HCV and ≥2 non-chronic HCV-related comorbidities/conditions 2.78 and 2.19, respectively.

Chronic-HCV and non-chronic HCV-related comorbidities and conditions were also strong predictors of liver disease progression with odds ratios for ≥2 chronic HCV-related and ≥2 non-chronic HCV-related comorbidities and conditions of 2.18 and 1.50, respectively.

Reference

Predictors of high healthcare resource utilization and liver disease progression among patients with chronic hepatitis C. LaMori J, Tandon N, Laliberté F et al. J Med Econ. 2015 Dec 1:1-31. [Epub ahead of print]

 

Date Added: 17/12/15
High risk of drug-drug interactions with new direct acting antivirals
News Type: Clinical News

Researchers have warned a significant number of HCV patients are at risk for drug-drug interactions (DDIs) if treated with the recently approved direct acting antivirals (DAAs).

Researchers from Hannover Medical School and the University of Liverpool, studied 261 HCV monoinfected patients who received DAA therapy at two intervals between 2011 and 2014. The potential for DDI between all these drugs and sofosbuvir/ribavirin, ledipasvir/sofosbuvir, sofosbuvir/daclatasvir,sofosbuvir/simeprevir, ombitasvir/paritaprevir/ritonavir±dasabuvir as well as boceprevir and telaprevir triple therapy was assessed using www.hep-druginteractions.org and the relevant prescribing information.

The 261 patients took a median number of two drugs and 20% did not take any medication. Sofosbuvir/ribavirin had the lowest risk to cause a potentially significant DDI (9.6%). In contrast, for ombitasvir/paritaprevir/ritonavir±dasabuvir, potentially significant DDI could be expected in 66.3% of the patients. Significant DDI for sofosbuvir/simeprevir would be expected in 31.4%, for sofosbuvir/daclatasvir in 36.8% and sofosbuvir/ledipasvir in 40.2%.

Proton pump inhibitors, thyroid hormones and dihydropyridine derivatives were frequently used and presented a risk of interacting with the antiviral regimen.

Reference

Drug-drug interactions with novel all oral interferon free antiviral agents in a large real-world cohort. Höner Zu Siederdissen C, Maasoumy B, Marra F et al. Clin Infect Dis. 2015 Nov 26 [Epub ahead of print]

Date Added: 17/12/15
Daclatasvir plus asunaprevir improves renal dysfunction in HCV
News Type: Clinical News

Clinicians have concluded the combination of daclatasvir and asunaprevir is safe for chronic HCV patients with renal dysfunction. 

The clinicians, at Hiroshima University, treated a patient with HCV-related liver cirrhosis with severe leg oedema due to chronic renal dysfunction using this dual oral therapy.

Although serum ALT increased rapidly during the first week of treatment, the antiviral therapy was able to continue and liver function recovered spontaneously. After one month of treatment, serum HCV RNA became continuously undetectable, and serum albumin level gradually increased.

Throughout the therapy, serum creatinine level nearly normalised, and leg oedema gradually improved. These improvements continued after the combination therapy was completed. HCV RNA remained undetectable following the end of therapy, and sustained virological response at 12 weeks was achieved.

Reference

Improvement of renal dysfunction in a patient with HCV-related liver cirrhosis by daclatasvir and asunaprevir combination therapy: A case report. Tsuge M, Hiramatsu A, Shinohara F et al. Hepatol Res. 2015 Nov 27 [Epub ahead of print]

Date Added: 01/12/15
NHS members required to join Appeal Panels
News Type: BASL News

NICE is seeking to recruit up to three people who currently provide healthcare within the NHS to take part in its Appeals Panels.  The successful candidates will join a pool of members who hear appeals against NICE’s recommendations on the use of new drugs and other technologies for treating patients with very rare diseases and very complex healthcare needs.

When an appeal is submitted it is heard by an Appeal Panel comprising five members who are selected for their expertise, experience, and ability and do not represent their organisation.

Skills and experience

You will need to be currently employed within the NHS. You will also need to be able to understand the process and methods NICE uses to appraise new health technologies, and to critically assess the arguments put forward by companies, professional groups and patient organisations appealing against our guidance. 

For further information about what the role involves and how to apply please visit our website at: 

www.nice.org.uk/get-involved/join-a-committee/nhs-member-appeals-committee  

 

 

Date Added: 19/10/15
RCN Launch Caring for People with Liver Disease: A Competence Framework for Nursing
News Type: BASL News

A newly updated RCN competency framework is helping health professionals identify people at risk of liver disease.

Caring for People with Liver Disease: A Competence Framework for Nursing (publication code 004 983) will help nursing staff promote healthy livers and lifestyles as well as care for individuals with existing liver disease.

Members of the RCN Gastrointestinal Nursing Forum’s Steering Committee, Michelle Clayton and Lynda Greenslade helped write the framework alongside other liver specialists. Published earlier this month, it was sponsored by Norgine Pharmaceuticals Limited and is available from the RCN publications website: www.rcn.org.uk/publications and is available to order in hard copy from the RCN publications team on 0345 772 6100.

As part of the work to update the framework, the forum commissioned a survey to gather nurses’ views and experiences of using the prior version. The survey showed that the previous edition had been used to develop and support new nursing roles in liver care, expand ward teams and support the appraisal process.

Lynda, a clinical nurse specialist in hepatology at the Royal Free Hospital NHS Foundation Trust in London, said: “In the feedback, nurses requested more guidance on how to implement the framework into practice and a further section has been added to support this.”

Both Michelle and Lynda would be happy to hear from nursing staff who would like help implementing the framework into their practice. You can email them at m.clayton@leeds.ac.uk or lynda.greenslade@nhs.net.

 

Date Added: 24/09/15
Dame Sheila Sherlock travelling fellowship in hepatology 2016
News Type: BASL News

The Royal College of Physicians 2016 award is now open and applications are being accepted.

This award is aimed at trainees and consultants wishing to gain research experience in hepatology and may be of interest to BASL members.

Please click here for more information on the fellowship.

Application forms can be found on here

Date Added: 17/09/15
Welcome to Professor Graeme Alexander - the new President of BASL
News Type: BASL News

I take great pleasure in welcoming Professor Graeme Alexander as the new President of BASL. He is currently Honorary Consultant (part time) at Cambridge University Hospitals and Professorial Research Associate (also part time) in the UCL Division of Medicine, based at the RFH with Prof Massimo Pinzani. In 1991 he was invited to Cambridge as the University Lecturer in Hepatology and Consultant to work alongside Prof Roy Calne with a view to establishing a new Hepatology unit to support their surgical endeavours. The unit has grown substantially and proved successful over 24 years. Graeme was the clinical lead for 17 years as well as programme director for gastroenterology training for 6 years. He maintained a strong interest in clinical and laboratory based research throughout that time, with a large throughput of MD/PhD students as well as Gastroenterology trainees. He has published over 300 peer reviewed original papers and is an expert in the science of liver senescence.

Graeme is well known to BASL, having served two terms on the committee, most recently as research lead helping to establish and contribute to national research groups – most notably HCV Research UK, UK-PBC and UK-PSC, which have proved effective with large patient series, good publications and international recognition. He has also been a driving force behind the BASL Science Retreat.

Graeme will bring a new energy to the role of BASL President and is the ideal person to take the society forward.

 

Date Added: 16/09/15
NHS Jobs - Senior Clinical Fellow in Hepatology
News Type: BASL News

Employer - University Hospitals Birmingham NHS Foundation Trust - Medical & Dental.

Click here to view the full job description.

Date Added: 28/08/15
Nurses' Educational Support Programme (NESP)
News Type: BASL News

The Nurses Educational Support Programme (NESP) is a series of one day training meeting sponsored by Gilead Sciences Ltd, designed to develop and share knowledge of nurses working in the field of hepatology throughout the UK & Ireland.

The meetings will cover presentations on non-invasive liver disease assessment methodology and use of new direct acting antivirals (DAAAs), including drup-drup interactions (DDIs) and resistance, as well as discussion around data and case study reviews.

The dates and locations of the meetings are as follows:

  • Friday, 2 October 2015: Hotel Pullman London St Pancras 
  • Friday, 9 October 2015: The Morisson Hotel, Dublin
  • Friday, 16 October 2015: Macdonald Manchester Hotel

Who is it for? 

Clinical nurse specialists who would like to advance their knowledge and skill set in these areas.

Other information

Please note that you must register in advance to attend the meeting. If you are interested in attending, please contact the NESP events team at: is-hepatitis-team@is-health-group.co.uk 

 

Date Added: 27/08/15
Invitation - Hepatitis C in the Offender Health setting educational meeting
News Type: BASL News

Click here to find out more

Date Added: 24/08/15
Survey Regarding The Use Of Non-Invasive Liver Fibrosis Tests In Clinical Pathways
News Type: BASL News

Background: 

The assessment of liver fibrosis forms a key element in the management of chronic liver disease. 

Liver biopsy is still regarded as the reference test but non-invasive methods of assessment of liver fibrosis are entering clinical practice.

As part of Ankur Srivastava PhD, a survey is being conducted of attitudes and use of non-invasive methods for assessing liver fibrosis, which should take 5-10 minutes.

All responses will be kept confidential and data will be aggregated.

Click here to take part

Date Added: 21/08/15
Hepatitis C in the UK 2015 - Briefing
News Type: BASL News

Most notably:

The broad picture from the report is that while the prevalence of the disease is steady, the health impact is growing, with an increase in hospital admissions and liver transplants

On a more positive note, the estimated number of people infected in Scotland has fallen to 36,700 people this year from 39,000 last year and the report also found that in Scotland the number of chronically infected people who began treatment had increased 2.7-fold since 2007/08

In previous years, only 3% of people infected were receiving treatment.  The overall treatment figure is not given in this year’s report.

The report endorses the important role played by action plans in tackling hepatitis C:  “Action plans and work programmes have driven improvements in the prevention, diagnosis and treatment of HCV across the UK”

Despite this endorsement, no mention is made of the ongoing development of a hepatitis C improvement framework for England, as announced in Dr Paul Cosford’s foreword to last year’s report.

Click here to view the report

Date Added: 20/08/15
Dame Sheila Sherlock award 2015
News Type: BASL News

BASL are pleased to announce that the Dame Sheila Sherlock award 2015 has been awarded to Dr Luke Boulter. This is a tremendous achievement in what was a very competitive field this year.

BASL look forward to Dr Boulter presenting his work at the Basic Science Retreat event on 30th September to the 2nd October in Newton Abbott, Devon.  Booking link for this event is below.

http://www.basl.org.uk/events/158/Basic-Science-Retreat-2015/index.cfm 

Date Added: 14/08/15
MSD TRAVEL BURSARY SCHOLARSHIP 2015 in collaboration with BASL.
News Type: BASL News

Closing date for applications is 28th August 2015.

MSD in collaboration with the BASL have made provision for 15 scholarship awards to be made available to assist healthcare professionals to attend the forthcoming AASLD to be held in San Francisco on 12th-17th November 2015. Scholarship awards are capped at a maximum of £2,500 per person and are considered a contribution towards an award winner’s registration fee, travel and accommodation expenses.

This is available to SpRs, consultant doctors (within 5 years of current appointment), nurses and scientists in the field of Hepatology medicine.

To download the guidelines please click >here.
To apply please click >here. 

Date Added: 12/08/15
Call for nominations for BASL Research Committee Chair
News Type: BASL News

Due to the current post holders having served their tenure, BASL are seeking nominations/ expressions of interest for one Committee post.

Post holders may be re-elected if they should choose to stand again.

• Research Committee Chair 

The Research Committee Chair is elected by the membership to serve for a period of up to three years and may be re-elected once. The appointee is responsible for basic science and portfolio development. In addition to his/her role on the Governing Board, the Chair of the Research Committee will make specific recommendations to Governing Board regarding the program of the Annual Scientific Meeting. 

Nomination Process

Candidates wishing to be considered for election will require one BASL member to propose them and a second member to confirm their suitability for the role in writing.

Please email Judy Hawksworth at the Secretariat admin@basl.org.uk with your nominations by Monday 7th September 2015, 17.00.  Following this time, candidate statements will be sought and voting will take place if necessary.

 

Date Added: 05/08/15
James Lind Alliance - Priority Setting Partnership
News Type: BASL News

A significant proportion of people suffer from liver and gallbladder disorders. Every year, more than 10,000 deaths occur in UK because of chronic liver diseases. Approximately 1% of all deaths in UK are caused because of gallbladder disorders. There are a number of different prevention, treatment, diagnosis, support, and care options for liver and gallbladder disorders. It is important that we undertake research try to understand which of these are effective and make a difference to those affected. Research should focus on questions that are important to people with, or at high risk of liver and gallbladder disorders, those who care for them and healthcare professionals who treat, identify and try to prevent infections.

 

This survey therefore aims to collect research questions from all these groups. Your responses will help us start to identify where there is uncertainty regarding prevention, treatment, diagnosis, support, and care of non-alcohol related liver and gallbladder disorders. It will also determine if the most important research outcomes have been recorded - this means that if there is no existing research providing a reliable answer the question should be addressed by future research.

 

Survey link: http://goo.gl/forms/fJT6IndJV3

 

Link to JLA website: http://www.lindalliance.org/

 

You can also download the survey as a word document from:

https://www.dropbox.com/s/83xf9fubm9c0kqp/JLANLIP%20survey.docx?dl=0.

Please send the completed form to k.gurusamy@ucl.ac.uk with the subject "JLA NARLIP completed survey.

 

 

Date Added: 03/08/15
European HIV Hepatitis Co-infection (EHHC) Conference
News Type: BASL News

The British HIV Association (BHIVA) in collaboration with ANRS, BASL, BVHG, DAIG, GEHEP and SIMIT held the ‘Five Nations Conference on HIV and Hepatitis’ in London on 9–10 December 2014. This two-day annual conference, which has now been rebranded as the ‘European HIV Hepatitis Co-infection (EHHC) Conference’, has aimed to bring together those directly involved in the care of HIV-infected patients co-infected with hepatitis as well as those who have a clinical or research interest in the epidemiology, natural history or basic science of viral hepatitis.

A number of eminent speakers have agreed to come to London to share their latest research. We would like to thank all our speakers for their invaluable contribution in helping to make the conference, what we hope will be, a great success.

The conference will be hosted at the QEII Centre in Westminster, London. The centre is situated in the shadow of Big Ben, Houses of Parliament, London Eye and Westminster Abbey and is served by outstanding transport links providing easy access to everything London has to offer. The conference centre is located within an hour’s transfer from five surrounding international airports.

Please begin to make plans to be in attendance for both days of this important event. The conference will run for one and a half days and be preceded by a half-day clinical course for non-consultants. 

Please follow the link below for programme details:-

http://www.bhiva.org/EHHC2015.aspx 

Date Added: 03/08/15
PHE 2015 Report
News Type: BASL News

Please follow the link below for full details:-

https://www.gov.uk/government/publications/hepatitis-c-in-the-uk 

Date Added: 24/07/15
Sponsored Places Available for AASLD 2015
News Type: BASL News

We are delighted to announce that Janssen-Cillag Ltd has made provision for 5 sponsored places to be made available for Healthcare professionals to attend the forthcoming AASLD conference, San Francisco, USA, November 13-17, 2015. 

Sponsorship awarded will cover registration, accommodation on a bed and breakfast basis, and return economy air travel from the UK.  Recipients of the sponsorship will be responsible for all other expenditure. All the above would be booked on behalf of the successful applicant by Janssen’s appointed agents.

Eligibility is as follows:

  • Must be a newly appointed consultant within 2 years of their current consultant post, currently planning on reaching consultant status or already involved in viral hepatitis research.
  • All applicants will be involved in the treatment of, or research into viral hepatitis.

The application deadline is Friday 14th August 2015.

Please click for the  >application form and >guideline documents.

For information on AASLD 2015, San Francisco, USA please visit the event website http://www.aasld.org/events-professional-development/liver-meeting-2015

If you have any queries, please do not hesitate to contact the BASL Secretariat +44 (0)1543 442154, jane.douthwaite@execbs.com

Date Added: 23/07/15
Andy Burroughs Young Investigator Award
News Type: BASL News

In honour of the late Professor Andrew Burroughs, who sadly passed away in March 2014, the BASL committee have launched  the ‘Andy Burroughs Young Investigator Award’.  Amongst Professor Burroughs’ many achievements was his significant contribution to liver transplantation. Consequently, the Young Investigator Award will be associated with the BLTG Liver Transplant Meeting.

The award winner will deliver the prize lecture at the second BLTG Meeting which is being held at Royal College of Physicians on 8th September 2015, and will also receive free registration to the meeting and £1,000.

Eligibility

This prize is awarded to young investigators, scientific or clinical, who are in training or within 2 years of taking up consultant positions (or equivalent).

Applications

To apply, please send one A4 sheet outlining the transplant related research and another A4 sheet listing up to 5 related publications.

Please send submissions to admin@basl.org.uk before the deadline of Sunday 9th August 2015, 23:59hrs.

For any queries, please contact admin@basl.org.uk 

For further information on the BLTG Meeting please click here: http://www.basl.org.uk/events/160/BLTG-Transplant-Day-2015/index.cfm 

Date Added: 15/07/15
AHA endorse Alcohol Focus Scotland's response to Alcohol Bill
News Type: BASL News

Alcohol Focus Scotland submission of evidence to the Health and Sport Committee

Summary of Alcohol Focus Scotland’s view on the bill as a whole:

• Alcohol Focus Scotland (AFS) supports the overall aim of this bill, to bring about a reduction in alcohol-related harm in Scotland.  Considerable progress to date in the implementation of Scotland’s alcohol strategy, however continued efforts are critical to ensure a sustained, long-term reduction in levels of alcohol consumption and harm. 

• The provisions in this bill should be considered in the context of Scotland’s wider alcohol strategy to ensure overall coherence in the strategic approach.  An effective alcohol strategy contains a wide range of interventions, but it is important to ensure that attention and resources are not diverted from the most effective and cost-effective measures for reducing alcohol harm, namely controls on the affordability, availability and marketing of alcohol, particularly at a time when public finances are stretched. 

• AFS supports the provisions in this bill to tighten the quantity discount ban, restrict alcohol advertising, and extend notification and consultation in premises licence applications.  We believe a lot more can be done to protect children from exposure to alcohol marketing in Scotland, and to make the licensing process more accessible and responsive to local people.  Action in these areas needs to go beyond what is proposed in this bill.  

• AFS is less certain of other provisions in the bill, particularly those relating to offences involving alcohol.  In principle we are in favour of interventions to reduce alcohol-related offences, and of help and support being provided to individuals whose drinking is identified as a factor in their offending behaviour.  However, the evidence base on the effectiveness and cost-effectiveness of the proposed measures is lacking.  We support further assessment and evaluation of these measures before being legislated on and widely implemented. 

 

Further information

For the AFS opinion on particular provisions of the bill and more information please click 'Further Information' for the full document.

Date Added: 07/07/15
Closing date for the consultation to review ONS's definition of avoidable mortality has now been extended from 01 July to 31 July 2015
News Type: BASL News

To ensure that our mortality data continues to meet your needs we are reviewing our current definitions of avoidable mortality.

Avoidable mortality is based on the concept that premature deaths from certain conditions should be rare, and ideally should not occur if there are timely and effective healthcare or public health interventions.

We plan to review the list of causes of death considered avoidable, along with the associated age limits, every three years, and are now seeking your views to assist with this process.

The definition of avoidable mortality requires regular review because deaths from a condition, which was previously not considered avoidable, may have become avoidable following medical advances and public health interventions. There may also be a case for reviewing the age limits within which deaths are considered avoidable, in light of increasing life expectancy and improvements to cause of death coding at older ages.

Further information is available in the 'Review of Avoidable Mortality Definition: 2015 Consultation' document on our website at:

www.ons.gov.uk/ons/about-ons/get-involved/consultations-and-user-surveys/consultations/review-of-avoidable-mortality-definition/index.html

You can submit your responses using our online questionnaire. You can also respond by post or email, using the contact details below.

Email: mortality@ons.gsi.gov.uk

Postal address:
Mortality Analysis Team
Office for National Statistics – Room 1059
Government Buildings
Cardiff Road
Newport
NP10 8XG


Mortality Analysis Team

Date Added: 06/07/15
BASL Comment on NCEPOD report
News Type: BASL News

The report highlights major deficiencies in care and identifies areas where the organization and delivery of care especially related to portal hypertensive bleeding needs to improve. 

Specifically none of the patients who bled from gastric varices had therapy with glue as recommended by guidelines perhaps reflecting the finding that only 50% of hospitals had a guideline for glue injection and 50% of Consultants on endoscopy rotas were not competent in the use of glue. Whilst gastric varices represent a small number of presentations with variceal haemorrhage there were still deficiencies in the basic care of patients presenting with oesophageal variceal bleeding. 37% of patients with variceal bleeding did not receive prophylactic antibiotics despite strong recommendations in all guidelines. Furthermore plans for rebleeding were not documented in a third of patients. The overall rate of failure to control bleeding was quite high with almost a third of patients failing to achieve haemostasis. Despite this high rate of failure to control bleeding only 13 hospitals in the UK have a 24/7 TIPS service and only 51% of hospitals had a formal network for TIPS referral. 

It is very clear from this report that there remain major deficiencies in the care of patients with acute variceal bleeding in the UK. These deficiencies range from limited access to TIPS and glue injection to failure to comply with simple evidence based guidance such as antibiotic use. Some of these deficiencies will be addressed by the widespread uptake of the cirrhosis care bundle. However, the major challenge to the UK hepatology and gastroenterology community is the organization of GI bleeding networks to enable access for all patients to timely TIPS and advanced endoscopy that would be in line with the proposals for liver service provision  described within the Lancet Commission. 

Please click 'Further Information' below to access the Cirrhosis Care Bundle document.

Date Added: 06/07/15
Clinical Research Fellow vacancy.
News Type: BASL News

Please click on the link for details

http://www.ed.ac.uk/schools-departments/human-resources/jobs

Click on 'Search Vacancy'

Enter 033285 in 'Vacancy Reference' field

 

Date Added: 30/06/15
Policy and Advocacy Manager available
News Type: BASL News

Employer: Alcohol health Alliance

Location: Alcohol Concern’s offices in Old Street

Duration: Full time on a 12 Month contract

Benefits include 28 days leave and contributory pension scheme.

Salary: 30,000 per year including London Weighting

Closing Date: Monday 6th July 9am.

Interview: 13th/ 14th July

The AHA is currently recruiting for a Policy and Advocacy Manager as Madeleine Harris Smith will sadly be leaving at the start of next month.

The role is full-time on a 12 month contract, and will be based at Alcohol Concern’s offices in Old Street.

Please see attached for the full job description

Please click here to find out how to apply.

If you have any questions about the role please contact Tom Smith, Head of Policy at Alcohol Concern for more information on 0207 566 9807 or alternatively I am happy to pass on any queries.

