On World hepatitis day, what is the place of emerging technologies in hepatitis management?
Raouf Hajji, MD, PhD.
HealthTech Futurist | Professor Assistant of Medicine | Co-Founder & Medical Lead of International Medical Community (IMC) | Chief Academic Officer (CAO) of Supernova Academy Inc.
World Hepatitis Day: ?
Public health holiday is held each year to raise awareness about hepatitis, a group of infectious liver diseases worldwide frequent. It promotes testing and prevention for all five types of the disease: A, B, C, D, and E. The World Hepatitis Alliance established this day in 2008 but did you know it was initially held on May 19? The date moved to July 28 in, 2010, after the World Health Assembly decided to commemorate the birthday of Baruch Samuel Blumberg, an American physician who discovered hepatitis B in the Sixties, eventually winning a Nobel Prize for his work on the virus and its vaccine.
Hepatitis, a global public health burden:
“The World Hepatitis Summit 2022 will review progress and renew commitments by global partners to accelerate action to achieve the global target of eliminating of viral hepatitis by 2030.
At the 2016 World Health Assembly, countries made a historic commitment to eliminate viral hepatitis by 2030. Since 2016, countries have met the global 2020 target of reducing the incidence of hepatitis B in children under 5, and the number of people receiving treatment for hepatitis C has increased 10-fold.?
However, most countries failed to meet other 2020 targets. Timely access to the hepatitis B birth dose is still low in many low- and middle-income countries. Meanwhile, lack of awareness, limited political commitment, as well as stigma and discrimination continue to stop people from accessing testing and care. It is estimated that 354 million people globally are still living with this life-threatening infection, and at least one person dies from viral hepatitis every 30 seconds. That’s over 1 million deaths per year – a greater toll than that from HIV and malaria combined.
“Hepatitis is one of the most devastating diseases on earth, but it’s also one of the most preventable and treatable, with services that can be delivered easily and cheaply at the primary health care level,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.
“Many of the reasons people miss out on those services are the same reasons they miss out on services for other health challenges – accessibility and affordability, because of who they are, where they live or how much they earn. We call on all countries to commit to realising the dream of eliminating viral hepatitis by 2030, as part of a broader commitment to universal health coverage based on strong primary health care.”
Most recently, in the months leading up to the Summit, some 700 cases of sudden and unexplained hepatitis in young children have come under investigation in 34 countries. Symptoms of this acute hepatitis come on quickly leading to a high proportion of children developing liver failure with a few requiring liver transplants.
More About Viral Hepatitis:
Viral hepatitis is inflammation of the liver caused by a virus. WHO say that the total deaths cause by viral hepatitis, including acute cases, cirrhosis and liver cancer account for 1.1 million deaths globally in 2019. There are 5 different hepatitis viruses - hepatitis A, B, C, D and E. Hepatitis A and E is spread mainly through ingestion of contaminated food and water and the disease is often endemic in countries with a lack of safe water and poor sanitation, but rarely becomes chronic.
Hepatitis B is transmitted through contact with the blood or other bodily fluids of an infected person and approximately 296 million people are living with chronic infections. Hepatitis C is mainly spread through blood-to-blood contact such as unsafe injection practices and inadequate sterilisation of medical equipment. Today, 58 million people are living with the disease. Hepatitis D is passed on through contact with infected blood and only occurs in people who are already infected with hepatitis B.?
In total, over 350 million people in the world are living with viral hepatitis. Each year over a million people lose their lives because of conditions related to acute hepatitis and chronic infection that cause liver cancer and cirrhosis. Chronic hepatitis B and C infections are the leading cause of liver cancer.
Despite there being a vaccine and effective treatment for hepatitis B and a cure for hepatitis C – few countries in the world are on track to achieve the WHO target of eliminating viral hepatitis by 2030 (Polaris Observatory - CDA Foundation)”
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Emerging technologies and machine learning a promising tool in the fight against hepatitis:
± Machine learning algorithms for predicting direct-acting antiviral treatment failure in chronic hepatitis C: An HCV-TARGET analysis published in Hepatology on January 16, 2022:
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*??????Scientists aimed to develop and validate machine learning algorithms to predict direct-acting antiviral (DAA) treatment failure among patients with HCV infection.
*??????They used HCV-TARGET registry data to identify HCV-infected adults receiving all-oral DAA treatment and having virologic outcome.
*??????They applied multivariable logistic regression, elastic net, random forest, gradient boosting machine (GBM), and feedforward neural network machine learning algorithms to predict DAA treatment failure.
*??????Their study showed that The top 10 GBM-identified predictors included albumin, liver enzymes (aspartate aminotransferase, alkaline phosphatase), total bilirubin levels, sex, HCV viral loads, sodium level, HCC, platelet levels, and tobacco use.
*??????Authors conclude that Machine learning algorithms performed effectively for risk prediction and stratification of DAA treatment failure
Park, H,?Lo-Ciganic, W-H,?Huang, J,?Wu, Y,?Henry, L,?Peter, J, et al.?Machine learning algorithms for predicting direct-acting antiviral treatment failure in chronic hepatitis C: An HCV-TARGET analysis.?Hepatology.?2022;?76:?483–?491.?doi:10.1002/hep.32347
± Novel machine learning models outperform risk scores in predicting hepatocellular carcinoma in patients with chronic viral hepatitis published in JHEP Reports on January 22 ?2022.
*??????In this study, the authors aimed we aimed to develop novel clinical and laboratory parameter-based prediction models using machine learning algorithms to define the risk levels of HCC in patients with CVH. These models can potentially be incorporated into computer-based management systems to facilitate clinical assessment and?risk stratification?of HCC in patients with CVH
*??????Accurate hepatocellular carcinoma (HCC) risk prediction is helpful in reducing mortality.
*??????Existing HCC risk scores usually include a few known risk factors and preselected parameters.
*??????Machine learning allows for the direct selection of predictive parameters without subjective preselection.
*??????HCC ridge score (HCC-RS) built from machine learning modelling has higher accuracy than existing HCC risk scores.
*??????HCC-RS may be incorporated into electronic medical health systems to facilitate real-time update of HCC risk
*??????The authors conclude:” This novel HCC-RS from ridge regression machine learning model accurately predicted HCC in patients with CVH. These machine learning models may be developed as built in functional keys or calculators in electronic health systems to reduce cancer mortality. Prospective studies and randomised trials comparing machine learning model-guided HCC surveillance with routine clinical practice for the early diagnosis of HCC in patients with CVH are warranted”.
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Wong GL, Hui VW, Tan Q, et al. Novel machine learning models outperform risk scores in predicting hepatocellular carcinoma in patients with chronic viral hepatitis.?JHEP Rep. 2022;4(3):100441. Published 2022 January 22. doi:10.1016/j.jhepr.2022.100441