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Tu T, Wettengel J, Xia Y, Testoni B, Littlejohn M, Le Bert N, Ebert G, Verrier ER, Tavis JE, Cohen C. Major open questions in the hepatitis B and D field - Proceedings of the inaugural International emerging hepatitis B and hepatitis D researchers workshop. Virology 2024; 595:110089. [PMID: 38640789 DOI: 10.1016/j.virol.2024.110089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
The early and mid-career researchers (EMCRs) of scientific communities represent the forefront of research and the future direction in which a field takes. The opinions of this key demographic are not commonly aggregated to audit fields and precisely demonstrate where challenges lie for the future. To address this, we initiated the inaugural International Emerging Researchers Workshop for the global Hepatitis B and Hepatitis D scientific community (75 individuals). The cohort was split into small discussion groups and the significant problems, challenges, and future directions were assessed. Here, we summarise the outcome of these discussions and outline the future directions suggested by the EMCR community. We show an effective approach to gauging and accumulating the ideas of EMCRs and provide a succinct summary of the significant gaps remaining in the Hepatitis B and Hepatitis D field.
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Affiliation(s)
- Thomas Tu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, NSW, Australia; Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Westmead, NSW, Australia.
| | - Jochen Wettengel
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA; Institute of Virology, Technical University of Munich /Helmholtz Munich, Munich, Germany; German Center for Infection Research, Munich Partner Site, 81675, Munich, Germany
| | - Yuchen Xia
- State Key Laboratory of Virology and Hubei Province Key Laboratory of Allergy and Immunology, Institute of Medical Virology, TaiKang Center for Life and Medical Sciences, TaiKang Medical School, Wuhan University, Wuhan, China; Hubei Jiangxia Laboratory, Wuhan, China; Pingyuan Laboratory, Henan, China
| | - Barbara Testoni
- INSERM U1052, CNRS UMR-5286, Cancer Research Center of Lyon, Lyon, France; University of Lyon, Université Claude-Bernard, Lyon, France; Hepatology Institute of Lyon, France
| | - Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital and Department of Infectious Disease, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Nina Le Bert
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Gregor Ebert
- Institute of Virology, Technical University of Munich /Helmholtz Munich, Munich, Germany
| | - Eloi R Verrier
- University of Strasbourg, Inserm, Institute for Translational Medicine and Liver Disease, UMR_S1110, Strasbourg, France
| | - John E Tavis
- Department of Molecular Microbiology and Immunology, Saint Louis University School of Medicine and the Saint Louis University Institute for Drug and Biotherapeutic Innovation, Saint Louis, MO, USA
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Airewele NE, Shiffman ML. Chronic Hepatitis B Virus in Patients with Chronic Hepatitis C Virus. Clin Liver Dis 2021; 25:817-829. [PMID: 34593155 DOI: 10.1016/j.cld.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Many patients with hepatitis C virus (HCV) have also been exposed to hepatitis B virus (HBV). The 2 viruses interact and in most cases HCV suppresses HBV. When HCV is treated with direct antiviral agents, this suppressive effect is removed, HBV replication may increase, and a flare in liver enzymes with liver injury may occur. All patients with chronic HCV should therefore be checked for serologic evidence of HBV. Patients with hepatitis B surface antigen are at the highest risk for reactivation, and these patients should receive prophylactic treatment of HBV during and for 6 months after HCV treatment.
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Affiliation(s)
- Nelson E Airewele
- Liver Institute of Richmond, Bon Secours Mercy Health, Richmond, VA, USA; Liver Institute of Hampton Roads, Bon Secours Mercy Health, Newport News, VA, USA.
| | - Mitchell L Shiffman
- Liver Institute of Richmond, Bon Secours Mercy Health, Richmond, VA, USA; Liver Institute of Hampton Roads, Bon Secours Mercy Health, Newport News, VA, USA
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Weldemhret L. Epidemiology and Challenges of HBV/HIV Co-Infection Amongst HIV-Infected Patients in Endemic Areas: Review. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:485-490. [PMID: 33981165 PMCID: PMC8107003 DOI: 10.2147/hiv.s273649] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022]
Abstract
With the introduction of highly active antiretroviral treatment, HIV-related morbidity and mortality have declined. But underlying hepatitis B virus infection remains the major cause of AIDS-defined illness and liver-related disease progression mainly in endemic settings. Moreover, HBV-HIV co-infection is the leading cause of cirrhosis, hepatocellular carcinoma, and liver-related death. This review paper emphasizes reviewing the burden and impact of HBV-HIV co-infection in liver-related disease progression, immune recovery, and therapeutic management of HIV-infected individuals on ART regimen.
