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Hwang EG, Jung EA, Yoo JJ, Kim SG, Kim YS. Risk of dyslipidemia in chronic hepatitis B patients taking tenofovir alafenamide: a systematic review and meta-analysis. Hepatol Int 2023; 17:860-869. [PMID: 37099248 DOI: 10.1007/s12072-023-10528-7] [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: 01/02/2023] [Accepted: 03/18/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND The aim of this study was to demonstrate how tenofovir alafenamide (TAF) and other hepatitis B treatment drugs differentially impact lipid profiles in chronic hepatitis B patients. METHODS We searched PubMed, Ovid MEDLINE, EMBASE, and the Cochrane Library to identify studies on the changes in cholesterol level in hepatitis B patients who underwent TAF therapy. The changes in lipid profiles (e.g., HDL-c, LDL-c, total cholesterol [TC], and triglyceride [TG]) were compared between the TAF treatment group and the baseline, other nucleoside analogs (NAs), and tenofovir disoproxil fumarate (TDF)-only treatment groups. In addition, risk factors for worsening cholesterol level when treated with TAF were examined. RESULTS Twelve studies involving 6,127 patients were selected. After 6 months of TAF treatment, LDL-c, TC, and TG were increased by 5.69 mg/dL, 7.89 mg/dL, and 9.25 mg/dL, respectively, from the baseline level. In particular, with the treatment of TAF, levels of LDL, TC, and TG rose by 8.71 mg/dL, 18.34 mg/dL, and 13.68 mg/dL, respectively, showing a greater deterioration of cholesterol when the TAF treatment was implemented compared to other NAs (e.g., TDF or entecavir). When TAF was compared to TDF, LDL-c, TC, and TG worsened with a mean difference of 14.52 mg/dL, 23.72 mg/dL, and 14.25 mg/dL, respectively. As a result of a meta-regression analysis, risk factors for worsening lipid profiles were found to be treatment-experienced, previous diabetes, and hypertension. CONCLUSIONS TAF continues to worsen lipid profiles including LDL-c, TC, and TG after 6 months of use compared to the other NAs.
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Affiliation(s)
- Eui Gwon Hwang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyaung University College of Medicine, Bucheon, Republic of Korea
| | - Eun-Ae Jung
- Department of Medical Library, Soonchunhyang University Bucheon Hospital, Soonchunhyaung University College of Medicine, Bucheon, Republic of Korea
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyaung University College of Medicine, Bucheon, Republic of Korea.
- Department of Gastroenterology and Hepatology, Digestive Research Center and Liver Clinic, Soonchunhyang Bucheon Hospital, 170 Jomaruro Wonmigu, Bucheonsi Gyeonggido, 14584, Republic of Korea.
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyaung University College of Medicine, Bucheon, Republic of Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyaung University College of Medicine, Bucheon, Republic of Korea
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2
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Liu TW, Huang CF, Yeh ML, Tsai PC, Jang TY, Huang JF, Dai CY, Chuang WL, Yu ML. Less liver fibrosis marker increment in overweight chronic hepatitis B patients observed by age-adjusted Fibrosis-4 Index. BMJ Open Gastroenterol 2020; 7:bmjgast-2020-000543. [PMID: 33323472 PMCID: PMC7745320 DOI: 10.1136/bmjgast-2020-000543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background and aims Chronic hepatitis B patients in Taiwan with no or limited liver injury are not reimbursed for antiviral treatment by the Taiwan National Health Insurance (NHI). Innovative fibrosis marker, age-adjusted Fibrosis-4 Index (FIB4-AA), was implemented to evaluate the tendency of liver fibrosis in these patients. Methods The FIB-4 indices of 256 antiviral treatment-naïve chronic hepatitis B patients at Kaohsiung Medical University Hospital from 2003 to 2019 were reviewed. The difference in initial FIB-4 and last FIB4-AA was treated as a categorical variable, representing the tendency of liver fibrosis in each individual aside from ageing. Logistic regression was implemented to evaluate the three parameters most dependent on increment of FIB4-AA: e seroconversion, body mass index (BMI) and initial FIB-4 index. Results The yearly FIB-4 growth rate of an individual without chronic hepatitis was lower than that of the study group (0.0237 vs 0.0273 for males, 0.02 vs 0.0288 for females). Patients undergoing or completing e seroconversion were less prone to increment of FIB4-AA (p=0.036, OR 0.524). Logistic regression revealed that BMI ≥25 kg/m2 significantly less increment of FIB4-AA (p=0.001, OR 0.383, 95% CI 0.212 to 0.690), while patients with initial FIB-4 <1.29 were prone to increasing liver FIB4-AA (p=0.000, OR 3.687, 95% CI 1.999 to 6.797). Conclusion Chronic hepatitis B patients not meeting the reimbursement criteria of the Taiwan NHI are prone to increment of liver fibrosis marker. Overweight is associated with less increment of fibrosis marker, while initial FIB-4 <1.29 is associated with increasing fibrosis marker.
