Title

Coinfections: Old and new

Code

WESY04

Session Type

Symposia Session

Venue

Auditorium

Date Time

Wednesday 25 July, 14:30 - 16:00

Co-Chairs:

Cristiana Oprea, Carol Davila University of Medicine and Pharmacy, Romania
Annabel Baddeley, World Health Organization (WHO), Switzerland

This session will discuss the latest data on the epidemiology, pathophysiology, treatment and prevention of tuberculosis, viral hepatitis from A to E, the emerging threats in infectious diseases, and their interplay with HIV. New tools for screening tuberculosis will be explored, whereby experts will browse and update the therapeutic landscape with a special focus on the issue of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. It will also discuss the lengthy road to hepatitis C elimination, the new strategies developed to possibly eradicate hepatitis B, and how the epidemics of hepatitis A and E may be controlled in special populations. Finally, specific talks will address the old and new threats in infectious diseases in the context of HIV (haemorrhagic fevers, invasive fungal infections, etc.).

14:30 WESY0401	Introduction

14:35 WESY0402	Re-emerging hepatitis A Philip Yi-Chun Lo, Taiwan CDC,	Slides

14:55 WESY0403	TB shorter courses and new drugs Richard Chaisson, Johns Hopkins University, United States

15:15 WESY0404	Elimination of hepatitis B Karine Lacombe, Saint-Antoine Hospital (AP-HP), France	Slides

15:35 WESY0405	Panel discussion

15:55 WESY0406	Closing remarks

AUTHOR

Saskia Janssen

SUMMARY

This session covered recent data on epidemiology, prevention and treatment of viral hepatitis, and therapeutic advances for TB. The re-emergence of hepatitis A was discussed, and future prospects towards hepatitis B elimination. Novel insights in TB treatment including potential shorter regimens for both drug-resistant and drug-sensitive TB were presented.

HIGHLIGHTS

Dr Yi-Chun Lo presented on an outbreak of hepatitis A in Taiwan. Outbreak control was achieved by vaccination scale-up from 4.7% to 70% in one year. Hepatitis A vaccination is effective and durable in HIV-infected patients. Dr Lacombe discussed challenges towards elimination of hepatitis B. Eradication is still not possible, mainly due to cccDNA persistence in cells. Limited access to HBV DNA testing in endemic settings impedes identification of patients eligible for treatment. Promising developments include clinical algorithms based on ALT and HBeAg tests and use of dried blood spots. Dr Chaisson presented recent advances in TB treatment. Improved survival was reported when including Bedaquiline for treatment of MDR TB. For XDR TB, cure rates were 88% when combining Bedaquiline, Linezolid and Pretomanid. Higher doses of rifamycins can potentially shorten treatment of DS-TB. Several rifamycin-based shortened options for latent TB have proved non-inferior to isoniazid monotherapy.

CRITICAL ASSESSMENT

Hepatitis A vaccination is effective and durable in HIV-infected patients, with 96% seroconversion and 88% being seroprotected at 5 years, at least when HIV viral loads are suppressed. For hepatitis B, significant decreases in new cases and mortality are possible integrating scale-up of vaccination, prevention and treatment. Treatment for drug-resistant TB can be improved in terms of duration, toxicity and outcomes by including new drugs into regimens, however it remains challenging to get new drugs to the people in need. Shorter options for treatment of latent TB might increase uptake, including 1-month of rifapentine/isoniazid or 4-months of rifampicin monotherapy.