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1.
Arch. argent. pediatr ; 119(2): e117-e120, abril 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1151875

ABSTRACT

La infección crónica con el virus B de la hepatitis es una de las enfermedades de mayor prevalencia mundial. Puede evolucionar a la cirrosis y carcinoma hepatocelular. La detección temprana, evitar la utilización de drogas intravenosas, la educación sexual y la vacunación son fundamentales para la prevención. La infección neonatal y durante el primer año de vida evoluciona hacia la cronicidad en más del 90 % de los niños. La transmisión vertical, de una madre con virus B de la hepatitis al recién nacido, es, actualmente, la forma más frecuente de infección. Su detección y la administración de inmunoglobulinas y vacuna disminuyen esta vía de infección. El tratamiento antiviral puede acelerar en dos o tres años el pasaje de la fase activa a la inactiva de la infección, sin influir en el proceso hacia la recuperación. El tratamiento oportuno de algunos casos elegidos puede evitar la progresión de la enfermedad


Chronic hepatitis B virus infection is one of the most prevalent diseases worldwide. It may progress to cirrhosis and hepatocellular carcinoma. An early detection, not using intravenous drugs, sex education, and immunization are critical for prevention. An infection in the neonatal period and in the first year of life becomes chronic in more than 90 % of children. Vertical transmission from a mother with hepatitis B virus to the newborn infant is currently the most common mode of transmission. Detection, immunoglobulin administration, and immunization help to reduce it. Antiviral therapy may accelerate the transition from the active to the inactive phase of infection by two or three years, without affecting the recovery process. A timely treatment of some selected cases may prevent hepatitis B progression.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Hepatitis B, Chronic/therapy , Pediatrics , Disease Transmission, Infectious , Disease Progression , Hepatitis B, Chronic
2.
Chinese Journal of Hepatology ; (12): 25-40, 2021.
Article in Chinese | WPRIM | ID: wpr-879635

ABSTRACT

The age-adjusted incidence of primary liver cancer (PLC) has been declining in China. However, PLC cases in China account for 55% globally. The disease burden is still high and the 5-year survival rate was not improved significantly in the past two decades. This guideline outlines PLC screening in the risk populations, both in hospital and community. Liver cirrhosis and chronic hepatitis B are the main causes of PLC in China. For better PLC surveillance and screening in clinical practices, it is recommended to stratify population at the risk into 4 risk levels, namely, low-risk, intermediate-risk, high-risk, and extremely high-risk.The lifelong surveillance is suggested for those at the risk of PLC. The intervals and tools for surveillance and screening are recommended based on the risk levels. Abdominal ultrasonography combined with serum alpha-fetoprotein examination (routine surveillance) every 6 months is recommended for those at a high risk of PLC.Routine surveillance every 3 months and enhanced CT/MRI examination every 6-12 months are recommended for those at an extremely high risk of PLC. The surveillance interval can be extended every 1 year or longer for those at a low-risk or at an intermediate-risk of PLC, because their annual incidence of PLC is very low. The cost-effectiveness of these recommendations remains to be evaluated.


Subject(s)
Carcinoma, Hepatocellular , China/epidemiology , Early Detection of Cancer , Hepatitis B, Chronic , Humans , Liver Cirrhosis , Liver Neoplasms/epidemiology
3.
Article in Chinese | WPRIM | ID: wpr-878896

ABSTRACT

To evaluate the efficacy and safety of Compound Glycyrrhizin Injection(CGI) in improving liver damage in chronic hepatitis B(CHB). PubMed, Web of Science, SinoMed, CNKI, Wanfang and VIP databases were retrieved from their inception to February 10, 2020. The randomized controlled trial(RCT) of CGI in the treatment of CHB was included. Data were independently extracted by two authors, and the methodological quality was evaluated using the Cochrane bias risk assessment tool by other two authors. Statistical analysis was performed using RevMan 5.3 software. A total of 18 two-armed RCTs were included, involving 1 915 participants. The methodological quality of all studies included was generally low. In the comparison between CGI and diammonium glycyrrhizinate, the results showed that CGI was superior to the control group in improving the overall clinical effectiveness, but there was no statistical difference between the two groups in increasing ALT normalization rate, reducing ALT and AST level. In the comparison between CGI and diammonium glycyrrhizinate+other general hepatoprotective drugs, the results showed that CGI was superior to the control group in reducing AST level, while there was no statistical difference between the two groups in reducing ALT level and increasing overall clinical effectiveness. In the comparison between CGI+other commonly used drugs(including energy mixture, glutathione, vitamins, potassium magnesium aspartate) and diammonium glycyrrhizinate+other commonly used drugs, the results showed that CGI combined with other commonly used drugs was better than the control group in reducing ALT and AST level and improving the clinical total effective rate, and there was no statistical difference between the two groups in increasing the rate of ALT normalization. In the comparison between CGI+other commonly used drugs and other commonly used drugs, the results showed that CGI combined with other commonly used drugs was superior to the control group in reducing ALT and AST level and improving the overall clinical effectiveness. In the comparison between CGI+vitamins and diammonium glycyrrhizinate+potassium magnesium aspartate+vitamins, the results showed no statistical difference between the two groups in reducing AST level. A small number of studies included reported that CGI caused mild adverse reactions when used alone or in combination with other drugs. Based on the results, CGI has a certain effect in improving CHB liver damage, but the evidence is not enough to prove that CGI would cause serious adverse events. In the future, more well-designed and strictly-enforced RCT with an adequate sample size are needed to further evaluate the effect CGI in alleviating CHB liver damage.


