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Chien HT, Su TH, Huang H, Chiang CL, Lin FJ. Real-world epidemiology, treatment patterns and disease burden of patients diagnosed with chronic hepatitis B in Taiwan. Liver Int 2023; 43:2404-2414. [PMID: 37615056 DOI: 10.1111/liv.15702] [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: 03/19/2023] [Revised: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND AIMS This study aimed to update the epidemiology, clinical, and economic outcomes of patients diagnosed with chronic hepatitis B (CHB) infection in Taiwan. METHODS This is a retrospective observational study using claims data from the National Health Insurance Research Database. Cases were identified between 2010 and 2019 using CHB diagnosis codes and claims for alanine aminotransferase laboratory tests or CHB treatment within one year of the first CHB diagnosis. Patient characteristics, epidemiology, clinical, and economic outcomes were described. RESULTS A total of 730 154 CHB-diagnosed cases were identified. The prevalence of diagnosed CHB increased from 1.13% in 2010 to 2.43% in 2019, with the highest occurring among those aged 55-64 years (4.76%) and 45-54 years (4.37%) and being higher in men (2.98%) than in women (2.21%). The majority of newly diagnosed CHB patients were 35 years of age or older (86.6%), with a median age of 49 years. After a median follow-up period of 6.42 years, 12.5%, 7.9%, 2.8%, and 0.35% were diagnosed with cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation respectively. Among 456 706 incident CHB-diagnosed patients, 17.4% had received at least one CHB medication, with the majority taking entecavir (67.9%). Patients with increasing disease severity had higher healthcare resource utilization, and inpatient costs accounted for 48.9%-65.5% of the overall medical cost in different health states. CONCLUSION Despite the decreasing incidence of newly diagnosed CHB, the prevalence of diagnosed CHB remains high and poses a significant healthcare challenge owing to the high economic burden associated with the complications of CHB.
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Affiliation(s)
- Hsiu-Ting Chien
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tung-Hung Su
- Division of Gastroenterology and Hepatology Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University, College of Medicine, Taipei, Taiwan
- Hepatitis Research Center National, Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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2
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Oh H, Lee HY, Kim J, Kim YJ. Systematic Review with Meta-Analysis: Comparison of the Risk of Hepatocellular Carcinoma in Antiviral-Naive Chronic Hepatitis B Patients Treated with Entecavir versus Tenofovir: The Devil in the Detail. Cancers (Basel) 2022; 14:cancers14112617. [PMID: 35681596 PMCID: PMC9179302 DOI: 10.3390/cancers14112617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are the preferred anti-viral agents used as first-line treatments for chronic hepatitis B. Despite many meta-analyses being conducted, it is still not clear whether TDF is more effective than ETV at reducing the risk of HCC due to the inconsistent statistical methodologies employed in previous observational studies. To reduce heterogeneity, we analysed only hospital cohort data studies with anti-viral naive patients. Additionally, unlike previous studies, we conducted subgroup analyses with enrolment criteria and socioeconomic factors that could not be corrected with statistical techniques. There is no difference between the two drugs in terms of reducing the risk of HCC in a pooled analysis of PS-matched patients. In the subgroup analysis, if there was interval of over three years from the start point of patient enrolment, we found that TDF was associated with significantly lower HCC risk. This result will provide new perspectives for future research. Abstract Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are the preferred anti-viral agents used as first-line treatments for chronic hepatitis B (CHB). However, the efficacy of these agents in reducing the incidence of hepatocellular carcinoma (HCC) remains unclear. We conducted this meta-analysis to assess the efficacy of anti-viral agent on preventing HCC in CHB. Two investigators independently searched all relevant studies that examined the efficacy of anti-viral agent for preventing HCC using MEDLINE, Embase, and Cochrane Library databases through August 2021. The extracted data were analysed using a random-effects meta-analysis model based on the inverse-variance method (DerSimonian–Laird) and expressed as hazard ratio (HR) and 95% confidence interval (95% CI). We included 19 retrospective studies in the analysis. Although there was substantial heterogeneity between the studies, the overall pooled HR indicated that TDF significantly lowered the risk of HCC (HR: 0.72, 95% CI: 0.58–0.90, I2 = 66.29%). However, the pooled analysis of propensity score (PS)-matched subpopulations showed no significant differences (HR, 0.83; 95% CI, 0.65–1.06; I2 = 52.30%) between TDF and ETV. In a subgroup analysis, an interval of over three years in the start point of patient enrolment and excluding alcoholic liver disease patients significantly lowered the HCC risk associated with TDF. In conclusion, TDF may be more effective than ETV at reducing HCC incidence in treatment-naive CHB patients, but this effect was not consistent in the PS-matched subpopulation that reduced heterogeneity. As a result of subgroup analysis, the conflicting findings of previous studies may result from heterogeneous inclusion criteria. Further studies with standardised protocols are needed to reduce the residual heterogeneity.
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Affiliation(s)
- Hyunwoo Oh
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu 11759, Korea; (H.O.); (H.Y.L.)
| | - Hyo Young Lee
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu 11759, Korea; (H.O.); (H.Y.L.)
