April 17, 2012

Steatosis is the predictor of relapse in HCV genotype 3- but not 2-infected patients treated with 12 weeks of pegylated interferon-α-2a plus ribavirin and RVR

J Viral Hepat. 2012 May;19(5):346-53. doi: 10.1111/j.1365-2893.2011.01555.x. Epub 2011 Nov 9.

Restivo L, Zampino R, Guerrera B, Ruggiero L, Adinolfi LE.

Internal Medicine & Hepatology, Second University of Naples, Naples, Italy.


Summary. HCV genotypes 2- or 3-infected patients with a rapid virological response (RVR) to therapy with pegylated interferon and ribavirins who have a low viral load, noncirrhotic and nonobese may be considered for a shorter course of treatment. However, no studies have assessed host-viral factors associated with relapse in genotype 2 and 3 separately. Accordingly, we assessed whether 12 weeks of pegylated interferon and ribavirin was an optimized regimen for treatment of HCV genotype 2 and 3 with positive predictors of response. Power and sample size were a priori calculated and 96 consecutive chronic hepatitis C patients (53, genotype 2 and 43, genotype 3) without cirrhosis who were not obese and who achieved a RVR to therapy with peg-IFN-α-2a and ribavirin were enrolled. Fibrosis, steatosis, homeostatic model assessment-insulin resistance and HCV RNA were predefined variables to be evaluated in relapse. An intention-to-treat analysis was performed. SVR rates were 98% and 84% for genotype 2 and 3, respectively. Analysis of genotype 3 patients who had relapse showed a negative correlation with steatosis (P < 0.0001) and HCV RNA (P < 0.015). Multivariate analysis showed that steatosis was the independent predictor of relapse (OR, 0.988; 95% CI, 0.981-0.993; P < 0.001). Genotype 3 patients with steatosis had a relapse rate of 36.4% and 15.8% in those with high and low viral load, respectively, whereas there was no relapse in those without steatosis. In conclusion, a 12-week course of therapy is sufficient for patients without cirrhosis, not obese and infected with HCV genotype 2 achieve a RVR. This is not the case for genotype 3. Steatosis is the independent predictor of relapse. New therapeutic strategies are necessary for this subgroup of HCV genotype 3.

© 2011 Blackwell Publishing Ltd.


Bipolar patients can safely and successfully receive interferon-based hepatitis C antiviral treatment

Eur J Gastroenterol Hepatol. 2012 Apr 8. [Epub ahead of print]

Kelly EM, Corace K, Emery J, Cooper CL.

Department of Medicine, The Ottawa Hospital Division of Infectious Diseases Viral Hepatitis Program, University of Ottawa, Ottawa, Canada.

AIM: Patients with bipolar disease are often not considered for hepatitis C virus (HCV) antiviral treatment and are excluded from clinical trials because of the risk of interferon-induced exacerbation of their underlying mood disorder. As this risk has not been well quantified in bipolar patients, we evaluated the safety and efficacy of HCV treatment in this population.

METHODS: A retrospective analysis of HCV patients evaluated at The Ottawa Hospital between January 2000 and February 2008 (n=910) was carried out. Information on demographics, psychiatric history and treatment, baseline liver biopsy and blood work, treatment initiation, adherence, and therapeutic outcomes was collected. This was compared between bipolar patients (B), those with a history of depression (D), and those with no mental health disorders (N).

RESULTS: Of 38 bipolar patients (4.2%), 16 (42.1%) initiated HCV treatment, a rate similar to that in patients with a history of depression (41.4%) and in those without psychiatric illness (32.6%). On-treatment psychiatric complications were comparable between the bipolar and depression groups (B=68.8%, D=54.8%; P=0.29) and were higher than in those without psychiatric illness (N=37.1%; P=0.01). Manic episodes were rare. [B=2 (12.5%), D=1 (0.9%), N=1 (0.7%)]. Interferon dose reduction or discontinuation rates for psychiatric complications (B=12.5%, D=7.9%, N=7.4%; P=NS), completion rates (B=50%, D=69%, N=58%), and sustained virologic response rates (genotype 1: B=33%, D=45%, N=49%) were similar between the groups.

CONCLUSION: Stable bipolar patients have similar rates of on-treatment psychiatric complications as patients with a history of depression. With pharmacologic intervention and close clinical monitoring, well-selected bipolar patients can successfully complete treatment and achieve outcomes comparable to those in nonbipolar patients.