Date Added: 29/06/15
EASL Special Conference in Glasgow 25th to 27th September 2015
News Type: BASL News

https://events.easl.eu/EventPortal/Information/EventInformation.aspx?EventInformationPageCode=HOME&EventCode=SG

EASL SPECIAL CONFERENCE

ADDRESSING END-STAGE LIVER DISEASE: A MULTIFACETED CHALLENGE

September 25-27, 2015, Glasgow, UK

 

ORGANISING COMMITTEE:

Mauro Bernardi, Italy 

Richard Moreau, France

 

DAY 1 – FRIDAY, SEPTEMBER 25, 2015

15:15 – 15:25 Introduction

Mauro Bernardi, Italy

State-of-the-art lecture

Chair: Mauro Bernardi, Italy

15:25 – 15:55 End-stage liver disease: a multifaceted condition

Vicente Arroyo, Spain

 

Session 1

Are there (still) possible specific treatments in end-stage liver disease?

Chair: Alexander Gerbes, Germany

15:55 – 16:15

Viral cirrhosis

Antonio Craxì, Italy

16:15 – 16:35

Alcoholic liver disease

Philippe Mathurin, France

16:35 – 16:55

Autoimmune liver disease

Arndt Vogel, Germany

 

16:55 – 17:15

Discussion

17:15 – 17:40 Coffee break

 

Session 2

Is there a common pathophysiological background for the multifaceted manifestations of end-stage liver disease?

Chair: Richard Moreau, France

17:40 – 18:00

Intestinal microbiota in chronic and end-stage liver disease

Bernd Schnabl, USA

18:00 – 18:20

Translocation of bacteria and bacterial products

Andrea De Gottardi, Switzerland 

18:20 – 18:40

The immune and inflammatory response

Agustin Albillos, Spain 

 

18:40 – 19:00

Discussion

19:00 Cocktail Reception

 

DAY 2 – SATURDAY, SEPTEMBER 26, 2015

State-of-the-art lecture

Chair: Richard Moreau, France

8:30 – 9:00 Gene – environment interactions: What we learned from cardiologists 

Aldons J. Lusis, USA

 

Session 3

The Cardinal Manifestations of End-stage Liver Disease

Chair: Guadalupe Garcia-Tsao, USA

  A) Splanchnic circulation abnormalities

9:00 – 9:20

Pathophysiology of portal hypertension 

Jaime Bosch, Spain

 

10:00 – 10:20  

Discussion

10:20 – 10:40 

Coffee break

 

B) Systemic circulation and cardiac abnormalities

10:40 – 11:00               

Hyperdynamic circulation and cirrhotic cardiomyopathy

Søren Møller, Denmark

11:00 – 11:20

 

Management of ascites and hyponatremia

Pere Ginès, Spain

11:20 – 11:40               

Management of acute renal failure

Paolo Angeli, Italy

11:40 – 12:00

Discussion

C) Neurological abnormalities

12:00 - 12:20 

Pathophysiology of hepatic encephalopathy

Dieter Häussinger, Germany

12:20 – 12:40 Management of hepatic encephalopathy

Arun Sanyal, USA

12:40 – 13:00 Discussion

13:00 – 15:00 Lunch

 D) Relative adrenal insufficiency

15:00 - 15:20

Pathophysiology and management of relative adrenal insufficiency

Alexander Wilmer, Belgium

15:20 - 15:30 Discussion

 E) Abnormalities of hemostasis

15:30 – 15:50 The coagulation system in end-stage liver disease

Armando Tripodi, Italy

15:50 – 16:10 Management of hemostasis abnormalities

Dominique Valla, France

16:10 – 16:25 Discussion

16:25 – 16:45

Coffee break

 

Session 4

Bacterial infectious in end-stageliver disease

Chair: Rajiv Jalan, UK

16:45 – 17:05

The ever changing epidemiology of bacterial infections

Pierluigi Viale, Italy

17:05 – 17:25

Genetic predisposition to infectious in cirrhosis

Frank Lammert, Germany

17:25 – 17:45

Management of bacterial infections

Mauro Bernardi, Italy

17:45 – 18:05

Prophylaxis of bacterial infections

Guadalupe Garcia-Tsao, USA

18:05 – 18:30

Discussion

 

 

DAY 3 – SUNDAY, SEPTEMBER 27, 2015

State-of-the-art lecture

Chair: Vicente Arroyo, Spain

 

8:30 – 9:00 

Acute-on-chronic liver failure

Rajiv Jalan, UK

Session 5

 

Intensive care of end-stage liver disease

Chair: Pere Ginès, Spain

9:00 – 9:20

Who should receive intensive care? Criteria for admission to ICU 

Julia Wendon, UK

9:20 - 9:40

Organ support in end-stage liver disease

Valentin Fuhrmann, Austria

9:40 – 10:00

Bridging to liver transplantation: extracorporeal liver support systems

Faouzi Saliba, France

10:00 - 10:20

Discussion

10:20 - 10:45

Coffee Break

 

Session 6

Liver transplantation for end-stage liver disease and beyond

Chair: Pere Ginès, Spain

10:45 – 11:05 

Is there a perfect prognostic tool to prioritize patients?

Patrick Kamath, USA

11:05 – 11:25 

The multifaceted manifestations of end-stage liver disease: which require to be prioritized?

François Durand, France

11:25 – 11:45 

The transplant benefit in terminal patients

Antonio D. Pinna, Italy

11:45 – 12:05

Stem cells in end-stage liver disease                               

Stuart J. Forbes, UK

12:05 – 12:35

Discussion

12:35 – 12:50

Closing remarks

Richard Moreau, France

 

 

Date Added: 26/06/15
The Royal College of Physicians of Edinburgh annual symposium on Gastroenterology
News Type: BASL News

Like many areas of medicine, gastroenterological management continues to evolve. This symposium addresses some important areas of disease management which is being informed by new evidence (such as alcoholic hepatitis and acute severe colitis). The gut microbiome is an emerging and rapidly expanding area of research endeavour that seems likely to impact not only on gut and liver health and disease but on many other parts of the human body so it is appropriate to review this. A major public health problem, hepatitis C, is reviewed with respect to challenges of identifying and treating asymptomatic cases. While there are now highly effective treatments, there is a debate to be had balancing affordability with the risks and expense of managing advanced liver disease in the future. This leads onto the issues of the need for palliative treatment in advanced liver disease: recognition of the palliative needs of end stage liver disease patients and how this sits with being on a liver transplant list.

Endoscopic treatments continue to evolve and the technical ability to diagnose early neoplasia have improved, so it is appropriate to review what can be achieved and to understand where endoscopic therapy may be heading in the future.

Finally, some areas of common clinical practice, where symptoms are at variance with normal endoscopic findings, are identified and explored in a practical and interactive session.

Professor John de Caestecker

Chair, Organising Committee

 

Date Added: 24/06/15
Webcast Best of HCV from EASL 2015
News Type: BASL News

Overview of the EASL 2015 HCV webcast:

Lead by Professor Graham Foster and Cihan Yurdaydin, an expert faculty will discuss some of the HCV topics of highest interest from this year’s International Liver Congress in Vienna, Austria. Topics will include Phase 3 data from late stage all oral regimens, treatment data in patients with severe renal disease, the latest clinical data in genotype 3 patients, as well as advances in the treatment of decompensated cirrhotics and liver transplant recipients. The newly issued EASL recommendations on the treatment of HCV are also discussed.

Webcast supported by: AbbVie, Bristol-Myers Squibb, and Gilead Sciences

>Click here to view the EASL 2015 webcast

Other IC-Hep Webcasts

You can access previous IC-Hep webcasts from International meetings using the links below:

>AASLD 2014 webcast
>EASL 2014 webcast

About IC-Hep

IC-Hep (International Coalition of Hepatology Education Partners) is a global collaboration of leading educational providers dedicated to providing healthcare professionals the most current information and clinically meaningful education on chronic liver diseases.  For further information please visit the IC-HEP Website: http://www.ic-hep.com

 

Date Added: 23/06/15
UK National Screening Committee (UK NSC)
News Type: BASL News

Any interested parties of these vacancies internally or any potential candidates should complete an application form by 26 June 2015. 

A copy of the application pack is available at https://www.gov.uk/government/organisations/department-of-health/about/recruitment.

Please note that members are appointed as individuals to fulfil the terms of reference of the Committee, not as representatives of their particular professions, or their employer or any interest group.

Date Added: 12/06/15
Paracetamol Challenge is Dangerous and Potentially Fatal
News Type: BASL News

You may be aware that there is a facebook and instagram trend occurring called the paracetamol challenge where by young people are experimenting with how many paracetamol they can take. 

This is an incredibly dangerous and idiotic activity.

BASL would like to state that it is extremely concerned that people whatever age may be unaware of the potentially fatal implications of taking high doses of paracetamol not advised by the medical professional. 

Paracetamol is a well recognised liver toxic drug when taken above the recommended dose of 4g per day, which can frequently result in acute liver failure, death, and if survived, life changing disability. 

BASL urge young people and all to not participate in the Paracetamol Challenge or take any dose above the recommended guidlelines.

Please circulate to your networks where appropriate.

Date Added: 11/06/15
A Big Thank You to Amanda Clements
News Type: BASL News

Until recently Amanda Clements was the Hepatology Nurse Consultant for the South West liver unit, Derriford Hospital, Plymouth. She had been in post for 15 years and had been actively involved with BASL Nurse Forum (BASLNF) since it first began. Amanda has now left both the BASLNF and her job in Plymouth to embark on a new career pathway.

During her time with BASL NF hepatology nursing services have rapidly expanded reflecting the growth of liver disease and Amanda was pivotal in promoting and developing the forum, ensuring that liver nursing stayed on the national agenda. She was always trying to highlight and expand access to educational opportunities and was chief editor for the BASL Nurse e-learning toolkits. Amanda also did exemplary work for end of life and long term condition management for patients and their care givers, affected by end stage liver disease. 

Amanda will be missed from BASLNF but as a committee we will continue to develop and promote liver nursing at a national level. From all of the committee we wish Amanda every success in her new role.

Date Added: 11/06/15
Academic Hepatology posts available at the Institute of Hepatology
News Type: BASL News

Employer: Foundation for Liver Research 

Location: Institute of Hepatology, London, UK

Duration: 5 years in the first instance

Start date: October 2015

Salary range: £75,249-82,318 

Closing date: 5pm, Wednesday 17th June 2015

The Foundation for Liver Research is seeking to appoint two academic/NHS consultant hepatologists to establish research teams within the Clinical (Translational) Research Centre at the Institute of Hepatology, London, as part of an exciting collaboration with King’s College Hospital (KCH) and King’s College London (KCL).

The Institute, currently based in central London, is relocating in spring 2016 to a purpose-built new Institute on the KCH Denmark Hill campus. The appointments will be a 75:25 split between research at the Institute of Hepatology and clinical sessions at KCH. A strong academic interest and track record in research is essential. The appointments include 2yrs funding for a postdoctoral scientist and consumables. Preferred areas of research include autoimmune liver disease, alcoholic and non-alcoholic fatty liver disease, acute liver failure and hepatocellular carcinoma.

Applications including a detailed curriculum vitae with a 2 page summary of research plans should be sent to Natalie Day, Head of Administration (E-mail: n.day@researchinliver.org.uk Tel: 020 7255 9832).

Applicants are encouraged to discuss their application in advance with Professor Roger Williams, CBE, Director of the Institute of Hepatology, London. A detailed job description is available at www.liver-research.org.uk/jobopportunities or by email from: n.day@researchinliver.org.uk. Due to current UK immigration restrictions we are unable to consider non-EU nationals for this post. Job ref RS15

Date Added: 11/06/15
NIHR Clinical Research Fellow Vacancy - Birmingham
News Type: BASL News

Clinical Research Fellow - 54589

Clinical trial of human mesenchymal stem cells in patients with primary sclerosing cholangitis.

Available from August 2015 to work on a clinical trial of mesenchymal stromal cells in patients with primary sclerosing cholangitis in the Liver Unit in Birmingham and the Centre for Liver Research (CLR) laboratories. The clinical trial will be led by Dr Gideon Hirschfield and Professor Philip Newsome.

The post is funded by the European Commission as part of an FP7 programme for 24 months which is co-ordinated by Prof Newsome. The programme will test the efficacy of human mesenchymal stromal cells in models of liver damage and also explore mechanisms of action. The post-holder will also have close interactions with the other work-packages led by groups across Europe.

We are looking for a Clinical Research Fellow with excellent academic qualifications and good teamwork skills. The position will be based in the internationally regarded Liver Unit at the Queen Elizabeth Hospital and the NIHR funded Liver Biomedical Research Unit in the JIF-funded Institute of Biomedical Research.

We a looking for a clinician with MRCP or equivalent, a potential ability to conduct and publish their own research, strong communication skills and an ability and eagerness to work in a multi-disciplinary team. You will recruit patients and co-ordinate clinical trials in cell therapy or autoimmune liver disease with the assistance of the Liver Clinical Trials team.

You will have an enthusiasm to learn and will be encouraged to register for a higher degree. You will work closely with all members of the project team in advancing our research programmes in liver disease.  

The position is available for 24 months with an expectation to register for a higher degree. Salary will be at the appropriate point on the appropriate clinical scale, with placement according to qualifications and experience.

Contact Professor Philip Newsome p.n.newsome@bham.ac.uk   or Dr Gideon Hirschfield g.hirschfield@bham.ac.uk for informal enquiries.

Closing date extended to 03 July 2015.

 

Job Description: http://www.download.bham.ac.uk/vacancies/jd/54589a.pdf

Date Added: 11/06/15
Thousands more patients to be cured of hepatitis C
News Type: BASL News

In what will be the NHS’ single largest investment in new treatments this year, NHS England has today (10 June 2015) announced it will be investing an estimated further £190 million in new cures for hepatitis C, on top of the approximately £40 million extra which began last year.

Thousands of patients in England with cirrhosis caused by the hepatitis C virus will now be able to access new treatment options which can cure the virus and therefore prevent further damage to the liver, including the potential of end stage liver disease or cancer. The hepatitis C virus affects the liver’s ability to function and is most commonly a result of the use of infected needles by intravenous drug users.

The widening of NHS England’s ‘early access’ scheme to patients with cirrhosis will see an expected additional 3,500 patients accessing treatment in this year, representing an additional investment of around £190m. This is additional to the new funding introduced last year for patients at imminent risk of liver failure, benefiting around 1000 people so far.

Richard Jeavons, NHS England’s Director of Specialised Services, said: “At a time when funding is inevitably constrained across the NHS this is a huge new investment; in fact it’ll be the NHS’ single largest new treatment expansion this year. That’s why we’re also running a competitive tendering process in parallel, to seek to bring down the price of these very expensive new drugs.”

Peter Moss, a Consultant and Chair of NHS England’s Infectious Diseases Clinical Reference Group, said: “The new anti-viral drugs being made available through this scheme offer a huge improvement in care for patients with hepatitis C-related liver cirrhosis. Now we are in a position to cure the large majority of patients and so to prevent further liver damage and premature death.”

Infectious Diseases Clinical Reference Group

Charles Gore, Chief Executive of the Hepatitis C Trust, said: “Patients with cirrhosis will be delighted to have access to these new drugs. They are so tolerable that almost all of those with cirrhosis will want to take them and so potent that almost of those that do will be cured of their hepatitis C thereby massively reducing their risk of liver failure or liver cancer.

“This is a big step forward towards reversing the rising death-toll from this disease. People living with hepatitis C have been waiting for this revolution in therapy with huge expectation and now it has arrived we hope NHS England will move quickly to make it available to a rapidly increasing number of patients.”

Source: http://www.england.nhs.uk/2015/06/10/patients-hep-c/

Click 'further information' below for access to the NHS England Treatment of chronic Hepatitis C in patients with cirrhosis policy statement.

Date Added: 26/05/15
Calls for Nominations for BASL President 2015-2017
News Type: BASL News

The tenure of the current BASL President, Dr Mark Hudson, will come to an end in September 2015.  As such, BASL are now seeking expressions of interest for the position of BASL President. 

The President is one of the three principal officers of the Association along with the Secretary and Treasurer.

The President is Chairman of the Association and serves for two years. The President will Chair the annual Scientific Meeting and the meetings of the Governing Board.


Nomination Process

Please send your nominations to the BASL Secretariat at paula@execbs.com by the deadline of Friday 5th June 2015 12:00 (midday).

Candidates wishing to be considered for election will require one BASL member to propose them and a second member to confirm their suitability for the role in writing.

If more than one candidate is nominated, the Secretariat will arrange for an electronic election of all members.  A member cannot be re-elected to the post of President.

The newly elected President will be announced at the next Business Meeting of the Association during DDF on Wednesday 24th June 2015.

A handover period will follow leading up to the end of the tenure of the current President.

 

 

Date Added: 08/05/15
Nurse Bursaries for DDF 2015-Deadline Extended to 18th May
News Type: BASL News

AbbVie Ltd are offering 20 bursaries, available to Nurse members of BASL to help support travel to and attendance at DDF 2015, 22nd - 25th June 2015.

Each bursary will be capped at £750 and will cover:

Registration for DDF 2015

Return travel to London

Accommodation

The application deadline is extended to 18th May 2015.

 For an application form and guidelines, please click the links below.

>Download the Application Form

>Download the Guidance Notes

If you experience any problems downloading the documents, please contact jane.douthwaite@execbs.com

For information on DDF 2015, London, please visit the event website

Date Added: 05/05/15
NHS England Approved Update Statement - Treatment Access for Cirrhotic Patients
News Type: BASL News

Dear Colleagues

We are writing to update you on access to treatment for patients with chronic HCV infection. As you know the first review of the Early Access Program was presented at EASL last week. These data show that therapy for patients with decompensated cirrhosis has been very successful and this program will continue.

NHS England has confirmed that access to treatment should be extended, and the CRG have completed a proposal for a new scheme to offer the best available oral antiviral therapy to all patients with cirrhosis.   There is a formal sign off step to be completed but we anticipate that the scheme will be up and running by late May.  However given the inevitable slippage in delivery times it may be prudent to advise patients that treatment may not commence until early June 2015. The precise details of how treatment will be delivered are still under discussion but we envisage a network approach, and details of centre selection will be circulated as soon as possible, probably within the next 10 days.

We understand that clinicians and patients want to get access to these treatments as soon as possible. However colleagues will be aware that NHS commissioning is governed by strict rules and any attempt to short circuit the process raises the possibility of legal challenge which can only lead to further delay. It is therefore important that we set up the commissioning process correctly and we can assure you that no efforts are being spared to move this forward as quickly as possible.  

In parallel with the expansion of therapy to patients with cirrhosis we are working to establish treatment networks, and the draft specification for these has already been circulated for stakeholder comment. We anticipate that the new networks will be commissioned in July 2015 and, at this point, they will take over delivery of all hepatitis C treatments. The networks will act as co-ordinating centres for therapy and we anticipate a wide diversity of providers with treatment provided as close to the patient as is practical. 

In order to consider how oral therapy can be offered to patients with lesser degrees of fibrosis a clinically-led working party has been established to define the patient groups who should be offered therapy once those in greatest need have been treated. Details of this will be made available as soon as possible but we hope that we will be able to expand treatment towards the end of the year. NHS England wants to be assured that all patients with cirrhosis are able to get access to treatment before widening the scope.  Careful monitoring of the numbers receiving treatment as well as their outcomes will be critical to support the commissioning strategy and will be an important function of the network administrative centres.

Setting up this complex program has needed to be considered carefully by NHS England which has taken time and we recognise the pressure that this has placed upon clinical teams. We are grateful to everyone for their patience and we hope that we will shortly be able to announce the process for delivering therapy to patients with cirrhosis and provide full details on the planning of the next phase.

 

Peter Moss, Chair HCV CRG

Graham Foster, Vice Chairman HCV CRG

This is an official statement approved by NHS England.  If you have any queries, please direct them to Professor Graham Foster g.r.foster@qmul.ac.uk and Dr Peter Moss Peter.Moss@hey.nhs.uk of the HCV CRG’.

 

Date Added: 29/04/15
ACCEA 2015 Round Open
News Type: BASL News

ACCEA opened the 2015 awards round on Tuesday 14th April. The final closing date for applications to ACCEA is Wednesday 17th June.  BASL will need to complete the process of selecting applicants who will receive our support shortly.

Application Forms
If you would like to apply for BASL support, please complete and submit Application Form A and any other supplementary CVQs, available below by Friday 15th May 2015, 09.00:

Form A - Application Form

Form D - Supplementary CV Questionnaire: Research & Innovation Assessment 

Form E - Supplementary CV Questionnaire: Teaching & Training Assessment 

Form F - Supplementary CV Questionnaire: Leadership & Management Assessment

Please be aware that there is a maximum number of supplementary forms that can be completed at each National Level: Bronze and Silver applicants: 1 / Gold applicants: 2.  These forms are optional and it is for the applicant to decide whether using them will increase chances of success.

(For use of the Supplementary Forms, please see 'Domains' within the Application form A)

If you are having problems downloading these forms, you can find them online at https://www.gov.uk/government/publications/clinical-excellence-awards-2014-application-forms

Guidance can also be found on the ACCEA website at https://www.gov.uk/government/publications/clinical-excellence-awards-2014-application-guidance

 

Eligibility

As in previous years BASL would be able to support colleagues directly by nomination for national Gold, Silver and Bronze awards.

As a specialist society, BASL cannot make nominations for Platinum awards, this must be done through the applicant’s University/Research Body and Universities UK.  BASL can however provide a citation to support an application for a Platinum award.  

As a rule, candidates for National Bronze (Level 9) should have a minimum of at least five local Clinical Excellence Awards.  Award holders applying for higher level awards or a renewal must specify which achievements have been made after the date of their last award or renewal particularly concentrating on current activities and activities in the last 4 or 5 years, therefore you must date activities.

 

To apply for BASL support, please follow these steps:

1.  Send your completed application forms to the BASL Secretariat (paula@execbs.com) by 09.00 on Friday 15th May 2015 for review.

Please understand that in fairness to all applicants, late submissions will not be considered.

2.  All applicants will be asked to provide the name of an individual who could write a supporting citation upon submitting their application to the BASL.  ACCEA regard the citations provided  in support of individuals as giving added value to the process.

3. You must submit your own application to ACCEA online by their deadline Wednesday 17th June 2015, 17.00.  This is your own responsibility. >Access ACCEA Website here.

4. If you are in receipt of BASL support then we will upload your citation - please can you ensure your application is uploaded at least one week before the ACCEA deadline (by Wednesday 10th June 2015) so that we have sufficient time to upload your citations onto your application on the ACCEA website. 

 

Date Added: 27/04/15
Book now for the NICE Annual Conference 2015
News Type: BASL News

You can book now for the NICE Annual Conference 2015

Taking place on the 13 and 14 October at the ACC in Liverpool, the conference will bring together representatives from the NHS, social care, local government and industry with patient and service users groups, to map out how to deliver the personalised and coordinated services that people need.