Subject(s)
Drugs, Chinese Herbal/adverse effects , Glycyrrhizic Acid , Hepatitis B, Chronic/drug therapy , Humans
4.
Chinese Journal of Biotechnology ; (12): 301-311, 2021.
Article in Chinese | WPRIM | ID: wpr-878563

ABSTRACT

Chronic hepatitis B (CHB) is a global epidemic disease caused by hepatitis B virus that can lead to hepatic failure, even liver cirrhosis and hepatocellular carcinoma. The occurrence and development of CHB are closely related to the changes in the gut microbiota communities. To explore the relationship between the structure of gut microbiota and liver biochemical indicators, 14 CHB patients (the CHB group) and 11 healthy people (the CN group) were randomly enrolled in this study. Our results demonstrate that CHB caused changes in the gut microbiota communities and biochemical indicators, such as alanine transaminase, total bilirubin and gamma glutamyl transferase. Furthermore, CHB induced imbalance of the gut microbiota. Prevotella, Blautia, Ruminococcus, Eubacterium eligens group, Bacteroides uniformis and Ruminococcus sp. 5_1_39BFAA were associated with the critical biochemical indicators and liver injury, suggesting a new approach to CHB treatment.


Subject(s)
Bacteroides , Eubacterium , Gastrointestinal Microbiome , Hepatitis B virus , Hepatitis B, Chronic , Humans , Liver Cirrhosis , Liver Neoplasms
5.
Chinese Medical Journal ; (24): 1160-1167, 2021.
Article in English | WPRIM | ID: wpr-878100

ABSTRACT

BACKGROUND@#Hepatitis B core-related antigen (HBcrAg) is a promising disease-monitoring marker for chronic hepatitis B (CHB). We investigated correlations between HBcrAg with antiviral efficacy and virological and histological variables.@*METHODS@#One hundred and forty-five CHB patients from the mainland of China between August 2013 and September 2016 who underwent liver biopsy received entecavir therapy and had paired liver biopsy at 78 weeks. We analyzed correlations between HBcrAg and virological and histological variables in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. We also explored the predictors of HBeAg loss after 78 weeks of antiviral therapy. Pearson correlation analysis and logistic forward stepwise regression were the main statistic methods.@*RESULTS@#HBeAg-positive patients (n = 93) had higher baseline HBcrAg (median 7.4 vs. 5.3 log10 U/mL P < 0.001) and greater HBcrAg declines (median 1.6 vs. 0.9 log10 U/mL P = 0.007) than HBeAg-negative patients after 78 weeks of therapy. At baseline, HBcrAg correlated with hepatitis B virus (HBV) DNA in both HBeAg-positive (r = 0.641, P < 0.001) and -negative patients (r = 0.616, P < 0.001), with hepatitis B surface antigen (HBsAg) in HBeAg-positive patients (r = 0.495, P < 0.001), but not with anti-hepatitis B virus core antibody (anti-HBc). Weak correlations existed between HBcrAg, histology activity index (HAI; r = 0.232, P = 0.025), and Ishak fibrosis score (r = -0.292, P = 0.005) in HBeAg-positive patients. At 78 weeks, significant correlations existed only between HBcrAg and anti-HBc in HBeAg-positive (r = -0.263, P = 0.014) and HBeAg-negative patients (r = -0.291, P = 0.045). Decreased HBcrAg significantly correlated with reduced HBV DNA (r = 0.366, P = 0.001; r = 0.626, P < 0.001) and HBsAg (r = 0.526, P = 0.001; r = 0.289, P = 0.044) in HBeAg-positive and -negative patients, respectively, and with reduced HAI in HBeAg-positive patients (r = 0.329, P = 0.001). Patients with HBeAg loss (n = 29) showed a larger reduction in HBcrAg than those without (median 2.3 vs. 1.3 log10 U/mL, P = 0.001). In multivariate analysis, decreased HBcrAg was an independent predictor of HBeAg loss (P = 0.005).@*CONCLUSIONS@#HBcrAg reflects viral replication and protein production. Decreased HBcrAg could predict HBeAg loss after antiviral therapy.@*TRIAL REGISTRATION@#Clinical Trials.gov: NCT01962155; https://www.clinicaltrials.gov/ct2/show/NCT01962155?term=NCT01962155&draw=2&rank=1.


