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Rose TV, Christensen PB, Hjorth P, Madsen LW, Hansen JF, Dröse S, Harvald GB, Røge BT, Øvrehus ALH. Combining cross-sectional survey and register data improved the estimate of hepatitis C prevalence among patients attending a psychiatric emergency department in Denmark. Infect Dis (Lond) 2024; 56:277-284. [PMID: 38150183 DOI: 10.1080/23744235.2023.2298460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/17/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND The prevalence of hepatitis C (HCV) among psychiatric patients is elevated compared to the background population in many studies, but the prevalence among Danish psychiatric patients is unknown. The aim of the study was to determine the HCV prevalence and the proportion of the psychiatric patient population that remains to be diagnosed and treated in a Danish setting. METHODS During a 5-month period, patients attending the psychiatric emergency room in Vejle, Denmark, were offered point-of-care anti-HCV testing. Previous hepatitis C tests for all patients attending the Psychiatric Department in the study period were extracted from the national laboratory database (DANVIR). We combined the survey and register data in a capture-recapture estimate of undiagnosed patients with HCV. RESULTS During the study 24.9% (589 of 2364) patients seen at the psychiatric department attended the emergency room. The prevalence of anti-HCV among those tested in the emergency room was 1.6%. The laboratory register identified 595/2364 patients previously tested for anti-HCV with a positive prevalence of 6.1%. The undiagnosed anti-HCV positives among the 1483 never tested was estimated to 1.1%. Thus the total estimated prevalence of anti-HCV was 2.3% (54/2364, 95% CI 1.7%-3.0%) in the population, of whom 70.4% had been diagnosed, and 72.2% of diagnosed patients had received treatment or cleared HCV. CONCLUSION Combining survey and register data showed that the WHO target of 90% diagnosed and 80% treated was not met. To eliminate HCV in the psychiatric population, both undiagnosed and untreated patients must be targeted.
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Affiliation(s)
- Thomas Vemmelund Rose
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Hjorth
- Department of Psychiatry, Mental Health Services, Region of Southern Denmark, University Hospital of Southern, Vejle Denmark
| | - Lone Wulff Madsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Internal Medicine, Hospital Lillebælt-Kolding, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Sandra Dröse
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Gustav Bang Harvald
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Birgit Thorup Røge
- Department of Internal Medicine, Hospital Lillebælt-Kolding, Kolding, Denmark
| | - Anne Lindebo Holm Øvrehus
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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152
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Winter RJ, Griffin S, Sheehan Y, Nguyen W, Stoové M, Lloyd AR, Thompson AJ. People in community corrections are a population with unmet need for viral hepatitis care. EClinicalMedicine 2024; 70:102548. [PMID: 38516104 PMCID: PMC10955648 DOI: 10.1016/j.eclinm.2024.102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
To reach World Health Organization elimination targets for hepatitis C, different strategies are needed to reach people who have not yet been diagnosed and treated. In the context of declining treatment initiation rates, innovation in service design and delivery is necessary: testing and treatment needs to be offered to people in non-traditional settings. The community corrections (probation and parole) population is larger than the prison population, which has high prevalence of hepatitis C and-in some countries-established diagnosis and treatment programs. In this Viewpoint we identify a gap in hepatitis C care for people under community correctional supervision, a group who have either never been imprisoned or need continuity of healthcare provided in prison. We propose that offering hepatitis C screening and treatment would benefit this population, and accelerate progress to hepatitis C elimination.
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Affiliation(s)
- Rebecca J. Winter
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Samara Griffin
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yumi Sheehan
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Andrew R. Lloyd
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - National Prisons Hepatitis Network
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Hepatitis Queensland, Brisbane, QLD, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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153
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Philips CA, Theruvath AH, Ravindran R, Augustine P. Complementary and alternative medicines and liver disease. Hepatol Commun 2024; 8:e0417. [PMID: 38563584 PMCID: PMC10990366 DOI: 10.1097/hc9.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
Complementary and alternative medicines (CAM) include conventional medical treatments. Patients worldwide use CAM at alarming rates; thus, reports of CAM-related DILI have been on the rise. The clinical presentations include asymptomatic liver test abnormalities, acute hepatitis with or without jaundice, acute cholestatic liver disease (bland or with hepatitis), acute liver failure, severe hepatitis with features of portal hypertension, and acute decompensation of known or unknown cirrhosis that can lead to acute-on-chronic liver failure. Acute hepatitis with or without necrosis, hepatocellular and canalicular cholestasis, herb-induced or CAM-triggered autoimmune hepatitis, granulomatous hepatitis, severe steatohepatitis, and vanishing bile duct syndrome are common liver biopsy findings in CAM-DILI. The presence of preexisting liver disease predicts severe liver injury, risk of progression to liver failure, and decreased transplant-free survival in patients with CAM-DILI. This review discusses global epidemiology and trends in CAM-DILI, clinical presentation, assessment and outcomes, commonly emerging threats in the context of hepatotoxic herbs, pragmatic assessment of "liver beneficial" herbs and health care myths, patient communication, regulatory framework, and future directions on research in CAM.
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Affiliation(s)
- Cyriac Abby Philips
- Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
- Department of Clinical Research, Division of Complementary and Alternative Medicine (AYUSH) and the Liver, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Arif Hussain Theruvath
- Department of Clinical Research, Division of Complementary and Alternative Medicine (AYUSH) and the Liver, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Resmi Ravindran
- Department of Clinical Research, Division of Complementary and Alternative Medicine (AYUSH) and the Liver, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Philip Augustine
- Gastroenterology and Advanced G.I Endoscopy, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
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154
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Gao C, Dai Y, Chai Y, Wang Y, Wu J, Ye M, Yi X, Jiang X, Jia Q. Knowledge, Attitudes, Willingness, and Associated Factors to Organ Donation Among Intensive Care Unit Health Care Workers: Findings of a Cross-Sectional Study. Transplant Proc 2024; 56:469-478. [PMID: 38365513 DOI: 10.1016/j.transproceed.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/18/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND The lack of donor organs is a major barrier to the advancement of organ transplantation. This study aimed to understand the current status of knowledge, attitudes, and willingness to donate organs among intensive care unit (ICU) health care workers and analyzed the influencing factors to provide a scientific basis for improving the situation of a serious imbalance between the ratio of organ supply and demand. METHODS From November 2021 to March 2022, 160 ICU health care workers from 3 level 3A hospitals in Huzhou City, Zhejiang Province, China were chosen as subjects by the cluster sampling method. A cross-sectional study of the participants was carried out using a general information questionnaire, Organ Donation Knowledge Scale, Organ Donation Attitude Scale, and Organ Donation Willingness Scale. The determinants of ICU health care workers' knowledge, attitudes, and willingness toward organ donation were examined using multiple linear regression analysis. RESULTS A total of 150 ICU health care workers completed the survey within the prescribed time, and the recovery rate of this questionnaire was 93.75%. The score on the Organ Donation Knowledge Scale was 7 (5, 7) points, and the full score was 10 points. The score on the Organ Donation Attitude Scale was (3.87 ± 0.93), and the full score was 7. The Organ Donation Willingness Scale score was 2 (2, 3) out of 5. The results of the multiple linear regression analysis revealed that several factors significantly influenced the score of organ donation knowledge. These factors were identified as the professional title and persuasive experience related to organ donation. Additionally, the score of organ donation attitude was found to be influenced primarily by the persuasive experience of organ donation. Furthermore, the score of organ donation willingness was influenced by 3 main factors: marital status, professional title, and persuasive experience in the context of organ donation. CONCLUSIONS Although the level of ICU health care workers' knowledge and attitudes toward organ donation was above the median level, they still needed to be improved. The current status of ICU health care workers' desire to donate organs is not optimistic; thus, relevant departments should take specific actions to improve the situation.
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Affiliation(s)
- Chu Gao
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yaqin Dai
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Yufei Chai
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yingying Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiayun Wu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mengyuan Ye
- School of Nursing, Huzhou Teachers College, Huzhou, Zhejiang, China
| | - Xiaoyan Yi
- School of Nursing, Huzhou Teachers College, Huzhou, Zhejiang, China
| | - Xiurong Jiang
- School of Nursing, Huzhou Teachers College, Huzhou, Zhejiang, China.
| | - Qin Jia
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China.
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155
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Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, Kim J, Sinn DH, Joo DJ, Choi Y, Lee JH, Choi HJ, Yoon KT, Yim SY, Park CS, Kim DG, Lee HW, Choi WM, Chon YE, Kang WH, Rhu J, Lee JG, Cho Y, Sung PS, Lee HA, Kim JH, Bae SH, Yang JM, Suh KS, Al Mahtab M, Tan SS, Abbas Z, Shresta A, Alam S, Arora A, Kumar A, Rathi P, Bhavani R, Panackel C, Lee KC, Li J, Yu ML, George J, Tanwandee T, Hsieh SY, Yong CC, Rela M, Lin HC, Omata M, Sarin SK. Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024; 18:299-383. [PMID: 38416312 DOI: 10.1007/s12072-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.
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Affiliation(s)
- Dong-Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheon-Soo Park
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deok-Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Woo-Hyoung Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Ilsan, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Soek Siam Tan
- Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Zaigham Abbas
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ananta Shresta
- Department of Hepatology, Alka Hospital, Lalitpur, Nepal
| | - Shahinul Alam
- Crescent Gastroliver and General Hospital, Dhaka, Bangladesh
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Pravin Rathi
- TN Medical College and BYL Nair Hospital, Mumbai, India
| | - Ruveena Bhavani
- University of Malaya Medical Centre, Petaling Jaya, Selangor, Malaysia
| | | | - Kuei Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jun Li
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming-Lung Yu
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | - H C Lin
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Bunkyo City, Japan
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156
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Kumar S, Irtaza M, Patra BR, Rao PK, Gopan A, Kale AP, Shukla A. Clinical profile of adult and pediatric patients with hepatic Wilson's disease. Indian J Gastroenterol 2024; 43:425-433. [PMID: 38730078 DOI: 10.1007/s12664-024-01586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The clinical profile varies in patients with Wilson's disease (WD). There is paucity of data regarding adult and pediatric patients with hepatic WD. METHODS As many as 140 consecutive patients diagnosed with hepatic WD between December 2006 and January 2021 were included in the study. Data was collected regarding the demographic parameters, clinical presentation, extrahepatic organ involvement, liver histology and laboratory investigations. Adult and children (0-14 years) with hepatic WD were compared regarding these features. RESULT Eighty-eight adults and 52 children were included in the study. The median age of presentation was 17 years (range: 1.1-42 years). Male preponderance was seen (adult 68/88, 69%; children 40/52, 77%). Adults as compared to children presented more commonly as cirrhosis (52/88 vs. 15/52, p = 0.0005) and with hepatic decompensation (35/88 vs. 9/52, p = 0.005). Presentation with acute-on-chronic liver failure (ACLF) was more common in children (10/52 vs. 2/88, p = 0.0005). Twenty-eight-day mortality was 50% (5/10) in children and none in adults presenting with ACLF. Nazer's Prognostic Index (≥ 7) and New Wilson Index were more accurate in predicting mortality among children with ACLF with AUROC 1, while AARC (APASL ACLF Research Consortium) was less accurate with AUROC 0.45. Liver histology findings were similar in adults and children. Extrahepatic involvement was also similar. (8/88 in adults vs. 3/52 children, p value 0.48). CONCLUSION Most patients with WD present as cirrhosis in adulthood. ACLF is more common in children. Nazer's prognostic index and new Wilson Index score are accurate in predicting mortality in children with ACLF.
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Affiliation(s)
- Sanjay Kumar
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Gastroenterology Office, 9th Floor, New Building, Parel, Mumbai, 400 012, India
| | - Mohd Irtaza
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Gastroenterology Office, 9th Floor, New Building, Parel, Mumbai, 400 012, India
| | - Biswa Ranjan Patra
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Gastroenterology Office, 9th Floor, New Building, Parel, Mumbai, 400 012, India
| | - Praveen Kumar Rao
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Gastroenterology Office, 9th Floor, New Building, Parel, Mumbai, 400 012, India
| | - Amrit Gopan
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Gastroenterology Office, 9th Floor, New Building, Parel, Mumbai, 400 012, India
| | - Aditya P Kale
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Gastroenterology Office, 9th Floor, New Building, Parel, Mumbai, 400 012, India
| | - Akash Shukla
- Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Gastroenterology Office, 9th Floor, New Building, Parel, Mumbai, 400 012, India.
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157
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Graf C, Sarrazin C. [The status of national and global hepatitis C elimination]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:308-317. [PMID: 38478058 DOI: 10.1007/s00108-024-01684-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND In 2016, the World Health Organization propagated the elimination of hepatitis C virus (HCV) by 2030 in order to address the public health threat posed by viral hepatitis. This article looks at the progress that has been made globally and in Germany since 2016. METHODS A selective literature search was conducted, with particular focus on studies and reviews relating to the elimination of hepatitis C infection both globally and in Germany. RESULTS In 2020, 56.8 million HCV infections were counted worldwide, which corresponds to a decline of 6.8 million since 2015. Countries that made a significant contribution to the elimination figures during this period included Egypt, Georgia, and Iceland, which were able to drastically reduce the number of HCV infections by means of national commitment in politics and healthcare. With regard to the status of elimination in Germany, the inclusion of screening for viral hepatitis in the general health check-up ("Check-up 35") in 2022/2023 has led to a significant increase in HCV case numbers. Globally and in Germany, men who have sex with men, intravenous drug users, migrants, and prison inmates are particularly vulnerable groups with regard to HCV infection. CONCLUSION In order to sustainably eliminate HCV, it is necessary to optimize education and prevention strategies in risk groups. With regard to the subgroup of prison inmates, political measures must be used to create a standardized approach in prison medicine. At a global level, elimination in low- and middle-income countries needs to be promoted in the future.
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Affiliation(s)
- Christiana Graf
- Medizinische Klinik II, LMU Universitätsklinikum München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Christoph Sarrazin
- Medizinische Klinik I, Klinikum der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Deutschland
- Medizinische Klinik II, St. Josefs-Hospital, Wiesbaden, Deutschland
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158
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Garoufalia Z, Bellato V, Cunha MF, Avellaneda N, Dudi-Venkata NN, Gallardo C, Meyer J, Zaffaroni G, Christensen P, Aytac E, Brady RRW, Pellino G. A narrative on diversity, equity, and inclusion in surgery: insights from the European Society of Coloproctology and identification of points for action. Updates Surg 2024; 76:529-537. [PMID: 38280108 PMCID: PMC10995079 DOI: 10.1007/s13304-023-01685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 01/29/2024]
Abstract
The focus of the 2022 European Society of Coloproctology (ESCP) annual campaign was diversity, equity, and inclusion (DEI) in surgery. The ESCP "Operation Equal Access" campaign sought to interview key-opinion leaders and trainees, to raise awareness on inequalities, inform the community of the status of the topic, and to identify future areas for improvement. The ESCP Social Media Working Group interviewed experts who have made significant contributions to DEI in colorectal surgery and were acknowledged opinion leaders in the field. The interviews focused on their career, professional life, experiences, and opportunities during their training, and their views on DEI in colorectal surgery. DEI principles, education, and values need further promotion to reduce and address bias within the profession and overall improve the experience of minority community including health professionals and patients. International Societies are working to facilitate training opportunities and overcome DEI, and networking have contributed to that. Collaborations between societies will be pivotal to contribute to offering research and leadership opportunities equally. Access to advanced workshops including cadaveric training and simulation can be consistently promoted and provided globally via societies through telemonitoring. Involving patients in research should be encouraged, as it brings the perspective of a living experience.