  • Key topics for this year include:
  • Supporting vulnerable people
  • Long term conditions
  • Lifestyle and wellbeing
  • Innovation into practice
  • Service delivery, organisation and staffing

The full conference programme is now available and tickets are on sale at the discounted early bird rate. 

> For further information, please visit the website

Date Added: 24/04/15
Policy Forum for Wales Keynote Seminar
News Type: BASL News

with

Professor Sir Mansel Aylward, Chair, Public Health Wales; Director, Centre for Psychosocial and Disability Research and Professor of Public Health Education in the School of Medicine, Cardiff University; 

 

Peter Davies, Wales’ Commissioner for Sustainable Futures and Chair, Climate Change Commission; and 

 

Professor Simon Murphy, Professor in Public Health Improvement, Principal Investigator on PHIRN and Cardiff Co-Director for DECIPHer, Cardiff University

and

Martin Blakebrough, Kaleidoscope Project; Chris Cashin, Cardiff Nutrition Consultancy and Welsh Board British Dietetic Association and Sports Dietitians UK; Paul Dunning, Abertawe Bro Morgannwg University Health Board; John Hardy, Conwy County Borough Council; Giovanni Isingrini, Rhondda Cynon Taf County Borough Council; Elen de Lacy, ASH Wales Cymru and Kim Roberts, HENRY 

 

Chaired by:

Jenny Rathbone AM, Chair, Cross Party Group on Diabetes, National Assembly for Wales

 

This event is CPD certified

 

Morning, Thursday, 2nd July 2015

 Central Cardiff

 

Our Website | Book Online | Live Agenda | Unsubscribe

Please note there is a charge for most delegates, although concessionary and complimentary places are available (subject to terms and conditions - see below).

 

 The focus:

 

The future of public health policy in Wales.

 Context:

 

 To note:

 

Includes keynote addresses from:

  • Professor Sir Mansel Aylward, Chair, Public Health Wales; Director, Centre for Psychosocial and Disability Research and Professor of Public Health Education in the School of Medicine, Cardiff University; Peter Davies, Wales’ Commissioner for Sustainable Futures and Chair, Climate Change Commission; and Professor Simon Murphy, Professor in Public Health Improvement, Principal Investigator on PHIRN and Cardiff Co-Director for DECIPHer, Cardiff University.

 Key discussion points:

 

  • Reducing harms to health: implementation and likely impact of key proposals on smoking, alcohol, substance misuse and obesity, such as the restriction of the use of e-cigarettes in public places and introduction of a Minimum Unit Price for alcohol of 50p per unit;
  • Improving health regulation: the proposed introduction of a National Special Procedures Register and the effectiveness of current food safety and hygiene schemes;
  • Encouraging healthy lifestyles: steps to improve the prevention of health issues more widely, encourage greater participation in physical activity and the development of nutritional standards for certain settings;
  • Strengthening community assets and delivering healthcare services closer to people’s homes; and
  • Engagement in public health issues: the role of employers and improving co-production across services.

 The draft agenda is copied below my signature, and a regularly updated version is available to download here. The seminar is organised on the basis of strict impartiality by the Policy Forum for Wales.

 

 Speakers

 

 We are delighted to be able to include in this seminar keynote addresses from: Professor Sir Mansel Aylward, Chair, Public Health Wales; Director, Centre for Psychosocial and Disability Research and Professor of Public Health Education in the School of Medicine, Cardiff University; Peter Davies, Wales’ Commissioner for Sustainable Futures and Chair, Climate Change Commission and Professor Simon Murphy, Professor in Public Health Improvement, Principal Investigator on PHIRN and Cardiff Co-Director for DECIPHer, Cardiff University.

 

 Further confirmed speakers include: Martin Blakebrough, Chief Executive Officer, Kaleidoscope Project; Chris Cashin, Owner, Cardiff Nutrition Consultancy and Chair, Welsh Board British Dietetic Association and Sports Dietitians UK; Paul Dunning, Occupational Therapist, Wellbeing through Work, Abertawe Bro Morgannwg University Health Board; John Hardy, Head of Active and Creative Lifestyles, Conwy County Borough Council; Giovanni Isingrini, Group Director of Community & Children Services, Rhondda Cynon Taf County Borough Council; Elen de Lacy, Chief Executive, ASH Wales Cymru and Kim Roberts, Chief Executive, HENRY.

 

 Jenny Rathbone AM, Chair, Cross Party Group on Diabetes, National Assembly for Wales has kindly agreed to chair part of this seminar.

 

 Additional senior participants are being approached.

 

 Networking

 

 This seminar will present an opportunity to engage with key policymakers and other interested parties, and is CPD certified (more details). Places have been reserved by parliamentary pass-holders from the National Assembly for Wales and officials from Better Regulation Delivery Office; Healthcare Inspectorate Wales; ONS; Wales Audit Office and the Welsh Government. Also due to attend are representatives from Abertawe Bro Morgannwg University Health Board; Association for Improvements in the Maternity Services; Cancer Research UK; Cardiff Metropolitan University; Cardiff University; Cathays High School; Faculty of Public Health; Forgotten Parents; HENRY; Public Health Wales; Smokefree South West; Swansea University; University of Wales Trinity Saint David; Vale 50+ Strategy Forum; Welsh Local Government Association; Welsh Rugby Union; Welsh Senate of Older People and Young Advisors Charity.

 

 Overall, we expect speakers and attendees to be a senior and informed group numbering more than 120, including Members of the National Assembly for Wales and senior officials from the Welsh Government, representatives from Public Health Wales, Local Health Boards and from across the NHS; charities; sports bodies and the leisure industry; affected sectors such as the licensed pub trade, breweries, tobacco companies and retailers; and academics with an interest in these important issues together with reporters from the national and trade press based in Wales and elsewhere.

 

 Output and About Us

 

 A key output of the seminar will be a transcript of the proceedings, sent out around 10 working days after the event to all attendees and a wider group of Ministers and officials in the Wales Office and Welsh Government departments affected by the issues; as well as Assembly Members with a special interest in the subject. It will also be made available more widely. This document will include transcripts of all speeches and questions and answers sessions from the day, along with access to PowerPoint presentations, speakers’ biographies, an attendee list, an agenda, sponsor information, as well as any subsequent press coverage of the day and any articles or comment pieces submitted by delegates. It is made available subject to strict restrictions on public use, and is intended to provide timely information for interested parties who are unable to attend on the day.

 

 All delegates will receive complimentary PDF copies and are invited to contribute to the content.

 

 The Policy Forum for Wales is strictly impartial and cross-party. The Forum has no policy agenda of its own.

 

 Booking arrangements

 

 To book places, please use our online booking form.

 

 Once submitted, this will be taken as a confirmed booking and will be subject to our terms and conditions below.

 

 Please pay in advance by credit card on 01344 864796. If advance credit card payment is not possible, please let me know and we may be able to make other arrangements.

 

 Options and charges are as follows:

 

  • Places at Improving public health and wellbeing in Wales (including refreshments and PDF copy of the transcripts) are £210 plus VAT;
  • Concessionary rate places for small charities, unfunded individuals and those in similar circumstances are £80 plus VAT. Please be sure to apply for this at the time of booking.

 For those who cannot attend:

 

  • Copies of the briefing document, including full transcripts of all speeches and the questions and comments sessions and further articles from interested parties, will be available approximately 10 days after the event for £95 plus VAT;
  • Concessionary rate: £50 plus VAT.

 If you find the charge for places a barrier to attending, please let me know as concessionary and complimentary places are made available in certain circumstances (but do be advised that this typically applies to individual service users or carers or the like who are not supported by or part of an organisation, full-time students, people between jobs or who are fully retired with no paid work, and representatives of small charities - not businesses, individuals funded by an organisation, or larger charities/not-for-profit companies). Please note terms and conditions below (including cancellation charges).

 

 I do hope that you will be able to join us for what promises to be a most useful morning, and look forward to hearing from you soon.

Jonny Roberts

 

Associate Editor, Policy Forum for Wales / Golygydd Cysylltiol, Fforwm Polisïau Cymru

 

 

Policy Forum for Wales Keynote Seminar: Improving public health and wellbeing in Wales

Timing: Morning, Thursday, 2nd July 2015

Venue: Central Cardiff

Draft agenda subject to change

8.30 - 9.00

Registration and coffee

 

 

9.00 - 9.05

Chair’s opening remarks

Jenny Rathbone AM, Chair, Cross Party Group on Diabetes, National Assembly for Wales

 

 

9.05 - 9.25

Public health in Wales: the context for policy direction

Professor Simon Murphy, Professor in Public Health Improvement, Principal Investigator on PHIRN and Cardiff Co-Director for DECIPHer, Cardiff University

Questions and comments from the floor

 

 

9.25 - 10.25

Implementing the Public Health Bill - challenges and next steps for policy

 

 

 

Public health in the community

Senior speaker, community pharmacy

 

 

 

Encouraging healthy lifestyles

John Hardy, Head of Active and Creative Lifestyles, Conwy County Borough Council

Chris Cashin, Owner, Cardiff Nutrition Consultancy and Chair, Welsh Board British Dietetic Association and Sports Dietitians UK

 

 

 

Reducing harms to health

Elen de Lacy, Chief Executive, ASH Wales Cymru

Martin Blakebrough, Chief Executive Officer, Kaleidoscope Project

 

 

 

Priorities for  regulation

Senior speaker, professional body

 

 

 

Questions and comments from the floor

 

 

10.25 - 10.30

Chair’s closing remarks

Jenny Rathbone AM, Chair, Cross Party Group on Diabetes, National Assembly for Wales

 

 

10.30 - 10.55

Coffee

 

 

10.55 - 11.00

Chair’s opening remarks

Senior Assembly Member

 

 

11.00 - 11.40

Looking forward: The Well-being of Future Generations (Wales) Bill

 

 

 

Professor Sir Mansel Aylward, Chair, Public Health Wales; Director, Centre for Psychosocial and Disability Research and Professor of Public Health Education in the School of Medicine, Cardiff University

 

 

 

Peter Davies, Wales’ Commissioner for Sustainable Futures and Chair, Climate Change Commission

 

 

 

Questions and comments from the floor

 

 

11.40 - 12.25

Health inequalities and the impact of The Well-being of Future Generations (Wales) Bill

 

 

 

Tackling and reducing health inequalities

Senior speaker, health board

 

 

 

Early intervention - prenatal and early years support 

Kim Roberts, Chief Executive, HENRY

 

 

 

Community engagement and opportunities for co-production across services

Giovanni Isingrini, Group Director of Community & Children Services, Rhondda Cynon Taf County Borough Council

 

 

 

Engaging employers in health and wellbeing initiatives

Paul Dunning, Occupational Therapist, Wellbeing through Work, Abertawe Bro Morgannwg University Health Board

 

 

 

Questions and comments from the floor

 

 

12.25 - 12.55

Next steps for healthcare policy

Senior speaker to be confirmed

Questions and comments from the floor

 

 

12.55 - 13.00

Chair’s and Policy Forum for Wales closing remarks

Senior Assembly Member

Jonny Roberts, Associate Editor, Policy Forum for Wales

 

 

Date Added: 16/04/15
Multinational study comparing the severe form of steatohepatitis by the CLASH Study collaboration group
News Type: BASL News

We are conducting a multinational study comparing the severe form of steatohepatitis that is found in patients with alcoholic hepatitis, with the mild form of steatohepatitis that is found in early asymptomatic patients. The study, entitled CLASH (Clinical, Histological and Molecular Characterization of two Subtypes of Alcoholic Steatohepatitis), incorporates a proposal to revise the nomenclature.

In order to develop unified terminology, we are conducting a brief survey. Please follow this link:https://www.surveymonkey.com/s/6T2F32G. Your responses will be treated with confidentiality and reported anonymously.

Thank you for taking the time to consider this important clinical issue.

Sincerely,

CLASH Study collaboration group

On behalf of;

Prof. Ramon Bataller, MD on behalf the CLASH investigators

 

University of North Carolina at Chapel Hill, USA

Date Added: 16/04/15
Final Recommendations for new HCV drugs
News Type: BASL News

Following the consensus meeting on Therapy for Chronic Hepatitis C London on March 3 2015, the following final recommendations have been proposed.


Background

The treatment options for patients with chronic hepatitis C are expanding rapidly.  To guide clinicians and commissioners the national societies (BASL, BHIVA BIA, BSG, BVHG) representing clinicians with an interest in this area convened a meeting to provide evidence based treatment and management recommendations. 


Methods

A nominated individual outlined the background data (both published and outcome data from the English early access program) and presented proposals for therapy. These were discussed by the 80 attendees and a consensus was reached. This document outlines the consensus recommendations.


Treatment recommendations:
 

Genotype 1 - Patients with no evidence of cirrhosis/severe fibrosis 

For patients who are treatment naïve preferred treatment is with all oral direct acting antiviral regimens.  The following options are all acceptable on efficacy and safety criteria:- 

                    

Sofosbuvir/Ledipasvir  +/- ribavirin*  8 weeks
Ombitasvir/Paritaprevir (r)/Dasabuvir +/- ribavirin* 12 weeks
Sofosbuvir/Simeprevir 12 weeks
Sofosbuvir/Daclatasvir  12 weeks


If oral DAA regimens are not funded for this patient group by the NHS, patients have the option of waiting for oral therapy, self-funding or starting treatment with an interferon-based regimen.


Interferon based regimes include:-

Sofosbuvir/PEG-interferon/Ribavirin 12 weeks
Simeprevir/PEG-interferon/Ribavirin   
G1b or G1a without Q80K variant                                                                                                                                                                                                                                                                        12 weeks plus 12 or 36 weeks PEG/RBV


For patients with G1a who are Q80K variant positive simeprevir based regimes are not recommended. 


Genotype 1 Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations 

Preferred treatment is with all oral direct acting antiviral regimens.  The following options are all acceptable on efficacy and safety criteria: 

Ombitasvir/Paritaprevir (r)/Dasabuvir +/- ribavirin*  12 weeks (Child Pugh A only)
Sofosbuvir/Ledipasvir  +/- ribavirin* 12 weeks
Sofosbuvir/Simeprevir +/- ribavirin 12 weeks
Sofosbuvir/Daclatasvir +/- ribavirin                                                                                                                                                                                     12 weeks

For all  patients who have failed to achieve SVR with PEG-interferon/Ribavirin treatment is as above (i.e. as per G1 compensated cirrhosis). However for  patients with genotype 1a virus, and previous null response to PEG-interferon/Ribavirin, treatment should be 24 weeks of Ombitasvir/Paritaprevir (r)/Dasabuvir/Ribavirin.


For patients who have failed to achieve an SVR with PEG-interferon/Ribavirin and a protease inhibitor treatment should avoid a protease containing regime and preferred treatment options are sofosbuvir plus ledipasvir OR sofosbuvir plus daclatasvir.


Genotype 1 - Patients with decompensated cirrhosis

Treatment is recommended with oral Sofosbuvir/Ledipasvir +/- Ribavirin for a total of 12 weeks

*Strong consideration should be given to adding ribavirin, though individual patient decisions are to be made by MDT. For G1b patients without cirrhosis the licensed indication for AbbVie 3D does not include ribavirin.

 
Genotype 2  - Patients with no evidence of cirrhosis/severe fibrosis

Treatment naive
PEG-interferon/Ribavirin 24 /52 (12-16/52 in low viral load/rapid viral response)
Treatment experienced (previous PEG-interferon/Ribavirin),  or IFN intolerant Sofosbuvir/ribavirin or those with extrahepatic manifestations 12/52


Genotype 2 - Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations

Treatment naive:               Sofosbuvir/Ribavirin 12/52
Treatment experienced:     Sofosbuvir/Ribavirin 12/52 (cirrhotics 16/52)


Genotype 2 - Patients with decompensated cirrhosis

Treatment is recommended with either

Sofosbuvir/Ledipasvir +/- Ribavirin for a total of 12 weeks
Sofosbuvir/Daclatasvir +/- Ribavirin for a total of 12 weeks


Genotype 3 - Patients with no evidence of cirrhosis/severe fibrosis

For patients who are treatment naïve preferred therapy is:-
PEG-interferon/Ribavirin for 24 weeks (12-16/52 in low viral load/rapid viral response)


For those intolerant of interferon – Sofosbuvir plus daclatasvir or ledipasvir +/- ribavirin for 12 weeks is recommended.

For patients who are treatment experience preferred therapy is:-
PEG-interferon/Ribavirin /Sofosbuvir for 12 weeks


For those intolerant of interferon – sofosbuvir plus daclatasvir or ledipasvir +/- ribavirin for 12 weeks is recommended. 


Genotype 3 - Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations

Preferred treatment is:-
PEG-interferon/Ribavirin /Sofosbuvir for 12 weeks


For those intolerant of IFN the following treatment options are all acceptable:-

Sofoabuvir/daclatasvir/ribavirin  for 12 weeks
Sofosbuvir/ledipasvir/ribavirin for 12 weeks
Sofosbuvir/ribavirin for 24 weeks

 
Genotype 3 - Patients with decompensated cirrhosis

Treatment is recommended with either:

Sofosbuvir/Ledipasvir +/- Ribavirin for a total of 12 weeks
Sofosbuvir/Daclatasvir +/- Ribavirin for a total of 12 weeks
 

Genotype 4 - Patients with no evidence of cirrhosis/severe fibrosis Non-cirrhotic G4 patients

Preferred treatment is for 12/52 therapy with all oral direct acting antiviral regimens.  The following options are all acceptable on efficacy and safety criteria: choice to be determined by NICE approval, availability of funding from NHS England, and local MDT choice:

PEG-interferon/Ribavirin /Sofosbuvir for 12/52
PEG-interferon/Ribavirin/Simeprevir for 12/52 with PEG-interferon and ribavirin for a further 12 weeks
Ombitasvir/paritaprevir/ritonavir/ribavirin for 12/52
Sofosbuvir/Ledipasvir/ribavirin for 12/52


Genotype 4 - Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations

Sofosbuvir/Ledipasvir/ribavirin for 12/52 

Should none of the options above be available, patients wishing to be treated should be offered Simeprevir/PEG-interferon/ribavirin with 24-48 weeks therapy (response guided therapy).


Genotype 4 - Patients with decompensated cirrhosis

Treatment is recommended with either:

Sofosbuvir/Ledipasvir +/- Ribavirin for a total of 12 weeks
Sofosbuvir/Daclatasvir +/- Ribavirin for a total of 12 weeks


Liver transplant patients

Evidence of fibrosis post-transplant should mandate therapy as current data suggest that earlier treatment delivers comparable outcomes to non- transplant, non-cirrhotic populations. Therapy options can impact on immunosuppression thus monitoring and therapy should be delivered by, or in close collaboration with  a transplant centre. Peg-interferon can precipitate graft rejection and its use can no longer be justified for the majority of transplant patients.


Options:

G1 sofosbuvir/ daclastavir +/- ribavirin 12 weeks
  sofosbuvir/ ledipasvir +/- ribavirin 12 weeks
  ombitasvir/paritaprevir (r)/dasabuvir/ribavirin 24 weeks
   sofosbuvir/ simeprevir +/- ribavirin 12 weeks
G3 sofosbuvir/ daclastavir +/- ribavirin 12 weeks
  sofosbuvir/ ledipasvir +/- ribavirin 12 weeks
G4 sofosbuvir/ ledipasvir +/- ribavirin 12 weeks
  ombitasvir/paritaprevir/ritonavir/ribavirin 12 weeks

 

Cirrhotic post–transplant are a small population and treatment should be individualized – ie no recommendations can be made due to a paucity of data.  


Other general recommendation

  • It is strongly recommended that all patients starting DAA therapy have a baseline plasma sample archived in the event of treatment failure. All patients with DAA failure should have a sample tested for relevant resistance on the first sample following failure
  • Whilst currently treatment recommendations for HIV+ patients are the same as for HIV negative patients, this may change with emerging data.  Furthermore the choice of therapy will need to be guided by potential for drug-drug interactions with HIV therapies (see http://hep-druginteractions.org/).  All HIV co-infected should be managed jointly with experts in managing co-infection
  • It is recommended that consideration is given to embedding strategically important research questions into the specialist commissioning process


Diagnosis of cirrhosis
 

The following working definition of 'cirrhosis/advanced fibrosis' was agreed for the sole purpose of including all/most patients likely to have cirrhosis due to hepatitis C* into the treatment algorithms proposed. Any one of the measures listed will suffice: 

  • Liver biopsy with stage 5/6 fibrosis or METAVIR 3/4
  • Imaging evidence of cirrhosis (either US, CT or MR scan)
  • APRI >2 and AST:ALT>1 on at least two occasions
  • Evidence of established portal hypertension (varices or ascites) excluding non-cirrhotic or other causes
  • Fibroscan elastography score >11.5 (or equivalent ARFI)


*where the patient has other risk factors for cirrhosis it will be for clinical judgement to consider the relative contribution from HCV and potential impact of treatment

 

 

 

 

 

 

 

Date Added: 16/04/15
UK-PBC survey - Management of Primary Biliary Cirrhosis
News Type: BASL News

Primary biliary cirrhosis is an area of increasing clinical research activity and our understanding of disease mechanisms, clinical care, and new potential therapies is evolving.

Through this on-line survey we aim to:

*     Establish current practice in management of PBC in the UK
*     Identify knowledge amongst those involved in the care of patients with PBC regarding current research and emerging therapies.

The survey will take approximately 5-10 minutes to complete and can be accessed using the link below:

https://www.surveymonkey.com/s/MGKRXL3 

Closing Date 24th May 2015

We very much appreciate your time in filling in this survey.

Yours, on behalf of the UK-PBC team (www.uk-pbc.com)

Dr Margaret Corrigan and Dr Gideon Hirschfield Centre for Liver Research, Birmingham NIHR Liver BRU, University of Birmingham g.hirschfield@bham.ac.uk

 

 

 

 

Date Added: 14/04/15
Janssen Pharmaceutical Bursary to EASL
News Type: BASL News

Janssen Phamaceutical Companies offered bursaries for nurses to attend the EASL Conference in Vienna.  The following applicants were successful 

Bronwen Williams Hull and East Yorkshire Hospitals
David Whitely NHS Lothian
Jacqueline Martin Oxford University Hospitals NHS Trust
Jeanne Prosser Basingstoke & Northants Hospital
Katie Pritchard Gloucestershire Hospitals NHS Foundation Trust
Laura  Strang The Royal Devon and Exeter NHS Trust Foundation, Exeter, Devon
Lorma Bailey NHS GRAMPIAN
Lynda Greenslade Royal Free London Foundation Trust
Rebecca Robbins University Hospital Soton NHS Foundation Trust
Stephanie Cook Royal Hallamshire Hospital, Sheffield
Teresa Bowyer King’s College Hospital NHS Foundation Trust
Tracey Stirrup Leeds Teaching Hospital  NHS Trust 
Emma Robinson Freeman Hospital, Newcastle upon Tyne
Danielle Fullwood King’s College London
Liz Burge University Hospital Southampton

Date Added: 08/04/15
Progress update: Oral antiviral therapy for chronic Hep C patients
News Type: BASL News

Dear Colleagues

I am writing to update you on the progress of accessing all oral antiviral therapy for patients with chronic hepatitis C. At present patients with decompensated cirrhosis are offered treatment with all oral agents as part of the Early Access Programme. This is delivered through 17 centres and the programme will continue for the foreseeable future.  We hope to extend the offer of all oral antiviral therapy to all patients with cirrhosis in the very near future and, towards the end of the year, we hope to be able to offer these treatments to patients with less advanced fibrosis. We intend to deliver therapy to patients with cirrhosis and less advanced fibrosis through networks with patients managed and treated at their local centre.