Subject(s)
Antiviral Agents/therapeutic use , Biomarkers , China , DNA, Viral , Hepatitis B Core Antigens/therapeutic use , Hepatitis B Surface Antigens , Hepatitis B e Antigens , Hepatitis B virus/genetics , Hepatitis B, Chronic/drug therapy , Humans , Virus Replication
6.
Chinese Journal of Oncology ; (12): 60-77, 2021.
Article in Chinese | WPRIM | ID: wpr-877498

ABSTRACT

The age-adjusted incidence of primary liver cancer (PLC) has been declining in China. However, PLC cases in China account for 55% globally. The disease burden is still high and the 5-year survival rate was not improved significantly in the past two decades. This guideline outlines PLC screening in the risk populations, both in hospital and community. Liver cirrhosis and chronic hepatitis B are the main causes of PLC in China. For better PLC surveillance and screening in clinical practices, it is recommended to stratify population at the risk into 4 risk levels, namely, low-risk, intermediate-risk, high-risk, and extremely high-risk. The lifelong surveillance is suggested for those at the risk of PLC. The intervals and tools for surveillance and screening are recommended based on the risk levels. Abdominal ultrasonography combined with serum alpha-fetoprotein examination (routine surveillance) every 6 months is recommended for those at a high risk of PLC. Routine surveillance every 3 months and enhanced CT/MRI examination every 6-12 months are recommended for those at an extremely high risk of PLC. The surveillance interval can be extended every 1 year or longer for those at a low-risk or at an intermediate-risk of PLC, because their annual incidence of PLC is very low. The cost-effectiveness of these recommendations remains to be evaluated.


Subject(s)
Carcinoma, Hepatocellular , China/epidemiology , Early Detection of Cancer , Hepatitis B, Chronic , Humans , Liver Cirrhosis , Liver Neoplasms/epidemiology , Ultrasonography
7.
Rev. cuba. med ; 59(4): e35, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144504

ABSTRACT

Introducción: La infección por el virus de la hepatitis C es un evento común en los receptores de trasplante renal que la arrastran desde su estancia en los tratamientos de hemodiálisis previos al implante. La positividad al virus C se ha asociado a una evolución desfavorable después del trasplante, dado por una mayor frecuencia de complicaciones clínicas, metabólicas e inmunológicas que repercuten de forma negativa tanto en la supervivencia del injerto como del paciente. Objetivos: Caracterizar la evolución clínica de los pacientes trasplantados de riñón con virus de la hepatitis C positivo y determinar la evolución de este grupo de enfermo de acuerdo a variables demográficas, clínicas y de supervivencia. Método: Estudio analítico, transversal, retrospectivo en pacientes trasplantados renales del Hospital Clínico Quirúrgico Hermanos Ameijeiras, desde el año 2005 al 2017. Se excluyeron los menores de 15 años, los retrasplantes, los trasplantes dobles y los combinados o cuando no se pudo obtener la información. Se comparan las variables escogidas entre enfermos que llegan al trasplante con serología positiva al virus C, (HVC positivos), con los HVC negativos. Resultados: Del total de 156 enfermos, 65 por ciento (102) fueron HVC positivos, no se encontraron diferencias entre grupo en cuanto a edad y sexo de receptores y donantes, así como tampoco en el tratamiento inmunosupresor utilizado. El donante vivo se empleó menos en los HVC positivos donde se encontraron más enfermos con poliquistosis renal. La necrosis tubular aguda (NTA) y el rechazo fueron más frecuentes en los HVC positivos, siendo la primera estadísticamente significativa, p=0,0421, también resultaron significativamente más frecuente en el grupo HVC positivo, la proteinuria, p=0,041, la elevación de enzimas hepáticas, p=0,047 y la diabetes postrasplante, p=0,047. La supervivencia del injerto y los pacientes fue menor en los HVC positivos. Conclusiones: En este estudio la hepatitis por virus C impacta negativamente en la evolución del injerto y propicia la aparición de algunas complicaciones clínicas, lo que sin dudas pudiera influir en una menor expectativa de vida tanto para el injerto como para el enfermo(AU)


Introduction: Hepatitis C virus infection is a common event in kidney transplant recipients that has dragged it along since their stay in hemodialysis treatments prior to implantation. Positivity to virus C has been associated with an unfavorable evolution after transplantation, due to higher frequency of clinical, metabolic and immunological complications that negatively affect both graft and patient survival. Objectives: To describe the clinical evolution of kidney transplant patients with positive hepatitis C virus and to determine the evolution of this group of patients according to demographic, clinical and survival variables. Method: An analytical, cross-sectional, retrospective study in kidney transplant patients at Hermanos Ameijeiras Hospital was carried out from 2005 to 2017. This study excluded children under 15 years of age, re-transplants, double and combined transplants or when it was not possible to gather the information. The variables chosen among patients who arrive at transplantation with positive serology for virus C (positive HCV) were compared with negative HCV. Results: One hundred and fifty six patients were the total, 65 percent (102) were HVC positive, no differences were found between groups in terms of age and sex of recipients and donors, nor in the immunosuppressive treatment used. The living donor was less used in positive HVC where more patients with polycystic kidney disease were found. Acute tubular necrosis (ATN) and rejection were more frequent in positive HVC, the former being statistically significant, p = 0.0421, proteinuria, p = 0.041, elevation was also significantly more frequent in the positive HVC group of liver enzymes, p = 0.047 and post-transplant diabetes, p = 0.047. Graft and patient survival was lower in positive HCV. Conclusions: In this study, hepatitis C virus has negative impact on the evolution of the graft and favors the appearance of some clinical complications, which undoubtedly could influence a shorter life expectancy for both the graft and the patient(AU)