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Affiliation(s)
- Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
| | - Vittoria Bellato
- ESCP Social Media Committee Co-Chair, ESCP, Portsmouth, United Kingdom
- Minimally Invasive Surgery Unit, Università di Tor Vergata, Rome, Italy
- Gastroenterology Surgery Department, San Raffaele Hospital, Milan, Italy
| | - Miguel F Cunha
- ESCP Social Media Committee Co-Chair, ESCP, Portsmouth, United Kingdom
- Surgical Department, Algarve University Hospital, Portimão, Portugal
| | - Nicolas Avellaneda
- Nueva Proctologia, Buenos Aires, Argentina
- CEMIC, Buenos Aires, Argentina
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nagendra N Dudi-Venkata
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Cristián Gallardo
- Servicio de Coloproctologia, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland
- Medical School, University of Geneva, Rue Michel-Servet 1, 1205, Genève, Switzerland
| | | | - Peter Christensen
- Danish Cancer Society National Research Centre for Survivorship and Late Side Effect to Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Erman Aytac
- Department of Surgery, School of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Instanbul, Turkey
- Incoming ESCP Communication Committee Chair, ESCP, Portsmouth, United Kingdom
| | - Richard R W Brady
- Newcastle Centre for Bowel Disease Research Group, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Queen Victoria Road, Newcastle Upon Tyne, United Kingdom
- ESCP Communication Committee Chair, ESCP, Portsmouth, United Kingdom
| | - Gianluca Pellino
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.
- Department of Advanced Medical and Surgical Sciences, Universitá Degli Studi Della Campania "Luigi Vanvitelli, Naples, Italy.
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Shinde S, Taylor N, Chinthammit C, Wilson R, Burgess SM, Poon JL. Understanding the impact of non-alcoholic steatohepatitis with metabolic comorbidities on adults: a real-world qualitative study. Curr Med Res Opin 2024; 40:665-676. [PMID: 38363353 DOI: 10.1080/03007995.2024.2319820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Limited real-world evidence exists to better understand the patient experience of living with symptoms and impacts of non-alcoholic steatohepatitis (NASH). This study aimed to (1) describe patient-reported perspectives of NASH symptoms and impacts on patients' daily lives and (2) develop a patient-centered conceptual NASH model. METHODS A cross-sectional study using semi-structured qualitative interviews was conducted among adults (≥18 years) in the United States living with NASH. Eligible participants were diagnosed with NASH, had mild to advanced fibrosis (F1-F3), and no other causes of liver disease. The interview guide was informed by a targeted literature review (TLR) to identify clinical signs, symptoms, impacts, and unmet treatment needs of NASH. Participants described their experiences and perspectives around NASH and the symptoms, symptom severity/bother, and impact of NASH on their daily activities. Interviews were audio-recorded and transcribed verbatim for coding and thematic analysis. RESULTS Twenty participants (age: 42.4 years; female: 50.0%) were interviewed. Participants discussed their experience with NASH symptoms (most frequent: fatigue [75.0%]; weakness/lethargy [70.0%]) and impacts (most frequent: physical and psychological/emotional [70.0% each]; dietary [68.4%]). Participants considered most symptoms to be moderately severe or severe and moderately or highly bothersome. Findings from the TLR and qualitative interviews were incorporated into a conceptual model that describes patient-reported symptoms and impacts of NASH, clinical signs, risk factors, and unmet treatment needs. CONCLUSION Our study provides insights into patients' perspectives of NASH symptoms and their impact on their daily lives. These findings may guide patient-physician conversations, supporting patient-centered treatment decisions and disease management.
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Yu ML, Tai CM, Mo LR, Kuo HT, Huang CF, Tseng KC, Lo CC, Bair MJ, Wang SJ, Huang JF, Yeh ML, Chen CT, Tsai MC, Huang CW, Lee PL, Yang TH, Huang YH, Chong LW, Chen CL, Yang CC, Hung CH, Yang SS, Cheng PN, Hsieh TY, Hu JT, Wu WC, Cheng CY, Chen GY, Zhou GX, Tsai WL, Kao CN, Lin CL, Wang CC, Lin TY, Lin CL, Su WW, Lee TH, Chang TS, Liu CJ, Dai CY, Chen CY, Kao JH, Lin HC, Chuang WL, Peng CY. An algorithm for simplified hepatitis C virus treatment with non-specialist care based on nation-wide data from Taiwan. Hepatol Int 2024; 18:461-475. [PMID: 38246899 PMCID: PMC11014878 DOI: 10.1007/s12072-023-10609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/10/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Both European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD-IDSA) guidelines recommend simplified hepatitis C virus (HCV) treatment with pan-genotypic sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for eligible patients. This observational study used real-world data to assess these regimens' safety in eligible patients and develop an algorithm to identify patients suitable for simplified treatment by non-specialists. METHODS 7,677 HCV-infected patients from Taiwan Hepatitis C Registry (TACR) who received at least one dose of sofosbuvir/velpatasvir or glecaprevir/pibrentasvir, and fulfilled the EASL/AASLD-IDSA criteria for simplified treatment were analyzed. Multivariate analysis was conducted on patient characteristics and safety data. RESULTS Overall, 92.8% (7,128/7,677) of patients achieved sustained virological response and only 1.9% (146/7,677) experienced Grades 2-4 laboratory abnormalities in key liver function parameters (alanine aminotransferase, aspartate aminotransferase, and total bilirubin), with only 18 patients (0.23%) experiencing Grades 3-4 abnormalities. Age > 70 years old, presence of hepatocellular carcinoma, total bilirubin > 1.2 mg/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, and Fibrosis-4 > 3.25 were associated with higher risks of Grades 2-4 abnormalities. Patients with any of these had an odds of 4.53 times than that of those without in developing Grades 2-4 abnormalities (p < 0.01). CONCLUSIONS Real-world data from Taiwan confirmed that simplified HCV treatment for eligible patients with pan-genotypic regimens is effective and well tolerated. The TACR algorithm, developed based on this study's results, can further identify patients who can be safely managed by non-specialist care.
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Affiliation(s)
- Ming-Lung Yu
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, No. 70, Lianhai Rd, Gushan District, Kaohsiung City, Taiwan, 804
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd, Niaosong District, Kaohsiung City, Taiwan, 833
| | - Chi-Ming Tai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, I-Shou University, No. 1, Section 1, Xuecheng Rd, Dashu District, Kaohsiung City, Taiwan, 840
- School of Medicine for International Students, College of Medicine, I-Shou University, No. 1, Section 1, Xuecheng Rd, Dashu District, Kaohsiung City, Taiwan, 840
| | - Lein-Ray Mo
- Division of Gastroenterology, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), No. 670, Chongde Rd, East District, Tainan City, Taiwan, 701
| | - Hsing-Tao Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd, Yongkang District, Tainan City, Taiwan, 710
- School of Medicine, College of Medicine, National Sun Yat-Sen University, No. 70, Lianhai Rd, Gushan District, Kaohsiung City, Taiwan, 804
| | - Chung-Feng Huang
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, No. 70, Lianhai Rd, Gushan District, Kaohsiung City, Taiwan, 804
- Ph.D. Program in Translational Medicine, College of Medicine, Kaohsiung Medical University and Academia Sinica, No. 128, Section 2, Academia Rd, Nangang District, Taipei City, Taiwan, 115
| | - Kuo-Chih Tseng
- Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd, Dalin Township, Chiayi County, Taiwan, 622
- School of Medicine, Tzuchi University, No. 701, Section 3, Zhongyang Rd, Hualien City, Hualien County, Taiwan, 970
| | - Ching-Chu Lo
- Division of Gastroenterology, Department of Internal Medicine, St. Martin De Porres Hospital, No. 60, Minquan Rd, East District, Chiayi City, Taiwan, 600
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, No. 1, Lane 303, Zhangsha St, Taitung City, Taitung County, Taiwan, 950
- Mackay Medical College, No. 46, Section 3, Zhongzheng Rd, Sanzhi District, New Taipei City, Taiwan, 252
| | - Szu-Jen Wang
- Division of Gastroenterology, Department of Internal Medicine, Yuan's General Hospital, No. 162, Chenggong 1st Rd, Lingya District, Kaohsiung City, Taiwan, 802
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
| | - Chun-Ting Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd, Neihu District, Taipei City, Taiwan, 114
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County, Taiwan, 880
| | - Ming-Chang Tsai
- School of Medicine, Chung Shan Medical University, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N Rd, South District, Taichung City, Taiwan, 402
| | - Chien-Wei Huang
- Division of Gastroenterology, Kaohsiung Armed Forces General Hospital, No. 2, Zhongzheng 1st Rd, Lingya District, Kaohsiung City, Taiwan, 802
| | - Pei-Lun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd, Yongkang District, Tainan City, Taiwan, 710
| | - Tzeng-Hue Yang
- Lotung Poh-Ai Hospital, No. 83, Nanchang St, Luodong Township, Yilan County, Taiwan, 265
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, Beitou District, Taipei City, Taiwan, 112
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City, Taiwan, 112
| | - Lee-Won Chong
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Shilin District, Taipei City, Taiwan, 111
- School of Medicine, Fu-Jen Catholic University, No. 510, Zhongzheng Rd, Xinzhuang District, New Taipei City, Taiwan, 242
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, No. 701, Section 3, Zhongyang Rd, Hualien City, Hualien County, Taiwan, 970
| | - Chi-Chieh Yang
- Department of Gastroenterology, Division of Internal Medicine, Show Chwan Memorial Hospital, No. 542, Section 1, Zhongshan Rd, Changhua City, Changhua County, Taiwan, 500
| | - Chao-Hung Hung
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd, Niaosong District, Kaohsiung City, Taiwan, 833
| | - Sheng-Shun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung City, Taiwan, 407
| | - Pin-Nan Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 1, Dasyue Rd, East District, Tainan City, Taiwan, 701
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd, Neihu District, Taipei City, Taiwan, 114
| | - Jui-Ting Hu
- Liver Center, Cathay General Hospital, No. 280, Section 4, Ren'ai Rd, Da'an District, Taipei City, Taiwan, 106
| | - Wen-Chih Wu
- Wen-Chih Wu Clinic, Fengshan, Kaohsiung, Taiwan, 830
| | - Chien-Yu Cheng
- Division of Infectious Diseases, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, No. 1492, Zhongshan Rd, Taoyuan District, Taoyuan City, Taiwan, 330
- Institute of Public Health, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City, Taiwan, 112
| | - Guei-Ying Chen
- Penghu Hospital, Ministry of Health and Welfare, No. 10, Zhongzheng Rd, Magong City, Penghu County, Taiwan, 880
| | | | - Wei-Lun Tsai
- Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung City, Taiwan, 813
| | - Chien-Neng Kao
- National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Section 1, Jingguo Rd, North District, Hsinchu City, Taiwan, 300
| | - Chih-Lang Lin
- Liver Research Unit, Department of Hepato-Gastroenterology and Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, No. 222, Maijin Rd, Anle District, Keelung City, Taiwan, 204
| | - Chia-Chi Wang
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu Chi University, No. 289, Jianguo Rd, Xindian District, New Taipei City, Taiwan, 231
| | - Ta-Ya Lin
- Cishan Hospital, Ministry of Health and Welfare, No. 60, Zhongxue Rd, Qishan District, Kaohsiung City, Taiwan, 842
| | - Chih-Lin Lin
- Department of Gastroenterology, Renai Branch, Taipei City Hospital, No. 10, Section 4, Ren'ai Rd, Da'an District, Taipei City, Taiwan, 106
| | - Wei-Wen Su
- Department of Gastroenterology and Hepatology, Changhua Christian Hospital, No. 176, Zhonghua Rd, Changhua City, Changhua County, Taiwan, 500
| | - Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Far Eastern Memorial Hospital, No. 21, Section 2, Nanya S Rd, Banqiao District, New Taipei City, Taiwan, 220
| | - Te-Sheng Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan and College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd, Guishan District, Taoyuan City, Taiwan, 333
| | - Chun-Jen Liu
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 4, Roosevelt Rd, Da'an District, Taipei City, Taiwan, 106
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, No. 539, Zhongxiao Rd, East District, Chiayi City, Taiwan, 600
| | - Jia-Horng Kao
- Hepatitis Research Center and Department of Internal Medicine, National Taiwan University Hospital, No. 1, Section 4, Roosevelt Rd, Da'an District, Taipei City, Taiwan, 106
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd, Beitou District, Taipei City, Taiwan, 112
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao Tung University, No. 155, Section 2, Linong St, Beitou District, Taipei City, Taiwan, 112
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807.
- Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, No. 100, Shihcyuan 1st Rd, Sanmin District, Kaohsiung City, Taiwan, 807.
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Rd, North District, Taichung City, Taiwan, 404.
- School of Medicine, China Medical University, No. 91, Xueshi Rd, North District, Taichung City, Taiwan, 404.
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Yi K, Wang Y, Rong Y, Bao Y, Liang Y, Chen Y, Liu F, Zhang S, He Y, Liu W, Zhu C, Wu L, Peng J, Chen H, Huang W, Yuan Y, Xie M, Wang F. Transcriptomic Signature of 3D Hierarchical Porous Chip Enriched Exosomes for Early Detection and Progression Monitoring of Hepatocellular Carcinoma. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2305204. [PMID: 38327127 PMCID: PMC11005692 DOI: 10.1002/advs.202305204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/01/2023] [Indexed: 02/09/2024]
Abstract
Hepatocellular carcinoma (HCC) is a highly lethal malignant tumor, and the current non-invasive diagnosis method based on serum markers, such as α-fetoprotein (AFP), and des-γ-carboxy-prothrombin (DCP), has limited efficacy in detecting it. Therefore, there is a critical need to develop novel biomarkers for HCC. Recent studies have highlighted the potential of exosomes as biomarkers. To enhance exosome enrichment, a silicon dioxide (SiO2) microsphere-coated three-dimensional (3D) hierarchical porous chip, named a SiO2-chip is designed. The features of the chip, including its continuous porous 3D scaffold, large surface area, and nanopores between the SiO2 microspheres, synergistically improved the exosome capture efficiency. Exosomes from both non-HCC and HCC subjects are enriched using an SiO2-chip and performed RNA sequencing to identify HCC-related long non-coding RNAs (lncRNAs) in the exosomes. This study analysis reveales that LUCAT-1 and EGFR-AS-1 are two HCC-related lncRNAs. To further detect dual lncRNAs in exosomes, quantitative real time polymerase chain reaction (qRT-PCR) is employed. The integration of dual lncRNAs with AFP and DCP significantly improves the diagnostic accuracy. Furthermore, the integration of dual lncRNAs with DCP effectively monitors the prognosis of patients with HCC and detects disease progression. In this study, a liquid biopsy-based approach for noninvasive and reliable HCC detection is developed.