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Abstract
Currently, despite the use of a preventive vaccine for several decades as well as the use of effective and well-tolerated viral suppressive medications since 1998, approximately 250 million people remain infected with the virus that causes hepatitis B worldwide. Hepatitis C virus (HCV) and hepatitis B virus (HBV) are the leading causes of liver cancer and overall mortality globally, surpassing malaria and tuberculosis. Linkage to care is estimated to be very poor both in developing countries and in high-income countries, such as the United States, countries in Western Europe, and Japan. In the United States, by CDC estimates, only one-third of HBV-infected patients or less are aware of their infection. Some reasons for these low rates of surveillance, diagnosis, and treatment include the asymptomatic nature of chronic hepatitis B until the very late stages, a lack of curative therapy with a finite treatment duration, a complex natural history, and a lack of knowledge about the disease by both care providers and patients. In the last 5 years, more attention has been focused on the important topics of HBV screening, diagnosis of HBV infection, and appropriate linkage to care. There have also been rapid clinical developments toward a functional cure of HBV infection, with novel compounds currently being in various phases of progress. Despite this knowledge, many of the professional organizations provide guidelines focused only on specific questions related to the treatment of HBV infection. This focus leaves a gap for care providers on the other HBV-related issues, which include HBV's epidemiological profile, its natural history, how it interacts with other viral hepatitis diseases, treatments, and the areas that still need to be addressed in order to achieve HBV elimination by 2030. Thus, to fill these gaps and provide a more comprehensive and relevant document to regions worldwide, we have taken a global approach by using the findings of global experts on HBV as well as citing major guidelines and their various approaches to addressing HBV and its disease burden.
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Shiffman ML, Gunn NT. Management and Treatment of Chronic HBV and HCV Co-Infection and the Impact of Anti-Viral Therapy. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s11901-017-0352-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Amponsah-Dacosta E, Rakgole JN, Gededzha MP, Lukhwareni A, Blackard JT, Selabe SG, Mphahlele MJ. Evidence of susceptibility to lamivudine-based HAART and genetic stability of hepatitis B virus (HBV) in HIV co-infected patients: A South African longitudinal HBV whole genome study. INFECTION GENETICS AND EVOLUTION 2016; 43:232-8. [PMID: 27245151 DOI: 10.1016/j.meegid.2016.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/09/2016] [Accepted: 05/25/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Reports on the concomitant impact of HIV co-infection and long term highly active anti-retroviral therapy (HAART) on the genetic stability and molecular evolution of HBV are limited in sub-Saharan Africa. MATERIALS AND METHODS This retrospective study investigated the molecular evolution of chronic HBV in HIV co-infected patients on lamivudine (3TC)-based HAART over a 5year period. Four HIV co-infected patients, consecutively recruited and followed-up, were screened for hepatitis B serological markers, and their viral loads determined. The HBV genome was amplified from longitudinal samples and characterized by Bayesian inference, mutational analysis, and identification of immune selection pressure. RESULTS All patients exhibited persistent chronic HBV infection at baseline, as well as over the course of follow-up despite exposure to 3TC-based HAART. The polymerase gene in all isolates was relatively variable prior to HAART initiation at baseline and during the course of follow-up, although primary drug resistance mutations were not detected. All but one patient were infected with HBV subgenotype A1. The divergence rates between baseline and the last follow-up sequences ranged from 0 to 2.0×10(-3) substitutions per site per year (s/s/y). Positive selection pressure was evident within the surface and core genes. CONCLUSION Despite persistent HBV infection in the HIV co-infected patients exposed to long term 3TC-based HAART, the molecular evolution of HBV over a 5year period was unremarkable. In addition, HBV exhibited minimal genetic variability overtime.
