Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Factors influencing hepatitis B vaccination intention and behavior among college students in Tibet: Insights from the expanded theory of planned behavior

Hepatitis B (Hep B) remains a critical public health issue globally, particularly in Tibet, where vaccination rates and influencing factors among college students are yet understudied. This study applies a cross-sectional design to investigate the Hep B vaccination rate among 1,126 college students in Tibet and utilizes the expanded theory of planned behavior (ETPB) to identify vaccination behavior intention (BI) and vaccination behavior (VB). Stratified cluster sampling across three universities was used to assess behavioral attitudes (BA), subjective norms (SN), perceived behavioral control (PBC), past vaccination history (PVH) and vaccination knowledge (VK), and used structural equation modeling (SEM) for model validation and multi-group comparison. Results indicated that 16.3% of students had received the Hep B vaccine. VK notably improved BA toward vaccination (β = 0.518, p < .001). BA (β = 0.232, p < .001), PBC (β = 0.239, p < .001), SN (β = 0.385, p < .001) positively influenced BI. However, PVH failed to predict BI. BI (β = 0.448, p < .001) and PVH (β = 0.127, p < .001) were significant predictors of VB. Significant ethnic variations were noted. The positive effect of PVH on VB (β = 0.151, p < .001) and the mediating role of PBC in VB (β = 0.076, p < .05) were significant among Tibetan students. The effect of VK on BA was stronger among Tibetans (β = 0.503, p < .05),while the impact of attitude on BI was more pronounced among Han students (β = 0.366, p < .05). The vaccination rate for Hep B among college students in Tibet is relatively low, and the ETPB model effectively explains their vaccination intentions and behaviors. Tailored intervention strategies for Tibetan and Han students are recommended to boost vaccination rates effectively.

Mission 2030: Toward universal hepatitis B immunization

Despite the availability of efficacious and safe vaccines for more than 40 years, the rate of new hepatitis B virus (HBV) infections remains high, leaving large populations at risk of developing chronic hepatitis B, liver cirrhosis and cancer. The WHO aims at reducing the number of cases by 90% as part of its Immunization Agenda 2030. While legacy vaccines and established immunization protocols will play a significant role in achieving this goal, challenges such as an inconvenient multi-dose regimen and a reduced efficacy in adults persist. Novel vaccines with improved adjuvants, alternative antigens, and innovative administration routes show promise in overcoming these hurdles. However, achieving universal immunization requires increased vaccine coverage, likely by development and validation of two-dose vaccines for children, and the endorsement and implementation of such new approaches in future immunization policies. By addressing these challenges, the goal of controlling HBV globally through immunization becomes attainable.

The significance of antibody to hepatitis B surface antigen in infection and clearance of hepatitis B virus

One of the key features of chronic hepatitis B virus (HBV) infection is the inability to mount sufficient and coordinated adaptive immune responses against HBV. Recent studies on HBV-specific B cells and antibody to hepatitis B surface antigen (anti-HBs) have shed light on their role in the pathogenesis of chronic hepatitis B (CHB). Anti-HBs is recognized as a protective immune marker, both for HBV infection clearance and following vaccination, and it is also considered an important indicator of functional cure for CHB. Notably, functional impairment of HBV-specific B cells may be reversible. The restoration of HBV-specific B cell function, along with the induction of an anti-HBs antibody response, is regarded as pivotal for terminating chronic HBV infection and achieving functional cure. This article reviews the significance of anti-HBs in both the infection and clearance of HBV, and discusses the potential of neutralizing antibodies and therapeutic vaccines as promising future strategies.

Temporal trends in gender, etiology, severity and outcomes of acute pancreatitis in a third-tier Chinese city from 2013 to 2021

BACKGROUND

To evaluate temporal trends in gender, etiology, severity, outcomes, cost and median length of stay (MLS) in patients with acute pancreatitis (AP) in a third-tier Chinese city.

METHODS

Patients with AP admitted to a university hospital between January 2013 and December 2021. Relationships between etiology, prevalence of severe acute pancreatitis (SAP) and survey years were investigated by joinpoint regression analysis.

