The multidisciplinary treatment of liver diseases can change the natural history of disease.

I Multidisciplinar Open Classroom in Viral and Bacterial Infections of the Liver.

• Sponsored by Gilead Sciences Laboratory, the reunion is accredited by the Menendez Pelayo International University and sponsored by the Spanish Association for the Study of the Liver.

• One hundred hepatologists Spaniards have gathered in this first Open Classroom Cross is drawn into a discussion forum on infectious diseases of the liver.

• The ideal drug is one that achieves a potent viral suppression (effectiveness) as long as possible (no resistance).

• Around 400 million people worldwide are infected with Hepatitis B, and 200 million for hepatitis C. Most do not know.

• In Spain there are between 300,000 and 400,000 people with hepatitis B, and between 800,000 and one million with hepatitis C.

El Palacio de la Magdalena Santander I just host the Open Classroom in Cross Viral and Bacterial Infections of the liver that has brought over one hundred nationally hepatologists.

The objective of this class has been updated knowledge related to bacterial and viral infectious diseases of the liver, especially hepatitis B and C, so that specialists may be transferred to everyday clinical practice, it has been established what should be the action protocols in many cases. It also has a special focus on the most controversial points of the treatment of these diseases. This classroom has led Dr. Fernando Pons Romero, Professor of Medicine and Chief of Digestive Medicine of the Hospital Universitario Marqués de Valdecilla, Dr. José Luis Calleja, Deputy Medical Service of Gastroenterology Hospital Universitario Puerta de Hierro, and Dr. Javier Garcia Crespo, Physician Assistant Digestive Medicine Department of Hospital Universitario Marqués de Valdecilla. Sponsored by Gilead Sciences Laboratory, the reunion had the accreditation of the Menéndez Pelayo International University and sponsored by the Spanish Association for the Study of the Liver.

This meeting, held for the first time in Spain, intends to become a forum for discussion of liver disease in the coming years. It has highlighted the importance of multidisciplinary treatment of viral and bacterial diseases of the liver, focusing on the need to work together in addressing them to ensure that treatment is successful.

Thus, Dr. Fernando Pons explains that for this first class multidisciplinary "have been selected infectious diseases for several reasons, firstly by its frequency, because of its high morbidity and have at present a very effective therapeutic arsenal can control. " We therefore have analyzed the liver related to hepatitis B and C which are responsible for a significant number of hepatitis, which if not treated properly can lead to the development of liver cirrhosis and even liver cancer.
Similarly, we have studied the bacterial diseases that can present and cirrhotic patients whose diagnosis and treatment is essential because they are a very important cause of mortality.

Here I Cross Open Classroom in viral and bacterial diseases of the liver has been spoken of spontaneous bacterial peritonitis, bacterial infections in cirrhotic patients in hepatic disease or infectious diseases. About C virus has affected the clinical extrahepatic manifestations of this virus in the predictors of non-modifiable and modifiable treatment response and treatment of hepatitis C after liver transplantation. As for the B virus, in this meeting have been presented the epidemiological changes of infection by this virus in Spain, explaining the diagnosis of infection and evolving forms of B virus infection highlighting the therapeutic options currently available.

Specialist Hospital Universitario Marqués de Valdecilla stresses the importance of these meetings as a forum for exchange of knowledge between hepatologists and other specialists who treat diseases that are related to these infections and to alter its natural history, hence the importance the multidisciplinary approach. "

Hepatitis B and C. Treatment

Among other points, in this classroom were addressed novel aspects in epidemiology, natural history, diagnosis and treatment of chronic infection by hepatitis B. Dr. José Luis Calleja, Deputy Medical Service of Gastroenterology Hospital Universitario Puerta de Hierro, emphasizes that the majority of treatments are prescribed for long term is essential to choose appropriate candidates for the treatment. At present, most of the international consensus to recommend treating only those patients who present with histologic and analytical data relevant to active disease. " In this sense, it emphasized the importance of team-resistant effectiveness when planning appropriate treatment. The ideal drug is one that achieves a potent viral suppression (effectiveness) as long as possible (no resistance). In this sense, the new generation of antiviral drugs such as tenofovir, a major breakthrough for the treatment of these patients and are regarded as drugs of choice, "clarifies Dr. Calleja.

Regarding hepatitis C, this reunion was discussed the possibility of improving the antiviral response by modifying factors: treatment of docility, the host and virus. It also emphasized the individualization of treatment, ie the adaptation of treatment to each patient and each type of virus to achieve optimal viral response in the shortest possible time and with fewer side effects. Thus, Dr. Javier Crespo, Associate Medical Digestive Medicine Department of Hospital Universitario Marqués de Valdecilla, explains that "it is important impact on reducing the treatment time in patients infected with genotype I with low viral load and that they possible treatment of 6 months instead of 12 without loss of efficiency. " On the other hand, in the Open Classroom I Cross in viral and bacterial diseases of the liver, is said to increase the treatment in some cases of infection with genotype 3 and high viral loads do not exhibit an early virological response.

Hepatitis B and C. Prevalence

One in 12 people worldwide are living with hepatitis B or C, and most have known the disease. According to estimates by the World Health Organization estimated that there are approximately 400 million people globally affected by hepatitis B and between 170 and 200 million cases of hepatitis C. One in three people worldwide have ever been exposed to hepatitis B or C.

The prevalence of these diseases is highest in China, Southeast Asia and tropical Africa, and in turn the lowest in North America, Western Europe and Australia.

5% of the world population are carriers of hepatitis B virus and produces two million deaths annually caused by this virus. In Southeast Asia and in sub-Saharan Africa 10% of the population are chronic carriers. The level of prevalence of hepatitis B is such that the number of infected is 10 times higher than those infected with the AIDS virus and its transmission is 100 times easier than that of HIV.

In Spain, there are 12,000 cases of hepatitis B each year. Between 5 and 10% become chronic hepatitis B and approximately 250 cases developed hepatocarcinoma (liver cancer). In total, there are between 300,000 and 400,000 Spaniards infected by this virus, approximately 1% of the population. For its part, the prevalence of hepatitis C infection is relatively high, with between 800,000 and one million infected people in our country. It is estimated that nearly a million Spaniards are unaware that they carry some hepatitis viruses.

Complications commonly associated with hepatitis B and C are cirrhosis, liver failure and liver cancer, disorders that may affect 20 percent of these patients. The existence of such factors as alcohol consumption, being male, having been infected in late age and being infected by human immunodeficiency virus negative impact on prognosis and disease progression.

About Gilead Sciences

Gilead Sciences, sponsor of the Open Classroom I Cross in viral and bacterial infections of the liver, is a biopharmaceutical company that discovers, develops and markets innovative treatments in areas with unresolved medical needs. The company's mission is to advance the care of patients suffering from life-threatening diseases worldwide. Gilead Sciences now sells Viread ® (tenofovir), a single administration of antiviral daily for the treatment of chronic hepatitis B and Hepsera ®, widely used in Europe. In addition, the company is developing small molecule compounds for the treatment of hepatitis C and a hepatoprotective liver fibrosis due to hepatitis.