New software opens the door to wider use of 3-D imaging in the study of disease

Posted On: April 16, 2012 - 1:00pm

Philadelphia, PA, April 15, 2012 – Researchers have developed a novel, easy-to-use system for three-dimensional (3D) reconstruction and examination of tissues at microscopic resolution, with the potential to significantly enhance the study of normal and disease processes, particularly those involving structural changes. The new approach, using conventional histopathological methods, is described in the May issue of The American Journal of Pathology.

"The use of 3D imaging technology to study structure, function, and disease manifestations has been limited because of low resolution, and the time and difficulty associated with acquiring large numbers of images with a microscope," says lead investigator Dr. Darren Treanor, University of Leeds and the Leeds Teaching Hospitals NHS Trust, United Kingdom. "Our system can integrate tissue micro-architecture and cellular morphology on large tissue samples. It can be used by technical or medical staff in a histopathology laboratory without input from computing specialists."

Developed by Dr. Derek Magee at the University of Leeds, the system utilizes automated virtual slide scanners to generate high-resolution digital images and produce 3D tissue reconstructions at a cellular resolution level and can be used on any stained tissue section. It is based on a general image based-registration algorithm and operates using an integrated system that requires minimal manual intervention once the slides are sectioned, stained, and mounted. The virtual slide scanners digitize the tissue automatically, the software communicates with the software serving the image, which aligns the images, and produces visualization in one integrated package. The user can manually select a region, zoom in and re-register the area to get a higher resolution image of microscopic features.

The authors have applied the system to over 300 separate 3D volumes from eight different tissue types, using a total of 5,500 virtual slides. They describe cases that illustrate the possible applications of the system. For example, a 3D volume rendering of a mouse embryo demonstrates that the method could be useful for providing anatomical and expression data and for creating a "virtual archive" of 3D transgenic models. A 3D volume rendering of sections from a human liver containing a deposit of metastatic colorectal carcinoma adjacent to a blood vessel could provide insight into tumor vasculature and its response to anti-angiogenic agents. A 3D visualization of cirrhotic human liver infected with hepatitis C demonstrates the software's potential to provide information on disease development and aid diagnosis.

"Many fields, including tumor biology, embryology, and cardiovascular disease could benefit from correlation of structure and function in three dimensions, but getting high quality 3D reconstructions has always been difficult" says Dr. Treanor. "We have demonstrated that our software is accurate and robust enough to use without significant computer science input. This system provides the opportunity for increasing use of 3D histopathology as a routine research tool."

Source: Elsevier Health Sciences


The Race To Create The Best Antiviral Drugs


C. Goldsmith, P. Feorino, E. L. Palmer, W. R. McManus/CDC Public Health Image Library The HIV-1 virus cultivated with human lymphocytes.

April 17, 2012

If you've ever had a bacterial infection like staph or strep throat, your doctor may have prescribed penicillin. But if you've had the flu or a common cold virus, penicillin won't work. That's because antibacterials only kill bacteria, and both the flu and the common cold are viruses. So for illnesses like the flu, doctors prescribe antiviral drugs, which target the mechanisms that viruses use to reproduce.

"For example, there are antivirals for the flu that interfere with the virus as it tries to get out of its host cell," says science writer Carl Zimmer. "So this molecule latches on to that particular protein that the virus uses to escape, and interferes with it so that the virus is trapped inside."

Zimmer's latest piece for Wired magazine profiles the scientists who are developing antiviral medications, and examines the new ways medicine is working to attack viruses.

"There are some really amazing antivirals that have been invented over the last 40 years," he says. "There are antivirals for herpes. There are antivirals for HIV. ... Now, if you were to get Ebola and you tried to take HIV drugs, they'd do you no good at all because that HIV drug only works for HIV. It's a narrow-spectrum drug, and really, there are no broad-spectrum antivirals, at this point."

Targeting Viruses Broadly

But scientists are now working to create a "penicillin-like" drug that will target viruses more broadly. In San Francisco, a company called Prosetta is working on a drug that doesn't affect a virus directly. Instead, it works by affecting the proteins that are naturally in cells that help viruses replicate.

"The basic idea behind it is that viruses need help to build themselves," says Zimmer. "What happens is quite amazing: [Viruses] get lots of different proteins in our cells and cooperate to push their own proteins into place. And so the viruses need these groups of host proteins to form."

Prosetta created a drug that prevents the host proteins from performing their cooperative jobs and helping the viruses out. Preliminary studies have shown that targeting these host proteins — and not the virus itself — can stop Ebola, influenza, rabies and other viruses.