| | - Jihye Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Yoon Jun Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-3081; Fax: +82-2-743-6701
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3
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Lee MH, Ahn SH, Chan HLY, Choudhry A, Alvani Gani R, Mohamed R, Ong JP, Shukla A, Tan CK, Tanwandee T, Thuy PTT, Neo BL, Tsang V, Youn J, Singh S. Contextual and individual factors associated with knowledge, awareness and attitude on liver diseases: A large-scale Asian study. J Viral Hepat 2022; 29:156-170. [PMID: 34817896 DOI: 10.1111/jvh.13636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/27/2021] [Accepted: 11/15/2021] [Indexed: 12/13/2022]
Abstract
There are limited data to provide better understanding of the knowledge/awareness of general population towards liver health in Asia. We sought to identify the knowledge gaps and attitudes towards liver health and liver diseases as well as evaluate associated individual-level and macro-level factors based on contextual analysis. An online survey assessing knowledge, awareness and attitudes towards liver health and disease was conducted among 7500 respondents across 11 countries/territories in Asia. A liver index was created to measure the respondents' knowledge level and the degree of awareness and attitudes. Multilevel logistic regression was performed to identify individual factors and contextual effects that were associated with liver index. The overall liver index (0-100-point scale) was 62.4 with 6 countries/territories' liver indices greater than this. In the multilevel model, the inclusion of geographical information could explain for 9.6% of the variation. Residing in a country/territory with higher HBV prevalence (80% IOR: 1.20-2.79) or higher HCV death rate (80% IOR: 1.35-3.13) increased the individual probability of obtaining a high overall liver index. Individual factors like age, gender, education, household income, disease history and health screening behaviour were also associated with liver index (all p-values<0.001). The overall liver index was positively associated with the two macro-level factors viz. HBV prevalence and HCV death rate. There is a need to formulate policies especially in regions of lower HBV prevalence and HCV death rate to further improve the knowledge, awareness and attitudes of the general public towards liver diseases.
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Affiliation(s)
- Mei Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (ROC)
| | - Sang Hoon Ahn
- Yonsei University College of Medicine, Yonsei University, Seodaemun-gu, South Korea
| | - Henry L Y Chan
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Asad Choudhry
- Chaudhry Hospital, Ghulam Dastagir Khan Rd, Gujranwala, Pakistan
| | - Rino Alvani Gani
- Hepatobiliary Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Rosmawati Mohamed
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Janus P Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Akash Shukla
- King Edward Memorial Hospital, Global Hospital, Mumbai, India
| | - Chee Kiat Tan
- Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Tawesak Tanwandee
- Department of Medicine, Siriraj Hospital, Mahidol University, Nakhon Salaya, Thailand
| | - Pham Thi Thu Thuy
- Hepatology Department in Ho Chi Minh Medic Medical Center, City Ho Chi Minh, Vietnam
| | | | | | - Jin Youn
- Gilead Sciences, Hong Kong, China
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4
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Udompap P, Tanwandee T, Gani R. Affordability of Antiviral Therapy in Asia-Pacific Countries and Its Impact on Public Health Outcomes. Clin Liver Dis (Hoboken) 2021; 16:249-253. [PMID: 33489097 PMCID: PMC7805294 DOI: 10.1002/cld.977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Prowpanga Udompap
- Department of MedicineUniversity of MinnesotaMinneapolisMN,Division of GastroenterologyDepartment of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Tawesak Tanwandee
- Division of GastroenterologyDepartment of MedicineFaculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Rino Gani
- Hepatobiliary DivisionDepartment of Internal MedicineFaculty of MedicineUniversity of IndonesiaCipto Mangunkusumo HospitalJakartaIndonesia
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5
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Increasing antiviral treatment uptake improves survival in patients with HBV-related HCC. JHEP Rep 2020; 2:100152. [PMID: 33024950 PMCID: PMC7530304 DOI: 10.1016/j.jhepr.2020.100152] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background & Aims Antiviral treatment is known to improve survival in patients with chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). Yet, the treatment uptake in CHB patients remains low. We aimed to report the secular trend in antiviral treatment uptake from 2007-2017, and to compare the effect of different nucleos(t)ide analogue (NA) initiation times (before vs. after HCC diagnosis) on survival. Methods A 3-month landmark analysis was used to compare overall survival in patients not receiving NA treatment (i.e. no NA), patients receiving NAs after their first HCC treatment (i.e. post-HCC NA), and patients receiving NAs ≤3 months before their first HCC treatment (i.e. pre-HCC NA). A propensity score-weighted Cox proportional hazards model was used to balance clinical characteristics between the 3 groups and to estimate hazard ratios (HRs). Results The uptake of antiviral treatment in HCC patients increased from 47.3% in 2007 to 98.3% in 2017. The pre-HCC NA group contributed mostly to the uptake rate, which increased from 72.7% to 96.0% in the past decade. In addition, 3,843 CHB patients (407 no NA; 2,932 pre-HCC NA; 504 post-HCC NA) with HCC, receiving at least 1 type of HCC treatment, were included in the analysis. Lack of NA treatment at the time of HCC diagnosis increased the risk of death (weighted HR 3.05; 95% CI 2.70-3.44; p <0.001). The impact of the timing of NA treatment was insignificant (weighted HR 0.90; 95% CI 0.78-1.04; p = 0.161). Conclusions The uptake of antiviral treatment in HCC patients increased over the past decade. NA treatment, regardless of whether it was initiated before or after HCC diagnosis, improved survival. It is never too late to initiate NA treatment, even after HCC diagnosis. Lay summary More and more patients who have hepatitis B-related liver cancer received antiviral treatment over the past decade. The timing of starting antiviral treatment, regardless of whether it was before or after liver cancer happens, does not really matter in terms of survival benefits.
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Key Words
- AFP, alpha-fetoprotein
- ALT, alanine aminotransferase
- ASMD, absolute standardised mean difference
- CDARS, Clinical Data Analysis and Reporting System
- CHB, chronic hepatitis B
- Entecavir
- GGT, gamma-glutamyl transpeptidase
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hazard ratio
- ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification
- IPTW, inverse probability of treatment weighting
- IQR, inter-quartile range
- KS, Kolmogorov-Smirnov
- Lamivudine
- Local ablative therapy
- MICE, multivariate imputation by chained equations
- NA, nucleos(t)ide analogue
- PS, propensity score
- Propensity scores
- Surgical resection
- TACE, transarterial chemoembolisation
- TDF, tenofovir disoproxil fumarate
- Transarterial chemoembolisation
- aHR, adjusted hazard ratio
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6
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Abutaleb A, Khatun M, Clement J, Baidya A, Singh P, Datta S, Ahammed SM, George K, Mukherjee P, Santra A, Neogi S, Parikh S, Pillai V, Kottilil S, Chowdhury A. A Model of Care Optimized for Marginalized Remote Population Unravels Migration Pattern in India. Hepatology 2020; 73:1261-1274. [PMID: 32659859 PMCID: PMC7883670 DOI: 10.1002/hep.31461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/05/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India. APPROACH AND RESULTS We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV. CONCLUSIONS Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.