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Affiliation(s)
- Edina Amponsah-Dacosta
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University and National Health Laboratory Service, MEDUNSA, Pretoria, South Africa
| | - J Nare Rakgole
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University and National Health Laboratory Service, MEDUNSA, Pretoria, South Africa
| | - Maemu P Gededzha
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University and National Health Laboratory Service, MEDUNSA, Pretoria, South Africa
| | - Azwidowi Lukhwareni
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University and National Health Laboratory Service, MEDUNSA, Pretoria, South Africa; National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Jason T Blackard
- Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Selokela G Selabe
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University and National Health Laboratory Service, MEDUNSA, Pretoria, South Africa
| | - M Jeffrey Mphahlele
- HIV and Hepatitis Research Unit, Department of Virology, Sefako Makgatho Health Sciences University and National Health Laboratory Service, MEDUNSA, Pretoria, South Africa; South African Medical Research Council, Soutpansberg Road, Pretoria, South Africa.
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Lai CL, Yuen MF. Management of chronic hepatitis B in patients from special populations. Cold Spring Harb Perspect Med 2015; 5:5/6/a021527. [PMID: 26033083 DOI: 10.1101/cshperspect.a021527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Here we review the management of chronic hepatitis B (CHB) in four special categories of patients: CHB in pregnancy, in patients on immunosuppressive treatments, in patients undergoing liver transplantation, and in patients coinfected with human immunodeficiency virus (HIV) or hepatitis C virus (HCV).
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Affiliation(s)
- Ching-Lung Lai
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
| | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong 999077, China
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Yao ZQ, Moorman JP. Immune exhaustion and immune senescence: two distinct pathways for HBV vaccine failure during HCV and/or HIV infection. Arch Immunol Ther Exp (Warsz) 2013; 61:193-201. [PMID: 23400275 PMCID: PMC3792483 DOI: 10.1007/s00005-013-0219-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/01/2013] [Indexed: 12/11/2022]
Abstract
Given the shared risk factors for transmission, co-infection of hepatitis B virus (HBV) with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) is quite common, and may lead to increases in morbidity and mortality. As such, HBV vaccine is recommended as the primary means to prevent HBV super-infection in HCV- and/or HIV-infected individuals. However, vaccine response (sero-conversion with a hepatitis B surface antibody titer >10 IU/L) in this setting is often blunted, with poor response rates to standard HBV vaccinations in virally infected individuals when compared with the healthy subjects. This phenomenon also occurs to other vaccines in adults, such as pneumococcal and influenza vaccines, in other immunocompromised hosts who are really at risk for opportunistic infections, such as individuals with hemodialysis, transplant, and malignancy. In this review, we summarize the underlying mechanisms involving vaccine failure in these conditions, focusing on immune exhaustion and immune senescence--two distinct signaling pathways regulating cell function and fate. We raise the possibility that blocking these negative signaling pathways might improve success rates of immunizations in the setting of chronic viral infection.
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Affiliation(s)
- Zhi Q Yao
- Department of Veterans Affairs, Hepatitis (HCV/HBV/HIV) Program, James H. Quillen VA Medical Center, Johnson City, TN 37614, USA.
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Wang JM, Ma CJ, Li GY, Wu XY, Thayer P, Greer P, Smith AM, High KP, Moorman JP, Yao ZQ. Tim-3 alters the balance of IL-12/IL-23 and drives TH17 cells: role in hepatitis B vaccine failure during hepatitis C infection. Vaccine 2013; 31:2238-45. [PMID: 23499521 PMCID: PMC3667544 DOI: 10.1016/j.vaccine.2013.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/12/2013] [Accepted: 03/04/2013] [Indexed: 12/11/2022]
Abstract
Hepatitis B virus (HBV) vaccination is recommended for individuals with hepatitis C virus (HCV) infection given their shared risk factors and increased liver-related morbidity and mortality upon super-infection. Vaccine responses in this setting are often blunted, with poor response rates to HBV vaccinations in chronically HCV-infected individuals compared to healthy subjects. In this study, we investigated the role of T cell immunoglobulin mucin domain-3 (Tim-3)-mediated immune regulation in HBV vaccine responses during HCV infection. We found that Tim-3, a marker for T cell exhaustion, was over-expressed on monocytes, leading to a differential regulation of IL-12/IL-23 production which in turn TH17 cell accumulation, in HCV-infected HBV vaccine non-responders compared to HCV-infected HBV vaccine responders or healthy subjects (HS). Importantly, ex vivo blockade of Tim-3 signaling corrected the imbalance of IL-12/IL-23 as well as the IL-17 bias observed in HBV vaccine non-responders during HCV infection. These results suggest that Tim-3-mediated dysregulation of innate to adaptive immune responses is involved in HBV vaccine failure in individuals with chronic HCV infection, raising the possibility that blocking this negative signaling pathway might improve the success rate of HBV immunization in the setting of chronic viral infection.