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Affiliation(s)
- Ta-Wei Liu
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Chien Tsai
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Tyng-Yuan Jang
- Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan .,Hepatitis Center, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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3
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Chen GF, Wang C, Lau G. Treatment of chronic hepatitis B infection-2017. Liver Int 2017; 37 Suppl 1:59-66. [PMID: 28052634 DOI: 10.1111/liv.13309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
Since the registration of the first effective nucleoside analogue against the hepatitis B virus almost two decades ago, major progress has been made in the management of chronic hepatitis B infection. However, hepatitis B-related morbidity and mortality remain a major global health threat. This is partly due to the escalating costs and the decrease in compliance related to the need for prolonged therapy for most patients who cannot be "cured". New biomarkers such as quantitative hepatitis B surface antigen might help to determine if hepatitis B e antigen negative patients can be taken off nucleos(t)ide analogues. On the other hand, novel compounds that target the viral life cycle or modulate host immune response are in the pipeline. In the next few years, one should expect breakthrough advancement to be made leading to a "cure" for patients with chronic hepatitis B infection by inducing hepatitis surface antigen loss with or without the development of the hepatitis B surface antibody. In addition, attention and necessary actions should also be taken in patients with hepatitis B infection who are being treated with immunosuppressive therapy and direct anti-viral (DAAs) agents for hepatitis C infection to prevent hepatitis from hepatitis B reactivation.
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Affiliation(s)
- Guo-Feng Chen
- Beijing 302-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Center, Beijing, China.,Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China
| | - Cheng Wang
- Beijing 302-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Center, Beijing, China.,Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, SAR, China.,State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - George Lau
- Beijing 302-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Center, Beijing, China.,Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong, SAR, China.,Institute of Translational Hepatology, 302 Hospital, Beijing, China
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Al-Qahtani AA, Al-Ashgar HI, Al Mana H, Al-Ahdal MN, Soliman Ali A, Hasanain AF, Helmy A. Impact of Liver Biopsy on the Decision to Treat Patients with Chronic Hepatitis B Genotype D Virus Infection. Intervirology 2014; 57:248-53. [DOI: 10.1159/000360858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 02/24/2014] [Indexed: 11/19/2022] Open
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5
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Wang L, Zou ZQ, Liu CX, Liu XZ. Immunotherapeutic interventions in chronic hepatitis B virus infection: a review. J Immunol Methods 2014; 407:1-8. [PMID: 24747918 DOI: 10.1016/j.jim.2014.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 02/20/2014] [Accepted: 04/02/2014] [Indexed: 12/13/2022]
Abstract
Chronic hepatitis B virus (HBV) infection is a public health challenge worldwide. Antiviral agents (nucleos(t)ide analogues, NAs) and immune-based therapies (IFN-α or Pegylated-IFN-α) are two therapeutic approaches available currently against chronic hepatitis B (CHB). However, these approaches are associated with the development of acquired drug resistance or poor response rates and are accompanied by numerous side effects. Furthermore, due to defective innate and adaptive immune responses, HBV cannot be effectively controlled or completely eliminated, which may ultimately result in liver decompensation and hepatocelluar carcinoma. The imperative for development of new approaches targeting CHB cannot be overstated. Various immunotherapeutic interventions have been tried as adjuvants to inhibit HBV replication. In this paper, we will review immunotherapeutic interventions in the treatment of CHB.