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Affiliation(s)
- Ameer Abutaleb
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD,Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, MD
| | - Mousumi Khatun
- Department of Hepatology and Centre for Liver Research, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Jean Clement
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD
| | - Ayana Baidya
- Department of Hepatology and Centre for Liver Research, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Pratibha Singh
- Baptist Christian Hospital, Tezpur (Emanuel Hospital Association), Tezpur, Assam, India
| | - Simanti Datta
- Department of Hepatology and Centre for Liver Research, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sk Mahiuddin Ahammed
- Department of Hepatology and Centre for Liver Research, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Koshy George
- Baptist Christian Hospital, Tezpur (Emanuel Hospital Association), Tezpur, Assam, India
| | - ParthaSarathi Mukherjee
- Indian Institute of Liver and Digestive Sciences, Sonarpur, Kolkata, India,John C. Martin Centre for Liver Research and Innovations, Liver Foundation, Sonarpur, Kolkata, West Bengal, India
| | - Amal Santra
- Department of Hepatology and Centre for Liver Research, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India,John C. Martin Centre for Liver Research and Innovations, Liver Foundation, Sonarpur, Kolkata, West Bengal, India
| | - Suvadip Neogi
- John C. Martin Centre for Liver Research and Innovations, Liver Foundation, Sonarpur, Kolkata, West Bengal, India
| | - Sachin Parikh
- John C. Martin Centre for Liver Research and Innovations, Liver Foundation, Sonarpur, Kolkata, West Bengal, India,CTIS, Inc., Rockville, MD
| | - Vivek Pillai
- John C. Martin Centre for Liver Research and Innovations, Liver Foundation, Sonarpur, Kolkata, West Bengal, India,CTIS, Inc., Rockville, MD
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD
| | - Abhijit Chowdhury
- Department of Hepatology and Centre for Liver Research, School of Digestive and Liver Diseases, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India,Indian Institute of Liver and Digestive Sciences, Sonarpur, Kolkata, India,John C. Martin Centre for Liver Research and Innovations, Liver Foundation, Sonarpur, Kolkata, West Bengal, India
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7
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Stopping oral antiviral treatment to cure chronic hepatitis B, is it in sight? Hepatol Int 2020; 14:302-304. [PMID: 32304087 DOI: 10.1007/s12072-020-10039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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8
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Sarin SK, Kumar M, Eslam M, George J, Al Mahtab M, Akbar SMF, Jia J, Tian Q, Aggarwal R, Muljono DH, Omata M, Ooka Y, Han KH, Lee HW, Jafri W, Butt AS, Chong CH, Lim SG, Pwu RF, Chen DS. Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2020; 5:167-228. [PMID: 31852635 PMCID: PMC7164809 DOI: 10.1016/s2468-1253(19)30342-5] [Citation(s) in RCA: 294] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
Abstract
The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.
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Affiliation(s)
- Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Mohammed Eslam
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sheikh M Fazle Akbar
- Department of Pathology, Ehime University Proteo-Science Center, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Qiuju Tian
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan; University of Tokyo, Tokyo, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wasim Jafri
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Amna S Butt
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Chern H Chong
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Division of General Medicine, Woodlands Health Campus, Singapore
| | - Seng G Lim
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan
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9
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Shan S, You H, Niu J, Shang J, Xie W, Zhang Y, Li X, Ren H, Tang H, Ding H, Wang X, Nan Y, Dou X, Han T, Zhang L, Liu X, Deng C, Cheng J, Wang X, Xie Q, Lin S, Huang Y, Xu Y, Xiong Y, Li W, Yan X, Piao H, Huang W, Lu Q, Gong W, Li S, Hu X, Zhang X, Liu S, Li Y, Yang D, Li H, Yang C, Cheng M, Zhang L, Zheng H, Luo X, Lin F, Wang L, Xu G, Xu X, Wei L, Hou J, Duan Z, Zhuang H, Yang X, Kong Y, Jia J. Baseline Characteristics and Treatment Patterns of the Patients Recruited to the China Registry of Hepatitis B. J Clin Transl Hepatol 2019; 7:322-328. [PMID: 31915601 PMCID: PMC6943209 DOI: 10.14218/jcth.2019.00052] [Citation(s) in RCA: 4] [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: 10/13/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background and Aims: Chronic hepatitis B virus (HBV) infection remains a major public health problem globally. Here, we describe the baseline characteristics and treatment profiles of HBV-infected patients recruited to the China Registry of Hepatitis B. Methods: Inclusion criteria were patients with different stages of chronic HBV infection and complete key data. Exclusion criteria were patients with hepatocellular carcinoma. The baseline clinical, laboratory and treatment profiles were analyzed. Results: Finally, 40,431 patients were included. The median age was 43 years, with 65.2% being men and 51.3% being positive for hepatitis B e antigen (HBeAg). The most common initial diagnosis was chronic hepatitis B (81.0%), followed by cirrhosis (9.3%), inactive carrier of hepatitis B surface antigen (HBsAg) (6.7%), and immune tolerant phase of hepatitis B infection (3.0%). Among the 21,228 patients who were on treatment, 88.0%, 10.0% and 2.0% received nucleos(t)ide analogues (NAs), interferon or combination of NAs and interferon, respectively. The proportion of patients who received preferred NAs (entecavir or tenofovir disoproxil fumarate) had increased from 13.5% in 2003 to 79.7% in 2016. Conclusions: We concluded that middle-aged men accounted for most of the patients with chronic hepatitis B in this cross-sectional study. About half of the patients were HBeAg-positive. NAs were the most commonly used therapy, and use of the preferred NAs had steadily increased in the past decade.