Subject(s)
Humans , Male , Female , Adult , Clinical Evolution/methods , Kidney Transplantation/methods , Kidney Transplantation/rehabilitation , Hepatitis B, Chronic/complications , Cross-Sectional Studies , Retrospective Studies
8.
Rev. habanera cienc. méd ; 19(1): 48-62, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1099145

ABSTRACT

Introducción: La efectividad del programa nacional de inmunización ha impactado en la reducción de la incidencia del virus de la hepatitis B en Cuba; sin embargo, no es despreciable la cantidad de pacientes infectados crónicos, que por esta causa, se detectan en la práctica asistencial, aunque insuficientes los estudios epidemiológicos que los caracterizan. Objetivo: Describir las principales características clínicas, biomoleculares e inmunológicas de los pacientes con VHB crónica atendidos en el Instituto de Gastroenterología de Cuba. Materiales y métodos: 97 pacientes que tenían al menos un historial de 6 meses de infección crónica con VHB fueron reclutados en la propia institución desde enero 2016 hasta enero 2018. Se realizaron análisis estadísticos descriptivos para las características clínicas, estudios bioquímicos, virológicos, grado de dureza hepática (medido por elastografía transitoria) y terapia antiviral. Resultados: Todos los pacientes completaron el seguimiento; 61,9 por ciento eran varones y la mediana (rango) de edad fue de 46 (18-84) años. La media de tiempo desde el diagnóstico de la infección fue de 11,7 ± 8,9 años. El 61,9 por ciento tenían enfermedad inactiva sin fibrosis hepática o fibrosis ligera. Solamente el 2 por ciento eran negativos para el antígeno de superficie de la hepatitis B con el DNA cuantificable del VHB, el 81,4 por ciento tenían carga viral detectable y el 85,5 por ciento recibieron uno o más tratamientos antivirales, principalmente los análogos del nucleótido/sido. Conclusiones: Los pacientes con la infección crónica del VHB estudiados, en su mayoría se encuentran en fase inactiva de su enfermedad, sin evidencia significativa de daño hepático, con niveles detectables de viremia y han recibido algún tratamiento antiviral(AU)


Introduction: The effectiveness of the national immunization program has impacted on the reduction of the incidence of hepatitis B virus (HBV) infection in Cuba; however, the number of chronically infected patients is not negligible. These patients are diagnosed in the clinical practice, although the epidemiological studies that indicate the presence of the disease are insufficient. Objective: To describe the main clinical, biomolecular and immunological characteristics of patients with chronic hepatitis B virus infection treated at the National Institute of Gastroenterology, Havana, Cuba. Materials and methods: A total of 97 patients who had at least a 6-month history of chronic HBV infection were recruited at the above mentioned institution from January 2016 to January 2018. Descriptive statistical analyzes were performed to identify the clinical characteristics. Biochemical and virological studies, analysis of both liver stiffness values measured by transient elastography and use of antiviral therapy were also carried out. Results: All patients completed the follow-up. It was observed that 61,9 percent of them were male and the median (range) age was 46 (18-84) years. The mean time since the diagnosis of the infection was 11.7 ± 8,9 years. Inactive disease without liver fibrosis or light fibrosis was present in 61,9 percent. Only 2 percent were negative for hepatitis B surface antigen with quantitative analysis of HBV DNA; also, 81,4 percent of patients had detectable viral load and 85,5 percent received one or more antiviral treatments, mainly nucleotide analogues. Conclusions: The patients with chronic HBV infection studied are mostly in the inactive phase of their disease, without significant evidence of liver damage and detectable levels of viremia. All of them have received some antiviral treatment(AU)


Subject(s)
Humans , Male , Female , Hepatitis B, Chronic/immunology , Hepatitis B, Chronic/epidemiology
9.
Gastroenterol. latinoam ; 31(2): 79-84, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1292370

ABSTRACT

Chronic hepatitis B is a major public health problem, causing 30% of cirrhosis worldwide and up to 50% of hepatocellular carcinoma. In high prevalence regions, virus transmission is mainly vertical, which is associated with a risk of chronic disease in 90% of cases. The development of chronic hepatitis in adults is less than 5%, but it could reach up to 30% in patients with immunosuppression. In the evaluation of subjects with HBV infection is recommended to investigate risk factors for progression to cirrhosis and hepatocellular carcinoma, test for sexually transmitted infections and control liver comorbidities that will affect patient's prognosis, such as chronic alcohol consumption, nonalcoholic fatty liver disease and coinfection with hepatitis C and HIV. Management of patients with chronic hepatitis B includes testing and prevention for contacts, control of comorbidities, and specific treatment with antivirals when indicated. Treatment with nucleotide/nucleoside analogues is considered of choice as they are safe, achieves adequate control of viral replication and reduces the risk of liver complications. The goal of the WHO is to achieve a significant decrease in the prevalence of hepatitis B by 2030 through preventive measures in regions with a high prevalence of the disease.