As you know we had hoped to offer therapy to patients with cirrhosis in April but I am afraid that this deadline has now slipped due to the processes and committees such policies need to go through at NHSE and although we hope to be able to start patients on treatment in May there may be some further slippage and I think it would be prudent to advise patients that treatment is likely to commence in June. The CRG will continue to work with NHS England to ensure that these therapies are made available as quickly as possible.

I will continue to update physicians as more information is available and look forward to seeing many of you at the EASL meeting in Vienna

 


Graham Foster

Date Added: 07/04/15
Alcohol: preventing harmful alcohol use in the community
News Type: BASL News

NICE are pleased to announce that the alcohol: preventing harmful alcohol use in the community quality standard have been published on the NICE website. You can view the quality standard by following this link: http://www.nice.org.uk/guidance/qs83

 

 

Date Added: 07/04/15
Interventional Procedure Advisory Meeting -Thursday 16 April 2015
News Type: BASL News

The public registration facility for the Interventional Procedure Advisory Meeting to be held on Thursday 16 April 2015  is open on the NICE website.  The link to register is available by clicking here: https://www.nice.org.uk/event/ipac-april-2015

Registration for this meeting will close on 31st March 2015. Please note we are not able to accept late requests to observe this meeting. The agenda is below, this is subject to change.

 

Overviews

 

1283    Endovascular aneurysm sealing for abdominal aortic aneurysm

1160    Implantation of a graft-keratoprosthesis combination for severe corneal opacity

IPCD’s

 

253/2  Living-donor liver transplantation: donor safety

1148    Cyanoacrylate glue occlusion for varicose veins

Please note, people who come to watch a Committee meeting are there only as observers. As a public observer, you will be able to listen to the business of the meeting, except where confidential information is being discussed.

However, public observers will not:

-    be able to participate in the committee's discussions

-    be able to ask questions

-    take part in voting

-    or put your views to the members of the committee

 

For further information about meetings in public please refer to the following document: Common questions and answers about standing advisory committee meetings in public.

 

Should you have any queries regarding observing this meeting, please contact the Meetings in Public Coordinator, Melinda Kay Melinda.kay@nice.org.uk

Date Added: 07/04/15
NICE - Quality Standards Advisory Committees recruiting for members
News Type: BASL News

NICE’s quality standards are central to supporting the Government's vision for a health and social care system focused on delivering the best possible outcomes for people who use services. Derived from NICE guidance and other accredited sources, they are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care and are becoming the backbone of the new commissioning system for health and social care. The standards are also used to develop indicators for potential inclusion within the Clinical Commissioning Groups Outcome Indicator Set (CCGOIS) and Quality and Outcomes Framework (QOF) for general practice.

They are looking for a number of roles including commissioners of health, public health and social care services; primary care practitioners; secondary care providers and experts in measurement and safety to join the independent NICE committees that help us develop our quality standards.

If you have an interest in driving quality improvement in health, public health or social care, experience of working on committees and working groups, and highly developed interpersonal, communication and team working skills, then NICE would like to hear from you.

You will not be representing your organisation but will bring your expertise, experience and knowledge of current practice. The time commitment is one day a month, for a three year period, and your expenses will be reimbursed (if you are a general practitioner, locum cover will be covered).

More information on how to apply can be found at http://www.nice.org.uk/get-involved/join-a-committee/member-quality-standards-advisory-committee-2 and information on NICE quality standards at www.nice.org.uk/standards-and-indicators.

You can also contact Nicola Cunliffe at NICE on nicola.cunliffe@nice.org.uk or by calling 0161 870 3257. The closing date for applications is Monday 20 April 2015 at 5pm.

Date Added: 07/04/15
NICE Final Guidance on Rifaximin and hepatic encephalopathy
News Type: BASL News

The Final Guidance will be published on the NICE website: www.nice.org.uk/guidance/TA337 on Wednesday 25 March.  There will also be a version of the guidance available for people using services, carers and the public called ‘Information for the public’.  Additionally, the documentation used to develop the guidance such as the underpinning evidence submissions, will remain on the website.

 

A copy of the guidance is available for you to download from NICE Docs:

 

https://appraisals.nice.org.uk/request/4066

 

 

Date Added: 27/03/15
GASTROINTESTINAL HAEMORRHAGE - REPORT LAUNCH MEETING
News Type: BASL News

The event will be held on 3rd July 2015 at The Royal College of Physicians, 11 St Andrews Place, London NW1 4LE.  Registration will be between 10.00 - 11.00, with refreshments and close at 16.00

The aim of this study was to explore remediable factors in the process of care of patients (16 and over) who were diagnosed with a major upper or lower gastrointestinal bleed.

The report will provide comment on the quality of assessment including risk stratification and early warning scores, referral pathways: including who the patient is admitted under/transferred to, delays in treatment, endoscopy (CT, interventional radiology and surgery) and hospital resources.

Full details can be found by clicking this link http://t.co/YajkUowoXJ

Date Added: 24/03/15
Consensus Meeting Report: Therapy for Chronic Hepatitis C - 03 March 2015
News Type: BASL News

Following the meeting on 03 March 2015, the draft recommendations have been reported for the treatment options for patients with chronic hepatitis C.

Comment is welcomed for a 7 day consultation period ending Tuesday 31st March 2015.

The treatment options for patients with chronic hepatitis C are expanding rapidly.  To guide clinicians and commissioners the national societies (BASL, BIA, BSG, BVHG) representing clinicians with an interest in this area convened a meeting to provide evidence based treatment and management recommendations.

The consensus meeting took place on 03 March 2015 in London.  The treatment recommendations which resulted from the meeting cover the following groups:

Genotype 1 - Patients with no evidence of cirrhosis/severe fibrosis

Genotype 1 - Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations

Genotype 1 - Patients with decompensated cirrhosis

Genotype 2  - Patients with no evidence of cirrhosis/severe fibrosis 

Genotype 2 - Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations

Genotype 2 - Patients with decompensated cirrhosis

Genotype 3 - Patients with no evidence of cirrhosis/severe fibrosis 

Genotype 3 - Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations

Genotype 3 - Patients with decompensated cirrhosis

Genotype 4 - Patients with no evidence of cirrhosis/severe fibrosis Non-cirrhotic G4 patients

Genotype 4 - Patients with compensated cirrhosis/severe fibrosis/major extra-hepatic manifestations

Genotype 4 - Patients with decompensated cirrhosis

Other general reccommendation

Diagnosis of Cirrhosis

 

The Full Report

For the report, please cilck 'further information' below.


Providing Comment 

Please send any comments on the draft report to admin@basl.org.uk before the closing date of Tuesday 31st March, 23.59.

 

Date Added: 12/03/15
Bursaries for Trainees to Attend DDF 2015
News Type: BASL News

The Trainees Sections of BSG and BASL are very pleased to offer 10 bursaries for trainees to attend the Digestive Disorders Federation Meeting, to be held on 22nd – 25th June 2015 in London. Supported by Norgine Pharmaceuticals, the bursary is available to trainee members of the BSG and BASL. Applicants must hold a specialty registrar training number in gastroenterology or be in a LAT post.

Each bursary will be awarded following competitive application and judging by the BSG/BASL panel, independent of the sponsoring company. The bursary will cover the winning trainees' conference registration fees, reasonable travel costs, accommodation expenses and one evening meal. Norgine Pharmaceuticals, on behalf of the winning trainees, will arrange all aspects of the above. A minimum requirement is that Trainees must attend all four days of the conference.

Application Timeline:

Bursary Application Deadline: 30th March 2015

Advise applicants of status of their submission: 20th April 2015

Deadline for confirmation of acceptance: 24th April 2015

Advise reserve list of status of their submission: 27th April 2015

Deadline for reserve list to confirm their acceptance (if applicable): 30th April 2015

The bursary application form and guidance notes can be found below:

Application Form

Guidance Notes

Invitation Letter

Date Added: 06/03/15
Clinical Research Fellow Posts - Translational research in patients with chronic liver disease.
News Type: BASL News

Post Ref 49682 on University of Birmingham jobs site

Translational research in patients with chronic liver disease.

 We are seeking one (possibly two) highly motivated Clinical Research Fellows to undertake translational research studies in patients with chronic liver disease. The position will be based in the internationally regarded Liver Unit at the Queen Elizabeth Hospital and the NIHR funded Liver Biomedical Research Unit in the JIF-funded Institute of Biomedical Research.

We a looking for a clinician with MRCP or equivalent, a potential ability to conduct and publish their own research, strong communication skills and an ability and eagerness to work in a multi-disciplinary team. You will recruit patients and co-ordinate clinical trials in cell therapy, liver cancer or autoimmune liver disease with the assistance of the Liver Clinical Trials team.

You will have an enthusiasm to learn and will be encouraged to register for a higher degree. You will work closely with all members of the project team in advancing  our research programmes in liver disease.  

The position is available for 12 months with potential and expectation to extend for a higher degree and submission of a fellowship application to the MRC / Wellcome Trust or other funding bodies. Salary will be at the appropriate point on the appropriate clinical scale, with placement according to qualifications and experience.

Contact  Professor Philip Newsome p.n.newsome@bham.ac.uk or Dr Gideon Hirschfield g.hirschfield@bham.ac.uk for informal enquiries.

Closing date 17th March 2015.

 

Kind regards

Bridget

 

Bridget Gunson, NIHR Liver Biomedical Research Unit and Centre for Liver Research Manager                                    

Tel:  +44 (0) 121 414 2246 

Web:  http://www.birmingham.ac.uk/liver

 

Date Added: 26/02/15
BASLNF 10th Birthday
News Type: BASL News

It is with great pride that this month the BASLNF became 10 years old. During its 10 years, BASL Nurse Forum has evolved in to a thriving group that represents and supports nurses caring for liver patients. It has successfully increased membership year on year and has put on annual conferences that have provided high quality educational opportunities. The forum has a rising national profile as it continues to be invited to represent liver nurses on national agendas and be involved in areas such as NICE reviews. One of the biggest achievements for BASLNF has been the implementation and on-going development by Amanda Clements, one of the original members of the forum, of the eToolkits, which are unique to Hepatology nursing and continue to see increasing numbers of nurses signing up to use the eToolkits for their professional development.

BASLNF is looking forward to the future and remains committed to the support and development of all nurses who may see liver patients in their day to day practice. This will be achieved through the development of educational opportunities and by working with colleagues from other areas in collaborative projects. It is crucial we keep liver nursing on the national nursing agenda for the sake of our patients. If you have any ideas for BASLNF then please get in touch.

For further information, please contact BASLNF Chair, Fiona Fry f.fry@nhs.net

 

Date Added: 20/02/15
D-Liver Project: Showcase Workshop
News Type: BASL News

 

D-Liver are pleased to announce a Showcase Workshop to introduce new technological solutions to improve clinical care and patient quality of life in advanced liver disease. The d-LIVER project, funded by the European Commission FP7 programme, is a consortium of 13 partners across Europe which has developed home monitoring systems for remote patient management and a bio-artificial liver support device.

The home monitoring system will support patients with advanced liver disease using regular patient-led measurements of physiological parameters (including heart rate and blood pressure) and six blood biochemistry tests. An ICT-enabled system allows semi-automated optimisation of therapy with support from specialist clinicians, where required. It is envisaged that this system will allow the earlier detection of decompensation leading to improved clinical outcomes, improved patient quality of life and reduced costs of management.

The bio-artificial liver technology includes identification of a reliable and cost effective source of functional hepatocytes, derived from readily expandable progenitors, to carry out detoxification and other hepatic functions in an acute setting. A three-dimensional bioreactor will provide an environment in which these cells can be supported and monitored during the perfusion of serum from patients undergoing support. 

The Workshop is designed to showcase the developed technologies and to learn how these new technologies might fit in to current and future clinical practice.

Event Details
The Workshop will take place on May 27th 2015 at the Humanitas Research Hospital Congress Centre in Milan (Via Manzoni 113,  20089 Rozzano, Milan, Italy - www.humanitasedu.it/sedi/milano). Participation is free of charge but registration is required. To register please contact us at info@d-liver.eu 

For more information about d-LIVER see http://www.d-liver.eu or contact us at info@d-liver.eu

 

 

Date Added: 16/02/15
Invitation to join the new NICE Indicators Advisory Committee
News Type: BASL News

The NICE Indicators Advisory Committee prioritises, reviews and develops indicators for a range of purposes including for potential use in the Primary Care Quality and Outcomes Framework (QOF) and the Clinical Commissioning Group Outcomes Indicators Set (CCG OIS).

Recruitment for membership of the Indicators Advisory Committee has started and they are seeking applications for the following roles:

•   Health outcomes measurement expert

•   3 x secondary care consultants / clinicians, including a paediatrician and a geriatrician

•   Psychiatrist / mental health professional

•   Practice nurse

 Further information including how to apply is available on the NICE website; please follow the links below for details:  

http://www.nice.org.uk/get-involved/join-a-committee/member-indicators-advisory-committee 

 http://www.nice.org.uk/get-involved/join-a-committee/lay-member-indicators-advisory-committee 

Please note that the deadline for applications is Monday 2nd March at 17.00.

If you have any queries please don’t hesitate to contact a member of the team.

The Indicators Team

Health and Social Care Quality Programme

Health and Social Care Directorate

National Institute for Health and Care Excellence

Level 1A | City Tower | Piccadilly Plaza | Manchester M1 4BD | United Kingdom

Web: http://nice.org.uk

Date Added: 16/02/15
NHS England consultation on proposed changes to service specifications and clinical commissioning policies.
News Type: BASL News

NHS England has launched a three month public consultation from 30th January 2015 on proposed changes to a number of new and existing service specifications and clinical commissioning policies for specialised services.There has already been extensive engagement on these national specifications and policies, as they have been developed with the support and input of lead clinicians and patient and public representatives. This approach has helped ensure that the views of key stakeholders have informed and influenced the development of the policies and specifications so far.

For more information please click here.

They are consulting with anyone who may wish to respond. However, it is anticipated that the target audience will be those likely to be affected by these proposed changes.

Complete the public consultation here

Date Added: 16/02/15
Nominations are invited to populate the Governing Board of the British Liver Transplant Group.
News Type: BASL News

Expressions of interest in the position of Chair of BLTG should be submitted explicitly stating an interest in this position. 

Nominations will close at 5pm on Friday 13th March 2015.

Elections, where required, will be completed by Friday 10th April 2015.

Those elected to the BLTG Governing Board will be required to hold association membership at the start of their term if it is not already in place.

Please send nominations and expressions of interest via return email to paula@execbs.com before the closing date above.

The Governing Board of BLTG shall consist of:

1) The three principal officers of the Society:

a. The BLTG Chair; (2 years)

b. The BLTG Secretary; (3 years)

c. The BASL Treasurer; (2 years)

d. BLTG Chair elect (for 12 months prior to taking up post)

e. Immediate post-Chair (for 12 months after leaving post)

2) A conference, education and training lead – elected by the members for a term of 2 and 3 years alternating

3) A transplant hepatology representative – elected by the members for a term of 3 and 2 years alternating 

4) A transplant surgery representative – elected by the members for a term of 2 and 3 years alternating

5) A paediatric representative – elected by the members for a term of 3 years

6) Two nursing representatives representing patient care before and after liver transplantation, respectively – elected by the members for a term of 2 years

7) A pathology representative –nominated by the pathology group for a term of 3 years 

8) A pharmacist representative – nominated by the UK and Ireland Liver Transplant Pharmacist Group (term of 3 years)

9) A patient representative –nominated by the patients group (term of 2 years)

10) Chair of LAG (ex officio)

11) A BASL representative – nominated by BASL (for a term of 2 years)

12) A BTS representative – nominated by BTS (for a term of 2 years).

13) A BSG (Liver Section) representative – nominated by BSG (for a period of 3 years)

14) An AUGIS representative – nominated by AUGIS (for a term of 3 years)

15) A LICAGE representative – nominated by LICAGE (for a term of 2 years)

 

 

Date Added: 13/02/15
NHS England consultation on a new service specification for hepatitis C clinical networks.
News Type: BASL News

NHS England has opened a month-long consultation on a new service specification for hepatitis C clinical networks.  The consultation can be found here, should you wish to respond.

Unlike the other documents, which are being consulted upon until 30th April, the hepatitis C networks consultation has been shortened to a month to enable its implementation from April.  It would therefore be advisable to submit any responses by the end of February.

A response from the Hepatitis C Coalition will be prepared as a whole and shared with its members for comments shortly.

Separately, you might be interested to see Public Health England’s updated report on Hepatitis C in London, published on 13th February 2015. Please click here

Date Added: 13/02/15
NICE Technology Appraisal Advisory Committee
News Type: BASL News

The public registration facility to observe the committee meeting for Daclatasvir for treating chronic hepatitis C opened on 4 February 2015 on the NICE website.  

If you would like to register for this committee meeting, please do so via the following web page: https://www.nice.org.uk/event/tacd_march_2015 

Registration for this meeting will close on 18 February 2015 at 5pm. Please note that they may be unable to accept late requests to observe this meeting.

As a public observer, you will be able to listen to the business of the meeting, except where confidential information is being discussed, however, you will not be able to:

•         participate in committee discussions 

•         ask questions, take part in voting or put your views to members of the committee 

For further information about meetings in public please refer to the following document: Common questions and answers about meetings in public

 

Should you have any queries regarding observing this meeting, please contact the Meetings in Public Coordinator Lee.berry@nice.org.uk 

Date Added: 05/02/15
NICE seeks applications for Industry Representative on their Appeal Panel
News Type: BASL News

NICE is seeking to appoint two industry representatives to its Appeal Panel. Panel members hear appeals against recommendations on the use of new drugs and other technologies for treating patients with very rare diseases and very complex healthcare needs. 

The industry representative will have a broad understanding of the needs and experiences of NHS staff and patients, and will be expected to articulate a balanced view on the issues arising from an appeal that are relevant to the clinical and pharmaceutical environment.  They will need to be able to understand the process and methods NICE uses to appraise new health technologies and to critically assess the arguments put forward by companies, professional groups and patient organisations appealing against our guidance.  

Appeal Panels are established infrequently and you may only need to join a panel two to three times a year and no more than five.  Appeal hearings are held in public and will be location in central London or central Manchester.  Appointment to the panel, as an Industry representative, will be for four years in the first instance and is dependent on the agreement of the Secretary of State.  

The deadline for applicatiosn is 5pm on Wednesday 18 February 2015.  For further information and to apply for the role please refer to the NICE website:  http://www.nice.org.uk/get-involved/join-a-committee 

Alternatively you can contact Nicole Fisher, Project Manager - Corporate Office by email on Nicole.fisher@nice.org.uk  

 

Date Added: 04/02/15
Early Bird Fees Ends 6th February - Pre EASL workshop
News Type: BASL News

Wishing to learn more about the challenges  of clinical management of Hepatitis C infected patients prior to or post liver transplantation and the use of DAAs in patients with Cirrhosis and Liver Recipients?

Join Virology Education in Vienna for the 3rd Optimize Workshop on 21 April 2015 (one day prior to EASL)!

Early Bird Discount - 6th February Deadline
Register before 6 February and benefit from reduced fees.

The workshop is endorsed by BASL, members will receive a discount. 

www.virology-education.com/event/upcoming/3rd-optimize-workshop/

 

For further information
Please contact Fiona Ooms, Event Manager fiona.ooms@vironet.com with any queries.

Date Added: 02/02/15
Dr McCune Sahara Challenge for BLT
News Type: BASL News

 

BASL Member, Dr Anne McCune, is taking on a huge personal challenge in March undertaking a 6-day trek, over 100 km, in the heat of the Sahara Desert, to raise funds and awareness for British Liver Trust. Anne has personal reasons for supporting the charity particularly at this time as she sadly lost her father to liver disease.

If you would like to support Anne and read more about what she will be undertaking, please go to Anne’s fundraising page here https://www.justgiving.com/Anne-McCune

You can also contact or follow Dr McCune on Twitter @walkermccune.

Thank you.

 

Date Added: 26/01/15
The IDRN is recruiting new steering group members
News Type: BASL News

The IDRN is now inviting applications from UK-based colleagues to join the IDRN steering group. This is an exciting opportunity to guide the direction of the Network, and to provide advice on, and become involved in, IDRN activity. The main aim of the tenure would be to advise on and drive through efforts to secure long-term funding for the network. 

They are seeking to recruit enthusiastic colleagues in infection-related disciplines with a good track record as steering group or committee members; they will bring fresh ideas and new approaches to both securing funding and also potential IDRN activity. Steering group meetings are essential for setting the strategic direction for the network. The steering group meetings are also used to discuss suggestions for IDRN workshops, training days and other activities.

Meetings are held twice a year, typically in late Spring/early summer, and and in November / December, and take place in London.

They are hoping that steering group members will also contribute to the IDRN’s programme of activity, depending upon their area of expertise. 

This may involve: -

- attending protocol development groups

- attending planning meetings for research strategy workshops or training events

- liaising with the IDRN and key contacts in the area of research being worked on

The deadline is 5pm, Wed 4th February, and applications will include completion of a short online form and submission of a short CV. Applications will be assessed by current steering group members, and all applicants notified of decisions before the end of February. 

See http://www.idrn.org/about_us/steering_group/recruitment.php for more information and to apply. Contact Michael Head, mhead@idrn.org for any questions relating to this process.

Date Added: 20/01/15
SAGE Awards 2015 is now accepting entries.
News Type: BASL News

The SAGE Awards – Shire Awards for Gastrointestinal Excellence, is now accepting entries for the 2015 Awards.  This is the 5th year of the awards, which are supported by Shire and are designed to allow individual healthcare professionals, units and healthcare networks in gastrointestinal (GI) care to be recognised for innovative work, share best practice and raise standards of patient care. Three awards will be made in the form of financial grants to the amount of £10,000, £5,000 and £3,000, for use towards furthering the development of the winning projects.

For further information please click here.

The closing date for initial registration of interest is Monday 16th February 2015.  Entry packs and further information can be obtained from the Awards secretariat by emailing moffer@jangocom.com.  

Date Added: 15/01/15
Interactive Meeting to Discuss HCV Drugs, 3rd March, London
News Type: BASL News

As you will know, new direct acting antiviral drugs have revolutionised the treatment of chronic hepatitis C infection.  So far in England these drugs have been restricted to patients with advanced liver disease, but that situation will change over the course of this year and the new regimens will become more widely available.  