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Affiliation(s)
- Kezhen Yi
- Department of Laboratory MedicineZhongnan Hospital of Wuhan UniversityNo.169 Donghu Road, Wuchang DistrictWuhan430071P. R. China
| | - Yike Wang
- College of Chemistry and Molecular SciencesWuhan UniversityWuhan430072P. R. China
| | - Yuan Rong
- Department of Laboratory MedicineZhongnan Hospital of Wuhan UniversityNo.169 Donghu Road, Wuchang DistrictWuhan430071P. R. China
| | - Yiru Bao
- College of Chemistry and Molecular SciencesWuhan UniversityWuhan430072P. R. China
| | - Yingxue Liang
- College of Chemistry and Molecular SciencesWuhan UniversityWuhan430072P. R. China
| | - Yiyi Chen
- Department of Laboratory MedicineZhongnan Hospital of Wuhan UniversityNo.169 Donghu Road, Wuchang DistrictWuhan430071P. R. China
| | - Fusheng Liu
- Department of Hepatobiliary & Pancreatic SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubei430071P.R. China
| | - Shikun Zhang
- Department of Hepatobiliary & Pancreatic SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubei430071P.R. China
| | - Yuan He
- Medical Research Center for Structural BiologySchool of Basic Medical SciencesWuhan UniversityWuhan430072P. R. China
| | - Weihuang Liu
- Medical Research Center for Structural BiologySchool of Basic Medical SciencesWuhan UniversityWuhan430072P. R. China
| | - Chengliang Zhu
- Department of Clinical LaboratoryInstitute of Translational MedicineRenmin Hospital of Wuhan UniversityWuhanHubei430060P. R. China
| | - Long Wu
- Department of OncologyRenmin Hospital of Wuhan UniversityWuhan430060P. R. China
| | - Jin Peng
- Department of Radiation and Medical OncologyZhongnan HospitalWuhan UniversityWuhan430071P. R. China
| | - Hao Chen
- Department of PathologyZhongnan Hospital of Wuhan UniversityWuhan430071P. R. China
| | - Weihua Huang
- College of Chemistry and Molecular SciencesWuhan UniversityWuhan430072P. R. China
- Department of Hepatobiliary & Pancreatic SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubei430071P.R. China
| | - Yufeng Yuan
- Department of Hepatobiliary & Pancreatic SurgeryZhongnan Hospital of Wuhan UniversityWuhanHubei430071P.R. China
- Clinical Medicine Research Center for Minimally Invasive Procedure of Hepatobiliary & Pancreatic Diseases of Hubei ProvinceWuhanHubei430071P. R. China
- Tai Kang Center for Life and Medical SciencesWuhan UniversityWuhanHubei430071P. R. China
| | - Min Xie
- College of Chemistry and Molecular SciencesWuhan UniversityWuhan430072P. R. China
| | - Fubing Wang
- Department of Laboratory MedicineZhongnan Hospital of Wuhan UniversityNo.169 Donghu Road, Wuchang DistrictWuhan430071P. R. China
- Center for Single‐Cell Omics and Tumor Liquid BiopsyZhongnan Hospital of Wuhan UniversityWuhan430071P. R. China
- Wuhan Research Center for Infectious Diseases and CancerChinese Academy of Medical SciencesWuhan430071P. R. China
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Freeland C, Lo W, Kabagambe K, Wang S, Adda D, Graham CS, Gish R, Cohen C. Urgent need for lived experience in hepatitis B guideline development. Lancet Gastroenterol Hepatol 2024; 9:282-284. [PMID: 38272054 DOI: 10.1016/s2468-1253(23)00455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Affiliation(s)
| | - Wendy Lo
- Hepatitis B Foundation, Doylestown, PA, USA
| | - Kenneth Kabagambe
- The National Organisation for People Living with Hepatitis B, Kampala, Uganda
| | - Su Wang
- Hepatitis B Foundation, Doylestown, PA, USA; Center for Asian Health & Viral Hepatitis Programs, Cooperman Barnabas Medical Center, Livingston, NJ, USA
| | | | - Camilla S Graham
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Malaguti A, Byrne CJ, Sani F, Power K, Eriksen A, Dillon JF. Drug network identification predicts injecting risk behavior among people who inject drugs on hepatitis C virus treatment in Tayside, Scotland. Behav Med 2024; 50:130-140. [PMID: 36411523 DOI: 10.1080/08964289.2022.2142501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/10/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022]
Abstract
The risk of Hepatitis C Virus (HCV) acquisition among People Who Inject Drugs (PWID) remains high when injecting risk behavior within networks endures. Several psychosocial factors influence such behavior. Following a drive within Tayside, a geographic region in Scotland, to achieve World Health Organization HCV elimination targets, addressing HCV re-infection risk as a barrier to elimination is critically important. This cross-sectional study seeks to address this barrier to elimination by investigating associations between group identification (one's subjective sense of belonging and connectedness to a social group coupled with a sense of shared goals, beliefs and values with the other members of the group) and injecting risk behavior among PWID on HCV treatment at needle and syringe provision sites in Tayside. Participants completed psychosocial questionnaires between treatment weeks zero and three of treatment. Correlation analyses were undertaken, and significant factors included in multiple linear regression models for injecting risk behavior. Injecting frequency, drug network identification, and family identification, were correlated with injecting risk behavior, and drug network identification had a positive predictive on injecting risk behavior. Identification with a social group, conventionally associated with improved health, may pose health risks in specific contexts. Healthcare providers should consider stratifying individuals with higher group identification with PWID networks for enhanced harm reduction engagement to mitigate transmissible infection risk among PWID. Additionally, psychological interventions to strengthen group identification with networks which impact positively on health behavior should be explored.
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Affiliation(s)
- Amy Malaguti
- Tayside Drug and Alcohol Recovery Psychology Service, Constitution House, NHS Tayside, Dundee, UK
- Department of Psychology, Scrymgeour Building, School of Social Sciences, University of Dundee, Dundee, UK
| | - Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - Fabio Sani
- Department of Psychology, Scrymgeour Building, School of Social Sciences, University of Dundee, Dundee, UK
| | - Kevin Power
- Tayside Adult Psychological Therapy Services, Dudhope Terrace, NHS Tayside, Dundee, UK
- School of Natural Sciences, University of Stirling, Stirling, UK
| | - Ann Eriksen
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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164
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Mao Y, Ma S, Liu C, Liu X, Su M, Li D, Li Y, Chen G, Chen J, Chen J, Zhao J, Guo X, Tang J, Zhuge Y, Xie Q, Xie W, Lai R, Cai D, Cai Q, Zhi Y, Li X. Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update. Hepatol Int 2024; 18:384-419. [PMID: 38402364 DOI: 10.1007/s12072-023-10633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/18/2023] [Indexed: 02/26/2024]
Abstract
Drug-induced liver injury (DILI) is an important adverse drug reaction that can lead to acute liver failure or even death in severe cases. Currently, the diagnosis of DILI still follows the strategy of exclusion. Therefore, a detailed history taking and a thorough and careful exclusion of other potential causes of liver injury is the key to correct diagnosis. This guideline was developed based on evidence-based medicine provided by the latest research advances and aims to provide professional guidance to clinicians on how to identify suspected DILI timely and standardize the diagnosis and management in clinical practice. Based on the clinical settings in China, the guideline also specifically focused on DILI in chronic liver disease, drug-induced viral hepatitis reactivation, common causing agents of DILI (herbal and dietary supplements, anti-tuberculosis drugs, and antineoplastic drugs), and signal of DILI in clinical trials and its assessment.
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Affiliation(s)
- Yimin Mao
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, NHC Key Laboratory of Digestive Diseases, Shanghai Research Center of Fatty Liver Disease, Shanghai, 200001, China.
| | - Shiwu Ma
- Department of Infectious Diseases, The 920th Hospital of Chinese PLA Joint Logistics Support Force, Kunming, 650032, Yunnan, China
| | - Chenghai Liu
- Institute of Liver Diseases, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xiaoyan Liu
- Department of Pharmacy, Huangpu Branch of the 9th People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Minghua Su
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dongliang Li
- Department of Hepatobiliary Medicine, The 900th Hospital of Chinese PLA Joint Logistics Support Force, Fuzhou, 350025, Fujian, China
| | - Yiling Li
- Department of Gastroenterology, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Gongying Chen
- Department of Liver Diseases, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, Zhejiang, China
| | - Jun Chen
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, 518112, Guangdong, China
| | - Jinjun Chen
- Hepatology Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jingmin Zhao
- Department of Pathology and Hepatology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Xiaoyan Guo
- Department of Gastroenterology, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Jieting Tang
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, NHC Key Laboratory of Digestive Diseases, Shanghai Research Center of Fatty Liver Disease, Shanghai, 200001, China
| | - Yuzheng Zhuge
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Wen Xie
- Center of Liver Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, 100088, China
| | - Rongtao Lai
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Dachuan Cai
- Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Qingxian Cai
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, 518112, Guangdong, China
| | - Yang Zhi
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, NHC Key Laboratory of Digestive Diseases, Shanghai Research Center of Fatty Liver Disease, Shanghai, 200001, China
| | - Xiaoyun Li
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, NHC Key Laboratory of Digestive Diseases, Shanghai Research Center of Fatty Liver Disease, Shanghai, 200001, China
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165
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Tamaki N, Higuchi M, Keitoku T, Yamazaki Y, Uchihara N, Suzuki K, Tanaka Y, Miyamoto H, Yamada M, Okada R, Takaura K, Tanaka S, Maeyashiki C, Yasui Y, Tsuchiya K, Nakanishi H, Kanto T, Kurosaki M, Izumi N. Magnetic resonance elastography for the prediction of hepatocellular carcinoma in chronic hepatitis B. JGH Open 2024; 8:e13067. [PMID: 38665298 PMCID: PMC11044154 DOI: 10.1002/jgh3.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
Background and Aim Magnetic resonance elastography (MRE) is used for the evaluation of liver fibrosis; however, it remains unclear whether MRE-based liver stiffness is associated with hepatocellular carcinoma (HCC) development, particularly in patients with chronic hepatitis B. Methods A total of 504 patients with chronic hepatitis B receiving MRE were enrolled. The primary endpoint was the association between MRE-based liver stiffness and HCC. Results In a cross-sectional analysis at the time of MRE measurement, the median (interquartile range) liver stiffness values in patients with presence or history of HCC and those without HCC were 3.68 (2.89-4.96) and 2.60 (2.22-3.45) kPa, respectively, and liver stiffness was significantly higher in patients with presence or history of HCC than in those without HCC (P < 0.001). In a longitudinal analysis of patients without HCC, the 1-, 3-, and 5-year cumulative incidence of HCC in patients with liver stiffness ≥3.6 kPa and those with liver stiffness <3.6 kPa were 3.8%, 7.0%, and 22.9%, and 0%, 0.9%, and 1.5%, respectively (P < 0.001). In the multivariable analysis, MRE-based liver stiffness (per 1 kPa) or liver stiffness ≥3.6 kPa was an independent factor for HCC development with an adjusted hazard ratio (aHR) of 1.61 (95% confidence interval [CI], 1.3-2.0) or aHR of 8.22 (95% CI, 2.1-31). Conclusion MRE-based liver stiffness is associated with HCC risk in patients with chronic hepatitis B and may be used for the early prediction of HCC development and determination of indications for treatment.
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Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Mayu Higuchi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Taisei Keitoku
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Yudai Yamazaki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Naoki Uchihara
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Keito Suzuki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Yuki Tanaka
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Haruka Miyamoto
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Michiko Yamada
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Risa Okada
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Kenta Takaura
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Shohei Tanaka
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Chiaki Maeyashiki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Yutaka Yasui
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Hiroyuki Nakanishi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Tatsuya Kanto
- Department of Liver DiseaseThe Research Center for Hepatitis and Immunology, National Center for Global Health and MedicineChibaJapan
| | - Masayuki Kurosaki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Namiki Izumi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
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166
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Minier N, Guingané AN, Okeke E, Sinkala E, Johannessen A, Andersson MI, Davwar P, Desalegn H, Duguru M, Fall F, Mboup S, Maponga T, Matthews PC, Ramírez Mena A, Ndow G, Orlien SMS, Riches N, Seydi M, Sonderup M, Spearman CW, Stockdale AJ, Taljaard J, Vinikoor M, Wandeler G, Lemoine M, Shimakawa Y, Sombié R. Development and evaluation of a simple treatment eligibility score (HEPSANET) to decentralise hepatitis B care in Africa: a cross-sectional study. Lancet Gastroenterol Hepatol 2024; 9:323-332. [PMID: 38367633 DOI: 10.1016/s2468-1253(23)00449-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Hepatitis B virus (HBV) elimination requires expanding and decentralising HBV care services. However, peripheral health facilities lack access to diagnostic tools to assess eligibility for antiviral therapy. Through the Hepatitis B in Africa Collaborative Network (HEPSANET), we aimed to develop and evaluate a score using tests generally available at lower-level facilities, to simplify the evaluation of antiviral therapy eligibility in people living with HBV. METHODS We surveyed the availability of clinical and laboratory parameters across different health-care levels in sub-Saharan Africa. We used data from the HEPSANET dataset, the largest cross-sectional dataset of treatment-naive people living with HBV in sub-Saharan Africa, to derive and validate the score. Participants from this dataset were included in the analysis if they were aged 18 years or older and had liver fibrosis stages determined by a liver stiffness measurement or liver histopathology. Participants with co-infections or metabolic disorders were excluded. We allocated participants to the derivation and validation sets by geographical site. In the derivation set, we used stepwise logistic regression to identify the best performing parameters for identifying participants that met the 2017 European Association for the Study of the Liver (EASL) criteria. Regression coefficients were converted into integer points to construct simplified algorithms for different health-care levels. In the validation set, we estimated the area under the receiver operating characteristic, sensitivity, and specificity of the simplified algorithm for identifying antiviral therapy eligibility defined by the 2017 EASL criteria. FINDINGS At 11 sites from eight countries that returned surveys, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count were generally available at district hospital levels, and hepatitis B e antigen and point-of-care HBV DNA tests were available only at regional and provincial hospital levels or above. Among 2895 participants included from the HEPSANET database (1740 [60·1%] male, 1155 [39·9%] female), 409 (14·1%) met EASL antiviral therapy eligibility criteria. In the derivation set, the optimal district-level hospital score was: ALT (IU/L), less than 40 (0 points), 40-79 (+1), 80 or greater (+2); AST (IU/L), less than 40 (0), 40-79 (+1), 80 or greater (+2); and platelet counts (109/L), less than 100 (+2), 100-149 (+1), 150 or greater (0). When combined with family history and clinical data for decompensated cirrhosis that do not require any biological tests, a cut-off of 2 points or more had a sensitivity and specificity of 82% (95% CI 76-86) and 95% (93-96) to identify treatment-eligible individuals in the derivation set, and 78% (71-85) and 87% (86-89) in the validation set, respectively. INTERPRETATION Using a score incorporating platelet counts, AST, and ALT, the majority of people living with HBV requiring antiviral therapy can be identified. Our findings suggest that clinical staging can be decentralised down to district hospital level in sub-Saharan Africa. FUNDING European Association for the Study of the Liver Foundation, John C Martin Foundation. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Nicolas Minier
- Insitut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France
| | - Alice Nanelin Guingané
- Hepato-Gastroenterology Department, Bogodogo University Hospital Center, Ouagadougou, Burkina Faso
| | - Edith Okeke
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Edford Sinkala
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia
| | - Asgeir Johannessen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway
| | - Monique I Andersson
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Division of Medical Virology, Stellenbosch University Faculty of Medicine and Health Sciences & National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Pantong Davwar
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Hailemichael Desalegn
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway; Medical Department, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mary Duguru
- Faculty of Medical Sciences, University of Jos, Jos, Nigeria
| | - Fatou Fall
- Department of Hepatology and Gastroenterology, Hopital Principal de Dakar, Dakar, Senegal
| | - Souleyman Mboup
- L'Institut de Recherche en Santé, de Surveillance Épidémiologique et de Formations (IRESSEF), Dakar, Senegal
| | - Tongai Maponga
- Division of Medical Virology, Stellenbosch University Faculty of Medicine and Health Sciences & National Health Laboratory Service, Tygerberg Business Unit, Cape Town, South Africa
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Adrià Ramírez Mena
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gibril Ndow
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK; MRC Unit The Gambia, London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Stian M S Orlien
- Department of Infectious Diseases, Vestfold Hospital, Tønsberg, Norway; Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Nicholas Riches
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moussa Seydi
- Service de Maladies Infectieuses et Tropicales, Centre Regional de Recherche et de Formation, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mark Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alexander J Stockdale
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Michael Vinikoor
- Department of Internal Medicine, University of Zambia, Lusaka, Zambia; University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Yusuke Shimakawa
- Insitut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France.
| | - Roger Sombié
- Hepato-Gastroenterology Department, Yalgado Ouédraogo University Hospital Center, Ouagadougou, Burkina Faso
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Hsu CW, Chen SC, Wang PN, Wang HM, Chen YC, Yeh CT. Preventing viral relapse with prophylactic tenofovir in hepatitis B carriers receiving chemotherapy: a phase IV randomized study in Taiwan. Hepatol Int 2024; 18:449-460. [PMID: 38376651 DOI: 10.1007/s12072-023-10635-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/22/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND AIMS This study aimed to compare the efficacy of shorter vs. longer tenofovir disoproxil fumarate (TDF) prophylaxis in preventing hepatitis B virus (HBV) relapse in cancer patients with chronic hepatitis B (CHB) undergoing chemotherapy. METHODS This phase IV, prospective randomized trial enrolled cancer patients with CHB from 2014 to 2019 in Taiwan. Included patients were randomized to receive either 24- (Arm A) or 48-week (Arm B) post-chemotherapy TDF and compared for cumulative incidence of virological and clinical relapse. Logistic regressions were conducted to determine the factors associated with HBV relapse. RESULTS One hundred patients were randomized, and 41 patients in Arm A and 46 in Arm B completed the TDF treatment. No significant difference was found in cumulative incidence of virological relapse (Arm A: 94.4%, Arm B: 93.1%, p = 0.110) or clinical relapse among patients with baseline HBV DNA > 2000 IU/mL (Arm A: 38.9%, Arm B: 26.7%, p = 0.420) between the two arms. High baseline HBV DNA ≥ 10,000 IU/mL (OR = 51.22) and HBsAg ≥ 1000 IU/mL (OR = 8.64) were independently associated with an increased virological relapse. Alanine aminotransferase (ALT), serum phosphorus, vitamin D, and estimated glomerular filtration rate (eGFR) remained stable throughout the study. CONCLUSIONS The 24-week preventative TDF has comparable efficacy to the 48-week treatment in virologic and clinical relapse. High baseline HBsAg or HBV DNA is associated with a higher risk of HBV relapse. These findings imply a 24-week duration of TDF treatment with a close monitor for patients with a high baseline viral load. Hepatitis B virus infection is a prominent cause of liver cancer and chronic liver disease and affected millions of people worldwide. When HBV-infected people are exposed to immunosuppressive medication or chemotherapy for cancer, the chance of HBV reactivation rises considerably. This trial showed 24-week tenofovir disoproxil fumarate (TDF) may be sufficient for preventing HBV relapse in cancer patients receiving chemotherapy. CLINICAL TRIAL REGISTRATION NUMBER NCT02081469.