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Affiliation(s)
- Shan Shan
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Hong You
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Junqi Niu
- Department of Hepatology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jia Shang
- Department of Infectious Diseases, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Wen Xie
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuexin Zhang
- Department of Infectious Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hong Ren
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Huiguo Ding
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xihong Wang
- Center of Infectious Diseases, The Third People’s Hospital of Taiyuan, Taiyuan, Shanxi, China
| | - Yuemin Nan
- Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaoguang Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tao Han
- Department of Hepatology, Tianjin Third Central Hospital, Tianjin Medical University, Tianjin, China
| | - Lingyi Zhang
- Department of Hepatology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Cunliang Deng
- Department of Infectious Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, Gansu, China
| | - Jilin Cheng
- Department of Gastroenterology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Xiaozhong Wang
- Department of Hepatology, Xinjiang Uygur Autonomous Region Traditional Chinese Medicine Hospital, Urumqi, Xinjiang, China
| | - Qing Xie
- Department of Infectious Diseases, Shanghai Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - Shumei Lin
- Department of Infectious Diseases, The First Affiliated Hospital of Xian Jiao Tong University, Xi’an, Shaanxi, China
| | - Yan Huang
- Department of Infectious Diseases, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Youqing Xu
- Department of Digestive System, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wu Li
- Department of Infectious Diseases, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xuebing Yan
- Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Henan, China
| | - Hongxin Piao
- Department of Infectious Diseases, Yanbian University Hospital, Yanji, Jilin, China
| | - Wenxiang Huang
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Lu
- Department of Hepatology, The Fourth People’s Hospital of Qinghai Province, Xining, Qinghai, China
| | - Weijin Gong
- Department of Infectious Diseases, Xinjiang Changji Prefecture People’s Hospital, Changji, Xinjiang, China
| | - Shiping Li
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Xiaoxuan Hu
- Department of Hepatology, Hunan Provincial People’s Hospital, Changsha, Hunan, China
| | - Xiaolan Zhang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shourong Liu
- Department of Hepatology, Xixi Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Yufang Li
- Department of Infectious Diseases, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Dongliang Yang
- Department of Infectious Diseases, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hai Li
- Department of Hepatopancreatobiliary and Splenic Medicine, The Affiliated Hospital, Logistics University of People’s Armed Police Force, Tianjin, China
| | - Caixia Yang
- Department of Infectious Diseases, Infectious Disease Hospital of Wuhai, Wuhai, Inner Mongolia, China
| | - Mingliang Cheng
- Department of Infectious Diseases, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Liaoyun Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Huanwei Zheng
- Department of Infectious Diseases, The Fifth Hospital of Shijiazhuang, Shijiazhuang, Hebei, China
| | - Xinhua Luo
- Department of Infectious Diseases, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Feng Lin
- Department of Infectious Diseases, Hainan General Hospital, Haikou, Hainan, China
| | - Lei Wang
- Department of Infectious Diseases, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Guanghua Xu
- Department of Infectious Diseases, Yanan University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Xiaoyuan Xu
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Lai Wei
- Peking University Hepatology Institute, Peking University People’s Hospital, Beijing, China
| | - Jinlin Hou
- Institute of Hepatology and Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhongping Duan
- Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Infectious Disease Center, Peking University Health Science Center, Beijing, China
| | - Xizhong Yang
- The China Foundation of Hepatitis Prevention and Control, Beijing China
| | - Yuanyuan Kong
- Center for Clinical Epidemiology and EBM, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
- Correspondence to: Jidong Jia, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xicheng District, Beijing 100050, China. Tel & Fax: +86-10-63139246, E-mail: ; Yuanyuan Kong, Center for Clinical Epidemiology and EBM, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xicheng District, Beijing 100050, China. E-mail:
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, National Clinical Research Center for Digestive Diseases, Beijing, China
- Correspondence to: Jidong Jia, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xicheng District, Beijing 100050, China. Tel & Fax: +86-10-63139246, E-mail: ; Yuanyuan Kong, Center for Clinical Epidemiology and EBM, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xicheng District, Beijing 100050, China. E-mail:
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10
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Liu Y, Jia M, Wu S, Jiang W, Feng Y. Predictors of relapse after cessation of nucleos(t)ide analog treatment in HBeAg-negative chronic hepatitis B patients: A meta-analysis. Int J Infect Dis 2019; 86:201-207. [PMID: 31394205 DOI: 10.1016/j.ijid.2019.07.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/02/2019] [Accepted: 07/30/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify the predictors of relapse after the withdrawal of nucleos(t)ide analog (NA) therapy in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB). METHODS The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched through January 2019. A random-effects model meta-analysis was performed, with hazard ratios (HR) and 95% confidence intervals (CI) used as summary statistics. RESULTS Seventeen studies were included in the meta-analysis. Age (HR=1.022 per year), baseline hepatitis B surface antigen (HBsAg) (HR=1.509 per log IU/l), end of treatment (EOT) HBsAg level (HR=1.896 per log IU/l), EOT HBsAg level ≥1000 IU/ml (HR=1.749), and HBsAg decline from baseline to EOT (HR=0.748 per log IU/l) were associated with virological relapse. The predictors of clinical relapse were baseline HBsAg level (HR=1.312 per log IU/l), EOT HBsAg level (HR=1.458 per log IU/l), EOT HBsAg level ≥100IU/ml (HR=3.199) or ≥1000 IU/ml (HR=1.810), and duration of consolidation therapy (HR=0.991 per month). CONCLUSIONS This meta-analysis indicates that age, the duration of consolidation therapy, and levels of baseline and EOT HBsAg were factors predictive of relapse in HBeAg-negative CHB patients who discontinued NA treatment.
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Affiliation(s)
- Yun Liu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180# Fenglin Road, Shanghai, People's Republic of China
| | - Minglei Jia
- Department of Gastroenterology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Shengdi Wu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180# Fenglin Road, Shanghai, People's Republic of China
| | - Wei Jiang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, 180# Fenglin Road, Shanghai, People's Republic of China.
| | - Yifan Feng
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, 180# Fenglin Road, Shanghai, People's Republic of China.