On behalf of NHS England the relevant specialist societies (BIA, BASL, BSG, BVHG and BHIVA) have been asked to draw up some simple algorithms for recommended treatment strategies, to provide guidance for clinicians on making the best use of the new agents.  We are holding an interactive meeting in London on March 3rd at which the available data for each genotype and licensed drug will be summarised, and attendees can debate and agree on treatment protocols.  The outcome of the discussion will be used to draw up the guidance. 

To reserve your place

Places at this event are limited to 100, so if you would like to attend (and thus helping to shape national HCV treatment strategy) please register your interest as soon as possible by emailing the BASL Secretariat at paula@execbs.com with your name and contact details.

Please wait for confirmation that you have been offered a place at the meeting before booking your travel arrangements.

Thank you.


Please click 'Further Information' to open the programme.

 

Date Added: 08/01/15
BASL Membership Categories and Subscriptions for 2015 Reviewed
News Type: BASL News

Following a review of the subscription rates at the recent Committee meeting, the Committee have decided that for 2015 the following changes will apply:

The categories of membership will be simplified to;

   Medically qualified member  £90 per year                       
   Medically qualified member in training £45 per year
   Nurse member  £20 per year
   Scientist member   £20 per year

Under the new structure, subscriptions will give membership to BASL and all of its affiliate groups.

This allows all members free access to BASL and affiliate group meetings except for specific meetings where subsidised rates apply.  Any chargeable meetings will have rates advertised.

Emails will be sent out to all members regarding this.  

If your email address has changed or any of your information is out of date please contact us on the email address below. This will enable us to ensure that you receive all relevant communications, that you are in the correct category and paying the correct subscription.

New membership rates will be automatically changed through the Direct Debit payment system.  

Subscriptions for 2015 are due for payment on 31st January.

Please inform us by email before 20th January if you are not happy for us to do this, or if any changes to your category need to be made.  This will give us time to amend or cancel any payment as necessary, before it is requested from your Bank.

We are currently changing the Direct Debit payment to an automated, paperless system which will simplify the process for new members who wish to join.  Although all members will be moved to this system during 2015, members will not need to do anything and no changes will be noticed.

If you do not currently have a Direct Debit set up for payment please contact us to maintain your membership.

We hope that the above changes meet with your approval, but if  you have any queries or concerns please do not hesitate to contact us on Jane.Douthwaite@execbs.com

Date Added: 07/01/15
Debate in Westminster: Management and Treatment of Late State Hepatitis C
News Type: BASL News

Yesterday morning (Tuesdy 6th January 2015) Stephen Pound, MP for Ealing North, led a short debate in Westminster Hall on the management and treatment of late state hepatitis C, for which we provided briefing to a range of MPs.  The Minister recognised the work of the Coalition in her remarks and touched upon a number of issues which will be of interest to members.

The full debate transcript is enclosed below and can be accessed online here.  The main points were:

  • Stephen Pound described the burden of hepatitis C and its ‘sinister’ nature, given the asymptomatic period involved.
  • He saw the arrival of new therapies as ‘good news’ and one of the main reasons to hold a debate.  In particular, he emphasised the need for a national strategy in England to match the Scottish action plan.
  • Stephen called for the Minister to set out a clear timetable for the publication of the hepatitis C improvement framework and to commit to the inclusion of clear targets for improvement within the document.
  • Grahame M. Morris, MP for Easington, raised the ‘mixed messages’ from the Department of Health and asked Jane Ellison to correct Dan Poulter’s previous statement that hepatitis C was not curable.
  • Virendra Sharma, MP for Ealing Southall, raised the importance of hepatitis C for the South Asian population.
  • Andy Slaughter, MP for Hammersmith, mentioned the local hepatitis C prevalence data which the Coalition alerted him to during our meeting in December.

In her response, the Minister, Jane Ellison, made the following points:

  • The Government recognised hepatitis C as a ‘significant health issue that has been overshadowed by others for too long’
  • She paid tribute to the Hepatitis C Trust for its work, as well as to the Hepatitis C Coalition which she said had ‘impressed upon me with great force some of the issues that it wishes to see addressed'
  • 'She argued that the Government ‘cannot tackle the big killers if we are not tackling hepatitis C'
  • The Minister would be hosting a joint Hepatitis C/TB summit early this year with local authorities to discuss the steps required to see improvements.
  • On the improvement framework, the Minister described how NHS England and Public Health England were working together to publish a strategy this year.  She apologised for the delay in getting a document published to date and pledged that the document would set high-level aims ‘towards the elimination of hepatitis C-related liver disease as a public health issue, with specific, time-bound objectives’.
  • The Minister described how the Government saw ‘great potential’ in some of the new therapies and noted that more than 700 people had already been treated through the policy on access to new therapies for patients with liver failure.

The Hepatitis C Coalition stated that "the Minister’s remarks are very helpful in keeping hepatitis C on the political agenda and are particularly welcome in the context of the Coalition’s Vision document recommendations, which included Ministerial commitments to action and the development of an implementation plan for England."  They will continue to support the work of the Partnership Group in bringing the improvement framework to fruition, with a meeting scheduled tomorrow (Wednesday 7th January 2015) to consider the latest draft.


Further Information

If you would like any further information, please contact Andrew Wilkinson andrew@jmcinform.com Tel 0203 178 7573.


 

The Hepatitis C Coalition is a group of leading clinicians, patient organisations and other interested parties committed to the reduction of morbidity and mortality associated with Hepatitis C and its eventual elimination.  The Hepatitis C Coalition has funding from Gilead Sciences Ltd.

 

 

Date Added: 22/12/14
Nurse Bursaries for EASL 2015
News Type: BASL News

Janssen-Cilag Ltd are offering 15 bursaries available to UK nurses to help support travel to and attendance at EASL 2015, 22-26 April 2015, Vienna.

Each bursary will be capped at £1,250 and will cover:

  • Registration for EASL 2015
  • Return travel to Vienna
  • Accommodation

The application deadline is Friday 13th February 2015.

For an application form and guidelines, please click the links below.

>Download the Application Form

>Download the Guidance Notes

If you experience any problems downloading the documents, please contact jane.douthwaite@execbs.com


Registering for EASL

  • The early bird fee of 200Euros ends on 1st February 2015.
  • The late fee of 250Euros is applicable for 2nd February to 13th March 2015.
  • The onsite fee of 300Euros is applicable from 14th March 2015 and through the event.

For information on EASL 2015, Vienna, please visit the event website.

 

Date Added: 22/12/14
Nurse Survey: Use of Non-Invasive Liver Fibrosis Tests
News Type: BASL News

Dear Nursing Colleagues,

SURVEY REGARDING THE USE OF NON-INVASIVE LIVER FIBROSIS TESTS (INCLUDING FIBROSCAN) IN CLINICAL PATHWAYS

Link: https://opinio.ucl.ac.uk/s?s=32042 


BACKGROUND:

The assessment of liver fibrosis forms a key element in the management of chronic liver disease.

Liver biopsy is still regarded as the reference test but non-invasive methods of assessment of liver fibrosis such as fibroscan are entering clinical practice.

As part of my PhD, I am conducting a survey regarding this which should take 5 minutes to complete.

I would appreciate your assistance in completing this survey and distributing it to members of your team, who can use the link:

https://opinio.ucl.ac.uk/s?s=32042 

All responses will be kept confidential and data will be aggregated.

Many thanks in advance for your anticipated help.

Best wishes
Ankur Srivastava

UCL PhD student, Hepatology Clinical Research Fellow, Royal Free London NHS Foundation Trust

Supervisors: Professor William Rosenberg, Dr Emmanouil Tsochatzis, Dr Julie Parkes


 

If you have any questions, please contact: Ankur.srivastava@nhs.net

Date Added: 02/12/14
Decompensated Cirrhosis Care Bundle - First 24 Hours
News Type: BASL News

Decompensated cirrhosis is a medical emergency with a high mortality. Effective early interventions can save lives and reduce hospital stay. This checklist should be completed for all patients admitted with decompensated cirrhosis within the first 6 hours of admission.

The recent NCEPOD report 2013 on alcohol related liver disease highlighted that the management of some patients admitted with decompensated cirrhosis in the UK was suboptimal. Admission with decompensated cirrhosis is a common medical presentation and carries a high mortality (10-20% in hospital mortality).

Early intervention with evidence-based treatments for patients with the complications of cirrhosis can save lives. This checklist aims to provide a guide to help ensure that the necessary early investigations are completed in a timely manner and appropriate treatments are given at the earliest opportunity. 

 

Click 'Further Information' to download the BASL BSG Care Bundle for Decompensated Cirrhosis

Date Added: 28/11/14
Lancet Commission Published - Addressing Liver Disease in the UK
News Type: BASL News

The publication of the Lancet Commission is an important milestone in UK Hepatology with the report addressing the crisis of liver disease in the UK.  The commission makes 10 key recommendations to improve liver care and reduce premature mortality in this disease. The Lancet will continue to publish on an annual basis a scorecard of progress on these key recommendations.


The Background
The Lancet Commission into the crisis of liver disease in the UK was started after the meeting (Addressing the Crisis in Liver Disease in the UK: alcohol, viral hepatitis and obesity) by the Foundation for Liver Research in July 2013.  The meeting came just after the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report containing alarming statistics of Hospital Deaths from Alcohol-related Disease and poor care.  The annoucement that the UK Government were not proceeding with the minimum unit price proposal for targeting heavy drinkers, which was the cornerstone of their previously published alcohol strategy to bring down levels of overall alcohol consumption in the country also came at the same time.

The Report Outline
As stated in the introduction to the Lancet Commission report, the Commission describes the extent of the problem of liver disease in terms of mortality rates, numbers of hospital admissions, the present deficiencies both in hospital and primary care settings, and the association between the burden of liver disease and social deprivation in the UK.  It provides a blueprint for improving hospital care, with accreditation at two levels—acute district general hospital liver units providing 7-day acute services for emergency care and regional specialist centres—that would be responsible for more specialised investigations and care including liver transplantation.

The Aim of this Commission is to provide the strongest evidence base through involvement of experts from a wide cross-section of disciplines.  Of the large number of recommendations made to reduce the unacceptable premature mortality and disease burden from avoidable causes and to improve the standard of care for patients with liver disease in hospital, ten have been selected which have the biggest impact and need the most urgent action.

Although the recommendations are based mostly on data from England, they have wider application to the UK as a whole, and are in accord with the present strategy for health-care policy by the Scottish Health Boards, the Health Department of Wales, and the Department of Health and Social Services in Northern Ireland.


> Further information can be found on the Lancet website


> Click here to download the report
   (or click 'Further Information' located underneath the graphic if the download is slow)

 


Read the full Lancet Commission: The Lancet: Addressing liver disease in the UK

Date Added: 13/11/14
Launch of the Lancet Commission into Liver Disease in the UK
News Type: BASL News

A Symposium to mark the launch of the report of the Lancet Commission into Liver Disease in the UK, to be held at the Royal Society on Thursday 27 November 2014.

The meeting will start at 14.00 with a welcome from the editor of The Lancet, Dr Richard Horton, followed by a background to the Commission from Professor Roger Williams, CBE.  The programme will conclude at 17.00 followed by a reception.

For a full programme, please click on 'Further Information' below.

This meeting is supported by an educational grant from The Kohn Foundation.

For queries and to book a place please contact Natalie Day: n.day@researchinliver.org.uk Tel: 020 7255 9832

 

 

Date Added: 11/11/14
Dame Sheila Sherlock Travelling Fellowships 2015
News Type: BASL News

Applications are invited for these travelling fellowships, which are funded by a donation from Dr Geraint James in memory of his wife, Dame Sheila Sherlock. Their purpose is to offer consultants and trainees the opportunity to learn new techniques and acquire new experiences, ideas and stimulation through travel and the exchange of ideas.

Two travelling fellowships are available, covering a period of one month each, and will be offered to one consultant and one trainee. Each fellowship will be for a maximum of £2,000, with the recipients being responsible for funding any additional costs.

Restrictions

You must have current memberbership of the RCP.

How to apply

Please email your completed application, along with any supporting papers for the attention of the academic vice president by midnight 16 January 2015 to: trustfunds@rcplondon.ac.uk 


> For an application form and report on a previous recipient's visit, please go to the RCP website

 

Date Added: 07/11/14
Hepatology Research Fellow Post Fully Funded
News Type: BASL News

The post is funded by a Medical Research Council Project Grant for up to an ST4 clinical research fellow salary for 3 years plus consumables.

It’s based at UCL under myself & Professor Gilroy (Wellcome Trust Senior Research Fellow) but the successful candidate will also work at King’s College (Prof Julia Wendon is a collaborator).


Project summary:

Patients with advanced liver cirrhosis have an increased susceptibility to bacterial infection which represents a major health care challenge. We found that levels of a lipid hormone called prostaglandin E2 are elevated in the blood of these patients and that this underlies their susceptibility to infection (O’Brien & Gilroy, Nature Medicine 2014).

This project aims to pin-point the cellular and enzymatic source(s) of PGE2 as well as the receptor/s through which it mediates its effects. Through this work we hope to identify the most tractable target with which to neutralise PGE2’s immune suppressive effects and use this information to guide drug development potentially leading to improved treatment of infection in these patients.

The successful candidate will use flow cytometry, immunohistochemistry and RT-PCR to investigate COX, PGE2 and EP receptor expression as well as downstream synthase signalling (microsomal & cytosolic PGE2sythases) pathways on samples obtained from patients with advanced cirrhosis including liver, bonchoalveolar lavage fluid, urine, blood and ascitic fluid. Having fully characterised these pathways we shall use this information to determine which represents the optimum site of inhibition for further drug development. We believe that this strategy has great potential for clinical use.


The opportunity

This project represents an opportunity for a clinician/scientist with an interest in liver disease to complete a PhD, gain expertise into molecular and biochemical techniques and begin an academic career.


Applications by 21st November 2014

Please could interested trainees send a CV with covering email to a.o’brien@ucl.ac.uk by Friday 21st November. Enquiries are also welcome prior to this date. Start date is ideally January 2015.

 

Alastair O’Brien

Senior Lecturer, UCL

Consultant Hepatologist

 

Date Added: 30/10/14
BASL Supports AHA's Call for Civil Service CEO to Stand Down from SAB Miller
News Type: BASL News

BASL recently supported an open letter to Sir Jeremy Heywood, Cabinet Secretary, sent from the Alcohol Health Alliance expressing their concern around the decision to allow John Manzoni, the new CEO of the Civil Service to remain as a non-executive director to SAB Miller.   The letter to the Cabinet Secretary, Jeremy Heywood, expressed AHA's concerns around this decision and highlighting the potential conflict of interest that it may present. SAB Miller was one of the organisations that opposed minimum unit pricing and as such this decision raises potential questions concerning impartiality in the civil service.

For a copy of the letter sent to Sir Jeremy Heywood, please click 'Further Information' at the end of this article.

The open letter was shared with the press on Tuesday 28th October, and it was reported by the Financial Times on Wednesday 29th October that John Manzoni will stand down from his position at SAB Miller next summer and this was confirmed by the Cabinet Office this morning (30th October 2014). 

On the decision by John Manzoni to step down as non-executive director to SAB Miller, AHA stated:

"The Alcohol Health Alliance UK (AHA) welcomes the decision by John Manzoni to stand down as a non-executive director to SAB Miller next summer. The AHA believes that this development is a positive step towards addressing public concerns over potential conflicts of interest. However the AHA strongly believes that it is in the public interest that he stands down as soon as is possible rather than delaying until next summer.

The initial decision by the Cabinet Office to allow John Manzoni to continue in his position as a non-Executive Director to SAB Miller alongside his role as CEO of the Civil Service has highlighted a major issue regarding the appointment of industry personnel to senior civil service positions. It has also demonstrated the need for robust procedures relating to conflicts of interest."

The AHA letter has demonstrated the power of collective action.

 

The original article is here: http://www.theguardian.com/politics/2014/oct/10/civil-service-boss-john-manzoni-sabmiller-director

 

 

 

Date Added: 22/10/14
PHE Liver Disease Profiles
News Type: BASL News

Public Health England published its local liver profiles for England on Monday 20th October 2014.

The local liver profiles provides a detailed breakdown of local health service performance across a range of indicators, including the following for hepatitis C:

  • Persons who inject drugs – percentage who have received a hepatitis C test (70.3% avg for England)
  • Hospital admission rate for hepatitis C related end-stage liver disease/hepatocellular carcinoma (3.5 per 100,000 for England)
  • Under 75 mortality rate from hepatitis C related end-stage liver disease/hepatocellular carcinoma (0.53 per 100,000 for England)

Go to the PHE website pages for further information and the link to the online data tables.

The Hepatitis C Coalition will analyse the data carefully and, in particular, focus our future MP approaches on the areas of greatest challenge.

If you would like further information, please contact Paula Banks paula.banks@basl.org.uk with your request or Andrew Wilkinson of the Hepatitis C Coalition andrew@jmcinform.com

 

Click the Further Information link below to download the full data tables.

Date Added: 15/10/14
Five Nations Conference on HIV and Hepatitis 8-9 December 2014
News Type: BASL News

Early Registration and Extended Case Submission Deadline: Friday 17 October 2014
Register Now – 3 days to go!

For more information click here or go to the Events page.

Date Added: 13/10/14
National Survey on the Provision of Ultrasound Surveillance in Patients at risk of developing hepatocellular carcinoma (HCC)
News Type: BASL News

There has been much reporting in the media and in the medical literature highlighting the increasing burden of cirrhosis of the liver.  This has been attributed to the increasing levels of alcohol consumption, the rising prevalence of liver disease related to obesity and diabetes mellitus, as well as disease caused by chronic viral hepatitis B and C infections.  This rising tide of disease is leading to more cases of end-stage liver disease and also one of its most feared complications hepatocellular carcinoma.

Expert guidance from the American Association for the Study of liver disease (AASLD), The European Association for the study of the Liver (EASL), and the BSG, all recommend a liver ultrasound every six months for patients deemed to be at high risk of developing HCC.  The rationale is that this will lead to detection of cancer at an earlier stage when curative options could be available.

UK HCC in association with BASL and the BSG would like to determine what happens in “real life practice.”  Given the governments increasing emphasis on cancer diagnosis and treatment, the time would appear right, to see how HCC surveillance is actually delivered across the United Kingdom.
The survey takes between 5-10 minutes to complete, but the data that you submit could be vital in providing the evidence required to provide future funding and investment to benefit our patients in the future.

Ideally, we would only want to have one response per hospital, but if you are unsure if a response has been sent or not, we’d be grateful if you did reply.
We very much hope that you will contribute to this important national survey.

Please click here for the survey.

https://www.surveymonkey.com/s/NFNMV8D

Date Added: 22/09/14
BASL Committee Posts - Nominations Sought
News Type: BASL News

BASL Committee Posts

Due to the current post holders having served their tenure, BASL are now seeking expressions of interest for the following Committee Posts.  Post holders may be re-elected if they should choose to stand again:

  • Secretary
    The Secretary is the Chief Executive of the Association and serves for two years and may be re-elected once. The Secretary is responsible for running the administrative tasks pertaining to his/her function and will work closely with the Secretariat, which is appointed by the Governing Board.
  • Education & Training Councillor (x2)
    In addition to their role in the Governing Board, the Education and Training Councillors are responsible for Educational tasks as defined by the Governing Board, such as running the School of Hepatology.
  • Services Committee Chair
    The Services Committee Chair is elected by the membership to serve for a period of up to three years and may be re-elected once.  The Services Committee is commissioned by the BASL Governing Board to support the development and implementation of Clinical Standards and the provision of Clinical Services, including preparation and delivery of advice to national health authorities concerning liver diseases.  Links with the Lancet Commission publication.
  • Paediatric representative

 

Nominations by Monday 6th October 2014

Candidates wishing to be considered for election will require one BASL member to propose them and a second member to confirm their suitability for the role in writing.

Please email Paula Banks at the Secretariat paula.banks@basl.org.uk with your nominations by Monday 6th October 2014.  Following this time, candidate statements will be sought and voting will take place. 

Date Added: 12/09/14
BASL UNAUDITED REPORTS AND ACCOUNTS FOR THE YEAR ENDING 31 DECEMBER 2013
News Type: BASL News

BASL Unaudited Accounts for the year ending 31st December 2013 are available to view to all members on Clinical Communities.

This is your opportunity to view these prior to the discussion of key points at the Annual Business Meeting on Wednesday17th September at the Hilton, Newcastle.

Date Added: 09/09/14
MSD ltd Offering Bursaries to Attend the BVHG Meeting 17th October 2014
News Type: BASL News

MSD Ltd are offering 30 bursaries of up to £200 for delegates attending the BVHG Meeting 'HCV & HBV - Difficult to Treat Groups' in Birmingham.

This is towards travel, registration and accommodation.

For more information, a programme and application forms please click the following link.

http://www.basl.org.uk/events/102/BVHG-Meeting-Oct-2014---HCV--HBV---Difficult-to-Treat-Groups-Book-now/index.cfm

Date Added: 04/09/14
Barts Health spearheading a universal HIV/Hep B/Hep C testing programme
News Type: BASL News

Barts Health are spearheading a universal HIV/Hep B/Hep C testing programme in 9 A&E departments across the country for those ED patients having venepuncture.  They will be screening at 5 London sites and four sites outside of London in areas of high prevalence.
 
With the new DAA’s for Hep C, increased interest in screening is now occurring at a public health level. Based on HPA figures, despite a relatively high  prevalence  of Hep C within A&E settings , <2.5% of A&E attendees are being  tested.  Although seroprevalence studies have been conducted in the setting, a real-life unified BBV screening approach has not been done in A&E’s.  They plan to use their experience with linkage to care in the HIV field in order to link positives across the three viruses to care and determine if they are late diagnoses. The scale of A&E BBV data collated will inform current debates on hepatitis C screening.
 
Their funding is from grants to Gilead and Abbvie and  they have also submitted a grant to the  Barts Health Charity (under consideration).
 
The lead for Going Viral is Dr Chloe Orkin, a Consultant  HIV Physician from  Barts Health with experience of conducting HIV testing campaigns.
 
Going Viral has a fledgling website and twitter and Facebook pages. The URL is www.bartshealth.nhs.uk/goingviral
 
Dr Chloe Orkin, FRCP (UK) ?
Consultant Physician and Honorary Reader in HIV Medicine
Lead for HIV and HIV/Hep C Research
Ambrose King Centre
Royal London Hospital
E11BB
Barts Health NHS Trust
0207 377 7038(PA)
chloe.orkin@bartshealth.nhs.uk
www.bartshealth.nhs.uk

Date Added: 04/09/14
Dame Sheila Sherlock Award - 2015 award is now open
News Type: BASL News

Applications are invited for these travelling fellowships, which are funded by a donation from Dr Geraint James in memory of his wife, Dame Sheila Sherlock. Their purpose is to offer consultants and trainees the opportunity to learn new techniques and acquire new experiences, ideas and stimulation through travel and the exchange of ideas.