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Affiliation(s)
- Chao-Wei Hsu
- Liver Research Center, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
| | - Shin-Cheh Chen
- Department of General Surgeon, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Po-Nan Wang
- Department of Hemato-Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Hung-Ming Wang
- Department of Oncology, Chang Gung Memorial Hospital, Gung University College of Medicine, Taipei, Taiwan
| | - Yi-Cheng Chen
- Liver Research Center, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chau-Ting Yeh
- Liver Research Center, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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168
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Chen LD, Huang ZR, Yang H, Cheng MQ, Hu HT, Lu XZ, Li MD, Lu RF, He DN, Lin P, Ma QP, Huang H, Ruan SM, Ke WP, Liao B, Zhong BH, Ren J, Lu MD, Xie XY, Wang W. US-based Sequential Algorithm Integrating an AI Model for Advanced Liver Fibrosis Screening. Radiology 2024; 311:e231461. [PMID: 38652028 DOI: 10.1148/radiol.231461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background Noninvasive tests can be used to screen patients with chronic liver disease for advanced liver fibrosis; however, the use of single tests may not be adequate. Purpose To construct sequential clinical algorithms that include a US deep learning (DL) model and compare their ability to predict advanced liver fibrosis with that of other noninvasive tests. Materials and Methods This retrospective study included adult patients with a history of chronic liver disease or unexplained abnormal liver function test results who underwent B-mode US of the liver between January 2014 and September 2022 at three health care facilities. A US-based DL network (FIB-Net) was trained on US images to predict whether the shear-wave elastography (SWE) value was 8.7 kPa or higher, indicative of advanced fibrosis. In the internal and external test sets, a two-step algorithm (Two-step#1) using the Fibrosis-4 Index (FIB-4) followed by FIB-Net and a three-step algorithm (Three-step#1) using FIB-4 followed by FIB-Net and SWE were used to simulate screening scenarios where liver stiffness measurements were not or were available, respectively. Measures of diagnostic accuracy were calculated using liver biopsy as the reference standard and compared between FIB-4, SWE, FIB-Net, and European Association for the Study of the Liver guidelines (ie, FIB-4 followed by SWE), along with sequential algorithms. Results The training, validation, and test data sets included 3067 (median age, 42 years [IQR, 33-53 years]; 2083 male), 1599 (median age, 41 years [IQR, 33-51 years]; 1124 male), and 1228 (median age, 44 years [IQR, 33-55 years]; 741 male) patients, respectively. FIB-Net obtained a noninferior specificity with a margin of 5% (P < .001) compared with SWE (80% vs 82%). The Two-step#1 algorithm showed higher specificity and positive predictive value (PPV) than FIB-4 (specificity, 79% vs 57%; PPV, 44% vs 32%) while reducing unnecessary referrals by 42%. The Three-step#1 algorithm had higher specificity and PPV compared with European Association for the Study of the Liver guidelines (specificity, 94% vs 88%; PPV, 73% vs 64%) while reducing unnecessary referrals by 35%. Conclusion A sequential algorithm combining FIB-4 and a US DL model showed higher diagnostic accuracy and improved referral management for all-cause advanced liver fibrosis compared with FIB-4 or the DL model alone. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Ghosh in this issue.
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Affiliation(s)
- Li-Da Chen
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Ze-Rong Huang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Hong Yang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Mei-Qing Cheng
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Hang-Tong Hu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Xiao-Zhou Lu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Ming-De Li
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Rui-Fang Lu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Dan-Ni He
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Peng Lin
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Qiu-Ping Ma
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Hui Huang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Si-Min Ruan
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Wei-Ping Ke
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Bing Liao
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Bi-Hui Zhong
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Jie Ren
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Ming-De Lu
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Xiao-Yan Xie
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
| | - Wei Wang
- From the Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound (L.D.C., Z.R.H., M.Q.C., H.T.H., M.D. Li, R.F.L., H.H., S.M.R., W.P.K., M.D. Lu, X.Y.X., W.W.), Department of Traditional Chinese Medicine (X.Z.L.), Department of Pathology (B.L.), Department of Gastroenterology (B.H.Z.), and Department of Hepatobiliary Surgery (M.D. Lu), the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou 510080, People's Republic of China; Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China (H.Y., P.L.); Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China (D.N.H.); and Department of Medical Ultrasonics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China (Q.P.M., J.R.)
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Lin SH, Chen WT, Tsai MH, Liu LT, Kuo WL, Lin YT, Wang SF, Chen BH, Lee CH, Huang CH, Chien RN. A novel prognostic model to predict mortality in patients with acute-on-chronic liver failure in intensive care unit. Intern Emerg Med 2024; 19:721-730. [PMID: 38386096 DOI: 10.1007/s11739-024-03536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/11/2024] [Indexed: 02/23/2024]
Abstract
Acute-on-chronic liver failure (ACLF) implies high short-term mortality rates and usually requires intensive care unit (ICU) admission. Proper prognosis for these patients is crucial for early referral for liver transplantation. The superiority of CLIF-C ACLF score in Asian patients with ACLF admitted to an ICU remains inconclusive when compared to other scoring systems. The purpose of the study is (i) to compare the predictive performance of original MELD, MELD-Lactate, CLIF-C ACLF, CLIF-C ACLF-Lactate, and APACHE-II scores for short-term mortality assessment. (ii) to build and validate a novel scoring system and to compare its predictive performance to that of the original five scores. Two hundred sixty-five consecutive cirrhotic patients with ACLF who were admitted to our ICU were enrolled. The prognostic values for mortality were assessed by ROC analysis. A novel model was developed and internally validated using fivefold cross-validation. Alcohol abuse was identified as the primary etiology of cirrhosis. The AUROC of the five prognostic scores were not significantly superior to each other in predicting 1-month and 3-month mortality. The newly developed prognostic model, incorporating age, alveolar-arterial gradient (A-a gradient), BUN, total bilirubin level, INR, and HE grades, exhibited significantly improved performance in predicting 1-month and 3-month mortality with AUROC of 0.863 and 0.829, respectively, as compared to the original five prognostic scores. The novel ACLF model seems to be superior to the original five scores in predicting short-term mortality in ACLF patients admitted to an ICU. Further rigorous validation is required.
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Affiliation(s)
- Shih-Hua Lin
- Department of Gastroenterology and Hepatology, New Taipei Municipal TuCheng Hospital, Tucheng, New Taipei City, 236, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan
| | - Ming-Hung Tsai
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan
| | - Li-Tong Liu
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Wei-Liang Kuo
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Yan-Ting Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Sheng-Fu Wang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Bo-Huan Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Cheng-Han Lee
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Chien-Hao Huang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan.
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan.
| | - Rong-Nan Chien
- Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan
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170
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Xiao L, Chen J, Zhao S, Zhoudi W, He K, Qian X, Zhang F, Liu Q, Li T, Zhu D, Wu X, Pu Z, Huang J, Xie Z, Xu X. The 90-Day Survival Threshold: A Pivotal Determinant of Long-Term Prognosis in HBV-ACLF Patients - Insights from a Prospective Longitudinal Cohort Study. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2304381. [PMID: 38380526 DOI: 10.1002/advs.202304381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/05/2024] [Indexed: 02/22/2024]
Abstract
This work aims to explore the long-term prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). In this prospective study, eligible inpatients with HBV-ACLF are enrolled and followed up from December 2012 to February 2023, for clinical events, laboratory tests at least every 6 months. Overall, the survival rates at 28 days, 90 days, 1 year, 5 years, and 8 years are 64.7%, 48.8%, 46.1%, 43.8%, and 42.2%, respectively. Among the 8-year mortality and liver transplant cases, ACLF survivors (who survived over 90 days) accounted for 7.8% (9/115). Among 101 patients who survived for more than 90 days, 97.9% of patients achieve virologic response at 1 year. For HBeAg-positive patients, the HBeAg seroconversion are 25.5%, 63.6%, and 76.9% at 1, 5, and 8 years, respectively. Alanine aminotransferase, aspartate aminotransferase, total bilirubin, INR, white blood cell count, and albumin levels gradually improve within the first year. Fibrosis biomarkers APRI, FIB-4 and Chitinase-3-like protein 1 (CHI3L1) levels decreases within the first 5 years. The Cox proportional hazards regression reveal that high total bilirubin (HR = 1.008, p = 0.021) is the independent risk factor for 8-year survival of ALCF survivors. The 90-day period following of HBV-ACLF represented a critical juncture for long-term prognosis, revealing favorable outcomes beyond this timeframe.
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Affiliation(s)
- Lanlan Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Jiajia Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Shuai Zhao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Wenxin Zhoudi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Keting He
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Xiaohan Qian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Fen Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Qiuhong Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Tan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Danhua Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Xiaoxin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Zhangya Pu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Jianrong Huang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Zhongyang Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
| | - Xiaowei Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd., Hangzhou City, 310003, China
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Rane SV, Jain S, Debnath P, Deshmukh R, Nair S, Chandnani S, Kamat R, Rathi P. A comparative study of uncomplicated acute non-A-E hepatitis with acute viral hepatitis and acute onset autoimmune hepatitis. Indian J Gastroenterol 2024; 43:443-451. [PMID: 38457107 DOI: 10.1007/s12664-023-01474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/16/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIMS Non-A-E hepatitis (NAEH) not leading to acute liver failure (ALF) is poorly documented. The objective was to compare clinical and laboratory features of uncomplicated acute NAEH with acute viral (AVH) and autoimmune hepatitis (AIH) and histopathology in NAEH and AIH. METHODS Cases of hepatocellular jaundice were included. These were grouped into AVH, AIH and NAEH based on clinical, laboratory and, when indicated, liver biopsy findings. NAEH and AIH were followed up at three months. RESULTS Of 336 patients with hepatocellular jaundice, 15 (5%) were NAEH, 25 (7%) acute AIH and 45 (14%) AVH. Among NAEH patients, seven (46.7%) were males with a mean age of presentation 39 years. Jaundice (100%) was the most common presentation of NAEH. Peak bilirubin was 10.7 mg/dL. Peak aspartate and alanine aminotransferase (AST, ALT) were 512 and 670 U/L. Five (33.3%) patients had positive anti-nuclear antibody and one had anti-smooth muscle antibody. Mean immunoglobulin G (IgG) levels were 1829. On liver biopsy, all had ballooning degeneration, four (26.7%) had mild and three (20%) moderate interface hepatitis, four (26.7%) mild lymphoplasmacytic infiltrate, one (6.7%) rosette formation, bridging necrosis in none and stage 1 fibrosis in one. Comparing NAEH with AIH, AIH showed significantly older age at presentation, female predisposition, past history of jaundice, lower ALT, more autoantibodies, higher IgG, higher grade interface hepatitis, lymphoplasmacytic infiltrate, rosette formation and higher bilirubin, AST at three months. NAEH and viral hepatitis had similar features. CONCLUSION Etiology of NAEH is unlikely to be autoimmune and is probably viral, unidentified as yet. Uncomplicated NAEH likely has self-limiting course even without specific treatment.
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Affiliation(s)
- Siddhesh Vijay Rane
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India.
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India
| | - Partha Debnath
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India
| | - Rahul Deshmukh
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India
| | - Sujit Nair
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India
| | - Rima Kamat
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India
| | - Pravin Rathi
- Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India
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172
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Alam S, Lal BB. Pediatric Acute-on-Chronic Liver Failure. Indian J Pediatr 2024; 91:374-382. [PMID: 37347440 DOI: 10.1007/s12098-023-04717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
Acute-on-chronic liver failure (ACLF) is characterized by an acute hepatic insult happening in a patient with underlying cirrhosis with compromised hepatic reserve leading to development of systemic inflammation, sepsis, and organ failure resulting in poor outcome in majority. While Asia Pacific Association for Study of Liver Diseases (APASL) emphasizes on early diagnosis before development of organ failure, European Association for Study of Liver Diseases (EASL) mandates the presence of organ failures to define ACLF. There is a lack of consensus definition of pediatric ACLF although recent APASL guidelines have tried to address the issue. While Wilson disease (WD) and autoimmune hepatitis (AIH) are the most common cause of underlying cirrhosis in children, acute viral hepatitis and flares of WD and AIH are the commonest acute precipitating events. Poor outcomes [death and liver transplantation (LT)] ranging from 19 to 59% have been reported. Prognosis in pediatric ACLF is usually better than that in adults due to greater proportion of treatable etiologies, lesser organ failures, comorbidities and better hepatic reserves. APASL ACLF Research Consortium (AARC) score more than or equal to 11 is predictive of poor 28-90 d mortality. Treatment of pediatric ACLF relies mainly on prompt diagnosis and medical management of a potentially treatable etiology of underlying cirrhosis. Bridging therapies, especially high volume plasma exchange can be initiated early as a bridge to LT or native liver recovery. Those with no improvement in 4-7 d should undergo LT before development of sepsis or multi-organ failure.