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11
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Wu X, Zhou J, Xie W, Ding H, Ou X, Chen G, Ma A, Xu X, Ma H, Xu Y, Liu X, Meng T, Wang L, Sun Y, Wang B, Kong Y, Ma H, You H, Jia J. Entecavir monotherapy versus de novo combination of lamivudine and adefovir for compensated hepatitis B virus-related cirrhosis: a real-world prospective multicenter cohort study. Infect Drug Resist 2019; 12:745-757. [PMID: 31015765 PMCID: PMC6448536 DOI: 10.2147/idr.s185120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background De novo combination of lamivudine (Lam) and adefovir (Adv) was not rarely used in clinical practice. However, head-to-head comparisons of entecavir (Etv) monotherapy with this combination in hepatitis B virus (HBV)-related compensated cirrhosis patients are unavailable. This study aimed to compare the efficacy and safety of Etv monotherapy with combination therapy in patients with HBV-related compensated liver cirrhosis. Methods Treatment-naïve patients with HBV-related compensated liver cirrhosis were recruited to receive either Etv monotherapy or a de novo combination of Lam and Adv. Data were collected at baseline and every 6 months thereafter. Results A total of 578 patients (485 in Etv group, 93 in combination group) were included. Baseline characteristics were comparable between the two groups. At the end of 1, 2, and 3 years, HBV DNA was undetectable in 82.7%, 96.2%, and 94.3% of patients in the Etv group and 88.9%, 81.7%, and 84.6% in the combination group, respectively (all P>0.05). The cumulative virological breakthrough rate at 1, 2, and 3 years was 2.7%, 6.7%, and 9.8% in the Etv group and 2.9%, 13.3%, and 32.2% in the combination group, respectively (P=0.003). After propensity-score adjustment for age, sex, and baseline HBeAg, ALT, and total bilirubin, virological breakthrough was higher in the de novo combination of Lam and Adv (HR 2.83, 95% CI 1.37–5.86; P<0.01). The cumulative rate of liver-related events, including decompensation and hepatocellular carcinoma, at 1, 2, and 3 years was 2.9%, 4.2%, and 6.1% in the Etv group and 2.2%, 2.2%, and 6.7% in combination group, respectively (P=0.83). Biochemical response and serological response were similar between the groups. Conclusion Etv treatment had less virological breakthrough and potentially higher HBV-DNA suppression than de novo combination of Lam and Adv during 3 years in treatment-naïve HBV-related compensated liver cirrhosis.
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Affiliation(s)
- Xiaoning Wu
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Jialing Zhou
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Wen Xie
- Liver Fibrosis Centre, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huiguo Ding
- Department of Digestive Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Ou
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Guofeng Chen
- Liver Fibrosis Centre, Beijing 302 Hospital, Beijing, China
| | - Anlin Ma
- Department of Infectious Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoyuan Xu
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Hui Ma
- Liver Research Centre, Peking University People's Hospital, Beijing, China
| | - Youqing Xu
- Department of Digestive Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Tongtong Meng
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Lin Wang
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Yameng Sun
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Bingqiong Wang
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Yuanyuan Kong
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Hong Ma
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Hong You
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Jidong Jia
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
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12
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Cooke GS, Andrieux-Meyer I, Applegate TL, Atun R, Burry JR, Cheinquer H, Dusheiko G, Feld JJ, Gore C, Griswold MG, Hamid S, Hellard ME, Hou J, Howell J, Jia J, Kravchenko N, Lazarus JV, Lemoine M, Lesi OA, Maistat L, McMahon BJ, Razavi H, Roberts T, Simmons B, Sonderup MW, Spearman CW, Taylor BE, Thomas DL, Waked I, Ward JW, Wiktor SZ. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2019; 4:135-184. [PMID: 30647010 DOI: 10.1016/s2468-1253(18)30270-x] [Citation(s) in RCA: 346] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023]
Abstract
Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.
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Affiliation(s)
- Graham S Cooke
- Division of Infectious Diseases, Imperial College London, London, UK.
| | | | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jordan J Feld
- Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Canada
| | | | - Max G Griswold
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - JinLin Hou
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Guangzhou, China
| | - Jess Howell
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Beijing, China
| | | | - Jeffrey V Lazarus
- Health Systems Research Group, Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maud Lemoine
- Division of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AL, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | | | - Bryony Simmons
- Division of Infectious Diseases, Imperial College London, London, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | | | - David L Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Imam Waked
- National Liver Institute, Menoufiya University, Egypt
| | - John W Ward
- Program for Viral Hepatitis Elimination, Task Force for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefan Z Wiktor
- Department of Global Health, University of Washington, Seattle, WA, USA
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13
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Chen VL, Yeh ML, Le AK, Jun M, Saeed WK, Yang JD, Huang CF, Lee HY, Tsai PC, Lee MH, Giama N, Kim NG, Nguyen PP, Dang H, Ali HA, Zhang N, Huang JF, Dai CY, Chuang WL, Roberts LR, Jun DW, Lim YS, Yu ML, Nguyen MH. Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience. Aliment Pharmacol Ther 2018; 48:44-54. [PMID: 29797518 DOI: 10.1111/apt.14801] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/02/2018] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) worldwide. It remains incompletely understood in the real world how anti-viral therapy affects survival after HCC diagnosis. METHODS This was an international multicentre cohort study of 2518 HBV-related HCC cases diagnosed between 2000 and 2015. Cox proportional hazards models were utilised to estimate hazard ratios (HR) with 95% (CI) for anti-viral therapy and cirrhosis on patients' risk of death. RESULTS Approximately, 48% of patients received anti-viral therapy at any time, but only 17% were on therapy at HCC diagnosis (38% at US centres, 11% at Asian centres). Anti-viral therapy would have been indicated for >60% of the patients not on anti-viral therapy based on American criteria. Patients with cirrhosis had lower 5-year survival (34% vs 46%; P < 0.001) while patients receiving anti-viral therapy had increased 5-year survival compared to untreated patients (42% vs 25% with cirrhosis and 58% vs 36% without cirrhosis; P < 0.001 for both). Similar findings were seen for other patient subgroups by cancer stages and cancer treatment types. Anti-viral therapy was associated with a decrease in risk of death, whether started before or after HCC diagnosis (adjusted HR 0.62 and 0.79, respectively; P < 0.001). CONCLUSIONS Anti-viral therapy improved overall survival in patients with HBV-related HCC across cancer stages and treatment types but was underutilised at both US and Asia centres. Expanded use of anti-viral therapy in HBV-related HCC and better linkage-to-care for HBV patients are needed.