Two travelling fellowships are available, covering a period of one month each, and will be offered to one consultant and one trainee. Each fellowship will be for a maximum of £2,000, with the recipients being responsible for funding any additional costs.

The 2015 award is now open and we are accepting applications. Information on the award can be found on the link below:
https://www.rcplondon.ac.uk/research/funding-and-awards/travelling-fellowships-and-bursaries/dame-sheila-sherlock-travelling-fel

Restrictions
You must have current membership of the RCP.

How to apply
Please email your completed application, along with any supporting papers for the attention of the academic vice president by midnight 16 January 2015 to: trustfunds@rcplondon.ac.uk
Tel: +44 (0)20 3075 1564
Fax: +44 (0)20 7224 0719

 

 

 

 

 

 

 

Date Added: 04/09/14
Liver on Legs - a short film detailing the effects of liver failure.
News Type: BASL News

Joel Hewett and Fergus Cruickshank are two Scottish film-makers who are co-directing  a short film detailing the effects of liver failure.

The directors were approached several months prior by Arbroath local, Donna Yuille and were inspired by her story. Donna has been through two separate instances of liver failure and says she recovered thanks to her family, her art and her faith. Upon hearing her uplifting story, the film¬makers knew it was a story that they wanted to tell.

'Liver On Legs' follows Donna as she continues her recovery and prepares for an art show. It will aim to tell her story with humour and understanding and involve her friends, family and everyone who has helped her recover; detailing the highs, lows and everything in between from Donna's ordeal.

The film has been met with overwhelming interest within the local community and has received support from Young Scot and Creative Scotland in the form of a £750.00 Creative Enterprise Grant. A crowd-funding campaign has now been set up to help the film-makers reach the remainder of their funding target.

For more information about the film and the crowd-funding campaign, please visit the website and facebook page.  You can watch the Youtube video below:

 

Contact: Joel Hewett/Fergus Cruickshank 07847632633 /07787297586 joel@liveronlegs.com/fergus@liveronlegs.com
(Co-Directors)

Website : www.liveronlegs.com
Facebook : www.facebook.com/liveronlegs Twitter : @liveronlegs
Indie GoGo : www.indiegogo.com/projects/liver-on-legs/

Date Added: 19/08/14
BVHG Meeting Oct 2014 - HCV & HBV - Difficult to Treat Groups-Booking now open
News Type: BASL News

Friday, October 17, 2014

Venue:

Maple House
150 Corporation Street
Birmingham
B4 6TB

To view the outline programme please click here

MSD are offering 30 Travel Bursaries of up to £200 for registration, travel and accommodation.

To download the guidelines click hereTo download an application form please click here.

Registration cost:

  • Free to BVHG members
  • £20 to BASL members
  • £40 to non-members
  • £10 to Nurse Forum members

Gilead Science have sponsored our International Speaker Professor Anna Linda Zignego, Associate Professor of Internal Medicine from the University of Florence, to come and speak for us at this meeting.

Her brief Bio:
Clinical Immunology Speciality most practiced: Viral hepatitis, extrahepatic manifestations of HBV and HCV infection: diagnostic and prognostic classification, prevention and treatment

Booking is now open.  Please email admin@basl.org.uk to book or for enquiries.

 

Date Added: 06/08/14
Recruitment for Paediatric Liver Nurse to join NAFLD GDC closes 11th August 2014
News Type: BASL News

A reminder that recruitment for a paediatric liver nurse to join the NAFLD GDG closes on Monday 11th August 2014 at 5pm. If you, or someone you know, would be interested in applying to join this guideline development group please do not hesitate to contact me asap.

The advert details and information on how to apply can be found at:
http://www.nice.org.uk/Get-Involved/Join-a-committee/Member-Non-alcoholic-fatty-liver-disease-guideline-development-group

Date Added: 05/08/14
AbbVie Bursary for Nurses in ROI deadline extended to 11th August 2014
News Type: BASL News

For more information click here http://www.baslannualmeeting.org.uk/Index.cfm/content/page/cid/28

Date Added: 28/07/14
Bursary for Nurses from ROI for BASL Annual Meeting - Deadline extended to 11th August 2014
News Type: BASL News

Abbvie Ireland Ltd have made provision for 5 scholarship awards to be made available to Nurses from ROI to attend the forthcoming BASL Annual Meeting. Scholarship awards are capped at a maximum of £500.00 per person and are considered a contribution towards an award winner’s registration fee, travel and accommodation expenses, but not subsistence.

Eligibility

Applications are invited from ROI-based Nurses in the field of Hepatology medicine.

There will be a maximum of 5 awards.

Applicants must complete the NMC/Professional body number section on the application form.

How to Apply

Applicants will need to complete the formal Application Form for travel bursaries for BASL Annual Meeting 2014.

As part of the application form applicants will need to outline how the BASL Annual Meeting will benefit themselves and others in their future career.

Download: Application Form

Download: Guidance Notes

Application deadline 11th August 2014.

This travel bursary is funded by a grant from Abbvie Ireland Ltd, however, Abbvie Ireland Ltd have no involvement in the selection of the recipients of the bursary. Details regarding the application and review process for the scholarships can be found as part of these Guidance Notes.

Date Added: 28/07/14
Job Vacany: Senior Clinical Fellow Position in PB Medicine
News Type: BASL News

A full-time position is available for a Senior Clinical Fellow Position in Pancreatobiliary Medicine at the Royal Free Hospital, London.

This is a fixed-term contract for 12 months.

Closing date: 30/07/2014, 23:59.

For further information and to apply please go to the website >here.

Date Added: 28/07/14
NICE announcement on World Hepatitis Day
News Type: BASL News

Today is World Hepatitis Day and NICE is pleased to announce publication of its quality standard on hepatitis B (QS65).


You can view the quality standard by following this link:


http://www.nice.org.uk/guidance/qs65/chapter/introduction

Date Added: 17/07/14
Alcohol Health Alliance Calls for Action
News Type: BASL News

Will you contact your MP to highlight the levels of alcohol related harm in your local area? 

 

One person is killed every single hour by alcohol. Each of those people is a loved one - a parent, a brother or a sister, a friend and tragically, often a child. Annually 1.2 million people are admitted to hospital due to alcohol related causes and countless others see their health damaged because of it. The impact of alcohol all to often affects innocent bystanders through its role in child abuse and neglect, domestic violence, family breakdown and crime and disorder. It tears apart families and damages entire communities and as well as the human toll, it costs the British economy £21 billion every year.

We want politicians to realise how very real the problem is, and to commit to supporting measures to reduce levels of alcohol related harm. Will you contact your MP to highlight the levels of alcohol related harm in your local area? 

 

We are asking members and supporters to get in touch with their local MP to arrange a meeting at their local surgery or a visit to a hospital, high street or police station to see the effects of alcohol misuse first hand. The more people who speak to their MP on the 5th September, the louder our voice will be.   Politicians have shied away from facing the problem of alcohol misuse in the UK time and time again. If they can see that alcohol related harms are affecting their constituents and communities, they are much more likely to support the tools and policies that are so desperately needed to tackle alcohol misuse.

To request more information or to sign up for the day of action, please email Madeleine Harris Smith at the Alcohol Health Alliance, mharrissmith@alcoholconcern.org.uk or visit www.21billion.org . The Alcohol Health Alliance will provide template letters, briefings and support in getting in touch with your MP. 

Date Added: 17/07/14
National Survey on the Provision of Ultrasound Surveillance in Patients at risk of developing hepatocellular carcinoma (HCC)
News Type: BASL News

There has been much reporting in the media and in the medical literature highlighting the increasing burden of cirrhosis of the liver.  This has been attributed to the increasing levels of alcohol consumption, the rising prevalence of liver disease related to obesity and diabetes mellitus, as well as disease caused by chronic viral hepatitis B and C infections.  This rising tide of disease is leading to more cases of end-stage liver disease and also one of its most feared complications hepatocellular carcinoma.

Expert guidance from the American Association for the Study of liver disease (AASLD), The European Association for the study of the Liver (EASL), and the BSG, all recommend a liver ultrasound every six months for patients deemed to be at high risk of developing HCC.  The rationale is that this will lead to detection of cancer at an earlier stage when curative options could be available.

UK HCC in association with BASL and the BSG would like to determine what happens in “real life practice.”  Given the governments increasing emphasis on cancer diagnosis and treatment, the time would appear right, to see how HCC surveillance is actually delivered across the United Kingdom.
The survey takes between 5-10 minutes to complete, but the data that you submit could be vital in providing the evidence required to provide future funding and investment to benefit our patients in the future. 

Ideally, we would only want to have one response per hospital, but if you are unsure if a response has been sent or not, we’d be grateful if you did reply.
We very much hope that you will contribute to this important national survey.

Please click here for the survey. 

https://www.surveymonkey.com/s/NFNMV8D

Date Added: 11/07/14
Nurses Bursary Application Deadline Extended
News Type: BASL News

Date Added: 08/07/14
BSG/BASL Trainee Bursary to attend BASL Annual Meeting 2014
News Type: BASL News

The BSG Trainees Section, in collaboration with BASL Trainees Section, are very excited to offer 11 bursaries for trainees to attend the BASL Annual Meeting, to be held on 15th – 17th September 2014 in Newcastle.  Supported by Norgine Pharmaceuticals, the bursary is available to trainee members of the BSG and BASL and will be awarded competitively.

If you are not currently a member of either organisation and wish to join in order to apply for a bursary, please contact h.ellison@bsg.org.uk at the BSG or paula.banks@basl.org.uk at BASL.

Closing date for applications is Friday 18th July 2014

The application form and guidance notes can be found on the BSG website http://www.bsg.org.uk/sections/trainees-news/index.html 

We look forward to receiving your application.

Date Added: 08/07/14
BVHG May - Feedback & Vox Pops
News Type: BASL News

The May meeting of the BVHG concentrated on HBV and HEV.

The meeting explored some of the recent interesting advances in epidemiology, diagnostics and care of hepatitis B & E viruses.  As outlined in the welcome from our BVHG Chair, Dr Andy Ustianowski, there has been recent national guidance for HBV – which has caused some discussion and controversy; new ways of monitoring those on treatment; new protocols for preventing re-activation; we continue to debate vaccination; and there are very interesting pipeline strategies to improve treatment success and even aim for cure.

The epidemiology of HEV in the UK is becoming clearer, and there is interest in treatments and also the potential prospect of vaccination in the future.

Feedback

The meeting scored an average of 4.4/5, another highly rated meeting and we cannot thank our speakers and sponsors enough for their contributions to the success of the meetings.

You can view the Vox Pops from delegates here:

 

Next BVHG Meeting - HCV The Future, 18th July

As you will no doubt be aware Hepatitis C is moving ahead at a great pace. It is therefore difficult to keep abreast of developments in treatment (including pipeline drugs), assessment, vaccination, and how best to deliver care and therapy. For this purpose we have developed a day, free to BVHG members and at low cost to others, to help.

If you would like to book for the next BVHG meeting on 18th July at the Hallam Conference Centre in Central London, please contact the Secretariat to register admin@basl.org.uk

Download the programme here.

 

Date Added: 08/07/14
Recruitment Opportunities for Hepatology Fellows
News Type: BASL News

The Department of Gastroenterology and Hepatology at the Princess Alexandra Hospital, Brisbane, is recruiting Hepatology Fellow(s). The successful candidate(s) should be completing advanced training in Gastroenterology/Hepatology and have a strong interest in clinical/basic research. The selected candidate will participate in outpatient clinical services for management of liver disease especially viral hepatitis and non-alcoholic fatty liver disease and will also contribute to the junior medical staff education program. Clinical/basic research opportunities include many aspects of chronic liver disease, liver repair/regeneration and innate immune function.

For further information or expressions of interest, please contact:
Prof Elizabeth Powell, Director, Centre for Liver Disease Research and Hepatologist, Translational Research Institute on 61 7 34438015 or e.powell@uq.edu.au

Date Added: 02/07/14
BASLNF Chair Nominations - Deadline Extended
News Type: BASL News

The deadline for submitting nominations for the new BASL Nurse Forum Chair has now been extended to Monday 14th July 2014.

The current Chair, Amanda Clements will be leaving the BASLNF committee in a strong position and we are seeking someone to carry on the Amanda's notable contributions to promote educational resources and advance good clinical practice.

The handover to the new incumbent will take place at the BASLNF Annual Meeting on Tuesday 16th September 2014.

How to Nominate

Email the Secretariat by the deadline with the following:

  • A candidate should be proposed in writing (via email) by a BASL member.
  • The candidate should then be seconded by a different BASL Member confirming suitability for the role.

If you require any further information or you would like to submit a nomination, please email the Secretariat (paula.banks@basl.org.uk)

Thank you.

Date Added: 24/06/14
2014 ACCEA Round Open
News Type: BASL News

The 2014 national awards round has now been announced.  If you would like to apply for BASL support, please complete and submit your applications forms:

Form A - Application Form

Form D - Supplementary CV Questionnaire: Research & Innovation Assessment 

Form E - Supplementary CV Questionnaire: Teaching & Training Assessment 

Form F - Supplementary CV Questionnaire: Leadership & Management Assessment

(For use of the Supplementary Forms, please see 'Domains' within the Application form A)

If you are having problems downloading these forms, you can find them online at https://www.gov.uk/government/publications/clinical-excellence-awards-2014-application-forms

Guidance can also be found on the ACCEA website at https://www.gov.uk/government/publications/clinical-excellence-awards-2014-application-guidance

 

As in previous years BASL would be able to support colleagues directly for national Gold, Silver and Bronze awards.   

As a rule, candidates for National Bronze (Level 9) should have a minimum of at least five local Clinical Excellence Awards, and those applying for Silver (Level 10) and Gold (Level 11) should have held their current awards (Bronze for Silver applicants, Silver for Gold applicants) for a minimum of four years to have a realistic chance of success. Furthermore ACCEA will only consider those achievements made since the last award for Silver, Gold and Platinum applicants.

 

To apply for BASL support, please follow these steps:

1.  Send your completed application forms to the BASL Secretariat (paula.banks@basl.org.uk) by 09.00 on Monday 7th July 2014 for review.

Please understand that in fairness to all applicants, late submissions will not be considered.

2.  As soon as our selection process is complete, successful applicants will be notified and asked to provide the name of an individual who could write the supporting citation. ACCEA regard the citations provided  in support of individuals as giving added value to the process.

3. You must submit your own application to ACCEA online by their deadline Thursday 14th August 2014, 17.00.  This is your own responsibility. Access ACCEA Website here

4. If you are in receipt of BASL support then we will upload your citation - please can you ensure your application is uploaded at least one week before the ACCEA deadline so that we have sufficient time to upload your citations onto your application on the ACCEA website. 

Date Added: 17/06/14
Nurses Bursary for BASL Annual Meeting - Deadline extended until 28th July 2014
News Type: BASL News

Abbvie Ltd have made provision for 20 scholarship awards to be made available to Nurses to attend the forthcoming BASL Annual Meeting. Scholarship awards are capped at a maximum of £500.00 per person and are considered a contribution towards an award winner’s registration fee, travel and accommodation expenses, but not subsistence.

Eligibility

Applications are invited from UK-based Nurses in the field of Hepatology medicine.
There will be a maximum of 20 awards

How to Apply

Applicants will need to complete the formal Application Form for travel bursaries for BASL Annual Meeting 2014.

As part of the application form applicants will need to outline how the BASL Annual Meeting will benefit themselves and others in their future career.

Download: Application Form

Download: Guidance Notes

Application deadline 28th July 2014

This travel bursary is funded by a grant from Abbvie Ltd, however, Abbvie Ltd have no involvement in the
selection of the recipients of the bursary. Details regarding the application and review process for the
scholarships can be found as part of these Guidance Notes.

Date Added: 16/06/14
ACCEA 2014 Announcement
News Type: BASL News

The 2013 ACCEA round has only just been completed and successful applicants have been notified.

It is still not clear whether there will be a 2014 ACCEA round although we expect an announcement about this will be made in the near future. 

If ACCEA were to open the 2014 round in the next few weeks, this could mean the closing date might be the end of September 2014. BASL is entitled to support a small number of members for national awards. The RCP has already opened for nominations. 

If you wish to be considered for a national award if and when the 2014 round opens and you would like to seek BASL support, you should submit a CVQ to Paula Banks  at the BASL secretariat, Paula@execbs.com 

The closing date will be 09:00 on Monday 7th July  2014.

Please understand that in fairness to all applicants, late submissions will not be considered.

As soon as our selection process is complete, successful applicants will be notified and asked to provide the name of an individual who could write the supporting citation. ACCEA regard the citations provided  in support of individuals as giving added value to the process.

Date Added: 13/06/14
BASLNF Chair Nominations
News Type: BASL News

 

Would you like to be the next BASLNF Chair?  Amanda Clements' tenure of three years as BASLNF Chair is now coming to a close and we are seeking nominations for a new BASLNF Chair who will carry on the great work already underway.

The handover to the new incumbent will take place at the BASLNF Annual Meeting on Tuesday 16th September 2014.

Candidates wishing to be considered for election will require one member to propose them and a second member to confirm their suitability, in writing.

If you require any further information or you would like to submit a nomination, please email the Secretariat admin@basl.org.uk

Deadline: Monday 30th June 2014.

Thank you.

Date Added: 11/06/14
NICE Guidelines - New Manual out for Consultation
News Type: BASL News

Teams across NICE have been working together to create a single manual for the development of clinical, public health and social care guidelines. This new manual will set out consistent processes for developing guidelines across different areas and will increase transparency by documenting the rationale for use of different methods. The manual for developing NICE guidelines will be implemented in January 2015.


The draft manual for consultation and comment can be downloaded here.


Further details on the consultation can be found on the NICE website. Please click here.


How to send your comments:

Please send your comments to the Secretariat by email, noting the section and page number(s) to which your comment(s) refer(s)

Date Added: 03/06/14
National Institute for Health and Care Excellence seeks new member for its independent advisory committee on the use of medical technologies
News Type: BASL News

The National Institute for Health and Care Excellence (NICE) is seeking to recruit a secondary care clinician to join its Medical Technologies Advisory Committee (MTAC)

MTAC works with the NICE Medical Technologies Evaluation Programme – which exists to improve patient care and release resource within the NHS by driving the adoption and diffusion of innovative medical technologies more quickly throughout the NHS. A wide range of products is notified to NICE for review including medical devices, diagnostic tests and imaging technologies.

MTAC has two core functions:
 
• Review medical technologies notified to NICE and consider each technology’s suitability to be selected for a NICE evaluation. Selected products are referred by MTAC to the NICE programme best suited to conduct its evaluation.
• Consider and interpret evidence on the clinical and cost consequences of the health technologies selected in order to develop medical technologies guidance and formulate recommendations on their use by the NHS. Guidance includes recommendations for further research and recommendations that the case for adoption either is or is not supported.
 

Good insights and advice from all relevant specialties and viewpoints are pivotal to the Committee’s judgments for many technologies as is the need to interpret written and oral evidence obtained from experts, manufacturers and patients.
 
Advisory Committee members are drawn from healthcare professionals, industry representatives, NHS senior management, patients and carers, and academic specialists in health technology assessment. Committee members are not appointed to act as representatives of a particular organisation. They are expected to apply the experience and judgement from their individual backgrounds to the topics considered by the Committee and in doing so actively contribute to improving the quality and consistency of care provided by the NHS through the recommendations made in NICE guidance. They will be helping the Institute make some of the most difficult decisions in public life. 

We currently have vacancies for a Committee member in the following category:

CATEGORY:  Secondary care clinician   
FURTHER INFORMATION:  Applicants must have a keen interest in the evaluation and adoption of innovative technologies.
 
Applications are particularly welcome from clinicians with an interest, or experience, in the development of new devices or tests.

TIME COMMITMENTS AND CONDITIONS
Committee members attend eleven day-long committee meetings per year as well as an annual Away Day.  In addition, Committee members will need to be able to deal in a timely manner with the reading of substantial Committee documents as well as reviewing and commenting upon the Committee’s provisional recommendations before they are published for consultation. MTAC meetings are held at the NICE offices in Manchester, and dates are fixed and made available to Committee members at least a year in advance. Committee membership is unpaid although expenses, including overnight accommodation, are reimbursed.  The period of Committee membership is for three years in the first instance.

HOW TO APPLY
For further information about what the role involves, please use the link below:
 
http://www.nice.org.uk/getinvolved/joinnwc/MemberMTACMedicalTechnologiesAdvisoryCommittee.jsp
 
For further information, please contact Marlon Hope on 0161 219 3844 or at marlon.hope@nice.org.uk

Completed applications should be returned by 5pm on Monday 30th June 2014 to CCT@nice.org.uk in the first instance, or by post to:

CCT
CHTE Appraisals
NICE
Level 1A
City Tower
Piccadilly Plaza
Manchester, M1 4BD

Tel: 0845 003 7780
Fax: 0845 003 7784

www.nice.org.uk

EQUALITY AND DIVERSITY
NICE is committed to the values of equality and diversity and welcomes applications from all sections of the community.

Date Added: 28/05/14
Professor Dusheiko Webcast Summarising Important HCV Data from EASL
News Type: BASL News

Professor Dusheiko recorded a webcast summarising some of the most important HCV data from EASL geared towards the interests of the UK audience.  The webcast is approximately 30 minutes in length and can be viewed at http://www.ic-hep.com/webcasts/easl2014/Gdusheiko/

This educational webcast is part of a larger, global educational initiative (IC-HEP:  International Coalition of Hepatology Educational Providers) (www.ic-hep.com).  This educational platform is funded by multiple sponsors and follows ACCME rules in that sponsors have no input into content or speakers.  In addition, Professor Dusheiko (and Professor Graham Foster) are part of the newly formed European Regional Council that will be responsible for establishing the educational needs across the continent.  By bringing together experts under a multi-sponsored global initiative, the goal is to create synergies and decrease redundancy of educational materials.


 

Date Added: 16/05/14
NICE seeks new members for its Independent Advisory Committees
News Type: BASL News

National Institute for Health and Care Excellence seeks new members for its independent advisory committees on the use of health technologies
 
The National Institute for Health and Care Excellence (NICE) is recruiting members to join its four independent advisory Appraisal Committees. The Appraisal Committees consider and interpret evidence on the clinical and cost effectiveness of health technologies and formulates recommendations on their use.
 
Members of all Committees are drawn from the NHS, healthcare professionals, patients and carers, and the academic world. Committee members are not appointed to act as representatives of a particular organisation. They will be expected to apply the experience and judgement from their individual backgrounds to the topics considered by the Committee and in doing so actively contribute to improving the quality and consistency of care provided by the NHS. They will be helping the Institute make some of the most difficult decisions in public life.
 
