Miriam E. Tucker

October 28, 2013

With its major focus on hepatitis C screening and treatment, perhaps it's fitting that the Liver Meeting 2013 is taking place in Washington, DC, for the very first time, where just last week an advisory panel to the US Food and Drug Administration (FDA) voted in favor of licensing 2 direct-acting antiviral agents — sofosbuvir and simeprevir — that represent major advances in hepatitis C treatment.

"We're excited about it," American Association for the Study of Liver Diseases (AASLD) president J. Gregory Fitz, MD, told Medscape Medical News. "This is the 64th meeting of the organization, and the first time in Washington. So far, the attendance looks like it's going to set new records."

The projected attendance, some 10,000 liver specialists from more than 50 different countries, "reflects the excitement in the field," said Dr. Fitz, "but also the needs in the field and the searching for answers."

This summer, the US Preventive Services Task Force for the first time recommended hepatitis C screening for all baby boomers.

The Liver Meeting's scientific program committee chair Gary Davis, MD, said, "I think most people at both this meeting and the European meeting are most fascinated by what's happening with hepatitis C because that's an area that is changing so fast right now."

With the FDA's antiviral drugs advisory committee's endorsement of the NS5B polymerase inhibitor sofosbuvir, hepatologists are now excitedly looking toward a new era of all-oral, interferon-free regimens that are expected to successfully treat a greater proportion of infected patients with lower toxicity.

Dr. Davis told Medscape Medical News that the abstracts at the meeting will pick up where the data submitted to the FDA left off, with studies looking at more potential uses for sofosbuvir and other direct-acting antiviral agents in various drug combinations. "Some of the abstracts that are being presented are giving us a peek at what the next incremental steps are likely to be, and those are coming soon," he said.

Still, not everything at the conference will be about hepatitis C. Other hot topics include nonalcoholic fatty liver disease, which is an outgrowth of the obesity epidemic, prevention of acute-on-chronic liver failure in cirrhosis patients, drug-induced hepatotoxicity, and the recent rise in the incidence of liver cancer at a time when other cancer rates in the United States are declining.

In all, Dr. Fitz told Medscape Medical News, liver disease is now the eighth leading cause of death in the United States. "Despite huge progress in the field, the burden of diseases continues to increase."

Attendees looking for a broad overview of the very latest trends in their specialty can attend the AASLD Postgraduate Course on New Treatments in Liver Disease. Part of that course, which will be held on Friday afternoon, will cover new diagnostic approaches, including genetic testing, noninvasive alternatives to biopsy, and new biomarkers for hepatocellular carcinoma.

State-of-the-Art Hepatology

Another part, held on Friday evening, entitled Old Diseases, New Treatments, will revisit conditions such as primary sclerosing cholangitis and iron overload. On Saturday morning, entire sessions will be devoted to current and future management of viral hepatitis and fatty liver disease.

Previous meetings have featured the postgraduate course, but this year's will be particularly clinical, Dr. Davis, the former director of liver diseases at Baylor University Medical Center in Dallas, told Medscape Medical News.

"It will address a lot of questions and will reference many of the abstracts. In many areas, like hepatitis C, it's about incremental changes."

State-of-the-art lectures, from Sunday through Tuesday, will feature cutting-edge topics such as regenerative medicine, alpha-1 antitrypsin deficiency (a novel treatment strategy 50 years after discovery), acetaminophen and the liver, and hepatitis C therapeutics in the postinterferon era.

"I think the state of the arts this year are really great," Dr. Davis said, noting that he's particularly excited about the regenerative medicine talk Sunday morning by Anthony Atala, MD, director of the Wake Forest Institute for Regenerative Medicine in Winston-Salem, North Carolina, who will discuss building organs from stem cells. "It will be a fascinating talk."

Both Dr. Davis and Dr. Fitz told Medscape Medical News they're looking forward to the president's choice lecture by Bruce Beutler, MD, winner of the Nobel Prize in physiology or medicine. Dr. Beutler, from the University of Texas Southwestern in Dallas, shared the Nobel for discoveries concerning the activation of innate immunity.

Dr. Fitz pointed out that Dr. Beutler's work relates to "pathways that are fundamental to almost all causes of liver diseases, so the lecture will be of interest to both the scientists and clinicians."


Younger faces are expected at this year's meeting because the society has made an effort to bring in more trainees, Dr. Fitz told Medscape Medical News.

"We've gone out very specifically to try to identify younger physicians and scientists who are interested in the liver and bring them to the meeting and get them engaged and show them what the future might look like. I'm looking forward to having everyone interact with these younger people and hearing their thoughts."

Dr. Fitz said that free time will be an important facet of the meeting to encourage such exchanges. "That's really important to the success of the meeting — to have the unstructured time for the right kind of interactions necessary for collaborations and future plans."

Many of those social interactions are likely to take place at the Saturday evening cocktail reception, where alcohol will be served. "Even liver doctors drink wine," he said. "Alcohol continues to be a very important cause of liver disease around the world, but all things in moderation. AASLD definitely has an antiexcess alcohol stance, but we're not going back to the prohibition era."

Dr. Fitz has disclosed no relevant financial relationships. Dr. Davis serves on data safety and monitoring boards for the Duke Research Institute and for Bristol-Myers Squibb for a nonhepatology drug.


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