RESULTS

A total of 5459 (male 62.3%) patients with AP were included. Between January 2013 and December 2021, we observed: (a) the prevalence of biliary diseases-related AP was stable, while the prevalence of hypertriglyceridemia (HTG)-associated AP (Ptrend = 0.04) and alcohol-associated AP (Ptrend < 0.0001) both increased; (b) there was an increase in crude prevalence of SAP from 4.97% to 12.2% between 2013 and 2021 (Ptrend < 0.0001); (c) compared to female populations, male gender had a higher prevalence of AP; (d) there was a decrease in MLS from 11 days to 8 days (Ptrend < 0.0001) and in median cost of hospitalization (MCH) for all patients (from 20,166 to 12,845 YUAN) (Ptrend < 0.0001); (e) the overall in-hospital mortality rate was 1.28% (70/5459) for patients with AP. There was no statistically significant in the time trend of mortality during the study period (Ptrend = 0.5873). At multivariate analysis, survey year was associated with prevalence of SAP after adjustment by age and biliary diseases (OR: 1.07; 95% CI: 1.03-1.12). Based on the stratification by severity of disease, the decrease of MLS and MCH was more significant in non-SAP vs. SAP patients.

CONCLUSIONS

Over the observational period, the proportion of male patients with AP, prevalence of age-adjusted rate of HTG and alcohol-associated AP and SAP increased, while MLS and MCH for all patients decreased, and the time trend of mortality of AP was stable.

Interpretable machine learning model for prediction functional cure in chronic hepatitis B patients receiving Peg-IFN therapy: A multi-center study

BACKGROUND

Functional cure is the ideal treatment goal for chronic hepatitis B (CHB) treatment. We developed and validated machine learning (ML) models to predict functional cure in CHB patients.

METHODS

This study retrospectively recruited 534 CHB patients who received Peg-IFN treatment to construct model and 269 patients for external validation. We analyzed three strategies: baseline, week 12, week 24. Seven ML models were constructed using selected variables by Boruta and least absolute shrinkage and selection operator regression algorithm, and performance metrics, including area under the curve (AUC), sensitivity, specificity, and F1 score were applied to determine the best model. We utilized SHapley Additive exPlanation to visualize and interpret the best model and built a website to conveniently predict functional cure of CHB.

RESULTS

A total of 272 participants were cured in our study. Compared to baseline and week 12 strategies, week 24 using Support Vector Machine (SVM) model can better predict functional cure of CHB, with reliable predictive performance (AUC = 0.981), calibration and clinical applicability in external validation cohort. Age, ALT ratio at week 12, HBsAg at week 24 and HBsAg ratio at week 24 were important features. In order to enhance clinical convenience and effectiveness of the constructed model, a web-based dynamic nomogram was created (Dynamic Nomogram (shinyapps.io)).

CONCLUSION

This study developed SVM model to predict functional cure in CHB patients treated with Peg-IFN. Furthermore, we also built a website that clinicians can individualized predict the efficacy of Peg-IFN therapy in CHB patients.

Exploring the double-edged role of cellular senescence in chronic liver disease for new treatment approaches

Cellular senescence is a fundamental yet complex defense mechanism that restricts excessive proliferation, maintains cellular homeostasis under various stress conditions-such as oncogenic activation and inflammation-and serves as a dynamic stress response program involved in development, aging, and immunity. Its reversibility depends on essential maintenance components. Cellular senescence is a "double-edged sword": on one hand, it limits the malignant proliferation of damaged cells, thereby preventing tumor development. However, by retaining secretory functions, senescent cells can also induce persistent changes in the microenvironment and disrupt homeostasis, leading to tissue inflammation, fibrosis, and carcinogenesis. Senescence plays a critical role in the pathogenesis of various chronic liver diseases, including chronic viral hepatitis, liver fibrosis, and hepatocellular carcinoma. It exerts a dual influence by facilitating immune evasion and inflammation in chronic viral hepatitis, modulating hepatic stellate cell activity in fibrosis, and reshaping the tumor microenvironment to accelerate hepatocarcinogenesis. This article reviews the characteristics of cellular senescence and its role in the pathogenesis of these chronic liver diseases while exploring potential treatment and prevention strategies. The aim is to provide a comprehensive reference for future clinical and research investigations into chronic liver disease.