La infección por el virus de la hepatitis B (VHB) es un importante problema de salud pública, estimándose que causa 30% de los casos de cirrosis a nivel mundial y hasta 50% de los hepatocarcinomas. En las regiones de alta prevalencia, la transmisión del virus es principalmente vertical, la que se asocia a un riesgo de cronificación de hasta 90%. Por el contrario, el desarrollo de hepatitis crónica en adultos es menor de 5% y en inmunosupresión puede alcanzar hasta 30%. En la evaluación de sujetos con infección por VHB es necesaria pesquisar factores de riesgo de progresión a cirrosis y hepatocarcinoma, detectar otras infecciones de transmisión sexual y controlar comorbilidades hepáticas que afectarán el pronóstico del paciente, como el consumo crónico de alcohol, el hígado graso no alcohólico o la coinfección con hepatitis C y VIH. El manejo de los pacientes con hepatitis B crónica requiere preocuparse del testeo y medidas de prevención para los contactos, control de comorbilidades y tratamiento específico con antivirales cuando existe indicación. El tratamiento con análogos de nucleótidos/nucleósidos se considera de elección al ser seguro, lograr un adecuado control de la replicación viral y disminuir riesgo de complicaciones hepáticas. El objetivo de la OMS es lograr una disminución significativa de la prevalencia de la hepatitis B el año 2030 a través de medidas preventivas en regiones de alta prevalencia de la enfermedad.


Subject(s)
Humans , Hepatitis B, Chronic/diagnosis , Hepatitis B, Chronic/blood , Hepatitis B, Chronic/therapy , Prognosis , Risk Factors , Hepatitis B, Chronic/physiopathology
11.
Article in English | WPRIM | ID: wpr-827465

ABSTRACT

OBJECTIVE@#To evaluate the effects of a 48-week course of adefovir dipivoxil (ADV) plus Chinese medicine (CM) therapy, namely Tiaogan Jianpi Hexue () and Tiaogan Jiedu Huashi () fomulae, in hepatitis B e antigen (HBeAg)-positive Chinese patients.@*METHODS@#A total of 605 HBeAg-positive Chinese CHB patients were screened and 590 eligible participants were randomly assigned to 2 groups in 1:1 ratio including experimental group (EG, received ADV plus CM) and control group (CG, received ADV plus CM-placebo) for 48 weeks. The major study outcomes were the rates of HBeAg and HBV-DNA loss on week 12, 24, 36, 48, respectively. Secondary endpoints including liver functions (enzymes and bilirubin readings) were evaluated every 4 weeks at the beginning of week 24, 36, and 48. Routine blood, urine, and stool analyses in addition to electrocardiogram and abdominal B scan were monitored as safety evaluations. Adverse events (AEs) were documented.@*RESULTS@#The combination therapy demonstrated superior HBeAg loss at 48 weeks, without additional AEs. The full analysis population was 560 and 280 in each group. In the EG, population achieved HBeAg loss on week 12, 24, 36, and 48 were 25 (8.90%), 34 (12.14%), 52 (18.57%), and 83 (29.64%), respectively; the equivalent numbers in the CG were 20 (7.14%), 41 (14.64%), 54 (19.29%), and 50 (17.86%), respectively. There was a statistically significant difference between these group values on week 48 (P<0.01). No additional AEs were found in EG. Subgroup analysis suggested different outcomes among treatment patterns.@*CONCLUSION@#Combination of CM and ADV therapy demonstrated superior HBeAg clearance compared with ADV monotherapy. The finding indicates that this combination therapy may provide an improved therapeutic effect and safety profile (ChiCTR-TRC-11001263).


Subject(s)
Adenine , Therapeutic Uses , Adult , Antiviral Agents , Therapeutic Uses , Double-Blind Method , Drug Therapy, Combination , Drugs, Chinese Herbal , Therapeutic Uses , Female , Hepatitis B e Antigens , Allergy and Immunology , Hepatitis B, Chronic , Drug Therapy , Allergy and Immunology , Humans , Male , Medicine, Chinese Traditional , Organophosphonates , Therapeutic Uses , Young Adult
12.
Singapore medical journal ; : 619-623, 2020.
Article in English | WPRIM | ID: wpr-877439

ABSTRACT

In this paper, we aim to provide professional guidance to clinicians who are managing patients with chronic liver disease during the current coronavirus disease 2019 (COVID-19) pandemic in Singapore. We reviewed and summarised the available relevant published data on liver disease in COVID-19 and the advisory statements that were issued by major professional bodies, such as the American Association for the Study of Liver Diseases and European Association for the Study of the Liver, contextualising the recommendations to our local situation.