We currently have vacancies for Committee members in the following categories;

• Public Health Physician
• Device or Diagnostic Industry Representative
• Paediatrician 

Applicants must be prepared to travel to meetings in either Manchester or London
 
TIME COMMITMENTS AND CONDITIONS
 
Committee members attend eleven day-long committee meetings per year as well as an annual Away day.  In addition, Committee members will need to be able to deal in a timely manner with the reading of substantial Committee documents as well as helping with the production of consultation documents. Appraisal Committee meetings are held at the NICE offices in central Manchester or at a central London location, and dates are fixed and made available to Committee members up to a year in advance.  Committee membership is unpaid although expenses, including overnight accommodation, are reimbursed.  The period of Committee membership is for three years in the first instance.
 
HOW TO APPLY

For further information about what the role involves and how to apply, please follow the link below:
http://www.nice.org.uk/getinvolved/joinnwc/MemberTechnologyAppraisalsCommittees.jsp
 
For further queries please contact Kate Moore, Technology Appraisals Project Manager, on 0161 870 3154, or the recruiting team at CCT@nice.org.uk
 
Completed applications should be returned by 5pm Friday 13 June 2014 to CCT@nice.org.uk in the first instance, or by post to:
CCT
CHTE Appraisals
Centre for Health Technology Evaluation
NICE
Level 1A
City Tower
Piccadilly Plaza
Manchester, M1 4BT

Date Added: 14/05/14
NICE Recruiting Committee Members for CGU
News Type: BASL News

NICE are inviting applications for the position of: Standing committee members for the Clinical Guidelines Update Programme -Standing Committee C and D.
Members do not represent their organisations but are selected for their expertise, experience of working with multidisciplinary and lay colleagues and understanding of evidence based healthcare.
For further information on the NICE website click here

Date Added: 12/05/14
Administration of DAAs for HCV and Advanced Disease Patients
News Type: BASL News

12 May 2014

Dear Colleagues 

As you know NHS England have announced that sofosbuvir plus other DAAs will be made available to patients with HCV and advanced disease ahead of the NICE review, expected to conclude in October. There has been some speculation as to how this would be administered and I am writing to clarify the approach.

The aim is to provide treatment for a limited number of patients with very advanced disease.  Since the treatment will involve very sick patients receiving unlicensed drugs we need to ensure that appropriate monitoring, safety reporting, data collection etc is provided. The Hepatobiliary / Infectious Diseases CRGs through the Hepatitis C specialist group have therefore recommended that therapy will be provided by a limited number of sites, around 15 nationally and this advice was accepted by NHS England.  It is important to stress that this will NOT represent the final arrangement for delivering anti-viral care across England and specialist commissioning of HCV services will involve a much larger number of sites. This is an interim, emergency position to deal with patients at risk of death or disability whilst the full HCV service model is developed. This proposed national model will involve formal public consultation later in the year.

NHS England has agreed criteria for the sites drawn from advice from the CRGs and late last week EVERY trust in England was offered an opportunity to bid to provide this service. All of the bids will then be evaluated by a commissioner led independent panel who will evaluate the bids against the agreed criteria. It is anticipated that sites will be selected to ensure that patients throughout England have reasonable access to a service. NHS England is managing this through a formal procurement process that will provide an equitable and open approach to site selection and which will ensure that all interested trusts have an opportunity to apply.

The procurement process is expected to take a few weeks to complete. During that time it is recognised that there may be a few patients who will come to harm and therefore NHS England have announced an urgent access scheme whereby clinicians can apply to a clinical panel for use of sofosbuvir and other DAAs in patients who will come to critical harm if therapy is delayed for 8 weeks. You will appreciate that such patients will be extremely rare. Details on the scheme were circulated last week.

The details on both of these schemes have been cascaded through the NHS teams and both your area teams and chief executives will already have begun to receive notification. If your local teams have not forwarded the information appropriately then please do contact them.

I hope that this clarifies the issues – it is important to note that this is the first time that the new look NHS England has run an access program of this scale and, inevitably, it is taking a little while to get things going. I can assure you that I am as eager as you are to get patients onto therapy.

If colleagues have particular clinically related concerns or queries I am happy to receive emails – issues about the commissioning process should be directed your local specialised commissioning team but please note that I (and every other member of the CRG)  have absolutely no influence in the selection of sites.

Best wishes

Graham Foster

Date Added: 08/05/14
Obituary for Professor Andrew Burroughs
News Type: BASL News

 

Andy Burroughs, who sadly died on 15th March aged 60yrs, represented the best of clinical Hepatology in the UK.  Appropriately he was cared for during his illness at The Royal Free Hospital which was so dearly loved by him. It was where he first started on his career in Hepatology with the appointment as Clinical Registrar to Sheila Sherlock in January 1979, just three years after qualifying in Liverpool. 

Those early days of working on the ward under Sheila Sherlock’s sharp eye fired his enthusiasm for portal hypertension.  Hepatology in the 1970’s revolved around portal hypertension and the complications of it, namely, ascites, encephalopathy, as well as devastating variceal bleeding and hepatic vein pressure measurements on which he became an expert. By January 1988, when Andy was promoted to a consultant position at The Royal Free Hospital,  he had made major contributions on best clinical practice for managing episodes of variceal bleeding including original observations on the important roles of infection precipitating the event, and its recurrence.  Clinical practice was changed as a result of seminal studies, many of which were carried out in collaboration with Jamie Bosch of the Barcelona Clinic who became a great friend as well as a collaborator of Andy’s.

Another inherited, or more correctly termed epigenetically determined interest from Sheila Sherlock, was in primary biliary cirrhosis.  Pretty well all the PBC doctors had been won over by the joys of UDCA treatment but Andy showed that independent critical thought which underlay all his research endeavours and came to the conclusion after careful meta-analysis of available evidence that UDCA gave no major benefit in moderate/severe disease.  I remember very well the howls of rage that followed from Poupon in France, Jenny Heathcote and others.  Andy’s hypothesis for explaining the development   of   the   autoimmune reaction in PBC,  namely  molecular  mimicry  to   E.coli urinary tract antigens to which patients because of recurrent infections were so frequently exposed, was another important contribution.  

A major contribution to clinical Hepatology in the UK was the establishment of a liver transplant programme at the Free which he and Keith Rolles, as lead Surgeon, set up in 1984.  From that programme came further seminal studies on recurrent HCV disease in the graft and major clinical trials of immunosuppressive drugs, challenging again accepted dogma with his support for the use of Azathioprine.  

Andy was never been afraid of challenging accepted dogma and many of his papers - nearly 900 in all - provided new insights into clinical problems and in more recent years his interests ranged widely, for instance in coagulation and in primary HCC.  Over 100 research fellows came to work with him over the years and will have left the Free imbued with the same strictness he showed in carefully documented scientific enquiry.

Much of his work on practical aspects of cirrhosis care came together in what was a major review paper entitled “New therapeutic paradigm for patients with cirrhosis”, published in Hepatology in mid-2012.  This set out a way of management for cirrhotic patients which could maintain them in the compensated state with good survival prospects compared with progression to decompensation and an accompanying high mortality.

Finally, this obituary would be incomplete without reference to Andy’s sterling efforts to promote the work of BASL and BSG in this country. In EASL too, he held important roles at the time when vision and determination were required for it to achieve the necessary expansion for its pathway to becoming a major international congress. 

 

Professor Roger Williams, CBE

Director, Institute of Hepatology, London

Date Added: 08/05/14
Plymouth Nurses’ Peninsula Liver Study Day is a Big Success
News Type: BASL News

2 May 2013

Members of our Critical Care Education team and Specialist Hepatology Nursing Team welcomed over 100 delegates to their recent Peninsula Liver Study Day.

Delegates from across the country made the journey to the Postgraduate Medical Centre at Derriford Hospital to hear from a variety of speakers, including patients who shared their stories and experiences.

The day, organised by nursing staff from the Critical Care Education team and  the Specialist Hepatology Nursing Team, included sessions on anatomy and physiology, liver surgery, the clinical aspects of medical and nursing care for liver transplantation, patient experiences, and case study presentations.  Representatives from the primary and secondary care sectors and from local and regional government institutions also attended the event.

The event was sponsored by The British Association of Critical Care Nurses (BACCN) and the British Association for Study of the Liver (BASL) nurse forum.  

Organisers and delegates are hailing the day a success with feedback including:

“Excellent Study day. Thank you to you all especially the patients who gave their stories.”

“Very thought provoking - hope to change some attitudes.”

“Really useful and enjoyable day. Thank you, felt really privileged to have had the patients stories.”

"Thank you so much for a fantastic learning experience."

One of the organisers Kate Tantam, a Research & Education Sister from Critical Care said: “We’re so pleased with how the timetable and speakers were widely well received. We were particularly thrilled that patients were keen to come and share their stories of care and to provide a real insight into the challenges they faced.

“More inter-professional study days are planned for 2015 in partnership with the BACCN and The Critical Care Education Team and we welcome any suggestions on areas people would like educational input on.”

 

Ends

 

089/14

For further information please contact the Press & Communications Office for Plymouth Hospitals NHS Trust on 0845 155 8207 

Date Added: 08/05/14
SaBTO Report - transplantation of organs from deceased donors with cancer
News Type: BASL News

24/04/2014 - Taken from a letter from SaBTO

We would like to bring to your notice advice just published by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO).  SaBTO has reviewed the use of organs for transplantation from donors with cancer or a history of cancer, and drawn up evidence-based recommendations to guide decision making.

People with cancer are not usually considered as potential organ donors because of the risk of transmitting the malignancy. The risk varies widely, however, depending on the nature of the cancer in question.  In certain circumstances it may still be possible to carry out the wishes of this group of donors, and there is value in evidence-based guidance which transplant surgeons can use when deciding whether it would be to their patient’s benefit to accept an organ from a donor with cancer. 

SaBTO’s Working Group reviewed the literature and also analysed data from the UK National Transplant Registry relating to the outcomes of transplants from donors with a history of cancer.  Based on this evidence, they have categorised a number of cancers according to their risk of transmission to an organ recipient, and drawn up a series of recommendations.   

SaBTO are keen to make their findings and advice widely known, so that patients and transplant practitioners can benefit from them.  SaBTO’s report and recommendations have been published at https://www.gov.uk/government/publications/transplantation-of-organs-from-donors-with-a-history-of-cancer

 

Date Added: 30/04/14
Basic Science Retreat - Online Booking Open
News Type: BASL News

Date: 25-27 June 2014    Venue: Seale Hayne, Newton Abbot, Devon

The first event in 2012 was a resounding success and hopefully again this unique meeting will offer plenty of interaction and discussion as well as a unique opportunity to foster new and lasting collaborative projects across all areas of hepatology research.

Registration fee £150.00 (includes two nights accommodation, breakfast, lunch and dinner).

BOOKING OPEN.  Go to the event page to book online and see below for the programme.

PROGRAMME:

Wednesday 25th June
17:00-19:00 Genomics and Epigenetics - Professor Richard Sandford and Dr Mujdat Zeybel

Thursday 26th June
08:30-10:30 Fibrosis - Dr Neil Henderson and Dr Karen Piper Hanley
10:30-11:30 Coffee
11:00-13:00 Biomarkers and Imaging - Professor David Lomas - Professor Neil Guha
13:00-14:00 Lunch
14:00-16:00 NAFLD and HCC - Dr Quentin Anstee and Dr Helen Reeves
16:00-16:30 Tea
16:30-18:30 Stem Cells and Tissue Regeneration - Professor Stuart Forbes and Professor Philip Newsome

Friday 27th June
08:30-10:30 Immunology and Autoimmune disease - Professor David Adams and Professor Alberto Sanchez-Fueyo
10:30-11:00 Coffee
11:00-13:00 Hepatitis and Cellular Senescence - Professor Salim Khakoo and Dr Graeme Alexander
Packed Lunch

Date Added: 30/04/14
Book for BVHG 'HBV & HEV 2014 & Beyond' Meeting 09 May
News Type: BASL News

Date: 09 May 2014   Venue: America Square Conference Centre, London EC3N 2LB (Tower Hill)

We hope that you will join us in London on 9th May for what will be another engaging BVHG meeting including key presentations on HBV and new data on HEV:

10.00 Arrivals and registration
10.20 Welcome by Committee Co-Chairs

HBV
10.30 Interferon or oral therapies – the pros and cons…. Prof Geoff Dusheiko
11.10 Monitoring and assessment (including surface antigen quantification) Dr Charles Millson
11.55 Preventing reactivation in those that become immuno-suppressed, Professor Aftab Ala
12.20 Vaccination, Sema Mandal, PHE
12.50 Lunch
13.50 Pipeline therapies and strategies, also what is ‘cure’ and how to best achieve it, Dr Patrick Kennedy
HEV
14.30 Indigenous HEV Infections in England and Wales, Dr Samreen Ijaz, PHE
15.00 Refreshments
15.15 Blood safety & HEV, Dr Ines Ushiro-Lumb, NHS Blood and Transplant. Dr Samreen Ijaz, PHE
15.35 HEV Clinical Aspects - Immunisation & Treatment, Dr Harry Dalton
16.15 Conclusions and close of meeting.

BOOK TODAY To register, email the Secretariat or call 0845 521 0272/ 01543 442154.

Association Members - Free Entry; Non-Association delegates £40

Date Added: 30/04/14
Deadline for Basic Science Retreat Abstracts Extended to 16th May 2014
News Type: BASL News

For a chance to present your current research at the Basic Science Retreat in June, please submit your abstract for one of the seven scheduled sessions.  The format is simply free text, one page of A4 of contemporary research.

Email the Secretariat admin@basl.org.uk with your submission before the deadline date.

You will be notified if you are successful by Friday 23rd May.

Sessions include:
• NAFLD & HCC
• Fibrosis
• Biomarkers and Imaging
• Genomics and Epigenetics
• Stem Cells and Tissue Regeneration
• Immunology and Autoimmune disease
• Hepatitis and Cellular Senescence

Date Added: 23/04/14
NICE recruiting for GDG on Liver Disease
News Type: BASL News

(http://guidance.nice.org.uk/CG/Wave0/692).

NICE are currently seeking to recruit the following healthcare professionals to join this guideline development group (GDG):

Full GDG members:
• Hepatologist x2 (1 NASH specialist and 1 general)
• Paediatric hepatologist
• Liver nurse
• General Practitioner x2 (ideally with commissioning experience)
• Radiologist
• Clinical biochemist.

Co-opted expert advisers:
• Exercise physiologist
• Dietician
• Diabetologist
• Histopathologist.

The advert details and information on how to apply can be found at: http://www.nice.org.uk/getinvolved/joinnwc/MemberNonAlcoholicLiverDiseaseGDG.jsp.

The closing date for applications is Thursday 22 May 2014 at 5pm.

If you have any questions, or wish to discuss the posts further, please do not hesitate to contact NICE.

NICE Public Involvement Programme is also seeking to recruit patient members to join this GDG, please see here for further information.

Please find contact details below:

Amelia Unsworth 
Project Manager
National Clinical Guideline Centre
Royal College of Physicians
11 St Andrews Place
Regent’s Park
London NW1 4LE

Direct line +44 (0)20 3075 1268| Mobile 07990 745 419
www.rcplondon.ac.uk | www.ncgc.ac.uk | facebook | twitter | linkedin

The offices are located at: 180 Great Portland Street, London W1W 5QZ

NCGC is a governance partnership between the Royal Colleges of General Practitioners, Nursing, Physicians and Surgeons.

Date Added: 14/04/14
CLDF Small Grants Research Programme
News Type: BASL News

Just a reminder that the new round for the CLDF Small Grants Research Programme has begun and will close for applications on 30 June 2014.

Up to £5000 will be made available this quarter. Further details and application information can be found here - http://www.childliverdisease.org/What-we-do/Research/Small-Grants-Programme

Date Added: 27/03/14
On-line survey – Palliative Care Provision in UK Liver Services
News Type: BASL News

Dear Colleagues

Following a recent national meeting of medical, nursing and allied health professionals interested in the provision of better end of life care for people with cirrhosis, held at the Royal Free Hospital, London on November 2013, we are now conducting a national survey looking at palliative care provision in liver services across the UK.

The aims of this survey include:

1. Exploring the perceptions of health care professionals surrounding the role of palliative care in the management of cirrhosis.

2. Determining the level of palliative involvement in local liver services.

3. Identifying any issues surrounding access to palliative care.

This survey is aimed at three groups of health professionals: those working in hepatology and gastroenterology, those working in specialist palliative care and General Practitioners with an interest in gastroenterology. We hope that our findings will help to improve future collaboration between palliative care, liver services and primary care.

It will take about 5-10 minutes to fill in this short survey. The results will be anonymised.

We encourage all nurses, doctors or allied health professionals in each institution to fill out this survey (even if you work in the same institution/department), as it aims to sample individual perception. Please click on the link below to fill in this survey: 

https://www.surveymonkey.com/s/eolc_patients_with_cirrhosis

We have obtained ethical permission from UCL to conduct this survey (3552/002).

If you have any further questions about this survey, please do not hesitate to contact Dr Joe Low, Senior Research Fellow, Marie Curie Palliative Care Research Unit, (UCL) either by e-mail joseph.low@ucl.ac.uk or by phone on 020 7679 9718.

Please ignore this email if you have already completed this survey.

 

With kind regards,

Dr Aileen Marshall, Consultant Hepatologist, Royal Free London NHS Foundation Trust
Dr Louise Jones, Head, Marie Curie Palliative Care Research Unit, University College London
Miss Katherine Hopkins, Macmillian Nurse Consultant, Royal Free London NHS Foundation Trust

Date Added: 26/03/14
APPHG Liver Disease Inquiry Released
News Type: BASL News

'LIVER DISEASE:  Today's Complacency, Tomorrow's Catastrophe'

The All-Party Parliamentary Hepatology Group (APPHG) Inquiry into Improving Outcomes in Liver Disease

There have been successive government commitments to publish a national liver strategy since 2009 and considerable work has been invested by the Department of Health, charities and leading specialists, doctors and nurses from around the country into developing a national liver strategy.

However, in November 2013 the Government announced that NHS England, who would now be responsible for leading such work, had no plans to publish a strategy.

Out of disappointment at the persistent failure to develop a comprehensive approach to tackling liver disease, The All-Party Parliamentary Hepatology Group (APPHG) decided to conduct a comprehensive inquiry into the growing epidemic of liver disease.

They invited evidence from Royal Colleges, clinicians, patients, charities, relevant industry figures, the NHS, Public Health England and the Government, in order to establish what needs to be done to improve outcomes for liver disease patients and save lives.

In this Inquiry they listened carefully to the accounts of all of these stakeholders, and the resounding message to emerge is that much, much more needs to be done at all levels of the health service to address liver disease.

We encourage you to read this report. DOWNLOAD HERE.

Link to the BBC story 'Scandal of Liver Disease Inaction' published 25 March 2014

Date Added: 24/03/14
Liver Disease in the UK: A Lancet Commission
News Type: BASL News

The Lancet has commissioned an investigation into the high mortality and poor quality of life experienced by patients living with liver disease in the UK. As part of this investigation we are collecting data on nurse roles and nursing networks. We would be grateful if you could take the time to complete the following short survey:

  • What is you your current role title?
  • What percentage of time is in direct Hepatology care?
  • Is your role specific to viral hepatitis/ alcohol/ transplantation/HCC/ general Hepatology/ education/ research or other?
  • Are you a member of a liver nursing organisation/ network? If so, which?
  • Do you work in primary care/ secondary care/ specialist liver unit?
  • Which area are you located in?

Please send your responses by 14th April via:  Elizabeth.farrington@rcht.cornwall.nhs.uk

 

 

Date Added: 24/03/14
Southampton University Symposium Big Alcohol, Big Tobacco, Big Influence
News Type: BASL News

On 19th March 2014 George Osborne put a stop to the UK alcohol duty escalator, which was a major policy objective for the drinks industry and they have lobbied very hard for it since their victory over MUP in August.

Nick Sheron, member of BASL and Head of Clinical Hepatology at Southampton University commented "The duty escalator stopped a 9% year on year increase in liver death rates which were then stable from 2008 onwards, so we anticipate that liver death rates will now resume their inexorable rise. All we can do is to keep presenting the evidence and hope that at some stage decency and reason will prevail over vested interests."

To this end, the Southampton University symposium Big Alcohol, Big Tobacco, Big Influence videos are now available to watch online on the Public Policy website.

Symposium presentation from Dr Nick Sheron on 'Alcohol: unhealthy behaviours, toxic environments and vested interests'.

Please feel free to watch all of the videos at your leisure and to tweet the URL to your colleagues: 

http://publicpolicy.southampton.ac.uk/big-alcohol-videos/

Follow up Meeting

There will be a follow up meeting to discuss the imlpiactions of this Parliamentary decision on 1 April at 2pm in Committee Room 8 in the Palace of Westminster.

 

CLICK HERE to register for free tickets.

Date Added: 19/03/14
The APPHG Inquiry on Liver Disease: "Today's Complacency, Tomorrow's Catastrophy"
News Type: BASL News

In 2013, the All-Party Parliamentary Hepatology Group (APPHG) decided to conduct a comprehensive inquiry into the growing epidemic of liver disease.

They invited evidence from Royal Colleges, clinicians, patients, charities, relevant industry figures, the NHS, Public Health England and the Government, in order to establish what needs to be done to improve outcomes for liver disease patients and save lives.

The report of the Inquiry will be available to the public on Tuesday 25th March 2014 at 4.00pm.

Date Added: 04/03/14
Gilead UK and Ireland Viral hepatitis Fellowship Programme 2014
News Type: BASL News

Following the success of the Gilead UK and Ireland Fellowship Programme (GUKIFP) from 2009 to 2013, we are pleased to provide details for an expanded viral hepatitis Fellowship Programme for 2014, which aims to provide funding amounting to £300,000.

The aim of the Gilead UK and Ireland viral hepatitis Fellowship Programme is to award financial grants (or support and contribution to joint working initiatives between the NHS and Gilead or the NHS, Gilead and the third sector) to generate and promote best practice in the delivery of patient-centred care through innovative and reproducible models in hepatitis C virus (HCV).

In the Fellowship Programme, financial grants or support will be awarded on a competitive basis to individual organisations or groups of local healthcare providers such as, but not limited to, hospital clinics and patient organisations. In 2014 funding will be awarded to applicants whose proposals best demonstrate:

·         Targeted, locally based initiatives to increase diagnosis of HCV in high risk populations which demonstrate successful onward referral to specialist care

·         Targeted locally based initiatives to re-engage individuals who had been diagnosed with HCV but lost to follow up individuals with the hepatitis care pathway

 

Applications can be made through the Gilead Fellowship website www.ukifellowshipprogramme.com from 03 February 2014 to 05 May 2014; applicants will be notified by the end of June 2014.

Date Added: 11/02/14
BASL Online Abstract Submissions 2014
News Type: BASL News

We will open the online abstract submission system for the BASL Annual Meeting on 1st April.