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Affiliation(s)
- Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
| | - Bikrant Bihari Lal
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
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Yu W, Xiao Y, Luo Y, Hu Y, Ji R, Wang W, Wu Z, Qi Z, Guo T, Wang Y, Zhao C. Risk factors for short-term prognosis of end-stage liver disease complicated by invasive pulmonary aspergillosis. Eur J Clin Microbiol Infect Dis 2024; 43:713-721. [PMID: 38347245 DOI: 10.1007/s10096-024-04775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND AIM Patients with end-stage liver disease (ESLD) are susceptible to invasive pulmonary aspergillosis (IPA). This study aimed to investigate the risk factors affecting the occurrence and short-term prognosis of ESLD complicated by IPA. METHODS This retrospective case-control study included 110 patients with ESLD. Of them, 27 ESLD-IPA received antifungal therapy with amphotericin B (AmB); 27 AmB-free-treated ESLD-IPA patients were enrolled through 1:1 propensity score matching. Fifty-six ESLD patients with other comorbid pulmonary infections were enrolled as controls. The basic features of groups were compared, while the possible risk factors affecting the occurrence and short-term outcomes of IPA were analyzed. RESULTS Data analysis revealed invasive procedures, glucocorticoid exposure, and broad-spectrum antibiotic use were independent risk factors for IPA. The 54 patients with ESLD-IPA exhibited an overall treatment effectiveness and 28-d mortality rate of 50.00% and 20.37%, respectively, in whom patients treated with AmB-containing showed higher treatment efficacy than patients treated with AmB-free antifungal regimens (66.7% vs. 33.3%, respectively, χ2 = 6.000, P = 0.014). Multivariate logistic regression analysis revealed that the treatment regimen was the only predictor affecting patient outcomes, with AmB-containing regimens were 4.893 times more effective than AmB-free regimens (95% CI, 1.367-17.515; P = 0.015). The only independent predictors affecting the 28-d mortality rate were neutrophil-to-lymphocyte ratio and IPA diagnosis (OR = 1.140 and 10.037, P = 0.046 and 0.025, respectively). CONCLUSIONS Glucocorticoid exposure, invasive procedures, and broad-spectrum antibiotic exposure increased the risk of IPA in ESLD patients. AmB alone or combined with other antifungals may serve as an economical, safe, and effective treatment option for ESLD-IPA.
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Affiliation(s)
- Weiyan Yu
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China
| | - Ying Xiao
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yue Luo
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Public Health Clinical Center of Chengdu, Chengdu, 610011, China
| | - Yangyang Hu
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Ru Ji
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China
| | - Wei Wang
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China
| | - Zhinian Wu
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zeqiang Qi
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Tingyu Guo
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yadong Wang
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China.
| | - Caiyan Zhao
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China.
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Yip TCF, Lai JCT, Yam TF, Tse YK, Hui VWK, Lai MSM, Chan HLY, Wong VWS, Wong GLH. Long-term use of tenofovir disoproxil fumarate increases fracture risk in elderly patients with chronic hepatitis B. J Hepatol 2024; 80:553-563. [PMID: 38101755 DOI: 10.1016/j.jhep.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND & AIMS The use of tenofovir disoproxil fumarate (TDF) is associated with a reduction in bone mineral density and an increase in bone metabolism biomarkers. However, data on clinical bone fractures remain limited. We evaluated the impact of TDF compared to entecavir on the risk of fracture in elderly patients with chronic hepatitis B (CHB). METHODS Patients with CHB aged ≥60 years receiving entecavir or TDF between January 2008 and December 2022 were identified using a territory-wide database in Hong Kong. The risk of incident fracture in entecavir- and TDF-treated patients before and after month 24 were compared after propensity score matching. RESULTS A total of 41,531 patients with CHB (mean age 69.8±7.8 years, 61.6% male) receiving entecavir (n = 39,897 [96.1%]) and TDF (n = 1,634 [3.9%]) were analysed. At a median follow-up of 25.3 (9.1-58.5) months, 1,733 (4.2%) patients developed incident fracture. Patients with incident fracture were more likely to have diabetes, hypertension, congestive heart failure, rheumatoid arthritis, osteoporosis, and a history of fracture. Compared with propensity score-matched entecavir-treated patients, the risk of incident fracture in TDF-treated patients was comparable in the first 24 months (weighted subdistribution hazard ratio [sHR] 0.99, 95% CI 0.56-1.73, p = 0.960) but increased after month 24 (weighted sHR 1.80, 95% CI 1.11-2.93, p = 0.019). The 24-, 60-, and 96-month cumulative incidences (95% CI) of fracture in TDF-treated and entecavir-treated patients were 2.3% (1.6%-3.4%) vs. 2.6% (1.9%-3.5%), 6.4% (5.0%-8.2%) vs. 4.7% (3.8%-6.0%), and 10.2% (8.3%-12.6%) vs. 6.8% (5.4%-8.5%), respectively. CONCLUSIONS The risk of fracture increased with TDF treatment for ≥24 months in elderly patients with CHB. Selection of nucleos(t)ide analogues should be individualised based on age and comorbidities. IMPACT AND IMPLICATIONS Previous literature suggested that the use of tenofovir disoproxil fumarate (TDF) is associated with a decrease in bone mineral density. However, data on the impact of TDF on long-term incident clinical fracture remains scarce. In this real-world territory-wide study of 41,531 treated patients with chronic hepatitis B in Hong Kong, patients who received TDF were at a higher risk of fracture after 2 years of treatment than those who received entecavir. Given the ageing population of patients with chronic hepatitis B and the rising prevalence of comorbidities, our findings support the current treatment guidelines that recommend selecting antiviral treatment based on age and comorbidities.
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Affiliation(s)
- Terry Cheuk-Fung Yip
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jimmy Che-To Lai
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tsz-Fai Yam
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yee-Kit Tse
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vicki Wing-Ki Hui
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mandy Sze-Man Lai
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Henry Lik-Yuen Chan
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Internal Medicine, Union Hospital, Hong Kong SAR, China
| | - Vincent Wai-Sun Wong
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Lai-Hung Wong
- Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Tsai YN, Wu JL, Hsu YC. Optimizing off-treatment outcome predictions: The potential of time-varying HBcrAg and the need for more research. Clin Mol Hepatol 2024; 30:276-278. [PMID: 38606424 PMCID: PMC11016472 DOI: 10.3350/cmh.2024.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Ying-Nan Tsai
- Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Jia-Ling Wu
- Department of Public Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan
| | - Yao-Chun Hsu
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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176
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Biswas S, Kumar R, Shalimar, Acharya SK. Viral hepatitis-induced acute liver failure. Indian J Gastroenterol 2024; 43:312-324. [PMID: 38451383 DOI: 10.1007/s12664-024-01538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 03/08/2024]
Abstract
Viral hepatitis-induced acute liver failure (ALF) is a preventable cause for liver-related mortality worldwide. Viruses are the most common cause for ALF in developing nations in contrast to the west, where acetaminophen is largely responsible. Viruses may be hepatotropic or affect the liver secondary to a systemic infection. In tropical countries, infections such as leptospirosis, scrub typhus and malaria can mimic the symptoms of ALF. Differentiating these ALF mimics is crucial because they require etiology-specific therapy. Treatment of viral hepatitis-induced ALF is two-pronged and directed towards providing supportive care to prevent organ failures and antiviral drugs for some viruses. Liver transplantation (LT) is an effective modality for patients deteriorating despite adequate supportive care. Early referral and correct identification of patients who require a transplant are important. Liver support devices and plasma exchange have evolved into "bridging modalities" for LT. Preventive strategies such as hand hygiene, use of clean and potable water and inclusion of vaccines against viral hepatitis in the national program are simple yet very effective methods focusing on the preventive aspect of this disease.
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Affiliation(s)
- Sagnik Biswas
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, 801 507, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
| | - Subrat Kumar Acharya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
- KIIT University, Bhubaneswar, 751 024, India
- Fortis Escorts Digestive and Liver Institute, Okhla, New Delhi, 110 025, India
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177
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Arslan E, Yildiz Y, Karaşahin Ö, Demir Y, Tümbül Mermutluoğlu Ç, Ünlü G, Kuşçu F, Kaya Ş, Akgül F, Damar Çakirca T, Yilmaz Karadağ F, Altunişik Toplu S, Nazik S, Akdemir İ, Özer Balin Ş, Kandemir FÖ, İnan D, Bayindir Y, Taşova Y, Çelen MK. Evaluation of chronic hepatitis B patients who voluntarily discontinued oral antiviral therapy: is there an answer to the controversial topic? Eur J Gastroenterol Hepatol 2024; 36:438-444. [PMID: 38407855 DOI: 10.1097/meg.0000000000002722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The uncertain treatment duration for nucleos(t)ide analogues (NA) used in the treatment of chronic hepatitis B (CHB) is an important problem for both patients and physicians. The aim of this study was to evaluate the determinants of virologic relapse (VR) and the optimum time of treatment discontinuation in the follow-up of CHB patients who voluntarily discontinued treatment after virological suppression was achieved under NA use. METHODS Data from 138 patients from 11 centers were included in this registry-based study. Factors associated with VR were investigated using multivariate Cox regression analysis. RESULTS Ninety-nine (71.7%) of the patients were HBeAg (Hepatitis B e antigen) negative. During the 24-month follow-up period after treatment discontinuation, VR occurred in 58.7% (n = 81) of all patients and 57.6% (n = 57) of HBeAg-negative patients. The duration of NA treatment was significantly shorter (cutoff 60 months) in HBeAg-negative patients who later developed VR. In addition, the duration of virologic remission achieved under NA treatment was significantly shorter (cutoff 52 months) in those who later developed VR. In the Cox multivariate regression model of HBeAg-negative patients, having less than 60 months of NA treatment (HR = 2.568; CI:1.280-5.148; P = 0.008) and the levels of alanine aminotransferase being equal to or higher than twice the upper level of normal at the beginning of treatment (HR = 3.753; CI:1.551-9.081; P = 0.003) were found to be statistically significant and independently associated with VR. CONCLUSION The findings of this study may provide clinical guidance in terms of determining the most appropriate discontinuation time for NA.
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Affiliation(s)
- Eyüp Arslan
- Department of Infectious Diseases and Clinical Microbiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul
| | - Yeşim Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara
| | - Ömer Karaşahin
- Department of Infectious Diseases and Clinical Microbiology, Erzurum Regional Training and Research Hospital, Erzurum
| | - Yakup Demir
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakir
| | - Çiğdem Tümbül Mermutluoğlu
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakir
| | - Gülten Ünlü
- Department of Infectious Diseases and Clinical Microbiology, Derince Training and Research Hospital, Kocaeli
| | - Ferit Kuşçu
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Faculty of Medicine, Adana
| | - Şafak Kaya
- Department of Infectious Diseases and Clinical Microbiology, Gazi Yasargil Training and Research Hospital, Diyarbakir
| | - Fethiye Akgül
- Department of Infectious Diseases and Clinical Microbiology, Batman Regional State Hospital, Batman, Turkey
| | - Tuba Damar Çakirca
- Department of Infectious Diseases and Clinical Microbiology, Şanliurfa Training and Research Hospital, Şanliurfa
| | - Fatma Yilmaz Karadağ
- Department of Infectious Diseases and Clinical Microbiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul
| | - Sibel Altunişik Toplu
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya
| | - Selçuk Nazik
- Department of Infectious Diseases and Clinical Microbiology, Sütçü İmam University Faculty of Medicine, Kahramanmaraş
| | - İrem Akdemir
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara
| | - Şafak Özer Balin
- Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine, Elazığ
| | - Fatma Özlem Kandemir
- Department of Infectious Diseases and Clinical Microbiology, Mersin University Faculty of Medicine, Mersin
| | - Dilara İnan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Yaşar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, Malatya
| | - Yeşim Taşova
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University Faculty of Medicine, Adana
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakir
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Hou J, Gane E, Balabanska R, Zhang W, Zhang J, Lim TH, Xie Q, Yeh CT, Yang SS, Liang X, Komolmit P, Leerapun A, Xue Z, Chen E, Zhang Y, Xie Q, Chang TT, Hu TH, Lim SG, Chuang WL, Leggett B, Bo Q, Zhou X, Triyatni M, Zhang W, Yuen MF. Efficacy, safety, and pharmacokinetics of capsid assembly modulator linvencorvir plus standard of care in chronic hepatitis B patients. Clin Mol Hepatol 2024; 30:191-205. [PMID: 38190830 PMCID: PMC11016473 DOI: 10.3350/cmh.2023.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND/AIMS Four-week treatment of linvencorvir (RO7049389) was generally safe and well tolerated, and showed anti-viral activity in chronic hepatitis B (CHB) patients. This study evaluated the efficacy, safety, and pharmacokinetics of 48-week treatment with linvencorvir plus standard of care (SoC) in CHB patients. METHODS This was a multicentre, non-randomized, non-controlled, open-label phase 2 study enrolling three cohorts: nucleos(t)ide analogue (NUC)-suppressed patients received linvencorvir plus NUC (Cohort A, n=32); treatment-naïve patients received linvencorvir plus NUC without (Cohort B, n=10) or with (Cohort C, n=30) pegylated interferon-α (Peg-IFN-α). Treatment duration was 48 weeks, followed by NUC alone for 24 weeks. RESULTS 68 patients completed the study. No patient achieved functional cure (sustained HBsAg loss and unquantifiable HBV DNA). By Week 48, 89% of treatment-naïve patients (10/10 Cohort B; 24/28 Cohort C) reached unquantifiable HBV DNA. Unquantifiable HBV RNA was achieved in 92% of patients with quantifiable baseline HBV RNA (14/15 Cohort A, 8/8 Cohort B, 22/25 Cohort C) at Week 48 along with partially sustained HBV RNA responses in treatment-naïve patients during follow-up period. Pronounced reductions in HBeAg and HBcrAg were observed in treatment-naïve patients, while HBsAg decline was only observed in Cohort C. Most adverse events were grade 1-2, and no linvencorvir-related serious adverse events were reported. CONCLUSION 48-week linvencorvir plus SoC was generally safe and well tolerated, and resulted in potent HBV DNA and RNA suppression. However, 48-week linvencorvir plus NUC with or without Peg-IFN did not result in the achievement of functional cure in any patient.
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Affiliation(s)
- Jinlin Hou
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Edward Gane
- New Zealand Liver Transplant Unit, The University of Auckland, Auckland, New Zealand
| | | | | | - Jiming Zhang
- Huashan Hospital, Fudan University, Shanghai, China
| | | | - Qing Xie
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chau-Ting Yeh
- Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | | | - Xieer Liang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | | | | | | | - Yuchen Zhang
- China Innovation Center of Roche, Shanghai, China
| | - Qiaoqiao Xie
- China Innovation Center of Roche, Shanghai, China
| | | | - Tsung-Hui Hu
- Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan
| | | | - Wan-Long Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Barbara Leggett
- Royal Brisbane & Women’s Hospital, School of Medicine, University of Queensland, Queensland, Australia
| | | | - Xue Zhou
- China Innovation Center of Roche, Shanghai, China
| | | | - Wen Zhang
- China Innovation Center of Roche, Shanghai, China
| | - Man-Fung Yuen
- Department of Medicine, School of Clinical Medicine, State Key Laboratory of Liver Research, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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179
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Kalita S, Kalita MJ, Talukdar AJ, Das PP, Dutta K, Hazarika G, Dutta S, Das P, Idris G, Kaur H, Medhi S. Altered TLR7 Expression-Mediated Immune Modulation Is Supportive of Persistent Replication and Intrauterine Transmission of HBV. Viral Immunol 2024; 37:149-158. [PMID: 38573237 DOI: 10.1089/vim.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Hepatitis B Virus (HBV) is posing as a serious public health threat mainly due to its asymptomatic nature of infection in pregnancy and vertical transmission. Viral sensing toll-like receptors (TLR) and Interleukins (IL) are important molecules in providing an antiviral state. The study aimed to assess the role of TLR7-mediated immune modulation, which might have an impact in the intrauterine transmission of HBV leading to mother to child transmission of the virus. We investigated the expression pattern of TLR7, IL-3, and IL-6 by RT-PCR in the placentas of HBV-infected pregnant women to see their role in the intrauterine transmission of HBV. We further validated the expression of TLR7 in placentas using Immunohistochemistry. Expression analysis by RT-PCR of TLR7 revealed significant downregulation among the Cord blood (CB) HBV DNA positive and negative cases with mean ± standard deviation (SD) of 0.43 ± 0.22 (28) and 1.14 ± 0.57 (44) with p = 0.001. IL-3 and IL-6 expression revealed significant upregulation in the CB HBV DNA-positive cases with p = 0.001. Multinomial logistic regression analysis revealed that TLR7 and IL-3 fold change and mother HBeAg status are important predictors for HBV mother to child transmission. Immunohistochemistry revealed the decreased expression of TLR7 in CB HBV DNA-positive cases. This study reveals that the downregulation of TLR7 in the placenta along with CB HBV DNA-positive status may lead to intrauterine transmission of HBV, which may lead to vertical transmission of HBV.