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Affiliation(s)
- V L Chen
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - M-L Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - A K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - M Jun
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - W K Saeed
- Division of Gastroenterology, Hanyang University Medical Center, Seoul, Korea
| | - J D Yang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - C-F Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H Y Lee
- Division of Gastroenterology, Hanyang University Medical Center, Seoul, Korea
| | - P-C Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M-H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - N Giama
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - N G Kim
- Stanford University School of Medicine, Stanford, CA, USA
| | - P P Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - H Dang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - H A Ali
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - N Zhang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - J-F Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C-Y Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - W-L Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - L R Roberts
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - D W Jun
- Division of Gastroenterology, Hanyang University Medical Center, Seoul, Korea
| | - Y-S Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M-L Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
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14
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Chan WK, Treeprasertsuk S, Imajo K, Nakajima A, Seki Y, Kasama K, Kakizaki S, Fan JG, Song MJ, Yoon SK, Dan YY, Lesmana L, Ho KY, Goh KL, Wong VWS. Clinical features and treatment of nonalcoholic fatty liver disease across the Asia Pacific region-the GO ASIA initiative. Aliment Pharmacol Ther 2018; 47:816-825. [PMID: 29333610 DOI: 10.1111/apt.14506] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/06/2017] [Accepted: 12/16/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Gut and Obesity Asia (GO ASIA) workgroup was formed to study the relationships between obesity and gastrointestinal diseases in the Asia Pacific region. AIM To study factors associated with nonalcoholic steatohepatitis (NASH) and advanced fibrosis, and medical treatment of biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients. METHODS Retrospective study of biopsy-proven NAFLD patients from centres in the GO ASIA Workgroup. Independent factors associated with NASH and with advanced fibrosis on binary logistic regression analyses in a training cohort were used for the development of their corresponding risk score, which were validated in a validation cohort. RESULTS We included 1008 patients from nine centres across eight countries (NASH 62.9%, advanced fibrosis 17.2%). Independent predictors of NASH were body mass index ≥30 kg/m2 , diabetes mellitus, dyslipidaemia, alanine aminotransferase ≥88 U/L and aspartate aminotransferase ≥38 U/L, constituting the Asia Pacific NASH risk score. A high score has a positive predictive value of 80%-83% for NASH. Independent predictors of advanced fibrosis were age ≥55 years, diabetes mellitus and platelet count <150 × 109 /L, constituting the Asia-Pacific NAFLD advanced fibrosis risk score. A low score has a negative predictive value of 95%-96% for advanced fibrosis. Only 1.7% of patients were referred for structured lifestyle program, 4.2% were on vitamin E, and 2.4% were on pioglitazone. CONCLUSIONS More severe liver disease can be suspected or ruled out based on factors identified in this study. Utilisation of structured lifestyle program, vitamin E and pioglitazone was limited despite this being a cohort of biopsy-proven NAFLD patients with majority of patients having NASH.
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Affiliation(s)
| | | | - K Imajo
- Yokohama City University Graduate School of Medicine, Japan
| | - A Nakajima
- Yokohama City University Graduate School of Medicine, Japan
| | - Y Seki
- Yotsuya Medical Cube, Japan
| | | | - S Kakizaki
- Gunma University Graduate School of Medicine, Japan
| | - J-G Fan
- Shanghai Jiaotong University School of Medicine, China
| | - M J Song
- The Catholic University Korea, Korea
| | - S K Yoon
- The Catholic University Korea, Korea
| | - Y-Y Dan
- National University of Singapore, Singapore
| | - L Lesmana
- Medistra Hospital, Jakarta, Indonesia
| | - K-Y Ho
- National University of Singapore, Singapore
| | - K-L Goh
- University of Malaya, Malaysia
| | - V W-S Wong
- The Chinese University of Hong Kong, Hong Kong, China
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15
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Hsu YC, Mo LR, Chang CY, Wu MS, Yang TH, Kao JH, Chen CC, Tseng CH, Tai CM, Lin CW, Wu CY, Lin JT. Serum viral load at the virological relapse predicts subsequent clinical flares in chronic hepatitis B patients off entecavir therapy. J Gastroenterol Hepatol 2017; 32:1512-1519. [PMID: 28122151 DOI: 10.1111/jgh.13728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/18/2016] [Accepted: 01/10/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Therapeutic duration of nucleos(t)ide analogues for chronic hepatitis B (CHB) is not indefinite in many parts of the world. Viral reactivation is common off therapy, but the risk of subsequent clinical outcome remains unclear and unpredictable. We aimed to quantify the incidence of and explore the predictors for clinical flare following virological relapse in CHB patients who discontinue entecavir therapy. METHODS This multicenter cohort study prospectively monitored 133 CHB patients who were HBeAg-negative and viral DNA-undetectable when discontinuing entecavir after at least 3 years on therapy. Following virological relapse (viral DNA >2,000 IU/mL) that occurred in 92 patients, the incidences of subsequent clinical flare and persistent (unremittent for 3 months) or severe hepatitis (with jaundice or coagulopathy) were determined, and risk factors were explored. Patients did not resume antiviral therapy until occurrence of persistent or severe hepatitis. RESULTS The cumulative incidence of clinical hepatitis 2 years after virological relapse was 61.0% (95% confidence interval [CI], 49.9-72.3%) and that of persistent or severe hepatitis was 53.0% (95% CI, 40.9-66.2%). Serum viral load at the virological relapse was associated with both clinical hepatitis (adjusted hazard ratio [HR], 1.31 per log IU/mL; 95% CI, 1.07-1.60) and persistent or severe hepatitis (adjusted HR, 1.63 per log IU/mL; 95% CI, 1.27-2.10), after adjustment for serum aminotransferase and alfa-fetoprotein levels in the multivariate analysis. Viral DNA >100 000 IU/mL predicted a nearly inevitable occurrence of clinical flare (P < 0.0001). CONCLUSIONS A high viral load at the virological relapse predicts subsequent clinical hepatitis in CHB patients who discontinue entecavir.