Other researchers are working to replace or help interferons, our body's own natural virus-fighting system. Eleanor Fish, a researcher at the University of Toronto, is heading a project to create synthetic interferon, in order to accelerate the body's virus-fighting response.

"Today, people with Hepatitis C can get interferon treatment, but it doesn't work all that well. It has some benefit, but not as much as Eleanor Fish would like," says Zimmer. "So she has been essentially tweaking the interferon molecule to make it more effective, to make it last longer, to make it safe and to make it cheap. Because what she wants to do is deploy interferon all over the world where there isn't fancy refrigeration. She wants to help people who are dealing with viruses in very remote places."

A third approach, says Zimmer, involves creating an artificial protein that would latch onto viruses and then instruct them to literally self-destruct. Spearheaded by Todd Rider at MIT, the project has been tested in cells and in mice.

"Rider's basically hot-wiring your cells so that as soon as they get infected by a virus, that trips a switch," says Zimmer. "This doesn't exist naturally, but if you were to take a pill, the thinking is, then this molecule would go into your infected cells, and as soon as it detected the virus, it would kill the infected cell, and you would recover from your disease."

But successfully eradicating viruses may bring a host of other problems, says Zimmer. He points to broad-spectrum antibiotics, which wipe out good bacteria in addition to bad bacteria.

"Eventually your body may recover, and it can take awhile, and there may be some bad consequences of the antibiotics themselves," he says. "So it's going to be interesting to see what happens in the future if we are, in fact, knocking out lots of viruses. Because we don't understand the full ecology of the viruses that get into our bodies."

There are trillions of viruses that live in our bodies, even when we're not sick, says Zimmer.

"Some are harmful, some may not be harmful," he says. "Some may even help us defend against other viruses. It's very complicated in there, and we don't really understand it very well yet."

Gut Bacteria

Physicians are now using bacteria to combat other diseases. Zimmer points to an example of a patient infected with the Clostridium difficile bacteria, which causes severe diarrhea and can frequently return, even when treated with antibiotics. The patient was treated with a transfusion of gut microbials from a healthy individual's fecal material to restore the bacterial flora in her intestinal tract.

"Literally two days later she started feeling better, and a couple weeks later, when they went to sample the bacteria that was there, they couldn't find the C. difficile anymore. It was just gone," he says. "The only thing they had done was essentially restore her ecology, essentially like restoring a wetland."

Zimmer says fecal transplants have only been performed on patients when all other options fail — but they are seemingly quite effective.

"The problem is, as some other journalists have reported, is that the FDA has a very difficult time figuring out how to come up with regulations for this," he says. "Before it's going to become a widespread practice, the FDA is going to have to move beyond its old paradigm of giving people regular drugs to being able to give people tailored concoctions of living things — of bacteria, of maybe even viruses — as medical treatments."

These bacteria and viruses work in conjunction with other bacteria and viruses in the body, but scientists still know very little about their mechanisms, says Zimmer.

"There's this whole ecosystem of interactions going on inside our own bodies that we do not understand — barely at all," he says. "Scientists are just starting to figure it out with very big projects where they're sequencing all the genes these microbes have. But they're just at the beginning of understanding it."


Liquorice Root Found to Contain Anti-Diabetic Substance


Licorice root. (Credit: © Yves Roland / Fotolia)

ScienceDaily (Apr. 17, 2012) — Researchers have discovered a promising anti-diabetic substance in the amorfrutin class of natural substances.

It provides the raw material for liquorice candy, calms the stomach and alleviates diseases of the airways: liquorice root. Chosen as the "Medicinal plant 2012," the root has been treasured in traditional healing since ancient times. Researchers at the Max Planck Institute for Molecular Genetics in Berlin have now discovered that liquorice root also contains substances with an anti-diabetic effect. These amorfrutins not only reduce blood sugar, they are also anti-inflammatory and are very well tolerated. Thus, they may be suitable for use in the treatment of complex metabolic disorders.

Natural substances have a surprising and often largely unexploited potential in the prevention and treatment of common diseases. For example, liquorice root Glycyrrhiza contains different substances that help to alleviate disorders of the airways and digestive system. It has been used for millennia in traditional healing and is mainly administered in the form of tea. A team of researchers working with Sascha Sauer from the Max Planck Institute for Molecular Genetics in Berlin has now discovered that the plant from the papilionaceae or leguminous family might also be effective in the treatment of adult (type 2) diabetes. The scientists identified a group of natural substances with an anti-diabetic effect, the amorfrutins, in the plant's edible root.