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Affiliation(s)
- Jia M. Wang
- Department of Internal Medicine, Division of Infectious Diseases, James H. Quillen
College of Medicine, East Tennessee State University, Johnson City, Tennessee, United State of
America
- Department of Biochemistry and Molecular Biology, Soochow University School of
Medicine, Suzhou, China
| | - Cheng J. Ma
- Department of Internal Medicine, Division of Infectious Diseases, James H. Quillen
College of Medicine, East Tennessee State University, Johnson City, Tennessee, United State of
America
| | - Guang Y. Li
- Department of Internal Medicine, Division of Infectious Diseases, James H. Quillen
College of Medicine, East Tennessee State University, Johnson City, Tennessee, United State of
America
| | - Xiao Y. Wu
- Department of Internal Medicine, Division of Infectious Diseases, James H. Quillen
College of Medicine, East Tennessee State University, Johnson City, Tennessee, United State of
America
| | - Penny Thayer
- Hepatitis (HCV/HIV) Program, James H. Quillen VA Medical Center, Department of
Veterans Affairs, Johnson City, Tennessee, United State of America
| | - Pamela Greer
- Hepatitis (HCV/HIV) Program, James H. Quillen VA Medical Center, Department of
Veterans Affairs, Johnson City, Tennessee, United State of America
| | - Ashley M. Smith
- Hepatitis (HCV/HIV) Program, James H. Quillen VA Medical Center, Department of
Veterans Affairs, Johnson City, Tennessee, United State of America
| | - Kevin P. High
- Department of Internal Medicine, Section of Infectious Diseases, Wake Forest
University Baptist Medical Center, Winston Salem, North Carolina, United State of America
| | - Jonathan P Moorman
- Hepatitis (HCV/HIV) Program, James H. Quillen VA Medical Center, Department of
Veterans Affairs, Johnson City, Tennessee, United State of America
- Department of Internal Medicine, Division of Infectious Diseases, James H. Quillen
College of Medicine, East Tennessee State University, Johnson City, Tennessee, United State of
America
| | - Zhi Q. Yao
- Hepatitis (HCV/HIV) Program, James H. Quillen VA Medical Center, Department of
Veterans Affairs, Johnson City, Tennessee, United State of America
- Department of Internal Medicine, Division of Infectious Diseases, James H. Quillen
College of Medicine, East Tennessee State University, Johnson City, Tennessee, United State of
America
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Moorman JP, Zhang CL, Ni L, Ma CJ, Zhang Y, Wu XY, Thayer P, Islam TM, Borthwick T, Yao ZQ. Impaired hepatitis B vaccine responses during chronic hepatitis C infection: involvement of the PD-1 pathway in regulating CD4(+) T cell responses. Vaccine 2011; 29:3169-76. [PMID: 21376795 DOI: 10.1016/j.vaccine.2011.02.052] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/03/2011] [Accepted: 02/15/2011] [Indexed: 01/08/2023]
Abstract
Vaccination for hepatitis B virus (HBV) in the setting of hepatitis C virus (HCV) infection is recommended, but responses to vaccination are blunted when compared to uninfected populations. The mechanism for this failure of immune response in HCV-infected subjects remains unknown but is thought to be a result of lymphocyte dysfunction during chronic viral infection. We have recently demonstrated that PD-1, a novel negative immunomodulator for T cell receptor (TCR) signaling, is involved in T and B lymphocyte dysregulation during chronic HCV infection. In this report, we further investigated the role of the PD-1 pathway in regulation of CD4(+) T cell responses to HBV vaccination in HCV-infected individuals. In a prospective HCV infected cohort, a poor response rate to HBV vaccination as assayed by seroconversion was observed in HCV-infected subjects (53%), while a high response rate was observed in healthy or spontaneously HCV-resolved individuals (94%). CD4(+) T cell responses to ex vivo stimulations of anti-CD3/CD28 antibodies or hepatitis B surface antigen (HBsAg) were found to be lower in HBV vaccine non-responders compared to those responders in HCV-infected individuals who had received a series of HBV immunizations. PD-1 expression on CD4(+) T cells was detected at relatively higher levels in these HBV vaccine non-responders than those who responded, and this was inversely associated with the cell activation status. Importantly, blocking the PD-1 pathway improved T cell activation and proliferation in response to ex vivo HBsAg or anti-CD3/CD28 stimulation in HBV vaccine non-responders. These results suggest that PD-1 signaling may be involved in impairing CD4(+) T cell responses to HBV vaccination in subjects with HCV infection, and raise the possibility that blocking this negative signaling pathway might improve success rates of immunization in the setting of chronic viral infection.