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Affiliation(s)
- Li Wang
- Infectious Disease Hospital of Yantai, Huanshan Road 62, Zhifu District, 264001, Yantai, Shandong, China.
| | - Zhi Qiang Zou
- Infectious Disease Hospital of Yantai, Huanshan Road 62, Zhifu District, 264001, Yantai, Shandong, China
| | - Cheng Xia Liu
- Digestive Department, Affiliated Hospital of Binzhou Medical College, Huanghe Second Road 661, 256603, Shandong, China
| | - Xiang Zhong Liu
- Infectious Disease Hospital of Yantai, Huanshan Road 62, Zhifu District, 264001, Yantai, Shandong, China
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7
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Abstract
Large volume of new data on the natural history and treatment of chronic hepatitis B virus (HBV) infection have become available since 2008. These include further studies in asymptomatic subjects with chronic HBV infection and community-based cohorts, the role of HBV genotype/naturally occurring HBV mutations, the application of non-invasive assessment of hepatic fibrosis and quantitation of HBV surface antigen and new drug or new strategies towards more effective therapy. To update HBV management guidelines, relevant new data were reviewed and assessed by experts from the region, and the significance of the reported findings was discussed and debated. The earlier "Asian-Pacific consensus statement on the management of chronic hepatitis B" was revised accordingly. The key terms used in the statement were also defined. The new guidelines include general management, indications for fibrosis assessment, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug resistance, concurrent viral infection, hepatic decompensation, patients receiving immune suppression or chemotherapy and patients in the setting of liver transplantation and hepatocellular carcinoma, are also included.
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8
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Lau GKK, Wang FS. Uncover the immune biomarkers underlying hepatitis B e antigen (HBeAg) seroconversion: a need for more translational study. J Hepatol 2012; 56:753-5. [PMID: 22230868 DOI: 10.1016/j.jhep.2011.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 12/22/2011] [Accepted: 12/29/2011] [Indexed: 01/30/2023]
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9
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Lau GKK, Wang FS. Management of chronic hepatitis B e antigen-negative disease: another step forward. J Infect Dis 2012; 205:7-9. [PMID: 22095767 DOI: 10.1093/infdis/jir694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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10
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Merrill RM, Hunter BD. Seroprevalence of markers for hepatitis B viral infection. Int J Infect Dis 2010; 15:e78-121. [PMID: 21130675 DOI: 10.1016/j.ijid.2010.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To provide a comprehensive review of the prevalence of selected hepatitis B virus (HBV) seromarkers and to identify variability in seroprevalence across the 14 World Health Organization (WHO) sub-regions and among special groups and populations. METHODS Analyses involved 568 papers and 736 population studies. The complete data set included 21, 838, 249 individuals and covered the 14 WHO sub-regions. RESULTS Of the 687 studies that assessed hepatitis B surface antigen (HBsAg) seroprevalence, 30% had low (<2% affected), 36% had intermediate (2-8% affected), and 34% had high (>8% affected) endemicity. Median HBsAg seroprevalence differed by selected populations and among geographic regions. Overall, median seroprevalence was highest for 'other' populations, followed by patients, then by pregnant women and children. Median seroprevalence of antibody to hepatitis B core antigen (anti-HBc) followed a similar endemicity pattern to that of HBsAg across the 14 WHO sub-regions. Median seroprevalence of hepatitis B e antigen (HBeAg) showed considerable variability within each population group, with the greatest potential for infectivity seen among children. CONCLUSIONS This population-based review provides a comprehensive assessment of the burden of HBV throughout the world. Significant differences in seroprevalence exist between WHO regions, study populations, and seromarker testing methods. The results presented in this study will enable health professionals to track worldwide reported seroprevalence of hepatitis B markers.