Global Prevalence of Advanced Liver Fibrosis and Cirrhosis in the General Population: A Systematic Review and Meta-analysis

BACKGROUND & AIMS

Limited data exist regarding the estimate of the prevalence of advanced liver fibrosis and cirrhosis in the general population. Therefore, we conducted a systematic review and meta-analysis to evaluate the global prevalence and risk factors of advanced fibrosis and cirrhosis.

METHODS

We searched Embase, PubMed, Scopus, and Web of Science from inception to April 30 2024, with no language restriction. We included cross-sectional studies reporting the prevalence of advanced liver fibrosis and/or cirrhosis in a sample of at least 100 individuals aged ≥18 years from the general population. Subjects with cirrhosis were included in the advanced fibrosis group. The pooled prevalence proportions utilizing a random-effects model and 95% confidence intervals (CIs) were estimated using global data.

RESULTS

A total of 46 studies fulfilled the eligibility criteria, comprising approximately 8 million participants from 21 countries. The pooled prevalence rates of advanced liver fibrosis and cirrhosis in the general population were 3.3% (95% CI, 2.4%-4.2%) and 1.3% (95% CI, 0.9%-1.7%) worldwide, respectively. A trend was observed for an increase in the prevalence of advanced fibrosis (P = .004) and cirrhosis (P = .034) after 2016. There were significant geographic variations in the advanced fibrosis and cirrhosis prevalence at continental and national levels (P < .0001). Potential risk factors for cirrhosis were viral hepatitis, diabetes, excessive alcohol intake, obesity, and male sex.

CONCLUSIONS

The prevalence of advanced fibrosis and cirrhosis is considerable and increasing worldwide with significant geographic variation. Further research is needed to better understand the risk factors and how to mitigate them worldwide to address the growing global burden of cirrhosis.

Assessing the role of Mac-2 binding protein glycosylation isomer in the management of patients with chronic hepatitis B

BACKGROUND

The Mac-2 binding protein glycosylated isomer (M2BPGi) is a serum marker for fibrosis that correlates with the fibrosis stages in various liver diseases.

AIM

To examine the M2BPGi’s threshold for staging fibrosis in patients with chronic hepatitis B (CHB), and its changes during treatment.

METHODS

This was a prospective, longitudinal study. A total of 348 eligible patients were recruited from the Hepatology Department, Medic Medical Center between March 2020 and December 2023. Liver enzyme tests, platelet counts, M2BPGi levels, and FibroScan were conducted at baseline and at 3-month intervals until six months post-treatment. Correlation plots of M2BPGi, FibroScan, and the other parameters were generated. Receiver operating characteristic curves were constructed for M2BPGi and the other parameters to evaluate their performance.

RESULTS

M2BPGi levels correlated well with FibroScan results and increased as the fibrosis stage advanced. The median M2BPGi levels at the different stages of fibrosis showed statistically significant differences. The cut-off values of M2BPGi for diagnosing significant fibrosis (F ≥ 2), advanced fibrosis (F3), and cirrhosis (F4) were determined to be 1.08, 1.4, and 1.52, respectively. In the context of fibrosis regression in CHB patients during the first 6-month of treatment, M2BPGi levels appeared to decrease before this pattern occurred in the FibroScan results.

CONCLUSION

M2BPGi levels were strongly correlated with FibroScan. M2BPGi can be used to assess liver fibrosis, and to serve as a tool for monitoring fibrosis regression in CHB patients undergoing treatment.

Global burden of pediatric fracture (1992-2021) and projections of future disease burden trends

OBJECTIVE

Pediatric fracture are a significant public health concern, contributing to both immediate health impacts and long-term disability. This study aims to quantify the burden of pediatric fracture over a 30-year period (1992-2021) and provide forecasts for future disease burden.