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Affiliation(s)
- Yao-Chun Hsu
- Center for Database Research, E-Da Hospital, Kaohsiung, Taiwan.,Department of Medicine, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Lein-Ray Mo
- Superintendent Office, Tainan Municipal Hospital, Tainan, Taiwan
| | - Chi-Yang Chang
- Department of Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzeng-Huey Yang
- Division of Gastroenterology, Lotung Poh-Ai Hospital, Ilan, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Chi-Ming Tai
- Department of Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chih-Wen Lin
- Department of Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Ying Wu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Jaw-Town Lin
- Department of Medicine, E-Da Hospital, Kaohsiung, Taiwan.,Big Data Research Center, Fu Jen Catholic University, New Taipei, Taiwan
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Kim YA, Estevez J, Le A, Israelski D, Baatarkhuu O, Sarantuya T, Narantsetseg S, Nymadawa P, H Le R, Yuen MF, Dusheiko G, Rizzetto M, Nguyen MH. Screening and management of viral hepatitis and hepatocellular carcinoma in Mongolia: results from a survey of Mongolian physicians from all major provinces of Mongolia. BMJ Open Gastroenterol 2016; 3:e000119. [PMID: 27933202 PMCID: PMC5128837 DOI: 10.1136/bmjgast-2016-000119] [Citation(s) in RCA: 6] [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: 08/24/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022] Open
Abstract
Background According to Globocan, Mongolia has the highest worldwide hepatocellular carcinoma (HCC) incidence (78.1/100 000, 3.5× higher than China). Aims and methods We conducted an anonymous survey of physicians from major provinces who attended an educational liver symposium, analysing their demography, practice, knowledge, perceptions and proposed solutions. Multivariate logistic regression was used to estimate OR relating demography and practice factors with higher provider knowledge and improvement. Results Of the 121 attendees, 44–95 (36–79%) responded to each question. Most were female (87%), young (79% age <50), subspecialists (81%), university-affiliated (74%), and practised in urban areas (61%). The mean pretest and post-test scores per physician were 60.4±20.4 and 65.6±21.3, with no observed significant predictors for baseline knowledge or improvement. Most (>80%) noted that <50% of patients who need hepatitis or HCC screening receive it. The main perceived barriers to screening were inability to pay for tests, lack of guidelines and poor patient awareness. Hepatitis treatment rates were low; 83% treated hepatitis C virus in <10 patients in the past year, and 86% treated hepatitis B virus in <10 patients/month. Treatment barriers were multifactorial, with cost as a principal barrier. Proposed solutions were universal screening policies (46%), removal of financial barriers (28%) and provider education (20%). Conclusions Physicians from major regions of Mongolia noted low screening for viral hepatitis, even lower treatment rates, financial barriers and the need for increased educational efforts. We advocate broad-based medical education tailored to local needs and based on needs assessment and outcome measurements.
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Affiliation(s)
- Yoona A Kim
- Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA
| | - Jacqueline Estevez
- Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA
| | - An Le
- Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA
| | - Dennis Israelski
- Center for Innovation in Global Health, Stanford University, Stanford, California, USA; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Oidov Baatarkhuu
- Department of Infectious Diseases , Mongolian National University of Medical Sciences , Ulaanbaatar , Mongolia
| | - Tserenchimed Sarantuya
- Department of Internal Medicine , United Family Intermed Hospital , Ulaanbaatar , Mongolia
| | - Sonom Narantsetseg
- Shastin Memorial Third National General Hospital of Mongolia , Ulaanbaatar , Mongolia
| | - Pagbajabyn Nymadawa
- Public Health Branch , Mongolian Academy of Medical Sciences , Ulaanbaatar , Mongolia
| | - Richard H Le
- Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA
| | - Man-Fung Yuen
- Division of Gastroenterology and Hepatology , Queen Mary Hospital, The University of Hong Kong , Hong Kong , Hong Kong
| | - Geoffrey Dusheiko
- Kings College Hospital and University College London School of Medicine , London , UK
| | - Mario Rizzetto
- Department of Gastroenterology , University of Turin , Turin , Italy
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA; Center for Innovation in Global Health, Stanford University, Stanford, California, USA
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Wait S, Kell E, Hamid S, Muljono DH, Sollano J, Mohamed R, Shah S, Mamun-Al-Mahtab, Abbas Z, Johnston J, Tanwandee T, Wallace J. Hepatitis B and hepatitis C in southeast and southern Asia: challenges for governments. Lancet Gastroenterol Hepatol 2016; 1:248-255. [PMID: 28404097 DOI: 10.1016/s2468-1253(16)30031-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 12/19/2022]
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18
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Hsu YC, Mo LR, Chang CY, Wu MS, Kao JH, Wang WL, Yang TH, Wang CS, Chiang MF, Chen CC, Fang YJ, Hung HW, Wu CY, Lin JT. Association Between Serum Level of Hepatitis B Surface Antigen at End of Entecavir Therapy and Risk of Relapse in E Antigen-Negative Patients. Clin Gastroenterol Hepatol 2016; 14:1490-1498.e3. [PMID: 27018299 DOI: 10.1016/j.cgh.2016.03.