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Affiliation(s)
- Simanta Kalita
- Department of Bioengineering & Technology, Gauhati University, Guwahati India
| | - Manash Jyoti Kalita
- Department of Bioengineering & Technology, Gauhati University, Guwahati India
| | | | - Partha Pratim Das
- Department of Bioengineering & Technology, Gauhati University, Guwahati India
- Multidisciplinary Research Unit, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, India
| | - Kalpajit Dutta
- Department of Bioengineering & Technology, Gauhati University, Guwahati India
| | - Gautam Hazarika
- Department of Bioengineering & Technology, Gauhati University, Guwahati India
| | - Sangit Dutta
- Department of Medicine, Gauhati Medical College and Hospital, Guwahati, India
| | - Panchanan Das
- Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, India
| | - Ghaznavi Idris
- Department of Bioengineering & Technology, Gauhati University, Guwahati India
| | - Harpreet Kaur
- Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, India
| | - Subhash Medhi
- Department of Bioengineering & Technology, Gauhati University, Guwahati India
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180
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Morgan CE, Ngimbi P, Boisson-Walsh AJN, Ntambua S, Matondo J, Tabala M, Kashamuka MM, Emch M, Edwards JK, Powers KA, James L, Mbonze N, Mampunza S, Yotebieng M, Thompson P, Parr JB. Hepatitis B Virus Prevalence and Transmission in the Households of Pregnant Women in Kinshasa, Democratic Republic of Congo. Open Forum Infect Dis 2024; 11:ofae150. [PMID: 38623568 PMCID: PMC11017325 DOI: 10.1093/ofid/ofae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 04/17/2024] Open
Abstract
Background The World Health Organization Africa region has high regional hepatitis B virus (HBV) prevalence, and evidence suggests more frequent horizontal HBV transmission than other regions. Context-specific epidemiological studies are needed to inform additional HBV prevention measures. Methods In the cross-sectional Horizontal and Vertical Transmission of Hepatitis B (HOVER-HBV) study, we introduced HBV surface antigen (HBsAg) screening alongside existing HIV screening as part of routine antenatal care in high-volume maternity clinics in Kinshasa, Democratic Republic of Congo. We recruited households of pregnant women ("index mothers") who were HBsAg-positive and HBsAg-negative, defining households as index-positive and index-negative, respectively. Household members underwent HBsAg testing and an epidemiological survey. We evaluated HBsAg prevalence and potential transmission correlates. Results We enrolled 1006 participants from 200 households (100 index-positive, 100 index-negative) across Kinshasa. HBsAg-positivity prevalence was more than twice as high in index-positive households (5.0% [95% confidence interval {CI}, 2.8%-7.1%]) as in index-negative households (1.9% [95% CI, .6%-3.2%]). HBsAg-positivity prevalence was 3.3 (95% CI, .9-11.8) times as high among direct offspring in index-positive versus index-negative households. Factors associated with HBsAg positivity included older age, marriage, and having multiple recent partners or any new sexual partners among index mothers; and older age, lower household wealth, sharing nail clippers, and using street salons among offspring in index-positive households. Conclusions Vertical and horizontal HBV transmission within households is ongoing in Kinshasa. Factors associated with infection reveal opportunities for HBV prevention efforts, including perinatal prevention, protection during sexual contact, and sanitation of shared personal items.
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Affiliation(s)
- Camille E Morgan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Patrick Ngimbi
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Alix J N Boisson-Walsh
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Ntambua
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Jolie Matondo
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- L‘École de Santé Publique, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kimberly A Powers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda James
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nana Mbonze
- L‘École de Santé Publique, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Samuel Mampunza
- Faculté de Médecine, Université Protestante du Congo, Kinshasa, Democratic Republic of the Congo
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan B Parr
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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181
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Assadi-Rad M, Acosta BE, Hesterman MC, Fallon BS, Hill RL, Farnsworth EW, Barbeau B, Vilven D, Lynch KM, Weller ML. Hepatitis Delta Virus Reporting Requirements in the United States and Territories: A Systematic Review. Open Forum Infect Dis 2024; 11:ofae076. [PMID: 38590737 PMCID: PMC11000145 DOI: 10.1093/ofid/ofae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/06/2024] [Indexed: 04/10/2024] Open
Abstract
Hepatitis D virus (HDV) is a rare coinfection with hepatitis B virus. Currently, HDV is not a nationally notifiable disease in the United States. Only 55% of states and territories require HDV reporting, and most lack defined case definitions. Standardization of reporting requirements is crucial for monitoring HDV epidemiology.
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Affiliation(s)
| | - Brenda E Acosta
- School of Dentistry, University of Utah, Salt Lake City, Utah, USA
| | | | - Braden S Fallon
- School of Dentistry, University of Utah, Salt Lake City, Utah, USA
| | - Rachel L Hill
- School of Dentistry, University of Utah, Salt Lake City, Utah, USA
| | | | - Bree Barbeau
- Utah Department of Health and Human Services, Salt Lake City, Utah, USA
| | - Dede Vilven
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Keisa M Lynch
- Department of Gastroenterology and Hepatology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Melodie L Weller
- School of Dentistry, University of Utah, Salt Lake City, Utah, USA
- Division of Pathology, Department of Microbiology and Immunology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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182
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Hige S, Aoki K, Nakamoto D, Flaherty JF, Botros I, Mizutani H, Ishizaki A, Konishi H, Yuan J, Jinushi M, Ng LJ. Real-world safety and effectiveness of tenofovir alafenamide for 144 weeks in Japanese patients with chronic hepatitis B. J Viral Hepat 2024; 31:165-175. [PMID: 38163911 DOI: 10.1111/jvh.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
Tenofovir alafenamide (TAF), a prodrug of tenofovir, delivers high levels of active drug to hepatocytes and is given in a lower dose than tenofovir disoproxil fumarate (TDF). TAF reduces viral replication in patients with chronic hepatitis B (CHB) similar to TDF and has shown a lower risk of the renal and bone toxicities associated with TDF use. This post-marketing surveillance study examined the safety and effectiveness of TAF in treatment-naïve and -experienced CHB patients who received TAF for 144 weeks at real-world clinical sites in Japan. Safety assessments included the incidence of adverse drug reactions (ADRs), renal and bone events, and changes in selected laboratory parameters. Effectiveness was based on the proportion of patients with HBV DNA levels below the lower limit of quantitation or <29 IU/mL. This analysis included 580 patients; 18.4% of whom were treatment-naïve. The cumulative incidence of ADRs was 0.21 per 100 person-months, and the incidence of serious ADRs was 0.01 (95% CI, 0.00-0.04) per 100 person-months. There were no ADRs of declines in estimated glomerular filtration rates, renal failure or proximal tubulopathy. The most common ADR was hypophosphataemia in seven (1.2%) patients. Two (0.4%) patients each had decreased blood phosphorus, bone mineral density decreased, dizziness and alopecia. Overall, the proportion of virologically suppressed patients increased from 68.8% at baseline to 97.5% at Week 144. These results confirm the real-world safety and effectiveness of TAF in Japanese patients with CHB and are consistent with the findings of other evaluations of the safety and efficacy of TAF in CHB.
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Affiliation(s)
- Shuhei Hige
- Department of Gastroenterology, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Kouji Aoki
- Gilead Sciences K.K., Chiyoda-Ku, Tokyo, Japan
| | | | | | - Irina Botros
- Gilead Sciences, Inc., Foster City, California, USA
| | | | | | | | - Jason Yuan
- Gilead Sciences, Inc., Foster City, California, USA
| | | | - Leslie J Ng
- Gilead Sciences, Inc., Foster City, California, USA
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183
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Marshall AD, Willing AR, Kairouz A, Cunningham EB, Wheeler A, O'Brien N, Perera V, Ward JW, Hiebert L, Degenhardt L, Hajarizadeh B, Colledge S, Hickman M, Jawad D, Lazarus JV, Matthews GV, Scheibe A, Vickerman P, Dore GJ, Grebely J. Direct-acting antiviral therapies for hepatitis C infection: global registration, reimbursement, and restrictions. Lancet Gastroenterol Hepatol 2024; 9:366-382. [PMID: 38367631 DOI: 10.1016/s2468-1253(23)00335-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 02/19/2024]
Abstract
Direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection have delivered high response rates (>95%) and simplified the management of HCV treatment, permitting non-specialists to manage patients without advanced liver disease. We collected and reviewed global data on the registration and reimbursement (government subsidised) of HCV therapies, including restrictions on reimbursement. Primary data collection occurred between Nov 15, 2021, and July 24, 2023, through the assistance of a global network of 166 HCV experts. We retrieved data for 160 (77%) of 209 countries and juristrictions. By mid-2023, 145 (91%) countries had registered at least one of the following DAA therapies: sofosbuvir-velpatasvir, sofosbuvir-velpatasvir-voxilaprevir, glecaprevir-pibrentasvir, sofosbuvir-daclatasvir, or sofosbuvir. 109 (68%) countries reimbursed at least one DAA therapy. Among 102 low-income and middle-income countries (LMICs), 89 (87%) had registered at least one HCV DAA therapy and 53 (52%) reimbursed at least one DAA therapy. Among all countries with DAA therapy reimbursement (n=109), 66 (61%) required specialist prescribing, eight (7%) had retreatment restrictions, seven (6%) had an illicit drug use restriction, five (5%) had an alcohol use restriction, and three (3%) had liver disease restrictions. Global access to DAA reimbursement remains uneven, with LMICs having comparatively low reimbursement compared with high-income countries. To meet WHO goals for HCV elimination, efforts should be made to assist countries, particularly LMICs, to increase access to DAA reimbursement and remove reimbursement restrictions-especially prescriber-type restrictions-to ensure universal access.
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Affiliation(s)
- Alison D Marshall
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
| | - Alex R Willing
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Abe Kairouz
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Evan B Cunningham
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Alice Wheeler
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Colledge
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Danielle Jawad
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (IS Global), Hospital Clinic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Gail V Matthews
- Therapeutic and Vaccine Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; St Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - Andrew Scheibe
- TB HIV Care, Cape Town, South Africa; Community Orientated, Primary Care Research Unit, Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jason Grebely
- Viral Hepatitis Clinical Research Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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184
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Zhang Y, Yuan X, Wang J, Han M, Lu H, Wang Y, Liu S, Yang S, Xing HC, Cheng J. TRPV4 promotes HBV replication and capsid assembly via methylation modification of H3K4 and HBc ubiquitin. J Med Virol 2024; 96:e29510. [PMID: 38573018 DOI: 10.1002/jmv.29510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Abstract
Hepatitis B virus (HBV) infection poses a significant burden on global public health. Unfortunately, current treatments cannot fully alleviate this burden as they have limited effect on the transcriptional activity of the tenacious covalently closed circular DNA (cccDNA) responsible for viral persistence. Consequently, the HBV life cycle should be further investigated to develop new anti-HBV pharmaceutical targets. Our previous study discovered that the host gene TMEM203 hinders HBV replication by participating in calcium ion regulation. The involvement of intracellular calcium in HBV replication has also been confirmed. In this study, we found that transient receptor potential vanilloid 4 (TRPV4) notably enhances HBV reproduction by investigating the effects of several calcium ion-related molecules on HBV replication. The in-depth study showed that TRPV4 promotes hepatitis B core/capsid protein (HBc) protein stability through the ubiquitination pathway and then promotes the nucleocapsid assembly. HBc binds to cccDNA and reduces the nucleosome spacing of the cccDNA-histones complex, which may regulate HBV transcription by altering the nucleosome arrangement of the HBV genome. Moreover, our results showed that TRPV4 promotes cccDNA-dependent transcription by accelerating the methylation modification of H3K4. In conclusion, TRPV4 could interact with HBV core protein and regulate HBV during transcription and replication. These data suggest that TRPV4 exerts multifaceted HBV-related synergistic factors and may serve as a therapeutic target for CHB.
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Affiliation(s)
- Yu Zhang
- Peking University Ditan Teaching Hospital, Beijing, China
- Department of Hepatology, Beijing Ditan Hospital of Capital Medical University, Beijing, China
| | - Xiaoxue Yuan
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jun Wang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Peking University Ditan Teaching Hospital, Beijing, China
| | - Ming Han
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongping Lu
- Beijing Pan-Asia Tongze Institute of Biomedicine Co, Ltd, Beijing, China
| | - Yun Wang
- Department of Hepatology, Beijing Ditan Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, The First Section of Liver Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shunai Liu
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Song Yang
- Department of Hepatology, Beijing Ditan Hospital of Capital Medical University, Beijing, China
| | - Hui-Chun Xing
- Department of Hepatology, Beijing Ditan Hospital of Capital Medical University, Beijing, China
| | - Jun Cheng
- Peking University Ditan Teaching Hospital, Beijing, China
- Department of Hepatology, Beijing Ditan Hospital of Capital Medical University, Beijing, China
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185
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Yang R, Jiang J, Ouyang J, Zhao Y, Xi B. Efficacy and safety of probiotics in irritable bowel syndrome: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 60:362-372. [PMID: 38479936 DOI: 10.1016/j.clnesp.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common gastrointestinal disease characterized by abdominal pain, distension, and altered bowel habits. Probiotics may alleviate IBS symptoms, but clinical trials remain conflicting. AIMS To conduct a systematic review and meta-analysis of clinical trials to evaluate the efficacy and safety of probiotics for IBS patients. METHODS We searched relevant trials in PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar from 2000 to June 2023. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for continuous outcomes. A risk ratio (RR) and a 95% CI were calculated for dichotomous outcomes. RESULTS A total of 20 studies involving 3011 patients were obtained. The results demonstrated that probiotics are more effective than placebo in reducing global IBS symptoms improvement rate (RR = 1.401, 95% CI 1.182-1.662, P < 0.001) and quality of life scores (SMD = 0.286, 95% CI = 0.154-0.418, P < 0.001). Subgroup analyses showed that a shorter treatment time (less than eight weeks) could reduce distension scores (SMD = 0.197, 95% CI = 0.038-0.356, P = 0.015). High doses (daily dose of probiotics ≥ 10ˆ10) or multiple strains of probiotics exhibit beneficial effects on abdominal pain (SMD = 0.412, 95% CI = 0.112-0.711, P = 0.007; SMD = 0.590, 95% CI = 0.050-1.129, P = 0.032; respectively). However, there was no significant benefit on global symptom scores (SMD = 0.387, 95% CI 0.122 to 0.653, P = 0.004) with statistically high inter-study heterogeneity (I2 = 91.9%, P < 0.001). Furthermore, there was no significant inter-group difference in terms of adverse events frequency (RR = 0.997, 95% CI 0.845-1.177, P = 0.973). CONCLUSION Probiotics are effective and safe for IBS patients. High doses or multiple probiotic strains seem preferable, but definite conclusions are challenging due to the high heterogeneity. Large-scale, well-designed, and rigorous trials are needed to confirm their effectiveness.
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Affiliation(s)
- Ruwen Yang
- Zhenjiang Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Zhenjiang, China
| | - Jiawei Jiang
- Zhenjiang Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Zhenjiang, China
| | - Jun Ouyang
- Zhenjiang Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Zhenjiang, China
| | - Yuanpei Zhao
- Zhenjiang Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Zhenjiang, China
| | - Biao Xi
- Zhenjiang Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Zhenjiang, China.