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Affiliation(s)
- Ray M Merrill
- Department of Health Science, College of Life Sciences, Brigham Young University, Provo, Utah 84602, USA.
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11
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El-Zayadi AR, Badran HM, Saied A, Shawky S, Attia MED, Zalata K. Evaluation of liver biopsy in Egyptian HBeAg-negative chronic hepatitis B patients at initial presentation: implications for therapy. Am J Gastroenterol 2009; 104:906-11. [PMID: 19293791 DOI: 10.1038/ajg.2009.30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES A subgroup of HBeAg-negative chronic hepatitis B (CHB) patients with alanine aminotransferase (ALT) and/or hepatitis B virus (HBV)-DNA levels below the cutoff values of international guidelines may have significant liver disease and miss the opportunity for early treatment. Histopathological changes of HBeAg-negative CHB patients at initial presentation irrespective of HBV-DNA and/or ALT levels to increase the likelihood of patients for treatment are evaluated. METHODS CHB patients attending Cairo Liver Center from January 2006 to May 2008 had biochemical, serological, and virological screening as well as liver biopsy that was assessed by Metavir score. RESULTS Fifty-two HBeAg-negative CHB patients (46 male and 6 female) with a median age of 37.5 years were included in the study. Significant fibrosis (>or=F2) was found in 26% (5/19) of patients with serum HBV-DNA <2,000 IU/ml, and 53% (21/40) of patients with ALT level <2xULN. Liver biopsy increased candidacy for treatment by nearly 25% before implementation of the recommended lower ALT levels (30 U/l for male and 19 U/l for female patients), and by 21.2% after implementation of the lower ALT level. Implementation of the lower ALT level increased the candidacy of patients for treatment by 4% (two patients), whereas liver biopsy increased eligibility for treatment by 55.8 % (27/49). CONCLUSIONS Liver biopsy is more reliable than either ALT or HBV-DNA levels in the decision to treat Egyptian HBeAg-negative CHB patients, even with the implementation of the recommended lower ALT levels.
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Abstract
Since the introduction of the hepatitis B vaccine and other preventive measures, the worldwide prevalence of hepatitis B infection has fallen. However, chronic infection remains a challenging global health problem, with more than 350 million people chronically infected and at risk of hepatic decompensation, cirrhosis, and hepatocellular carcinoma. An improved understanding of hepatitis B virology, immunology, and the natural course of chronic infection, has identified hepatitis B virus replication as the key driver of immune-mediated liver injury and disease progression. The approval of potent oral antiviral agents has revolutionised hepatitis B treatment since 1998. Conventional and pegylated interferon alfa and nucleoside and nucleotide analogues are widely authorised treatments, and monotherapy with these drugs greatly suppresses virus replication, reduces hepatitis activity, and halts disease progression. However, hepatitis B virus is rarely eliminated, and drug resistance is a major drawback during long term therapy. The development of new drugs and strategies is needed to improve treatment outcomes.
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Affiliation(s)
- Yun-Fan Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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13
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Liaw YF. On-Treatment Outcome Prediction and Adjustment during Chronic Hepatitis B Therapy: Now and Future. Antivir Ther 2009. [DOI: 10.1177/135965350901400107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Studies published to date regarding on-treatment outcome prediction during chronic hepatitis B therapy were reviewed. Studies have shown that initial virological responses in terms of week 24 serum hepatitis B virus (HBV) DNA levels are associated with therapeutic outcomes of 1-year pegylated interferon-α and entecavir therapy, and weeks 52 or 104 of lamivudine and telbuvudine therapy. HBV DNA levels at week 48 are also associated with long-term adefovir therapy outcomes. Conceptual on-treatment adjustment and strategies have been proposed; however, this approach seems only necessary during therapy with nucleos(t)ide analogues with substantial risk of drug resistance. In addition, studies are needed to decide whether switching to or adding on a second drug, and with which drug, is the most cost-effective strategy.