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Affiliation(s)
- Jonathan P Moorman
- Medical Service, Department of Veterans Affairs, James H. Quillen VA Medical Center, Johnson City, TN 37614, USA.
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Abstract
Drug users with HIV infection successfully treated with highly active antiretroviral therapy are now living to older ages. As persons with HIV infection age, they become at risk for comorbidities that occur in any group of aging individuals. However, some of these conditions occur at increased rates, with increasing severity, or pose special problems in older persons with HIV infection. This article discusses the epidemiology of HIV infection in aging drug users, and hormonal, cardiovascular, liver, renal, bone, and cognitive disorders and depression and cancer in these individuals, as well as problems related to taking multiple medications and HIV disease progression.
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Affiliation(s)
- Robert S Klein
- Division of Infectious Diseases and Disease Prevention and Public Health Institute, The Mount Sinai School of Medicine, New York, New York 10029, USA.
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12
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Yang HI, Sherman M, Su J, Chen PJ, Liaw YF, Iloeje UH, Chen CJ. Nomograms for Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Virus Infection. J Clin Oncol 2010; 28:2437-44. [DOI: 10.1200/jco.2009.27.4456] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Counseling patients with chronic hepatitis B virus (HBV) on their individual risk of liver disease progression is challenging. This study aimed to develop nomograms for predicting hepatocellular carcinoma risk in patients with chronic hepatitis B. Patients and Methods Two thirds of the Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer–Hepatitis B Virus (REVEAL-HBV) study cohort was allocated for model derivation (n = 2,435), and the remaining third was allocated for model validation (n = 1,218). Previously confirmed independent risk predictors included in three Cox proportional hazards regression models were sex, age, family history of hepatocellular carcinoma, alcohol consumption habit, serum ALT level, hepatitis B envelope antigen (HBeAg) serostatus, serum HBV DNA level, and HBV genotype. Regression coefficients were rounded into integer risk scores, and predicted risk over 5- and 10-year periods for each risk score was calculated and depicted in nomograms. The predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC) and the correlation between predicted and observed hepatocellular carcinoma risk. Results All selected risk predictors were statistically significant in all models. In each model, either HBeAg seropositivity or HBeAg seronegativity with high viral load (HBV DNA level ≥ 100,000 copies/mL) and genotype C infection had the highest risk scores. All AUROCs for risk prediction nomogram were ≥ 0.82 in both model derivation and validation sets. The correlation coefficients between the observed hepatocellular carcinoma risk and the nomogram-predicted risk were greater than 0.90 in all model derivation and validation sets. Conclusion These easy-to-use nomograms based on noninvasive clinical characteristics can accurately predict the risk of hepatocellular carcinoma in patients with chronic hepatitis B. They may facilitate risk communication between patients and clinicians.