Subject(s)
COVID-19/epidemiology , Carcinoma, Hepatocellular/therapy , Chronic Disease , Hepatitis B, Chronic/therapy , Hepatitis C, Chronic/therapy , Humans , Liver Cirrhosis/therapy , Liver Diseases/therapy , Liver Neoplasms/therapy , Liver Transplantation , Singapore/epidemiology
13.
Article in English | WPRIM | ID: wpr-876622

ABSTRACT

@#Background: Hepatitis B infection on pregnancy has been linked to preterm labor, risk of prematurity, low birth weight, and the occurrence of gestational diabetes mellitus. Objective: To determine the association between Chronic Hepatitis B infectivity and fetomaternal outcome such as preterm birth, low birth weight, gestational diabetes and preeclampsia among pregnant patients admitted in a Tertiary Hospital. Methodology: A retrospective cohort study was done among pregnant women diagnosed with chronic hepatitis B infection admitted in a tertiary hospital from January 1, 2014 to December 31, 2018. The association of Hepatitis B infectivity and fetomaternal outcomes namely preterm birth, gestational diabetes, preeclampsia and low birth weight was determined Results: Chronic Hepatitis B infection had 1.43% prevalence among the study group. 149 patients were able to able to fulfill the inclusion criteria. Pregnant women with high infectivity Hepatitis B infection tend to be younger, have lower BMI, have lesser gravidity and parity than patients who are nonreactive to Hepatitis B e-antigen. AST and ALT were also higher among those with high infectivity Hepatitis B. However, there was no significant difference among the two groups in terms of elevated ALT. There was no significant association between Hepatitis B infectivity and fetomaternal outcomes such as preeclampsia, gestational diabetes mellitus, preterm birth and low birth weight. There is no increased risk for patients with high infectivity for preeclampsia, gestational diabetes mellitus, and low birth weight. There appears to be an excess risk in the likelihood of preterm birth/labor among those women who have a high infectivity Hepatitis B infection during pregnancy. Conclusion: The prevalence of chronic hepatitis B infection among Filipino pregnant women admitted in a tertiary hospital was 1.43% from 2014 to 2018. There was no association between chronic hepatitis B infectivity and preeclampsia, Gestational diabetes mellitus. There seems to be an increased risk for HBeAg positive patients for preterm birth preterm labor, and occurrence of low birth weight, but was not statistically significant in the study population.


Subject(s)
Hepatitis B, Chronic
14.
Braz. j. infect. dis ; 23(6): 419-426, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1089319

ABSTRACT

ABSTRACT Introduction: Hepatitis B virus (HBV) is responsible for one of the most common human viral infections. An estimated 257 million people are living with chronic HBV infection worldwide, and mortality has reached 900,000 deaths in recent years. In 2001, the World Health Organization reported a prevalence of chronic hepatitis B infection in Iran between 2-7%. Objective: To assess the effect of the national HBV mass vaccination program after 25 years. Methods: A retrospective cohort study was conducted in vaccinated and unvaccinated people according to the year of birth. Blood samples were obtained from each enrolled person and data about demographic variables, and medical and vaccination history were collected using a standardized questionnaire. Persons were considered uninfected if they were negative for both HBsAg and anti-HBc. Also, Vaccine effectiveness was measured by calculating the risk of disease among vaccinated and unvaccinated persons and defining the percentage risk reduction of infection in the vaccinated group. Results: A total of 2720 persons were interviewed. The rate of HBV breakthrough infection among the vaccinated group was significantly lower than in unvaccinated group. One hundred ninety-four cases with positive HBV markers of infection were identified. The risk ratio of HBV infection was 0.71, 95% CI: 0.54-0.94 (vaccinated/unvaccinated). The estimated vaccination effectiveness against Hepatitis B infection was 29% (95% CI: 6%-46%). Conclusions: Iran has successfully combined hepatitis B vaccination into regular immunization programs. The WHO goal of reducing HBsAg prevalence to an equivalent of 1% by 2020 has been reached. With respect to vaccination effectiveness and low prevalence of the disease in the country, catch-up hepatitis B vaccination programs for adolescents can guarantee the immunity of the population.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Young Adult , Vaccination/statistics & numerical data , Hepatitis B Vaccines/administration & dosage , Immunization Programs/statistics & numerical data , Hepatitis B, Chronic/prevention & control , Hepatitis B/prevention & control , Prevalence , Surveys and Questionnaires , Retrospective Studies , Hepatitis B, Chronic/immunology , Hepatitis B, Chronic/epidemiology , Hepatitis B/epidemiology , Iran/epidemiology
15.
Article in English | WPRIM | ID: wpr-785653