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Affiliation(s)
- Yun-Fan Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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14
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Abstract
Worldwide, chronic hepatitis B virus infection is a major cause of end-stage liver disease and hepatocellular carcinoma. While the past two decades have brought major advances in the availability of treatments to help delay or prevent these outcomes, treatment of chronic hepatitis B remains a serious challenge. With the recent availability of potent new nucleot(s)ide such as entecavir, tenofovir and telbuvidine, I still use pegylated interferon (PEG-IFN)-alpha for the treatment of chronic HBeAg-positive patients. This is based on its relatively higher effectiveness in restoring the host immune control on viral replication, resulting in sustained diseases remission in a proportion of patients, a finite course of therapy and the absence of viral resistance. The two major hindrances to its wide application are its lack of effectiveness in a large proportion of patients and its side-effect profile. The former shortcoming can be circumvented to a certain extent with the use of response predictor models. Recently, based on long-term follow-up study, the better durability of sustained response further enhances the confidence in the use of PEG-IFN-alpha in chronic HBeAg-positive patients.
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Affiliation(s)
- George K K Lau
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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15
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Abstract
Large amounts of new data on the natural history and treatment of chronic hepatitis B virus (HBV) infection have become available since 2005. These include long-term follow-up studies in large community-based cohorts or asymptomatic subjects with chronic HBV infection, further studies on the role of HBV genotype/naturally occurring HBV mutations, treatment of drug resistance and new therapies. In addition, Pegylated interferon alpha2a, entecavir and telbivudine have been approved globally. To update HBV management guidelines, relevant new data were reviewed and assessed by experts from the region, and the significance of the reported findings were discussed and debated. The earlier "Asian-Pacific consensus statement on the management of chronic hepatitis B" was revised accordingly. The key terms used in the statement were also defined. The new guidelines include general management, special indications for liver biopsy in patients with persistently normal alanine aminotransferase, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug resistance, concurrent viral infection, hepatic decompensation, patients receiving immune-suppressive medications or chemotherapy and patients in the setting of liver transplantation, are also included.
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16
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Liaw YF, Leung N, Kao JH, Piratvisuth T, Gane E, Han KH, Guan R, Lau GKK, Locarnini S. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int 2008; 2:263-83. [PMID: 19669255 PMCID: PMC2716890 DOI: 10.1007/s12072-008-9080-3] [Citation(s) in RCA: 727] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 04/09/2008] [Indexed: 12/13/2022]
Abstract
Large amounts of new data on the natural history and treatment of chronic hepatitis B virus (HBV) infection have become available since 2005. These include long-term follow-up studies in large community-based cohorts or asymptomatic subjects with chronic HBV infection, further studies on the role of HBV genotype/naturally occurring HBV mutations, treatment of drug resistance and new therapies. In addition, Pegylated interferon alpha2a, entecavir and telbivudine have been approved globally. To update HBV management guidelines, relevant new data were reviewed and assessed by experts from the region, and the significance of the reported findings were discussed and debated. The earlier "Asian-Pacific consensus statement on the management of chronic hepatitis B" was revised accordingly. The key terms used in the statement were also defined. The new guidelines include general management, special indications for liver biopsy in patients with persistently normal alanine aminotransferase, time to start or stop drug therapy, choice of drug to initiate therapy, when and how to monitor the patients during and after stopping drug therapy. Recommendations on the therapy of patients in special circumstances, including women in childbearing age, patients with antiviral drug resistance, concurrent viral infection, hepatic decompensation, patients receiving immune-suppressive medications or chemotherapy and patients in the setting of liver transplantation, are also included.
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Affiliation(s)
- Yun-Fan Liaw
- Liver Research Unit, Chang Gung University and Memorial Hospital, 199, Tung Hwa North Road, Taipei, Taiwan,
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17
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Affiliation(s)
- Yun-Fan Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, 199, Tung Hwa North Road, Taipei, 105, Taiwan,
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