METHODS

Comprehensive data on pediatric fracture from 1992 to 2021 were obtained from the Global Burden of Disease study. This dataset includes information on the incidence of pediatric fracture, disaggregated by gender. The Joinpoint regression model was used to identify turning points in epidemiological trends, while decomposition analysis helped identify the factors driving these trends. Health inequalities related to pediatric fracture were assessed using the Slope Index and Concentration Index. To forecast future incidence rates, the Norpred and BAPC models were applied.

RESULTS

The global ASIR of pediatric fracture was 2225.38 in 1992 and 1531.44 in 2021. The total number of pediatric fracture globally was 39,436,228 in 1992 and 31,033,294 in 2021. The results of the Joinpoint regression indicate a declining trend in the incidence of pediatric fracture globally and in all SDI regions, for both male and female children. Based on the Nordpred and BAPC model, the predicted age-standardized incidence rate for pediatric fracture by 2046 is 1347.61-1349.43. The total number of pediatric fracture predicted by 2046 is 25,048,299-25,123,204.

CONCLUSION

Over the past three decades, the global incidence of pediatric fractures has declined. However, population growth has sustained a substantial disease burden, underscoring the necessity for effective prevention and management strategies.

Host factor RBM25 promotes HBV replication through Yin Yang 1-mediated cccDNA transcription

The persistence of covalently closed circular DNA (cccDNA) in hepatitis B virus (HBV)-infected hepatocytes remains a major obstacle to effective antiviral treatment. Understanding the molecular mechanisms regulating HBV cccDNA transcription is essential for developing novel therapeutic strategies. In this study, we investigated the role of RNA binding motif protein 25 (RBM25) in HBV replication, focusing on its interaction with cccDNA and its regulation of host transcription factors. The results demonstrated that RBM25 knockdown markedly inhibited HBV replication, reducing levels of HBV DNA, hepatitis B e antigen (HBeAg), hepatitis B surface antigen (HBsAg), HBV RNA, and L-HBs in HBV-replicating and infection cell models. Consistent results were observed in a mouse model hydrodynamically injected (HDI) with 1.2×HBV plasmid. Conversely, RBM25 overexpression significantly enhanced HBV replication. Mechanistically, RBM25 promoted HBV promoter activities by binding to cccDNA through its RE/RD and PWI domains. This effect was mediated by increased Yin Yang 1 (YY1) expression, which enhanced acetylation of cccDNA-bound histones, promoting HBV transcription. Furthermore, RBM25 expression was upregulated and translocated to the nucleus following core protein expression and accumulation, while overexpression RBM25 promotes core protein degradation. In conclusion, this study demonstrated that RBM25 was a novel host factor that enhanced HBV replication by upregulating YY1-dependent transcriptional activation of cccDNA. It also revealed a reciprocal regulatory mechanism between the HBV core protein and RBM25, which helps sustain HBV replication.

HBV sequence integrated to enhancer acting as oncogenic driver epigenetically promotes hepatocellular carcinoma development

BACKGROUND

HBV integration is considered as the main contributor to hepatocellular carcinoma (HCC). However, whether HBV integrated sequences determine genotype pathogenicity and how to block their function during HCC progression remains unclear.

METHODS

An in vitro HBV-infected PHH model and liver cancer cell lines were established to confirm the pathogenic potential of HBV-SITEs. The roles of HBV-SITE-1 in HCC development were analyzed using cellular phenotypic assays and molecular biology techniques, including the combined analysis of RNA-seq and ChIP-seq. Animal models were also used to evaluate the therapeutic effect of HBV-miR-2 inhibitors.

RESULTS

We identified nine fragments of HBV Sequences Integrated To Enhancer, termed as "HBV-SITEs". Particularly, a single nucleotide variation (T > G) was embedded at seed sequence of HBV-miR-2 in the highest integrated HBV-SITE-1 between genotypes B and H. Unexpectedly, B-HBV-SITE-1, not H-HBV-SITE-1, could abnormally activate oncogenic genes including TERT and accelerate HCC cell proliferation and migration. Meanwhile, HBV-miR-2 was gradually increased in HBV-infected cells and patient plasma with different HCC stages. Importantly, 227 genes upregulated by HBV, were also activated by HBV-miR-2 through triggering HBV-SITE-1 enhancer. Conversely, enhancer activities were particularly decreased by HBV-miR-2 inhibitors, and further downregulated activated oncogenic genes. Finally, HCC growth was dramatically restrained and HBV-induced transcripts were systematically reduced via injection of HBV-miR-2 inhibitors in animal models.