ABSTRACT

BACKGROUND/AIMS: Hepatitis B virus reactivation (HBVr) following chemotherapy (CMT) is well-known among hematologic malignancies, and screening recommendations are established. However, HBVr data in solid organ malignancy (SOM) patients are limited. This study aims to determine hepatitis B surface antigen (HBsAg) screening rates, HBV prevalence, and the rate of significant hepatitis caused by HBVr in SOM patients undergoing CMT.METHODS: Based on the Oncology unit’s registration database from 2009–2013, we retrospectively reviewed records of all SOM patients ≥18 years undergoing CMT at Songklanagarind Hospital who were followed until death or ≥6 months after CMT sessions. Exclusion criteria included patients without baseline liver function tests (LFTs) and who underwent CMT before the study period. We obtained and analyzed baseline clinical characteristics, HBsAg screening, and LFT data during follow-up.RESULTS: Of 3,231 cases in the database, 810 were eligible. The overall HBsAg screening rate in the 5-year period was 27.7%. Screening rates were low from 2009–2012 (7.8–21%) and increased in 2013 to 82.9%. The prevalence of HBV among screened patients was 7.1%. Of those, 75% underwent prophylactic antiviral therapy. During the 6-month follow-up period, there were three cases of significant hepatitis caused by HBVr (4.2% of all significant hepatitis cases); all were in the unscreened group.CONCLUSIONS: The prevalence of HBV in SOM patients undergoing CMT in our study was similar to the estimated prevalence in general Thai population, but the screening rate was quite low. Cases of HBVr causing significant hepatitis occurred in the unscreened group; therefore, HBV screening and treatment in SOM patients should be considered in HBV-endemic areas.


Subject(s)
Asian Continental Ancestry Group , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Follow-Up Studies , Hematologic Neoplasms , Hepatitis B Surface Antigens , Hepatitis B virus , Hepatitis B , Hepatitis B, Chronic , Hepatitis , Humans , Liver Function Tests , Mass Screening , Prevalence , Retrospective Studies , Thailand , Virus Activation
16.
Article in English | WPRIM | ID: wpr-785650

ABSTRACT

BACKGROUND/AIMS: A risk prediction model for the development of hepatocellular carcinoma (HCC) from indeterminate nodules detected on computed tomography (CT) (Rad(CT) score) in patients with chronic hepatitis B (CHB)-related cirrhosis was proposed. We validated this model for indeterminate nodules on magnetic resonance imaging (MRI).METHODS: Between 2013 and 2016, Liver Imaging Reporting and Data System (LI-RADS) 2/3 nodules on MRI were detected in 99 patients with CHB. The Rad(CT) score was calculated.RESULTS: The median age of the 72 male and 27 female subjects was 58 years. HCC history and liver cirrhosis were found in 47 (47.5%) and 44 (44.4%) patients, respectively. The median Rad(CT) score was 112. The patients with HCC (n=41, 41.4%) showed significantly higher Rad(CT) scores than those without (median, 119 vs. 107; P=0.013); the Chinese university-HCC and risk estimation for HCC in CHB (REACH-B) scores were similar (both P>0.05). Arterial enhancement, T2 hyperintensity, and diffusion restriction on MRI were not significantly different in the univariate analysis (all P>0.05); only the Rad(CT) score significantly predicted HCC (hazard ratio [HR]=1.018; P=0.007). Multivariate analysis showed HCC history was the only independent HCC predictor (HR=2.374; P=0.012). When the subjects were stratified into three risk groups based on the Rad(CT) score (<60, 60–105, and >105), the cumulative HCC incidence was not significantly different among them (all P>0.05, log-rank test).CONCLUSIONS: HCC history, but not Rad(CT) score, predicted CHB-related HCC development from LI-RADS 2/3 nodules. New risk models optimized for MRI-defined indeterminate nodules are required.


Subject(s)
Asian Continental Ancestry Group , Carcinoma, Hepatocellular , Diffusion , Female , Fibrosis , Hepatitis B , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Incidence , Information Systems , Liver , Liver Cirrhosis , Liver Neoplasms , Magnetic Resonance Imaging , Male , Multivariate Analysis , Radiographic Image Interpretation, Computer-Assisted , Risk Assessment
17.
Article in English | WPRIM | ID: wpr-787223

ABSTRACT

BACKGROUND/AIMS: The utility of asialo-α1-acid glycoprotein (AsAGP) for assessing the fibrotic burden is unknown. This study examined the diagnostic performance of the AsAGP level for advanced liver fibrosis or cirrhosis in patients with chronic hepatitis B (CHB) or nonalcoholic fatty liver disease (NAFLD).METHODS: From July to December 2018, 48 patients with CHB and 75 with NAFLD were recruited prospectively. Transient elastography was used as the reference standard for liver fibrosis, and the cutoff liver stiffness values were defined as 10.0 kilopascal (kPa) for ≥F3 and 12.0 kPa for F4 in CHB patients, and 9.0 kPa for ≥F3 and 11.8 kPa for F4 in NAFLD patients.RESULTS: To predict stage ≥F3 and F4 fibrosis, the areas under the receiver operating characteristic curves of the AsAGP level in patients with CHB were 0.788 (95% CI 0.647-0.930; p=0.005) and 0.825 (95% CI 0.674–0.976; p=0.004), respectively. The cutoff AsAGP levels in patients with CHB that maximized the sum of the sensitivity and specificity values were 1.31 (sensitivity 100.0%, specificity 52.6%) and 1.55 (sensitivity 75.0%, specificity 80.0%), respectively. In contrast, the AsAGP level was similar regardless of the fibrosis stage in patients with NAFLD (all p>0.05 between the stages).CONCLUSIONS: The AsAGP level showed acceptable diagnostic accuracy in predicting advanced liver fibrosis and cirrhosis in patients with CHB but not in those with NAFLD. Further studies will be needed to validate the diagnostic performance of the AsAGP level in patients with NALFD.