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186
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Cooke GS, Flower B, Cunningham E, Marshall AD, Lazarus JV, Palayew A, Jia J, Aggarwal R, Al-Mahtab M, Tanaka Y, Jeong SH, Poovorawan K, Waked I, Hiebert L, Khue PM, Grebely J, Alcantara-Payawal D, Sanchez-Avila JF, Mbendi C, Muljono DH, Lesi O, Desalegn H, Hamid S, de Araujo A, Cheinquer H, Onyekwere CA, Malyuta R, Ivanchuk I, Thomas DL, Pimenov N, Chulanov V, Dirac MA, Han H, Ward JW. Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update. Lancet Gastroenterol Hepatol 2024; 9:346-365. [PMID: 38367629 DOI: 10.1016/s2468-1253(23)00321-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 02/19/2024]
Abstract
The top 20 highest burdened countries (in disability-adjusted life years) account for more than 75% of the global burden of viral hepatitis. An effective response in these 20 countries is crucial if global elimination targets are to be achieved. In this update of the Lancet Gastroenterology & Hepatology Commission on accelerating the elimination of viral hepatitis, we convene national experts from each of the top 20 highest burdened countries to provide an update on progress. Although the global burden of diseases is falling, progress towards elimination varies greatly by country. By use of a hepatitis elimination policy index conceived as part of the 2019 Commission, we measure countries' progress towards elimination. Progress in elimination policy has been made in 14 of 20 countries with the highest burden since 2018, with the most substantial gains observed in Bangladesh, India, Indonesia, Japan, and Russia. Most improvements are attributable to the publication of formalised national action plans for the elimination of viral hepatitis, provision of publicly funded screening programmes, and government subsidisation of antiviral treatments. Key themes that emerged from discussion between national commissioners from the highest burdened countries build on the original recommendations to accelerate the global elimination of viral hepatitis. These themes include the need for simplified models of care, improved access to appropriate diagnostics, financing initiatives, and rapid implementation of lessons from the COVID-19 pandemic.
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Affiliation(s)
- Graham S Cooke
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
| | - Barnaby Flower
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | | | | | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA; Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Adam Palayew
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Jidong Jia
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mamum Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Yashuito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, South Korea
| | - Kittiyod Poovorawan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Imam Waked
- Hepatology Department, National Liver Institute, Shibin El Kom, Egypt
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA
| | - Pham M Khue
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Haiphong, Viet Nam
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Diana Alcantara-Payawal
- Department of Internal Medicine, Fatima University Medical Center, Valenzuela, Philippines; Committee on Hepatology, Section of Gastroenterology, Cardinal Santos Medical Center, San Juan, Philippines
| | - Juan F Sanchez-Avila
- Global Health and Emerging Diseases Investigation Group, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey Monterrey, Mexico
| | - Charles Mbendi
- Service of Gastroenterology, Internal Medicine, University Clinic of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasha, DR Congo
| | - David H Muljono
- Ministry of Health, Jakarta, Indonesia; Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia; Indonesian Academy of Sciences, Jakarta, Indonesia
| | - Olufunmilayo Lesi
- Gastroenterology and Hepatology Unit, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Hailemichael Desalegn
- Department of Internal Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Saeed Hamid
- Clinical Trials Unit, Aga Khan University, Karachi, Pakistan
| | - Alexandre de Araujo
- Universidade Federal do Rio Grande do Sul, Gastroenterology and Hepatology Unit of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul, Gastroenterology and Hepatology Unit of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Charles A Onyekwere
- Deparment Of Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | | | - Iryna Ivanchuk
- Department of Viral Hepatitis Control at National Institute of Public Health, Kyiv, Ukraine
| | - David L Thomas
- Divison of Infectious Diseases, John Hopkins School of Medicine, Baltimore, MD, USA
| | - Nikolay Pimenov
- National Medical Research Center of Tuberculosis and Infectious Diseases, Moscow, Russia
| | | | - Mae Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Hannah Han
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, Task Force for Global Health, Decatur, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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He J, Miao R, Chen Y, Wang H, Liu M. The dual role of regulatory T cells in hepatitis B virus infection and related hepatocellular carcinoma. Immunology 2024; 171:445-463. [PMID: 38093705 DOI: 10.1111/imm.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/27/2023] [Indexed: 03/09/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is a major contributor to cancer-related deaths worldwide. Hepatitis B virus (HBV) infection is a major etiologic factor leading to HCC. While there have been significant advancements in controlling HBV replication, achieving a complete cure for HBV-related HCC (HBV-HCC) remains an intricate challenge. HBV persistence is attributed to a myriad of mechanisms, encompassing both innate and adaptive immune responses. Regulatory T cells (Tregs) are pivotal in upholding immune tolerance and modulating excessive immune activation. During HBV infection, Tregs mediate specific T cell suppression, thereby contributing to both persistent infection and the mitigation of liver inflammatory responses. Studies have demonstrated an augmented expression of circulating and intrahepatic Tregs in HBV-HCC, which correlates with impaired CD8+ T cell function. Consequently, Tregs play a dual role in the context of HBV infection and the progression of HBV-HCC. In this comprehensive review, we discuss pertinent studies concerning Tregs in HBV infection, HBV-related cirrhosis and HCC. Furthermore, we summarize Treg responses to antiviral therapy and provide Treg-targeted therapies specific to HBV and HCC.
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Affiliation(s)
- Jinan He
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rui Miao
- Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yao Chen
- Department of Internal Medicine, Northeast Yunnan Regional Central Hospital, Zhaotong, Yunan, China
| | - Han Wang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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188
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Wong YJ, Abraldes JG. Editorial: Shorter course of intravenous terlipressin in acute variceal bleeding - the promise, controversies and future directions. Aliment Pharmacol Ther 2024; 59:889-890. [PMID: 38462695 DOI: 10.1111/apt.17882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
LINKED CONTENTThis article is linked to Vaishnav et al papers. To view these articles, visit https://doi.org/10.1111/apt.17868 and https://doi.org/10.1111/apt.17893
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Affiliation(s)
- Yu Jun Wong
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
- Duke-NUS Medical School, Singapore
| | - Juan G Abraldes
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
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189
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Lyu L, Xu P. Hepatic CT Perfusion in Budd-Chiari Syndrome before and after Intervention. Radiology 2024; 311:e232426. [PMID: 38625011 DOI: 10.1148/radiol.232426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Lulu Lyu
- From the Department of CT and MRI, Xuzhou Central Hospital, Xuzhou, China (L.L.); Department of Radiology, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai W Rd, Xuzhou 221002, China (P.X.); and Department of Radiology, Mayo Clinic, Rochester, Minn (P.X.)
| | - Peng Xu
- From the Department of CT and MRI, Xuzhou Central Hospital, Xuzhou, China (L.L.); Department of Radiology, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai W Rd, Xuzhou 221002, China (P.X.); and Department of Radiology, Mayo Clinic, Rochester, Minn (P.X.)
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190
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Kim TH, Yim HJ, Jung YK, Song DS, Yoon EL, Kim HY, Kang SH, Chang Y, Yoo JJ, Jun BG, Lee SW, Park JG, Park JW, Kim SE, Kim TY, Jeong SW, Suk KT, Kim MY, Kim SG, Kim W, Jang JY, Yang JM, Kim DJ. New prognostic model for hospitalized patients with alcoholic cirrhosis and Maddrey's discriminant function <32. Hepatol Int 2024; 18:500-508. [PMID: 37831433 DOI: 10.1007/s12072-023-10582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/09/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND & AIMS Few studies have investigated the prognosis of patients with non-severe alcoholic hepatitis (Non-SAH). The study aimed to develop a new prognostic model for patients with especially Non-SAH. METHODS We extracted 316 hospitalized patients with alcoholic cirrhosis without severe alcoholic hepatitis, defined as Maddrey's discriminant function score lower than 32, from the retrospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort to develop a new prognostic model (training set), and validated it in 419 patients from the prospective KACLiF cohort (validation set). Prognostic factors for death and liver transplantation were analyzed to construct a prognostic model. RESULTS Twenty-one and 24 patients died within 6 months in both sets, respectively. In the training set, the highest area under the curve (AUC) of conventional prognostic models was 0.765, 0.732, and 0.684 for 1-, 3-, and 6-month mortality, respectively. Refractory ascites, vasopressor use, and hyponatremia were independently associated with mortality of cirrhotic patients with Non-SAH. The new model consisted of four variables: past deterioration, neutrophil proportion > 70%, Na < 128 mmol/L, and vasopressor use. It showed the highest accuracy for short-term mortality in the training and validation sets (0.803 and 0.786; 0.797 and 0.776; and 0.789 and 0.721 for 1-, 3-, and 6-month mortality, respectively). CONCLUSION There is a group of patients with high risk among those classified as Non-SAH. The new model will help stratifying cirrhotic patients with Non-SAH more accurately in terms of prognosis. The patients with high Non-SAH score need to monitor closely and might be considered for preemptive liver transplantation. TRIAL REGESTRATION ClinicalTrials.gov identifier: NCT02650011.
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Affiliation(s)
- Tae Hyung Kim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea.
| | - Young Kul Jung
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea
| | - Do Seon Song
- Department of Internal medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Hee Yeon Kim
- Department of Internal medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
- Department of Internal medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea
- Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Young Chang
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Baek Gyu Jun
- Department of Internal Medicine, Ulsan University Gangneung Asan Hospital, Gangneung, Korea
- Department of Internal Medicine, Asan Seoul Internal Medicine Clinic, Seoul, Korea
| | - Sung Won Lee
- Department of Internal medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Jung Gil Park
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Ji Won Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung-Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Tae Yeob Kim
- Department of Internal Medicine, New Hope Internal Medicine Clinic Seoul, Seoul, Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ki Tae Suk
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, 24253, Gangwon-do, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Won Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jin Mo Yang
- Department of Internal medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, 24253, Gangwon-do, Korea.
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Delphin M, Mohammed KS, Downs LO, Lumley SF, Waddilove E, Okanda D, Aliyan N, Van Schalkwyk M, Anderson M, Ocama P, Maponga T, Torimiro J, Iwuji C, Ndung'u T, Matthews PC, Taljaard J. Under-representation of the WHO African region in clinical trials of interventions against hepatitis B virus infection. Lancet Gastroenterol Hepatol 2024; 9:383-392. [PMID: 38367632 DOI: 10.1016/s2468-1253(23)00315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 02/19/2024]
Abstract
The WHO African region bears a disproportionate burden of morbidity and mortality related to chronic hepatitis B virus (HBV) infection and accounts for an estimated 70% of new HBV infections worldwide. We investigated the extent to which HBV clinical trials represented populations in this region by searching the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for interventional clinical trials published in English between database inception and May 29, 2023, using the search term "Hepatitis B". We identified 1804 unique clinical trials, of which 18 (1·0%) recorded involvement of the WHO African region. There is no evidence that the number of HBV clinical trials in this region has improved over time. The diversity of new interventions and industry sponsorship in the WHO African region were low, with trials of HBV comparing poorly with those of other endemic infectious diseases (eg, malaria, HIV, and SARS-CoV-2). HBV research and clinical trial investigations have neglected the WHO African region, leading to profound health inequities. HBV clinical trials are urgently needed to evaluate the efficacy of newly discovered therapeutics and to ensure that interventions can be equitably distributed and deployed as they become available.
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Affiliation(s)
| | - Khadija Said Mohammed
- The Francis Crick Institute, London, UK; Division of Biosciences, Faculty of Life Sciences, University College London, London, UK
| | - Louise O Downs
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford, UK; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford, UK
| | | | - Dorcas Okanda
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Marije Van Schalkwyk
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University-Tygerberg Academic Hospital, Cape Town, South Africa
| | - Motswedi Anderson
- The Francis Crick Institute, London, UK; Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana; Africa Health Research Institute, Durban, South Africa
| | - Ponsiano Ocama
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tongai Maponga
- Division of Medical Virology, Stellenbosch University-National Health Laboratory Service Tygerberg Business Unit, Cape Town, South Africa
| | - Judith Torimiro
- Molecular Biology Laboratory, Chantal Biya International Reference Centre for AIDS Research, Yaounde, Cameroon
| | - Collins Iwuji
- Africa Health Research Institute, Durban, South Africa; Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Thumbi Ndung'u
- Division of Infection and Immunity, University College London, London, UK; Africa Health Research Institute, Durban, South Africa
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK; Division of Infection and Immunity, University College London, London, UK; Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases, University College London Hospital, London, London, UK.
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University-Tygerberg Academic Hospital, Cape Town, South Africa
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Sharma VJ, Singh A, Grant JL, Raman J. Point-of-care diagnosis of tissue fibrosis: a review of advances in vibrational spectroscopy with machine learning. Pathology 2024; 56:313-321. [PMID: 38341306 DOI: 10.1016/j.pathol.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/24/2023] [Accepted: 11/01/2023] [Indexed: 02/12/2024]
Abstract
Histopathology is the gold standard for diagnosing fibrosis, but its routine use is constrained by the need for additional stains, time, personnel and resources. Vibrational spectroscopy is a novel technique that offers an alternative atraumatic approach, with short scan times, while providing metabolic and morphological data. This review evaluates vibrational spectroscopy for the assessment of fibrosis, with a focus on point-of-care capabilities. OVID Medline, Embase and Cochrane databases were systematically searched using PRISMA guidelines for search terms including vibrational spectroscopy, human tissue and fibrosis. Studies were stratified based on imaging modality and tissue type. Outcomes recorded included tissue type, machine learning technique, metrics for accuracy and author conclusions. Systematic review yielded 420 articles, of which 14 were relevant. Ten of these articles considered mid-infrared spectroscopy, three dealt with Raman spectroscopy and one with near-infrared spectroscopy. The metrics for detecting fibrosis were Pearson correlation coefficients ranging from 0.65-0.98; sensitivity from 76-100%; specificity from 90-99%; area under receiver operator curves from 0.83-0.98; and accuracy of 86-99%. Vibrational spectroscopy identified fibrosis in myeloproliferative neoplasms in bone, cirrhotic and hepatocellular carcinoma in liver, end-stage heart failure in cardiac tissue and following laser ablation for acne in skin. It also identified interstitial fibrosis as a predictor of early renal transplant rejection in renal tissue. Vibrational spectroscopic techniques can therefore accurately identify fibrosis in a range of human tissues. Emerging data show that it can be used to quantify, classify and provide data about the nature of fibrosis with a high degree of accuracy with potential scope for point-of-care use.
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Affiliation(s)
- Varun J Sharma
- Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Health, Heidelberg, Melbourne, Vic, Australia; Department of Surgery (Austin Health), Melbourne Medical School, The University of Melbourne, Vic, Australia; Spectromix Laboratory, Melbourne, Vic, Australia
| | - Aashima Singh
- Department of Surgery (Austin Health), Melbourne Medical School, The University of Melbourne, Vic, Australia; Melbourne Medical School, The University of Melbourne, Vic, Australia
| | | | - Jaishankar Raman
- Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Health, Heidelberg, Melbourne, Vic, Australia; Department of Surgery (Austin Health), Melbourne Medical School, The University of Melbourne, Vic, Australia; Spectromix Laboratory, Melbourne, Vic, Australia; Department of Cardiac Surgery, St Vincent's Hospital, Fitzroy, Melbourne, Vic, Australia.