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Affiliation(s)
- Hwai-I Yang
- From the Genomics Research Center, Academia Sinica; Graduate Institute of Epidemiology, College of Public Health and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; Toronto General Hospital, Toronto, Ontario, Canada; and Research and Development, Bristol-Myers Squibb, Wallingford, CT
| | - Morris Sherman
- From the Genomics Research Center, Academia Sinica; Graduate Institute of Epidemiology, College of Public Health and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; Toronto General Hospital, Toronto, Ontario, Canada; and Research and Development, Bristol-Myers Squibb, Wallingford, CT
| | - Jun Su
- From the Genomics Research Center, Academia Sinica; Graduate Institute of Epidemiology, College of Public Health and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; Toronto General Hospital, Toronto, Ontario, Canada; and Research and Development, Bristol-Myers Squibb, Wallingford, CT
| | - Pei-Jer Chen
- From the Genomics Research Center, Academia Sinica; Graduate Institute of Epidemiology, College of Public Health and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; Toronto General Hospital, Toronto, Ontario, Canada; and Research and Development, Bristol-Myers Squibb, Wallingford, CT
| | - Yun-Fan Liaw
- From the Genomics Research Center, Academia Sinica; Graduate Institute of Epidemiology, College of Public Health and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; Toronto General Hospital, Toronto, Ontario, Canada; and Research and Development, Bristol-Myers Squibb, Wallingford, CT
| | - Uchenna H. Iloeje
- From the Genomics Research Center, Academia Sinica; Graduate Institute of Epidemiology, College of Public Health and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; Toronto General Hospital, Toronto, Ontario, Canada; and Research and Development, Bristol-Myers Squibb, Wallingford, CT
| | - Chien-Jen Chen
- From the Genomics Research Center, Academia Sinica; Graduate Institute of Epidemiology, College of Public Health and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University; Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan; Toronto General Hospital, Toronto, Ontario, Canada; and Research and Development, Bristol-Myers Squibb, Wallingford, CT
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13
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Scarsi KK, Darin KM. Chronic Hepatitis B Infection: Principles of Therapy. J Pharm Pract 2009. [DOI: 10.1177/0897190008328692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic hepatitis B is a global health concern in many resource-limited settings due to perinatal or pediatric hepatitis B virus transmission. In the United States, pediatric infection has been virtually eliminated due to maternal screening during pregnancy and the availability of an effective vaccine. However, young adults remain an at-risk group for hepatitis B virus infection due to sexual transmission and injection drug use. The frequency of progression from acute hepatitis B virus infection to chronic hepatitis B infection depends on multiple factors, including host immune function and age at time of hepatitis B virus infection. Fortunately, there are 7 currently approved therapies for chronic hepatitis B infection, and several emerging therapies that show promise. Despite the availability of these agents, many clinical questions still surround chronic hepatitis B therapy including when to start therapy, which agent is ideal for first and second line therapy, the appropriate duration of therapy, and the role of combination antiviral therapy. This review focuses on agents available for chronic hepatitis B management, including pharmacology, safety and efficacy data, monitoring parameters, and the role for each in chronic hepatitis B therapy in adult patients.
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Affiliation(s)
- Kimberly K. Scarsi
- Northwestern University Feinberg School of Medicine, Division of Infectious Diseases, Chicago,
| | - Kristin M. Darin
- Northwestern University Feinberg School of Medicine, Division of Infectious Diseases, Chicago
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Potter M, Klein MB. Co-infections and co-therapies: treatment of HIV in the presence of hepatitis C and hepatitis B. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/17584310.3.2.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An increasing number of people are chronically infected with HIV and HCV, and/or HBV owing to shared routes of transmission. With the advent of HAART, liver disease secondary to hepatitis co-infections has emerged as a leading cause of morbidity and mortality in HIV-infected persons. There is increasing need to manage dual infection, but treatment is complicated by co-morbidities, overlapping toxicities, drug activities and resistance. A model of treatment that builds on the lessons learned from the treatment of HIV has evolved to maximize success of treating dual infections. This review will address current strategies for the management of HIV in the setting of HCV and HBV co-infection and discuss future treatment directions and challenges.
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Affiliation(s)
- Martin Potter
- Department of Medicine, Divisions of Infectious Diseases/Immunodeficiency, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Marina B Klein
- Department of Medicine, Divisions of Infectious Diseases/Immunodeficiency, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Montreal Chest Institute, 3650 Saint Urbain Street, Montréal, Quebec H2X 2P4, Canada
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