Subject(s)
Elasticity Imaging Techniques , Fibrosis , Glycoproteins , Hepatitis B , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Liver Cirrhosis , Liver , Non-alcoholic Fatty Liver Disease , Prospective Studies , ROC Curve , Sensitivity and Specificity
18.
Article in Korean | WPRIM | ID: wpr-787218

ABSTRACT

HBV is the most common etiology of both liver cirrhosis and hepatocellular carcinoma in Korea. Despite much progress made, the currently available antiviral therapies cannot eradicate or eliminate this virus. Hence, the benefits and risks of antiviral therapy should be carefully evaluated on an individual basis and within the context of the clinical situation. The ultimate goals of treatment are to decrease the mortality from liver disease. The benefits of antiviral therapy come from prevention of progression of liver disease. Understanding the natural history of chronic HBV infection is a key step in the decision making process to treat patients with chronic HBV infection. Generally, chronic hepatitis B patients in the immune tolerant phase and immune inactive phase are not recommended to undergo antiviral treatment, except for those patients in special conditions (e.g., immunosuppression or anticancer chemotherapy). Chronic hepatitis B patients in the immune active phase are recommended for antiviral therapy. For patients with liver cirrhosis, treatment should be considered when serum HBV DNA is detectable regardless of the serum level of ALT.


Subject(s)
Carcinoma, Hepatocellular , Decision Making , DNA , Hepatitis B virus , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Immunosuppression , Korea , Liver Cirrhosis , Liver Diseases , Mortality , Natural History , Risk Assessment
19.
Article in Korean | WPRIM | ID: wpr-787217

ABSTRACT

Multiple studies have shown that oral antiviral therapies reduced the incidence of hepatocellular carcinoma (HCC) and improved the survival of patients with chronic hepatitis B when compared with that of untreated patients. In particular, entecavir and tenofovir share the qualities of high efficacy in reducing the HBV DNA levels, and they have excellent tolerability and safety. These drugs modified the natural history of liver fibrosis, improve liver function, decrease the incidence of HCC, decrease the need for liver transplantation, and improve survival. Many studies have suggested that long-term antiviral therapy reduces the risk of HCC and liver cirrhosis in patients with chronic hepatitis. The mechanism of these drugs in reducing the risk of HCC is not clear. This article reviews the mechanisms of carcinogenic HBV by conducting a review of the literature on the efficacy of therapy for reducing the risk of HCC. A few recent articles have suggested that tenofovir offers advantages over entecavir in terms of HCC prevention, but these articles have the inherent limitations of observational data. No other head-to-head randomized trials exist. Further randomized studies would help provide stronger evidence of the association between the type of antiviral agent and the HCC outcomes. Only achieving complete viral eradication from the liver will truly decrease the mortality and incidence of HCC.


Subject(s)
Antiviral Agents , Carcinoma, Hepatocellular , DNA , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Incidence , Liver , Liver Cirrhosis , Liver Transplantation , Mortality , Natural History , Tenofovir
20.
Article in Korean | WPRIM | ID: wpr-787216

ABSTRACT

Improved management of chronic hepatitis B patients with oral nucleos(t)ide analogues has increased the number of these patients who are getting older and have other accompanying comorbidities. These comorbidities frequently require various immunosuppression treatments and/or cytotoxic chemotherapy. Not only the patients who are positive for HBsAg, but also the patients who are positive for isolated anti-HBc are at risk for hepatitis B reactivation during immunosuppression. Prophylactic antiviral treatment with oral nucleos(t)ide analogues with high genetic barriers can decrease the risks of HBV reactivation, HBV reactivation-associated hepatitis, and mortality in these patients. It is crucial to screen HBV markers in all of the patients who have to undergo immunosuppression, be administered prophylactic antiviral treatment in the high risk groups, and be monitored for HBV reactivation during and after immunosuppression and/or cytotoxic chemotherapy. This study summarizes the recommendations from the recently updated guidelines from Korea, United States, and Europe.


Subject(s)
Comorbidity , Drug Therapy , Europe , Hepatitis , Hepatitis B , Hepatitis B Surface Antigens , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Immunosuppression , Korea , Mortality , United States
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