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/16/2016] [Accepted: 03/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS This study investigated whether serum level of hepatitis B surface antigen (HBsAg) at the end of entecavir treatment was associated with risk of relapse. METHODS We performed a prospective multicenter study of 161 consecutive patients with chronic hepatitis B in whom the hepatitis B virus was no longer detected after 3 years or more of entecavir therapy. Treatment ended between July 1, 2011 and July 1, 2015. Patients were monitored for clinical relapse (hepatitis B virus DNA >2000 IU/mL and level of alanine aminotransferase more than 2-fold the upper limit of normal) and virologic relapse (hepatitis B virus DNA >2000 IU/mL). Outcomes were calculated using the Kaplan-Meier method and risk factors were identified by Cox proportional hazards modeling. RESULTS Two years after therapy ended, 49.2% of patients in the entire cohort had a clinical relapse (95% confidence interval [CI], 40.9%-58.1%) and 81.7% had a virologic relapse (95% CI, 74.3%-88.0%). Among patients who were hepatitis B e antigen-negative at the end of therapy, 39.2% had a clinical relapse (95% CI, 30.3%-49.6%) and 77.4% had a virologic relapse (95% CI, 68.6%-85.2%). Serum level of HBsAg was associated with relapse in the hepatitis B e antigen-negative patients (Ptrend = .006 for clinical relapse; Ptrend = .0001 for virologic relapse). In multivariate Cox regression analysis, the hazard ratio (per log IU/mL increment) for clinical relapse was 2.47 (95% CI, 1.45-4.23) and for virologic relapse was 1.80 (95% CI, 1.33-2.45). The 11 (9%) patients with levels of HBsAg <10 IU/mL did not relapse. CONCLUSIONS Serum level of HBsAg is associated with risk of relapse in patients who are hepatitis B e antigen-negative after treatment with entecavir. A low titer of HBsAg might be used to identify patients at low risk for relapse after treatment.
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Affiliation(s)
- Yao-Chun Hsu
- Center for Database Research, E-Da Hospital, Kaohsiung City, Taiwan; Division of Gastroenterology, E-Da Hospital, Kaohsiung City, Taiwan; School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan; Graduate Institute of Clinical Medicine, China Medical University, Taichung City, Taiwan
| | - Lein-Ray Mo
- Superintendent Office, Tainan Municipal Hospital, Tainan City, Taiwan
| | - Chi-Yang Chang
- Division of Gastroenterology, E-Da Hospital, Kaohsiung City, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei City, Taiwan
| | - Wen-Lun Wang
- Division of Gastroenterology, E-Da Hospital, Kaohsiung City, Taiwan
| | - Tzeng-Huey Yang
- Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan
| | - Chaur-Shine Wang
- Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan
| | - Ming-Feng Chiang
- Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan County, Taiwan
| | - Chieh-Chang Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yu-Jen Fang
- Department of Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan
| | - Hsu-Wei Hung
- Taipei Institute of Pathology, Taipei City, Taiwan
| | - Chun-Ying Wu
- Graduate Institute of Clinical Medicine, China Medical University, Taichung City, Taiwan; Division of Gastroenterology, Taichung Veterans General Hospital, Taichung City, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
| | - Jaw-Town Lin
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Abstract
HCV in the East is a complex scenario with prevalence rates of 0.5% to as high as 4.7%, and variable distributions of genotypes, with a dominance of genotype 1b in East Asia, genotype 3 in South Asia and South East Asia, and genotype 6 in Indochina. Approvals for the new oral directing antiviral agents (DAAs), in the East have been very slow, but ultimately will be achieved by 2019, consequently, pegylated interferon and ribavirin are still widely used. Nonetheless the main issues are the problems of screening and linkage to management, and the considerable barriers to access HCV care.
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Affiliation(s)
- Yock Young Dan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore; Cancer Science Institute, National University of Singapore, Singapore, Singapore
| | - Seng Gee Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore; Cancer Science Institute, National University of Singapore, Singapore, Singapore; Institute of Molecular and Cell Biology, Agency for Science and Technology, 61 Biopolis Drive, Singapore 138673, Singapore; Department of Gastroenterology and Hepatology, National University Hospital, 1E Lower Kent Ridge Road, Singapore 119228, Singapore.
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20
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Lim SG, Dan YY. A 2015 roadmap for the management of hepatitis C virus infections in Asia. Korean J Intern Med 2015; 30:423-33. [PMID: 26161008 PMCID: PMC4497329 DOI: 10.3904/kjim.2015.30.4.423] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/12/2015] [Indexed: 12/29/2022] Open
Abstract
The prevalence of hepatitis C virus (HCV) in Asia is 0.5% to 4.7%, with three different genotypes predominating, depending on the geographic region: genotype 1b in East Asia, genotype 3 in South and Southeast Asia, and genotype 6 in Indochina. Official approval for direct-acting antiviral agents (DAAs) in Asia lags significantly behind that in the West, such that in most countries the mainstay of therapy is still pegylated interferon and ribavirin (PR). Because the interleukin-28B genetic variant, associated with a high sustained virologic response (SVR), is common in Asians, this treatment is still acceptable in Asian patients with HCV infections. A roadmap for HCV therapy that starts with PR and takes into account those DAAs already approved in some Asian countries can provide guidance as to the best strategies for management, particularly of genotype 1 and 3 infections, based on SVR rates. Sofosbuvir and PR are likely to be the initial therapies for genotype 1 and 3 disease, although in the former these drugs may be suboptimal in patients with cirrhosis (62% SVR) and the extension of treatment to 24 weeks may be required. For difficult to treat genotype 3 infections in treatment-experienced patients with cirrhosis, a combination of sofosbuvir and PR result in an 83% SVR and is, therefore, currently the optimal treatment regimen. Treatment failure is best avoided since data on rescue therapies for DAA failure are still incomplete.
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Affiliation(s)
- Seng Gee Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore
- Institute of Molecular and Cell Biology, Agency for Science and Technology, Singapore
| | - Yock Young Dan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore
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