The categories are;

• Viral hepatitis
• Basic science
• Liver cancer
• Transplant
• Clinical science
 
The closing date to receive submissions is midnight on Sunday, 8th June 2014.

Date Added: 11/02/14
Dame Sheila Sherlock Research Prize 2014
News Type: BASL News

The closing date to receive submissions will be midnight on Sunday, 8th June 2014.
 
One of the highlights of the annual meeting is the presentation of the Dame Sheila Sherlock research prize. This prize is awarded annually to recognise the enormous contribution of Dame Sheila Sherlock to the development of Hepatology as a discipline in its own right. The winner of the award will deliver a 30 minute lecture presenting their research during the Annual Meeting on Tuesday 16th September.
 
Dame Sheila was involved in the foundation of the British Liver Club in 1961, which subsequently evolved into The British Association for the Study of the Liver (BASL). She was one of our past presidents and the first recipient of The BASL Distinguished Service Award. In keeping with Dame Sheila’s enthusiasm for fostering young researchers, this eponymous research prize is awarded to young investigators without substantive posts in either medicine or science for their research contributions in the field of Hepatology.

This year the prize is free registration to the meeting, a place at the annual dinner and £1,000.
Those interested in putting themselves forward for this award should send their application to the BASL Secretariat via email at admin@basl.org.uk.

The application should consist of one A4 sheet detailing the research and another A4 sheet detailing the applicant's publications. All applications will be reviewed by a BASL committee.
You must be a member of BASL to apply.

Date Added: 11/02/14
Job Advert. UK based Clinical Specialist
News Type: BASL News

Echosens are looking to recruit a UK based Clinical Specialist to support their installed base of 100+ FibroScan systems in UK and Ireland. 
The role will involve providing clinical training on the correct use of FibroScan. This will be a national role involving extensive travel and regular time away from home. 
Minimum qualifications: experience as a Hepatology or Infectious Disease Clinical Nurse Specialist or experience working in a similar medical device Clinical Specialist role with a strong biomedical/scientific background. 
For more information and full Job Description please forward your CV to David Stow, Echosens’ UK Consultant at: davidstow@hephealth.co.uk 

Date Added: 10/02/14
Call for expression of interest in joining/communicating with a UK Wilson’s Disease Network.
News Type: BASL News

Call for expression of interest in joining/communicating with a UK Wilson’s Disease Network.
 
Members of BASL who would like to have information on, or take part in a UK Wilson's Disease Network, are asked to contact:
Dr James Dooley, Consultant Hepatologist at the Royal Free London (james.dooley@nhs.net)
 
Following the Wilson’s Disease centenary Meeting in Autumn 2012, a group of individuals interested in this condition, including hepatologists, neurologist, clinical scientists, molecular geneticists and patient representatives are meeting to develop a UK Wilson’s Disease Network.
The objective is to:
    - Bring together the expertise of a multidisciplinary interest group in Wilson’s disease from across the UK
    - Provide a resource (hub and spoke structure) for clinicians to contact if they need advice in the management of a patient with Wilson's disease
    - Understand and develop a strategy/process for specialist commissioning for Wilson’s disease
    - Discuss and potentially become involved in research initiatives
 
Please contact Dr James Dooley if you would like to take part in this initiative, or have an interest in Wilson's disease and would like to be circulated with more details/information in the future.
 
 

Date Added: 29/01/14
Poor Sleep Worsens Cognitive Function in Cirrhosis
News Type: BASL News

A US study suggests poor-quality sleep is associated with a worsening of impaired cognitive function in cirrhosis patients.

 

Researchers at the University of Illinois carried out a comprehensive battery of neuropsychological tests and the validated Pittsburgh Sleep Quality Index (PSQI) on 34 patients with cirrhosis, but without evidence of overt hepatic encephalopathy.

 

For full story, login to the BASL Clinical Communities for Members.

 

Join the membership

Date Added: 21/01/14
Shape of Training Final Report
News Type: BASL News

'Shape of Training' Final Report The “Shape of Training” report for Health Education England presents new challenges. The drive towards more “generalist” skills in training has significant potential implications for Gastroeneterology and Hepatology. The recent NCEPOD report “Measuring the Units” highlights the problems that can arise in patient care where there is lack of adequate expertise. This further supports the need for the appointment of appropriately trained specialists in Hepatology in all District General Hospitals. However, talk of potentially shortening training and reducing “specialism” without clearly recognising what the workforce of the future should look like is concerning. This is particularly so when we look at the rising burden of liver disease in the UK.

We would urge you look at this document and would appreciate your comments to be fed back to us at the BASL Secretariat.

Please click 'further information' for the report.

Date Added: 16/01/14
Commissioning Specification for HCV
News Type: BASL News

Professor Graham Foster, Co-chair of the HCV Speciality Commissioning Sub-group has contacted us regarding a recently produced draft commissioning specification for HCV.

The plan is to approve this by spring time and then to begin to discuss an expanded, expedited access program for the new HCV drugs that are currently awaiting NICE approval. The aim is to help those most in need ahead of a NICE review.

As the plans mature you will be kept informed and further feedback will be solicited as we go forward.

Please take a look at this document which you can download here.

Your feedback and comments are welcome.  Please send these directly to Graham Foster at g.r.foster@qmul.ac.uk.

Date Added: 15/01/14
Required:Two Specialist Trainees to participate in the development of NICE clinical guidelines on Liver Disease (non-alcoholic) and Cirrhosis.
News Type: BASL News

We are recruiting two specialist trainees to participate in the development of NICE clinical guidelines on Liver Disease (non-alcoholic) and Cirrhosis.

Applicants must have an interest in liver disease or cirrhosis, and a desire to be actively involved in guideline development. Excellent communication/interpersonal skills, and ability to communicate complex issues to differing audiences, are required. Please click here for the job description with further details on the role.

To apply, please email the following information to NCGCtraineerecruitment@rcplondon.ac.uk by Wednesday 29 January 2014, 5pm:
• short CV
• statement outlining your suitability and motivation for applying (max. one page)
• Equality monitoring form
• Declaration of interests form
• Names and contact details for two referees.

The equality monitoring and DOI forms are available on the NICE website.

Interviews for shortlisted candidates will be held on Friday 14 February 2014 (morning) in central London. Applicants must be available to attend interview on this day if shortlisted.

Please direct any queries about the role to Amelia Unsworth, Project Manager, NCGC at: amelia.unsworth@rcplondon.ac.uk

Date Added: 14/01/14
Calling Gastro Consultants & Nurses - Crohn's Disease Survey
News Type: BASL News

To our members who are Gastroenterology Consultants or Specialist Nurses in the field, we would like to make you aware of a Crohn's Disease study with an aim to understand how Crohn’s disease is currently  managed with anti-TNF therapies.  The survey is being conducted by Opinion Health, an independent research agency specialising in healthcare based in London, UK.

 

For this study gastroenterologists and specialist nurses who are based in the community, hospitals and academic institutions are being invited to complete a short anonymous survey online. The survey can be accessed in total anonymity and no answer can be linked to individual participants. All information collected will be used for research purposes and in an aggregated form only.

 

Each participant will receive £25 from Opinion Health for completing the survey.

Click here to access the survey.

Date Added: 09/01/14
BASL Members win substantial funding for clinical trial
News Type: BASL News

Several BASL members were co-applicants on a recent successful application for substantial funding of a clinical trial in hepatology. Prof Julia Wendon, Prof Mark Thursz, Dr Steve Ryder, Prof Matthew Cramp, Prof Graham Foster, Dr Paul Richardson, Dr Ahmed Elsharkawy and Dr Stuart McPherson are among a group represented by Dr Alastair O’Brien. The group received £1.6 million from the Health Innovation Challenge Fund (joint Wellcome Trust and Department of Health) for ATTIRE (Albumin To prevenT Infection in chronic liveR failure).

The money will fund a multi-centre, clinical, phase II and phase III trial at 15 sites that will examine whether administration of albumin to patients admitted with decompensated liver failure, in order to increase plasma levels to near normal, will prevent hospital acquired infection. Dr O'Brien's local clinical research network (LCRN) will fund the research nurse costs (>£1million).

Over 100,000 patients are admitted to hospital every year with advanced liver cirrhosis; infection is their most common problem. Dr O’Brien and his team have shown that, in these patients, leukocyte function is markedly impaired by an up-regulation of the hormone Prostaglandin E2; infusion of albumin can reverse this process by binding and neutralising its effects.

Albumin is widely considered by hepatologists to be beneficial in liver disease but no putative mechanism had been identified, so no consensus had developed for how to prescribe it. Dr O’Brien and colleagues aim to repurpose albumin as an immunity-restoring drug to improve leukocyte function in patients with advanced cirrhosis and therefore improve their ability to fight off infection. They hope to demonstrate that its use will lead to reduced rates of nosocomial infection and mortality and shorter hospital stays, thereby reducing health care costs.

Date Added: 09/01/14
Child Liver Disease Foundation Small Grant Round
News Type: BASL News

The trustees of Children’s Liver Disease Foundation will make available £20,000 per annum for a small grants research programme. Applications must be in line with the CLDF research strategy which can be found here.

The money will be distributed quarterly with a maximum of £5,000 being awarded in any one quarter. Applicants may apply for up to £5,000 in a quarter. Successful applicants will not be eligible to apply for a further year following an award being made.  

The trustees will look favourably on applications where the candidates can show that they can add value to the contribution made by CLDF. Those who can show matching funding from their institution or other sources will be regarded favourably.  

For more information and to apply please click on the following link:

http://www.childliverdisease.org/What-we-do/Research/Small-Grants-Programme

 

 

 

 

 

 

 

 

 

 

 

 

 

http://www.childliverdisease.org/What-we-do/Research/Small-Grants-Programme

 

 

 

 

 

 

 

 

Date Added: 08/01/14
Bursary for EASL 2014 - Application Deadline 17/01/2014
News Type: BASL News

Overview

MSD in collaboration with the BASL have made provision for 30 scholarship awards to be made available to assist healthcare professionals to attend the forthcoming EASL to be held in London on 9th-13th April 2014.

Scholarship awards are capped at a maximum of £1,000 per person and are considered a contribution towards an award winner’s registration fee, travel and accommodation expenses, but not subsistence.

Eligibility

  • Applications are invited from UK-based healthcare professionals in the field of Hepatology medicine.
  • There will be a maximum of 30 awards available to SpRs, consultant doctors (within 5 years of current appointment), nurses and scientists in the field of Hepatology medicine.
  • Successful applicants from the MSD Travel Bursary Scholarship programmes held in 2012-2013 will not be eligible for the awards in 2014.

How to Apply

Applicants will need to complete the formal Application Form for travel bursaries for EASL 2014.

As part of the application form applicants will need to outline how they meet the criteria for registration at the forthcoming EASL conference and how the EASL conference will benefit themselves and others in their future career.

Download: Application Form

Download: Guidance Notes

Application deadline Friday 17th January 2014

This travel bursary is funded by a grant from MSD, however, MSD had no involvement in the selection of the recipients of the bursary. Details regarding the application and review process for the scholarships can be found as part of these Guidance Notes.

Date Added: 10/12/13
Call for participants to workshop on Cholangiocarcinoma: Sharing the Disease Burden in the UK and South-East Asia
News Type: BASL News

The British Council and The Thailand Researcher Fund have launched an initiative programme to encourage international research collaboration between ambitious young researchers from the UK and Thailand.

Application deadline Wednesday 15th January 2014.

 

Under the Researcher Links scheme, Khon Kaen University and Imperial College London will be holding a workshop on the above theme in Khon Kaen, Thailand on 12-14th March 2014. The workshop is being coordinated by Professor Paiboon Sithithaworn from KhonKaen University and Professor Simon Taylor-Robinson from Imperial College London, and will have contributions from other leading researchers:including Professor Sopit Wongkham and Professor Pisaln Mairiang from Khon Kaen University, Professor Debra Humphris (Vice-Provost, Imperial College London) and Professor Richard Syms (Imperial College London). 

We are now inviting Early Career Researchers (as defined in Appendix 2 –eligibility) from the UK andThailand to apply to attend this workshop. All travel and accommodation expenses will be covered by the Researcher Links programme. 

 

Download the application form, with more details on the initiative. The completed form should be sent to Dr Peter Norsworthy: p.norsworthy@imperial.ac.uk (for British applicants) or Mrs Duangsamorn Chankwang: duacha@kku.ac.th (for Thai applicants).

Application deadline is Wednesday 15th January 2014.

Date Added: 01/11/13
Job Advert - Senior Clinical Lecturer and Non-Clinical Lecturer in Hepatology - South West
News Type: BASL News

The Peninsula School of Medicine and Dentistry together with the South West Liver Unit at Derriford Hospital Plymouth are looking to appoint two substantive posts at Clinical Senior Lecturer and Lecturer (non-clinical) level in hepatology to broaden and strengthen our research in liver disease.

Plymouth University has invested significantly in liver research and has recently funded a chair in hepatology, and created these clinical senior lecturer and post-doctoral scientist lecturer posts. Extensive laboratory facilities are available adjacent to the hospital as well as on the main university campus.

The Senior Lecturer post will hold an Honorary Consultant contract with the South West Liver Unit and will work as part of the team of consultants providing a full range of specialist liver services.  Informal enquiries from enthusiastic, motivated individuals who wish to combine working in a stimulating academic and clinical environment with the excellent quality of life in the South-West are welcomed.

Please contact Professor Matthew Cramp on 01752 792725 or matthew.cramp@nhs.net  

Date Added: 06/06/12
BASL launches e-learning toolkit for liver disease nurse specialists and community nurses
News Type: BASL News

6 June 2012

The British Association for the Study of the Liver (BASL) has launched an e-learning toolkit designed to offer opportunities for liver nurses, ward nurses and community nurses to access evidence-based information and resources about liver well-being and disease.
 
Toolkit 1: Liver well-being and liver diseaseis available now and is broken into three bite-size learning topics. The topics for toolkit 1 are:
 
Understanding the healthy liver
Liver essentials when things go wrong, and
Getting the message across
 
Toolkit 1 provides a useful refresher and teaching aid on the anatomy and physiology of the liver and liver disease while asking nurses to reflect on their personal communication style. It explores specialist techniques including motivational interviewing to encourage behaviour change in patients.
 
The toolkit makes the use of the latest e-learning techniques to deliver information in an interactive and user-friendly format. The toolkit aims to help nurses share good practice and apply learning to nursing practice through case studies and reflective activities.
 
The toolkit content has been developed under the guidance of an editorial panel of senior liver disease nurses, with input from the British Liver Trust. The development of the toolkits was made possible by an unrestricted educational grant from MSD.
 
The Editorial Panel members are:
• Amanda Clements, Hepatology Nurse Consultant, Derriford Hospital, Plymouth (Chair)
• Katherine Oakes, Senior Nurse Viral Hepatitis, Kings College Hospital, London
• Sarah Wise, Campaigns and Media Manager, British Liver Trust
• Liz Farrington, Advanced Nurse Practitioner Hepatology, Royal Cornwall Hospitals NHS Trust
 
Amanda Clements, Chair of the BASL Nurse Forum, said, "BASL Nurses Forum is committed to raising the awareness of liver disease and sharing good practice in order to provide the highest quality of care of patients and their families affected by liver disease. This is increasingly important as the prevalence of liver disease is growing and is now the fifth most common cause of death in the U.K.
 
“This toolkit provides an invaluable and accessible educational resource to support the knowledge necessary to develop the clinical competencies that are required for Hepatology nursing."
 
Sarah Wise of the British Liver Trust said, ““From a patient’s perspective, we wholeheartedly welcome a tool such as this to aid the education of nurses looking to increase their understanding of liver conditions. The problems associated with the liver are broad however the majority of liver damage can be prevented through appropriate interventions and lifestyle advice. This tool encompasses solutions and information to help nurses make the right decisions for their liver patients.”
 
The toolkits are available on the BASL Clinical Community, the Association’s Professional Networking site.
To log-on to the BASL Clinical Community visit: www.clinicalcommunities.net/BASL
 
 
Membership of the BASL Clinical Community is open to nurses who are non-BASL members. For log-in details email
support@clinicalcommunities.net


Notes for editors

For more information please contact the British Liver Trust press office on 0845 521 0272
 
The toolkits were developed on behalf of BASL by Oyster Healthcare Communications Ltd, and were authored by e-learning specialist Jane Brotchie.  Oyster specialises in the development of online communities for healthcare professionals and has active Clinical Communities in range of therapy areas.

The British Association for the Study of the Liver is dedicated to the knowledge and understanding of the biology and pathology of the liver for the optimal care of patients. BASL is composed of interested individuals from clinical medicine, clinical and basic research and allied professions.

Date Added: 30/05/12
Programme now available for the Cambridge Liver Symposium Robinson College – 28th September 2012
News Type: BASL News

0800            Registration and coffee

0830            Chair: Dr Varuna Aluvihare (Kings)

Transplantation           

Case presentations

Expanding the indications in era of organ shortage           Prof Andy Burroughs, R Free

Assessing comorbidity – when is it prohibitive?                    Dr Fay Gilder, Cambridge

Withdrawal of immune suppression                                   Prof A Sanchez-Fueyo, Kings

Discussion            

1015            COFFEE

1045            Chair: Dr Susan Davies (Cambridge)

Liver fibrosis 

Can cirrhosis be reversed?                                                 Dr J Fallowfield, Edinburgh

Role of serum markers                                                           Dr Neil Guha, Nottingham

Transient elastography                                                           Dr Paul Richardson, Liverpool

MR Elastography                                                                   Prof David Lomas, Cambridge

1230            LUNCH

1330            Chair: Dr Steve Ryder (Nottingham)

HCC

Case presentations

Epidemiology and prevention                                                 Dr Helen Reeves, Newcastle

Screening – who, where and how                                            Dr A Marshall, Cambridge

Novel therapies                                                                    Dr Tim Meyer, UCL

1500            TEA

1530            Chair: Dr Simon Rushbrook (Norwich)             

Lecture - Viral hepatitis

How the liver CRN is shaping research in the UK                    Dr Steve Ryder, Nottingham

1615             Close

 

Click here for more details

Date Added: 08/05/12
BASL School Of Hepatology: Special one-day viral hepatitis meeting
News Type: BASL News

09.30–10.00                Registration and coffee

10.00 - 11-00              Hepatitis C – Genotype 1 – Today and tomorrow

                               Prof Graham Foster, Bart’s & The Royal London NHS Trust

11-00 -11-30              Coffee

11-30 – 12 -30            Hepatitis B – what to do and when

       Dr Patrick Kennedy, Bart’s & The Royal London NHS Trust

12-30 – 13-30            Lunch

13-30 -14-00             Hepatitis Delta

                              Dr P. Harrison, King’s College Hospital NHS Trust

14-00 – 14-30            Hepatitis E

      Dr Samreen Ijaz, Health Protection Agency

14-30 – 15-00            Hepatitis C – Genotype non-1

                              Professor Graham Foster, Bart’s & The Royal London NHS Trust

15-00 – 15-15            Tea

15-15 – 16-00            Case discussions

                              Prof Graham Foster, Bart’s & The Royal London NHS Trust

 Please note places for this meeting are limited and we advise those who are interested in booking to contact us at the earliest opportunity. We are taking reservations from today.


The School is aimed at trainees wishing to become hepatologists. Places are limited and will be allocated on a first-come-first-served basis with the priority being given to members of BASL and BVHG - all of whom can attend free-of-charge.

Non-members may attend without charge provided they join BASL ahead of the meeting and return a Direct Debit mandate form, found on the BASL website.

The purpose of the BASL School of Hepatology is to explore and teach the current pathophysiological basis of therapies in chronic liver disease, as well as guideline-based investigation and treatment.


To register please email alex.lock@basl.org.uk with your name, affiliation and whether you are already a member of the Association.

If you do have any questions please do not hesitate to contact me by email or phone.

Kind regards,

Alex Lock
BASL Secretariat
0845 5210272

Date Added: 27/04/12
Cambridge Liver Symposium 28th September 2012
News Type: BASL News

Date Added: 27/04/12
ICS: Liver Failure - Medical and Surgical Aspects Seminar
News Type: BASL News

Thursday, May 31, 2012

The Intensive Care Society:

Liver Failure - Medical and Surgical Aspects

Churchill House, London

This one day seminar will offer an exciting programme with renowned professionals discussing the latest information on Liver Failure.

Topics will include:

- Cirrhosis

- Dysfunction and Sepsis

- Trauma

- Alcoholic hepatitis and abuse

 

Confirmed Faculty: Dr William Bernal, Dr Michael Gilles , Dr Kevin Gunning, Dr Phillip Harrison, Dr Nick Murphy, Prof James Neuberger, Prof John O'Grady, Mr Andreas Prachalias, Prof Mervyn Singer, Dr Tony Whitehouse

 

Registration Fees:

Consultant ICS Member: £110

Consultant Non-Member: £165

Trainee/Nurse/AHP ICS Member: £55

Trainee/Nurse/AHP Non-Member: £85

Approved 5 CPD Points

Contact Lauren on lauren@ics.ac.uk for details. Register online today!

www.ics.ac.uk

Date Added: 23/04/12
Applications for the Sheila Sherlock Research Prize and Lecture
News Type: BASL News

The Prize

This year the prize is free registration to the BASL Scientific Meeting and £1,000.

How to enter

Those interested in putting themselves forward for this award should send their application via email to simon.williams@basl.org.uk before 4pm on the 7th June 2012.

Your application should summarize the research you have undertaken and explain how the research findings have advanced knowledge within the field of research endeavour. The application will consist of one A4 sheet using Arial Font size 10 (include figures and tables if these help to illustrate your case). Please enclose another A4 sheet detailing your recent publications. The Governing Board will review all applications and the prize winner will be informed by 30th June 2012.

We look forward to receiving your applications.

Yours sincerely

Dr Phil Harrison

General Secretary

British Association for the Study of the Liver

Date Added: 13/04/12
BVHG: Viral Hepatitis and the Kidney
News Type: BASL News

Venue:
The Kings Fund,
11-13 Cavendish Sq  
London W1G 0AN.

Date Added: 25/01/12
16th Advanced Gastroenterology & Hepatology Course
News Type: BASL News

Thursday, 9 February 2012 - Friday, 10 February 2012

Venue:
Queen Mother Conference Centre
Royal College of Physicians of Edinburgh
9 Queen Street
Edinburgh
EH2 1JQ

This well established 2 day course attracts trainees and consultants from around the UK and Europe. It is designed to cover important and "hot" topics and will have experts speaking in their fields. The course will highlight some of the new advances in the diagnosis and management of gastrointestinal and liver disease. The course will be held in Edinburgh at the Royal College of Physicians of Edinburgh on Queen Street.

Overall the course provides an update on the latest evidence base for the management and treatment of gastrointestinal and liver conditions. 

For more information:

http://events.rcpe.ac.uk/events/175/16th-advanced-gastroenterology--hepatology-course

To see the draft programme:

http://events.rcpe.ac.uk/booking-forms/Advanced_Course_2_day_programme_2012.pdf