The substances, which have a simple chemical structure, are not only found in liquorice root, but are also in the fruit of the Amorpha fruticosa bush. The new anti-diabetic agents were named after this plant, which is native to the US, Canada and Mexico. As the researchers demonstrated using diabetic mice, the amorfrutins not only have characteristics that reduce blood sugar, they are also anti-inflammatory in their effect. Moreover, they also prevent fatty liver -- a common disease caused by excessively fat-rich nutrition.

"The health-beneficial effects are based on the fact that the amorfrutin molecules dock directly onto a receptor in the nucleus called PPARγ," explains Sascha Sauer. PPARγ plays an important role in the cell's fat and glucose metabolism. The binding of the amorfrutin molecules activates various genes that reduce the plasma concentration of certain fatty acids and glucose. The reduced glucose level prevents the development of insulin resistance -- the main cause of adult diabetes.

"Although there are already drugs on the market that affect the PPARγ receptor, they are not selective enough in their effect and cause side effects like weight gain and cardio-vascular problems," says Sascha Sauer. In contrast, as demonstrated by the studies carried out to date, the amorfrutins are very well tolerated. "However, drinking liquorice tea or eating liquorice will not help to treat diabetes," explains the scientist. "The concentration of the substances in the tea and liquorice is far too low to be effective." The researchers therefore developed special extraction processes to obtain the amorfrutins from the plant in sufficient concentrations. This could be used to produce amorfrutin extracts on an industrial scale.

The newly discovered active substances not only seem to hold great promise for the treatment of complex metabolic disorders, they may also be suitable for prophylactic use. "The amorfrutins can be used as functional nutritional supplements or as mild remedies that are individually tailored to the patient," says Sascha Sauer. "In view of the rapid spread of metabolic diseases like diabetes, it is intended to develop these substances further so that they can be used on humans in the future." To do this, the researchers must now test the effect of the substances and the plant amorfrutin extracts in clinical studies on diabetes patients.

Story Source:

The above story is reprinted from materials provided by Max-Planck-Gesellschaft, via AlphaGalileo.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

  1. C. Weidner, J. C. de Groot, A. Prasad, A. Freiwald, C. Quedenau, M. Kliem, A. Witzke, V. Kodelja, C.-T. Han, S. Giegold, M. Baumann, B. Klebl, K. Siems, L. Muller-Kuhrt, A. Schurmann, R. Schuler, A. F. H. Pfeiffer, F. C. Schroeder, K. Bussow, S. Sauer. Amorfrutins are potent antidiabetic dietary natural products. Proceedings of the National Academy of Sciences, 2012; DOI: 10.1073/pnas.1116971109


Clinical Trial Data Should Be Open for Review


By Nancy Walsh, Staff Writer, MedPage Today

Published: April 16, 2012

Original clinical study reports, which contain far more detail than published randomized trials, should be made available to independent researchers seeking to verify efficacy and safety claims, a group of Cochrane reviewers argued.

In support of this argument, the history of the influenza antiviral oseltamivir (Tamiflu), which was approved by the FDA in 1999, was cited by Peter Doshi, PhD, from Johns Hopkins University in Baltimore, and colleagues in an article published online in PLoS Medicine.

In the run-up to the expected H1N1 influenza pandemic in 2009, the U.S. stockpiled a $1.5 billion supply of the drug to be used in case an outbreak occurred before a vaccine could be developed.

This action was done in light of claims by the Department of Health and Human Services that the antiviral would reduce hospitalizations, and by the Advisory Committee on Immunization Practices that its use could prevent disease complications.

The widespread belief in oseltamivir's efficacy, according to Doshi's group, was based on a meta-analysis of 10 trials conducted by the manufacturer prior to licensure.

The authors of that meta-analysis, which was published in 2003, suggested that the drug could reduce the likelihood of secondary complications. But the authors pointed out that the FDA, which was aware of these clinical trials, concluded that oseltamivir had not been shown to reduce complications and required a statement on the drug's label to that effect.

Moreover, oseltamivir was not given an FDA indication for prevention of spread of influenza.

To this, Doshi and colleagues commented, "If FDA is right, the drug's effectiveness may be no better than aspirin or acetaminophen."

The current authors requested the full clinical study reports from Roche, the manufacturer of oseltamivir, with the goal of independently scrutinizing all the available data. They reported receiving 3,200 pages in response.