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Heath K, Hill A. WHO hepatitis C elimination targets: the global equity challenge. Lancet Gastroenterol Hepatol 2024; 9:286-288. [PMID: 38367625 DOI: 10.1016/s2468-1253(23)00408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 02/19/2024]
Affiliation(s)
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
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194
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Zhang M, Li J, Xu Z, Fan P, Dong Y, Wang F, Gao Y, Yan J, Cao L, Ji D, Feng D, Zhong Y, Zhang Y, Hong W, Zhang C, Wang FS. Functional cure is associated with younger age in children undergoing antiviral treatment for active chronic hepatitis B. Hepatol Int 2024; 18:435-448. [PMID: 38376650 PMCID: PMC11014810 DOI: 10.1007/s12072-023-10631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/18/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND AIMS Functional cure is difficult to achieve using current antiviral therapies; moreover, limited data are available regarding treatment outcomes in children. This retrospective study aimed to assess the frequency of functional cure among children undergoing antiviral treatment for active chronic hepatitis B (CHB). METHODS A total of 372 children aged 1-16 years, with active CHB were enrolled and underwent either nucleos(t)ide analog monotherapy or combination therapy with interferon-α (IFN-α) for 24-36 months. All children attended follow-up visits every 3 months. Functional cure was defined as evidence of hepatitis B virus (HBV) DNA loss, circulating hepatitis B e antigen (HBeAg) loss/seroconversion, and hepatitis B surface antigen (HBsAg) loss. RESULTS After 36 months of antiviral treatment and/or follow-up visits, children with CHB aged 1- < 7 years exhibited higher rates of HBV DNA clearance, HBeAg seroconversion, and HBsAg loss than CHB children ≥ 7-16 years of age (93.75% versus [vs.] 86.21% [p < 0.0001]; 79.30% vs. 51.72% [p < 0.0001]; and 50.78% vs. 12.93% [p < 0.0001], respectively). Longitudinal investigation revealed more rapid dynamic reduction in HBV DNA, HBeAg, and HBsAg levels in children aged 1-7 years than in those aged ≥ 7-16 years with CHB. According to further age-stratified analysis, HBsAg loss rates were successively decreased in children with CHB who were 1- < 3, 3- < 7, 7- < 12, and 12-16 years of age (62.61% vs. 41.13% vs. 25.45% vs. 1.64%, respectively; p < 0.0001) at 36 months. In addition, baseline HBsAg level < 1,500 IU/mL was found to favor disease cure among these pediatric patients. No serious adverse events were observed throughout the study period. CONCLUSION Results of the present study demonstrated that children aged 1- < 7 years, with active CHB can achieve a high functional cure rate by undergoing antiviral therapy compared to those aged ≥ 7 years, who undergo antiviral therapy. These data support the use of antiviral treatment at an early age in children with CHB. However, future prospectively randomized controlled trials are necessary to validate the findings of this study.
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Affiliation(s)
- Min Zhang
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing Li
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, 100 Western 4th Ring Middle Road, Beijing, 100039, China
| | - Zhiqiang Xu
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peiyao Fan
- 302 Clinical Medical School, Peking University, Beijing, China
| | - Yi Dong
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fuchuan Wang
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yinjie Gao
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianguo Yan
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lili Cao
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dong Ji
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Danni Feng
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanwei Zhong
- Department of Liver Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Zhang
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, 100 Western 4th Ring Middle Road, Beijing, 100039, China
| | - Weiguo Hong
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, 100 Western 4th Ring Middle Road, Beijing, 100039, China
| | - Chao Zhang
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, 100 Western 4th Ring Middle Road, Beijing, 100039, China
| | - Fu-Sheng Wang
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, 100 Western 4th Ring Middle Road, Beijing, 100039, China.
- 302 Clinical Medical School, Peking University, Beijing, China.
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Walker SJ, Shrestha LB, Lloyd AR, Dawson O, Sheehan Y, Sheehan J, Maduka NBC, Cabezas J, Akiyama MJ, Kronfli N. Barriers and advocacy needs for hepatitis C services in prisons: Informing the prisons hepatitis C advocacy toolkit. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104386. [PMID: 38492433 PMCID: PMC11106844 DOI: 10.1016/j.drugpo.2024.104386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Carceral settings are a key focus of the 2030 WHO global hepatitis C virus (HCV) elimination goals. Despite this, access to HCV testing and treatment services in prisons remains low globally, limiting opportunities to achieve these goals. Advocacy efforts are needed to address service inequities and mobilise support for enhanced HCV programs in prisons globally. INHSU Prisons, a special interest group of the International Network on Health and Hepatitis in Substance Users (INHSU) is developing a Prisons HCV Advocacy Toolkit to address this need. Here we present findings of a mixed study to inform the development of the Toolkit. METHODS The aim of this study was to inform the development of the Toolkit, including understanding barriers for scaling up prison-based HCV services globally and advocacy needs to address these. An online survey (n = 181) and in-depth interviews (n = 25) were conducted with key stakeholders from countries of different economic status globally. Quantitative data were statistically analysed using R Studio and qualitative data were analysed thematically. The data sets were merged using a convergent design. RESULTS Key barriers for enhanced prison-based HCV services included lack of political will and action, lack of prison-based healthcare resources, and poor awareness about HCV and the importance of prison-based HCV services. These findings underscore how advocacy efforts are needed to motivate policymakers to prioritise HCV healthcare in prisons and ensure funds are available for services (including diagnostic tools and treatment, healthcare teams to implement services, and systems to measure their success). Advocacy resources to raise the awareness of policy makers, people working in the prison sector, and incarcerated populations were also identified as key to increasing HCV service uptake. CONCLUSION The Toolkit has the potential to support advocacy efforts for reaching HCV elimination targets. By understanding the advocacy needs of potential Toolkit end-users, the findings can inform its development and increase its accessibility, acceptability, and uptake for a globally diverse audience.
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Affiliation(s)
- Shelley J Walker
- National Drug Research Institute, Curtin University, Perth, Australia; Burnet Institute, Melbourne, Australia; Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Lok B Shrestha
- The Kirby Institute, University of New South Wales (UNSW), Sydney, Australia; School of Biomedical Sciences, University of New South Wales (UNSW), Sydney, Australia
| | - Andrew R Lloyd
- The Kirby Institute, University of New South Wales (UNSW), Sydney, Australia
| | - Olivia Dawson
- The International Network on Health and Hepatitis in Substance Users (INHSU)
| | - Yumi Sheehan
- The Kirby Institute, University of New South Wales (UNSW), Sydney, Australia
| | | | | | - Joaquin Cabezas
- Gastroenterology and Hepatology Department, University Hospital Marques de Valdecilla, Santander, Spain; Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Matthew J Akiyama
- Department of Medicine, Albert Einstein College of Medicine / Montefiore Medical Centre, New York, USA
| | - Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
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Sithamparapillai K, Zachariah U, Eapen CE, Goel A. Plasma exchange improves survival in acute liver failure - An updated systematic review and meta-analysis focussed on comparing within single etiology. Indian J Gastroenterol 2024; 43:397-406. [PMID: 38691239 DOI: 10.1007/s12664-024-01557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Therapeutic plasma exchange (PLEX) is increasingly used in patients with acute liver failure (ALF) as either stand-alone therapy or bridge to liver transplantation. Etiology plays a major role in prognosis of these patients and benefit of PLEX may consequently differ across etiologies. This systematic review and meta-analysis aims to evaluate the efficacy of PLEX in treating ALF, focussing on studies with single etiology. METHODS We conducted a systematic literature search and identified studies comparing PLEX vs. standard medical therapy (SMT) for patients with ALF across all age groups. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023442383). Pooled risk-ratios were determined by Mantel-Haenszel method within a random effect model. Primary outcome was mortality at ≤ 60-days and 90 days. Secondary outcome was adverse events attributable to PLEX. RESULTS Eight studies (pooled sample size in PLEX arm: 284; randomized trials: 2; Comparative cohorts: 6) with retrievable data on ALF were included in this systematic review. Analysis showed that PLEX was associated with significant reduction in mortality at ≤ 60-days (RR 0.64; CI, 0.51-0.80; P < 0.001) and at 90-days (RR 0.67; CI, 0.50-0.90; P = 0.008) as compared to SMT. On sub-group analysis, the survival benefit was noted irrespective of the volume of plasma exchanged during PLEX. Three studies (pooled sample size in PLEX arm: 110; all comparative cohorts) were identified, which included patients with a single etiology for ALF. These studies included patients with Wilson's disease, rodenticidal hepatotoxicity and acute fatty liver of pregnancy. Pooled analysis of studies with single etiology ALF showed better reduction in ≤ 90-day mortality with PLEX (RR 0.53; CI, 0.37-0.74; P < 0.001). Studies reported no major side-effects attributable to PLEX. CONCLUSION PLEX is safe and improves survival, independent of the volumes utilized, in patients with ALF as compared to standard medical treatment. The survival benefit is especially pronounced in studies restricted to single etiology.
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Affiliation(s)
| | - Uday Zachariah
- Department of Hepatology, Christian Medical College, Vellore 632 004, India
| | - C E Eapen
- Department of Hepatology, Christian Medical College, Vellore 632 004, India
| | - Ashish Goel
- Department of Hepatology, Christian Medical College, Vellore 632 004, India.
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Liu Y, Hu H, Li C, Zhang Y, Li M, Lu T, Wu Y, Yang Y, Li Y, Yang F, Shi X, Lin S. Impacts of the development of acute-on-chronic liver failure and bacterial infections on β-cell function and glucose homeostasis in patients with liver cirrhosis. Dig Liver Dis 2024; 56:648-655. [PMID: 37758609 DOI: 10.1016/j.dld.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The pathogenesis involved in glucose metabolism disorders (GMDs) in patients with liver cirrhosis remains unclear. AIMS We investigated the effects of acute-on-chronic liver failure (ACLF) development and bacterial infections (BIs) on pancreatic β-cell function and glucose homeostasis in individuals with liver cirrhosis. METHODS A retrospective analysis was conducted on 327 patients experiencing acute deterioration of liver cirrhosis. Oral glucose tolerance tests (OGTTs) and OGTT-based β-cell function indices were employed to assess β-cell function and glucose homeostasis. Univariate and multivariate logistic regression analyses were employed to identify GMD-associated risk factors. RESULTS Both the development of ACLF and BIs significantly increased the prevalence of GMDs. Both ACLF and BIs markedly elevated the homeostasis model of assessment 2-insulin resistance (HOMA2-IR). ACLF significantly impaired glucose-stimulated insulin secretion, as evidenced by reduced insulinogenic index (IGI). Patients with GMDs exhibited significantly lower IGI levels than those without GMDs. Independent risk factors associated with GMDs were prothrombin activity (odds ratio [OR]=0.981, 95% confidence interval [CI]: 0.960-0.995), HOMA2-IR (OR=1.749, 95% CI: 1.130-2.707), and IGI (OR=0.963, 95% CI: 0.947-0.978). CONCLUSIONS In liver cirrhosis, the onset of ACLF impairs glucose-stimulated insulin secretion from β-cells. Both liver impairment and BIs contribute to increased insulin resistance, ultimately disturbing glucose homeostasis.
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Affiliation(s)
- Yujuan Liu
- Suzhou Medical College of Soochow University, Suzhou 215325, China; Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Han Hu
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Chuan Li
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Yin Zhang
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Meichuan Li
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Tao Lu
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Yunchong Wu
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Yanyan Yang
- Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China
| | - Ying Li
- Department of Infectious Diseases, Second Affiliated Hospital of Zunyi Medical University, Guizhou, 563000, China
| | - Fangwan Yang
- Department of Infectious Diseases, Second Affiliated Hospital of Zunyi Medical University, Guizhou, 563000, China
| | - Xiuquan Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Guizhou, 563006, China
| | - Shide Lin
- Suzhou Medical College of Soochow University, Suzhou 215325, China; Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Guizhou, 563003, China; College of Laboratory Medicine, Zunyi Medical University, Guizhou, 563003, China.
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198
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Cohen EB, Regev A, Garg A, Di Bisceglie AM, Lewis JH, Vierling JM, Hey-Hadavi J, Steplewski K, Fettiplace A, Chen CL, Pehlivanov N, Kendrick S, I Avigan M. Consensus Guidelines: Best Practices for the Prevention, Detection and Management of Hepatitis B Virus Reactivation in Clinical Trials with Immunosuppressive/Immunomodulatory Therapy. Drug Saf 2024; 47:321-332. [PMID: 38353882 PMCID: PMC10954982 DOI: 10.1007/s40264-024-01399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 03/21/2024]
Abstract
Hepatitis B virus reactivation (HBVr) during and after immunosuppressive/immunomodulatory (IS/IM) therapy is associated with significant morbidity and mortality, including hepatic decompensation and acute liver failure. The risk of HBVr with IS/IM has been heterogeneous and often unpredictable. As a result, patients with active or previous HBV infection are often excluded from clinical drug trials of such agents. Thorough screening for HBV infection, antiviral prophylaxis, and careful monitoring for HBVr have proven to be effective in reducing the rate of HBVr and improving its outcome in the context of IS/IM. Therefore, safe enrollment and management of certain HBV-marker-positive patients in clinical trials is possible. There is a great, unmet need for consistent, evidence-based recommendations for best practices pertaining to enrollment, monitoring, and management of HBVr in clinical trial participants receiving IS/IM. The aim of these consensus guidelines is to provide a step-by-step blueprint to safely enroll, monitor and manage the patient with inactive chronic or resolved HBV in IS/IM clinical trials from the time of screening through to the end of post-treatment follow up.
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Affiliation(s)
- Eric B Cohen
- AbbVie Inc., Pharmacovigilance and Patient Safety, North Chicago, IL, USA.
| | - Arie Regev
- Eli Lilly and Company, Global Patient Safety, Indianapolis, IN, USA
| | - Anju Garg
- Sanofi, Patient Safety & Pharmacovigilance, Bridgewater, NJ, USA
| | | | - James H Lewis
- Division of Gastroenterology, Georgetown University, Washington, DC, USA
| | - John M Vierling
- Section of Gastroenterology and Hepatology and Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, USA
| | | | - Klaudia Steplewski
- GlaxoSmithKline LLC, Clinical Safety and Pharmacovigilance, Collegeville, PA, USA
| | | | - Chunlin L Chen
- Bayer HealthCare Pharmaceuticals, LLC. Pharmacovigilance, Berlin, Germany
| | - Nonko Pehlivanov
- Merck & Co., INC, Clinical Safety Risk Management, Rahway, NJ, USA
| | - Stuart Kendrick
- GlaxoSmithKline LLC, Medical Affairs-Hepatology, Stevenage, UK
| | - Mark I Avigan
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
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199
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Rubino C, Indolfi G, Foster C. Management of Hepatitis C in Children and Adolescents: An Update. Pediatr Infect Dis J 2024; 43:e131-e134. [PMID: 38456716 DOI: 10.1097/inf.0000000000004251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Chiara Rubino
- From the Hepatology Unit, Meyer Children's Hospital IRCSS, Viale Pieraccini, Florence, Italy
| | - Giuseppe Indolfi
- From the Hepatology Unit, Meyer Children's Hospital IRCSS, Viale Pieraccini, Florence, Italy
- Department of NEUROFARBA, University of Florence, Viale Pieraccini, Florence, Italy
| | - Caroline Foster
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom
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200
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Wang YH, Tang H, Chen EQ. Quantitative Measurement of Serum HBcrAg Can Be Used to Assess the Feasibility of Safe Discontinuation of Antiviral Therapy for Chronic Hepatitis B. Viruses 2024; 16:529. [PMID: 38675872 PMCID: PMC11055047 DOI: 10.3390/v16040529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Hepatitis B virus (HBV) infection is a serious global health problem, and chronic HBV infection significantly increases the risk of liver fibrosis, cirrhosis, and even hepatocellular carcinoma in patients. Current first-line therapeutics such as nucleos(t)ide analogues and interferons are unable to completely clear cccDNA, so the vast majority of patients need to take long-term or even lifelong medication. However, long-term virological and biochemical responses can be achieved in some patients after drug withdrawal. Successfully screening these patients with drug withdrawal advantages is difficult. Hepatitis-B-core-related antigen (HBcrAg) is a new HBV serological marker that which can reflect the level and transcription activity of cccDNA in hepatocytes. Therefore, HBcrAg has potential value in guiding patients in drug withdrawal. This review summarizes previous reports on HBcrAg and evaluates the application value of HBcrAg in safe drug discontinuation.
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Affiliation(s)
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - En-Qiang Chen
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu 610041, China;
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