13th International Symposium on Viral Hepatitis and Liver Disease: Meeting Summary 

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March 20-24, 2009.  Washington DC

By Jay Hoofnagle, MD, and David Thomas, MD

The 13th International Symposium on Viral Hepatitis and Liver Disease (ISVHLD) was held at the Marriott Wardman Park Hotel in Washington DC, on March 20-24, 2009, sponsored jointly by the American Association for the Study of Liver Disease and the National Institutes of Health with co-support from the Food and Drug Administration, the Centers for Disease Control and Prevention, and the European Association for the Study of the Liver, and chaired by Drs. Jay Hoofnagle (NIDDK) and David Thomas (Johns Hopkins). This meeting represented the continuation of a tradition of outstanding international symposia on viral hepatitis held every three years. The first ISVHLD was held in 1972 in San Francisco; the ensuing 11 symposia being rotated between major cities in the United States (Washington, New York, Houston, Atlanta), Europe (Paris, Rome, London), Australia (Sydney) and Asia (Tokyo). The ISVHLD are dedicated to bringing together outstanding clinical and basic researchers in viral hepatitis from around the world to provide summary updates on advances in the understanding, diagnosis, prevention, control, and treatment of all five forms of viral hepatitis. The meeting also provides a venue for reviewing the success of public health measures taken to control and prevent viral hepatitis. An important element in the ISVHLD is the inclusion of clinicians, investigators, and public health experts from all areas of the world, including developing nations where viral hepatitis contributes considerably to morbidity and mortality. The purpose of the meeting is to provide stimulus for future research and collaborations that promote control of viral hepatitis worldwide.

The 13th ISVHLD fulfilled the standards of the tradition of these symposia with state-of-the-art plenary talks by the foremost worldwide authorities. These plenary talks included an overview of the world-wide burden of viral hepatitis by Miriam Alter; a focused review of the evolving advances in specific therapies for hepatitis C by Jean-Michel Pawlotsky; a stimulating summary of the role of micro RNAs in human viral infections by Bryan Cullen; and updates on hepatitis A by Stanley Lemon and Daniel Shouval; on hepatitis E by Susan Emerson, Robert Purcell and X. J. Meng; on hepatitis B vaccine by Ding-Shinn Chen and Brian McMahon; on hepatitis B virology and pathogenesis by William Mason, Stefan Wieland; on hepatitis B natural history and therapy by Chien-Jen Chen, Anna Lok, E. Jenny Heathcote, Stephen Locarnini and Yves Benhamou; on hepatitis D virus by John Taylor and Patricia Farci (filling in for Mario Rizzetto); on hepatitis C virology and pathogenesis by Charles Rice, Stanley Lemon (filling in for Michael Gale), Barbara Rehermann and T. Jake Liang; on hepatitis C natural history and therapy by Patrick Marcellin, John McHutchison, Mark Sulkowski, Peter Ferenci and Michele Manos. Hepatocellular carcinoma (HCC) was the focus of the final day of the meeting with overview presentations by Jordi Bruix, Adrian Di Bisceglie, Snorri Thorgierrson and Masao Omata.
 
Between three and seven parallel sessions were held each afternoon of three days of the meeting that allowed for oral presentations based upon the 390 abstracts submitted to the symposium. These sessions allowed for more in-depth review and discussions of epidemiology, natural history, pathogenesis, diagnosis, preventionn and therapy of viral hepatitis with adequate time for discussion and airing of controversy.

A special, new component in the 13th ISVHLD was the “Sunrise Symposia” held on the three full days of the meeting. These 90-minute symposia included oral presentations from 2-4 speakers on special topics that were not adequately covered in the plenary sessions. Topics included: hepatitis B during pregnancy; therapy of hepatitis in children; high-throughput screening for antiviral agents; the molecular evolution of HCV and HBV; interferon-induced gene expression in hepatitis C; vaccines for prevention and therapy of hepatitis C; acute hepatitis C; acute liver failure; and liver transplantation for hepatitis C.  Particularly successful were the daily Sunrise Symposia on “The Burden of Viral Hepatitis” in the developing world, with separate sessions on Latin America (presentations from Venezuela, Brazil, and Argentina), Africa (Uganda, Nigeria and Egypt) and Asia (India, China and the WHO). These sessions showed the excellence and state-of-the-art research being done in these areas of the world that are rarely included in national and even international meetings on liver disease and viral hepatitis. 
Some of the research highlights of the 13th ISVHLD included description of the first, population-based national survey of hepatitis E seroprevalence in the USA (17% of Americans have anti-HEV); the role of swine in spread of hepatitis E (genotypes 3 and 4); the impact of hepatitis A vaccine in endemic areas (where vaccination of children results in major decreases in incidence even in adults); the impact of HBV vaccination on population disease rates in Alaska and Asia (with subsequent reductions in liver cancer);  new insights into the pathogenesis of hepatitis B (including persistence of the viral infection long after apparent recovery);  documentation that therapy of hepatitis C can result in decreases in rates of death from liver disease (as demonstrated in the California Kaiser Permanente system); new insights into the cell-surface receptors for the hepatitis C virus and how this virus evades and modifies the innate immune system; the status of promising new small molecule therapies of hepatitis C (including nucleoside and non-nucleoside inhibitors of the HCV polymerase and the peptidomimetic HCV protease inhibitors); the dramatic effects of intravenous silibinin on hepatitis C virus (blocking binding of the viral RNA to the HCV polymerase); the potential of high-throughput methods of screening new agents for anti-HCV activity; new insights into the cause of hepatocellular carcinoma from genomic and gene array studies of liver cancer tissue; the promise of new non-cytolytic approaches to therapy of HCC; and finally the use of markers of activation of the innate and adaptive immune system to identify new hepatitis viruses.
 
The 13th ISVHLD ended with a presentation from Dr. Harvey Alter on the natural history of chronic hepatitis C that was as informative as it was entertaining.  Dr. Alter has participated in all 13 of the ISVHLD meetings. While chronic hepatitis C represents the most common cause of chronic hepatitis and end-stage liver disease in the developed world, the majority of persons with chronic HCV infection have mild and minimally-progressive disease. Factors that affect the severity of hepatitis C include age, obesity, alcohol use, and concurrent illnesses including diabetes. 

At the close of the meeting the venue for the 14th ISVHLD was announced to be Shanghai, China by its chairperson, Dr. Mei-Lei Wen.
 
A shortcoming of the meeting was a less-than-expected attendance, most likely the result of the impact of the global economic crisis and competition from other meetings on liver disease and viral hepatitis.  In addition, financial constraints prevented some entire laboratories from contributing, and there were fewer trainees than would have been optimal because of limits on fellowships and registration waivers.  There were also problems with procuring VISAs to visit the United States from several areas of the world. At least six international faculty members and participants (from China, India, Pakistan, and Iran) were unable to get VISAs in time to participate.

The educational mission of the meeting was outstanding. The consistently high quality of scholarly contribution from speakers and researchers was remarkable. The participants all expressed enthusiasm for the quality of the meeting and the excitement engendered by the new advances that have been made in the last three years. The location was excellent. There were no major problems with the hotel facilities or audio-visual support. The administrative support from the AASLD was outstanding in all respects.