They subsequently were able to obtain more data through a Freedom of Information request to the European Medicines Agency, but consider this just a fraction of the manufacturer's data.

Nonetheless, what they have learned from the original documents reviewed thus far included:

  • Serious adverse events that were not reported
  • Uncertainty about the validity of subgroup analyses
  • Contradictory claims on the drug's mode of action

"This information has turned our understanding of the drug's effects on its head," the researchers stated. "We challenge industry to either provide open access to clinical study reports or publicly defend their current position of [randomized controlled data]."

They further argued that the public should have access to full clinical study reports for ethical reasons.

Rofecoxib (Vioxx) and rosiglitazone (Avandia) are other drugs for which previously unpublished clinical trial data "radically changed public knowledge of safety and efficacy include," they said.

"We should not lose sight of the fact that clinical trials are experiments conducted on humans that carry an assumption of contributing to medical knowledge," they wrote.

However, a group of authors from several European regulatory agencies responded in a PLoS Medicine perspective article that there are valid reasons for not opening trial data up to the public.

First is the importance of patient confidentiality, which could be compromised, according to lead author Hans-Georg Eichler, MD, of the European Medicines Agency in London.

Secondly, they challenged the notion that so-called "independent" research groups are necessarily free of conflict of interest.

"Personal advancement in academia, confirmation of previously defended positions, or simply raising one's own visibility within the scientific community may be powerful motivators," wrote Eichler and colleagues, also in PLoS Medicine.

Furthermore, unrestricted availability of data could lead to promulgation of misleading information and possible health scares among the public.

The regulators suggested several steps that could help resolve these conflicts, such the establishment of adequate, but not excessive, standards of protection for patients and quality requirements for meta-analyses.

They also called for openness not only on the part of industry, investigators, and regulators, but also on the part of those who conduct independent data re-analyses.

The authors have received a UK National Institute for Health Research grant to undertake a Cochrane review of neuraminidase inhibitors.

One co-author was an ad hoc advisor for F. Hoffman-La Roche Ltd, and has been retained as a consultant in a legal case involving Tamiflu.

Primary source: PLoS Medicine
Source reference:
Doshi P, et al "The imperative to share clinical study reports: recommendations from the Tamiflu experience" PLoS Medicine 2012; DOI: 10.1371/journal.pmed.1001201.

Additional source: PLoS Medicine
Source reference:
Eichler HG, et al "Open clinical trial data for all? a view from regulators" PLos Medicine 2012; DOI: 10.1371/journal.pmed.1001202.


HIV Prevention Pill's Value Varies by Target


By Michael Smith, North American Correspondent, MedPage Today

Published: April 16, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

The pill-a-day approach to HIV prevention can be cost-effective in men who have sex with men, but only in those at high risk for infection, researchers reported.

In a complex mathematical model, so-called pre-exposure prophylaxis, or PrEP, was found to prevent a large number of infections over a 20-year period, according to Jessie Juusola, MS, and colleagues at Stanford University in Palo Alto, Calif.

But the best bang for the buck came when PrEP was aimed mainly at men who have more than five sex partners a year, Juusola and colleagues reported in the April 17 issue of Annals of Internal Medicine.

"Promoting PrEP to all men who have sex with men could be prohibitively expensive," Juusola said in a statement. "Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank."

On the other hand, she noted, regardless of cost-effectiveness PrEP "is still very expensive."

"In the current healthcare climate," she added, "PrEP's costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals."

The researchers cautioned that their findings vary depending on assumptions about the cost of the pill used – tenofovir/emtricitabine (Truvada) – as well as how attractive men would find PrEP and which men would use it.

Interest in using anti-HIV medications to prevent infection has been growing, after the publication of studies that showed a benefit both in uninfected men who have sex with men and in heterosexual couples in which one partner was infected.

But there has also been criticism of the idea, since a landmark trial showed that treating an infected person reduces the risk of transmission of the virus by about 96%. The argument has been that widespread treatment would work better as prevention than PrEP.

The issue of how cost-effective PrEP would be is also up in the air.

Two previous modeling studies suggested a wide range of costs, the researchers noted, but they did not take into account declining transmission rates over time as more people take PrEP, which would increase cost-effectiveness.

The earlier studies also assumed that PrEP would be a life-long affair, while the current model assumes people would stay on PrEP for 20 years, reducing the cost.

