Hepatology Month in Review: January 2024

Coming off of a historic 2023, the first month of the new year already shows promise that 2024 has the potential to deliver an equally dynamic and progressive trajectory for the landscape of liver health. Our January 2024 month-in-review spotlights some of the top stories in HCPLive Hepatology’s coverage, encompassing a variety of topics ranging from gender-based research in liver disease to recognizing new benefits of achieving sustained virological response (SVR) and effective approaches to treating hepatic conditions.

A Greater Focus on Women’s Health in Hepatology

Pregnant Women in Rural Regions Face Greater HCV, Preterm Birth Burden

A retrospective cohort study conducted at a single tertiary care center in Appalachia may have larger implications for pregnant women in rural populations, calling attention to an 11.94% hepatitis C virus (HCV) infection rate and a 17.8% preterm birth rate among pregnant patients receiving prenatal care.

Of note, the HCV infection rate in this cohort (119.4 per 1000 liver births) was 5 times the rate of 22.6 per 1000 live births in West Virginia in 2014 and 35 times the national rate of 3.4 per 1000 live births. Although the preterm birth rate was significantly greater than the national average (10.09%), there was no difference between HCV-positive and negative individuals, a finding investigators attributed to an increased incidence of preterm birth contributory factors in the study population.

Women With Alcohol-Related Liver Disease Face Greater Risk of Mortality Than Men

An analysis of data from more than 30,000 National Health and Nutrition Examination Survey (NHANES) III participants revealed although the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) was generally greater among male patients, MetALD and ALD were associated with increased all-cause mortality in women.

“Because alcohol consumption is modifiable, limiting alcohol intake particularly in women at risk for SLD could be critical as part of efforts to mitigate mortality risk in patients with SLD,” study investigators wrote.

Assisted Reproductive Technology Outcomes Unaffected By Presence of Liver Disease

Findings from a retrospective study comparing assisted reproductive technology outcomes in patients with and without liver disease suggest it may be a viable treatment option for women struggling with infertility regardless of their hepatic disease status. Although some differences were observed in baseline characteristics, hormone levels, and in vitro fertilization (IVF) laboratory outcomes, IVF treatment and pregnancy outcomes were not significantly different in response to controlled ovarian stimulation, embryo fertilization rate, or ploidy outcome.

“Based on our findings, women with liver disease and impaired fertility should be counseled about contemporary, standard IVF treatment, and the presence of liver disease should not prevent them from seeking IVF as an option due to concerns about efficacy,” investigators wrote.

The editorial team of HCPLive Hepatology sat down with Tatyana Kushner, MD, BSCE, associate professor of medicine in the division of liver diseases at the Icahn School of Medicine at Mount Sinai, for further insight into the study’s results and their clinical significance.

Understanding the Benefits of SVR

Achieving SVR Reduces Risk of Cardiovascular Events in Patients with HCV

This prospective study of patients diagnosed with chronic HCV infection or HCV-related cirrhosis at a tertiary center in Romania found HCV eradication with direct-acting antiviral (DAA) therapy was linked to a decreased risk of carotid atherosclerosis and peripheral artery disease.

Specifically, achieving SVR was associated with improvements in intima-media thickness and ankle-brachial index measurements indicative of patients’ risk of cardiovascular events. Of note, these benefits were most pronounced among patients with advanced fibrosis and cirrhosis.

SVR Improves Long-Term Health-Related Quality of Life in Patients with Chronic HCV

Seeking to address the lack of real-world, prospective longitudinal studies about health-related quality of life in patients who achieved SVR, investigators followed more than 500 patients with HCV for 5 years to track changes in their EQ-5D utility and EQ visual analog scale (EQ-VAS) scores for mobility, self-care, usual activities, pain/discomfort, and anxiety/depression health status.

Multivariable analysis revealed age, income, and SVR24 (β = 0.040; 95% CI, 0.023-0.057; P = .000) were significant predictors of EQ-5D utility, while gender, age, HCV genotypes, and SVR24 (β = 5.333; 95% CI, 4.204-6.462; P = .000) were associated with EQ-VAS over time.

Treating, Preventing Liver Disease

Piperine Shows Potential Pharmacological Benefit for NAFLD, Early Cirrhosis

In the absence of approved medical intervention, this randomized, double-blind, placebo-controlled study suggests piperine consumption may have pharmacological benefits for individuals with nonalcoholic fatty liver disease (NAFLD). The bioactive alkaloid found in black pepper prompted statistically significant changes in aspartate aminotransferase (P = .002), alanine aminotransferase (P <.001), cholesterol (P <.001), low-density lipoprotein (P = .043), triglycerides (P = .005), fasting blood sugar (P = .011), and gamma-glutamyl transferase (P = .042) compared to placebo.

Fibrosis Screening May Spark Lifestyle Changes in Individuals at Risk of Liver Disease

Findings from a prospective cohort study revealed screening for liver fibrosis may motivate individuals at risk of ALD or MASLD to make lifestyle changes to improve their alcohol consumption, diet, weight, and exercise. This was especially prevalent among individuals whose transient elastography results indicated elevated liver stiffness, highlighting the potentially beneficial impact of knowledge on liver disease for aiding prevention and early detection efforts.