The landmark IPrEx study found that, overall, taking the pill rather than a placebo reduced the risk of infection by 44%, although among those who were highly adherent to the medication, risk reduction was even greater.

But in their model, Juusola and colleagues assumed a risk reduction of 44% and calculated such things as new HIV infections, discounted quality adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios in a range of scenarios.

In an untargeted analysis, they found, starting PrEP in all men who have sex with men would prevent 249,156 new infection over 20 years – more than half of what would be expected in the absence of PrEP – at a cost of $480 billion more than current care.

That scenario would see a gain of 2.2 million QALYs, with an incremental cost-effectiveness ratio, compared with no PrEP, of $216,480 per QALY.

On the other hand, if only 20% of men who have sex with men took PrEP, the number of infections prevented and cost would be lower, at 62,759 over 20 years and $95 billion, respectively.

There would be a gain of 550,166 QALYs, with an incremental cost-effectiveness ratio, compared with no PrEP, of $172,091 per QALY.

But targeting just the men who have sex with men considered to be at high risk – those with five or more sex partners a year -- would do considerably better, the researchers found.

In that group, thought to be about 20% of all men who have sex with men, starting PrEP would prevent 167,143 new infections over 20 years, at a total cost of $75 billion over current care. And that scenario would gain 1.4 million QALYs, with an incremental cost-effectiveness ratio of $52,443 per QALY, compared with no PrEP.

But even if only one in five of the high-risk population took the daily pill, it would prevent 41,061 new infections over two decades, cost a net of $14 billion, and gain 352,840 QALYs, with a cost-effectiveness ratio of $40,279 compared with no PrEP, they found.

All the models assume that the current cost of the daily pill – about $26 – but analysis found that cost-effectiveness would be better if the cost dropped below $15 or if the risk reduction was greater than 75%.

The study had support from the National Institute on Drug Abuse, the Department of Veterans Affairs, and the National Institute of Allergy and Infectious Diseases. No conflicts were reported.

Primary source: Annals of Internal Medicine
Source reference:
Juusola JL, et al "The cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States in men who have sex with men" Ann Intern Med 2012; 156.


EASL 2012: European Liver Patients Association (ELPA) Takes to Twitter for Upcoming Congress


SINT-TRUIDEN, Belgium, April 17, 2012 /PRNewswire/ --

ELPA is delighted to announce it will, for the first time, be utilising the real-time information network Twitter to transmit live updates to its followers from the forthcoming International Liver Congress, organised by the European Association for the Study of the Liver (EASL ILC 2012) in Barcelona, Spain between 18-22 April, 2012 (https://twitter.com/#!/EASLnews).

Throughout the congress, ELPA will be communicating content from both the scientific programme and its own events via the official ELPA Twitter account, @HepatitisEurope and the using hashtags #LiverPatients and the EASL congress's official hashtag #ILC2012 (https://twitter.com/#!/hepatitiseurope).

Key announcements relating to the ELPA organisation, its initiatives at the congress and developments concerning the treatment and care of liver disease will be covered.

ELPA will also be communicating highlights from its Annual General Meeting on 20 April and policy update sessions, as well as providing coverage of its symposium on 21 April ("You Shall Not Pass!": Stopping Hepatitis C in Drug Users).

Dr Stanimir Hasurdjiev, Chief Executive of ELPA, concludes: "Twitter is a fundamental source of information for many of those individuals and organisations ELPA represents and, for the first time, we are delighted to be able to share our highlights of the forthcoming EASL Congress in real time - especially as the vast majority will not be able to attend in person."

About ELPA

ELPA's aim is to promote the interests of people with liver disease and in particular to: Highlight the size of the problem; promote awareness and prevention; address the low profile of liver disease as compared to other areas of medicine such as heart disease; share experience of successful initiatives and; work with professional bodies such as EASL and with the EU to ensure that treatment and care are harmonised across Europe to the highest standards.

ELPA emerged from a desire amongst European liver patient groups to share their experiences of the often very different approaches adopted in different countries. In June 2004, 13 patient groups from 10 European and Mediterranean Basin countries met to create the association. ELPA was formally launched in Paris on April 14th 2005 during the annual conference of the European Association for the Study of the Liver (EASL) and now has 21 members from 17 countries.

For further information on activities being undertaken by ELPA at the EASL, please contact:

Martin Georgiev E-mail: martin@elpa-info.org
Twitter: @HepatitisEurope
Telephone: +359-879-449-983

Distributed by PR Newswire on behalf of European Liver Patients Association (ELPA)