CONCLUSION

HBV-SITEs were identified as novel oncogenic elements for HCC, which provides an insightful perspective for the other cancers caused by oncogenic DNA viruses. We demonstrated that the integrated HBV sequence itself acted as oncogenic enhancers and nucleotide variations of HBV genotypes account for particular pathogenic progression, supporting that the viral nucleotide sequences are vital pathogenic substances beyond viral proteins. And modulation of their enhancer activities could be clinically achievable strategy for blocking DNA viruses-related cancer progression in the future.

Uptake of combined immunoprophylaxis for newborns exposed to hepatitis B virus in a high hepatitis B endemic rural setting in Northern Ghana

BACKGROUND

Mother-to-Child Transmission (MTCT) is a major route of Hepatitis B Virus (HBV) transmission, accounting for a substantial proportion of new infections, particularly in highly endemic areas. The timely administration of combined immunoprophylaxis of Hepatitis B Immunoglobulin (HBIG) and hepatitis B vaccine to newborns exposed to hepatitis B virus is a crucial strategy for preventing MTCT. This study investigated the determinants of hepatitis B virus immunoprophylaxis utilization for newborns of HBV-seropositive mothers in the North-East region of Ghana.

METHODS

A cross-sectional survey design was employed, involving 213 HBV seropositive mothers who had given birth in four selected study sites. Systematic random sampling was used to select mothers from the selected health facilities. Data was collected using a structured questionnaire. Data was coded entered and analyzed using SPSS version 26. Bivariate and multivariate analyses were undertaken, and the level of significance was set at 0.05.

RESULTS

Key findings revealed that mothers aged 30-39 were less likely to ensure their newborns received both hepatitis B immunoglobulin and vaccine compared to younger mothers (aOR = 0.24, 95% CI [0.09, 0.65], p = 0.005). Employment status significantly influenced utilization, with salaried workers (aOR = 6.78, 95% CI [1.34, 34.46], p = 0.021) and self-employed mothers (aOR = 3.38, 95% CI [1.39, 8.22], p = 0.007) more likely to utilize immunoprophylaxis compared to unemployed mothers. Higher monthly income (501-1000 currency units) was associated with increased utilization (aOR = 4.70, 95% CI [1.28, 17.32], p = 0.020). Mothers with good knowledge of hepatitis B were more likely to ensure immunoprophylaxis for their newborns (aOR = 3.60, 95% CI [1.72, 7.54], p = 0.001).

CONCLUSION

This study found 63.4% HBV immunoprophylaxis uptake among newborns in rural Ghana, influenced by maternal age, employment, income, and knowledge. It recommends integrating immunoprophylaxis into the National Health Insurance Scheme to reduce financial barriers. Strengthening health education for mothers on HBV transmission is also crucial. Policy reforms and improved healthcare are needed to eliminate mother-to-child HBV transmission and achieve the global goal of eliminating viral hepatitis by 2030.

CLINICAL TRIAL REGISTRATION NUMBER

Not applicable.

Identification and characteristics of mutations promoting occult HBV infection by ultrasensitive HBsAg assay

The significance of occult hepatitis B virus (HBV) infection (OBI) has been increasingly recognized while the underlying mechanisms remain incompletely understood. This study aimed to identify high-frequency OBI-related mutations in HBV surface antigen (HBsAg)-negative samples tested by the ultrasensitive Lumipulse G HBsAg-Quant assay. OBI samples were collected from 32 blood establishments across 14 provinces in China. Lumipulse G HBsAg-Quant assay was performed for the re-testing and reclassification of OBI. Mutations in genotypes B (GTB) and C (GTC) were analyzed to identify high-frequency single and combined mutations. Additionally, the efficacy of commercial reagents commonly employed in clinical diagnostics for detecting mutant HBsAg was evaluated. Western Blot was used for the confirmation of extracellular HBsAg as well as the detection of intracellular HBsAg. Hydrophilicity analysis and transmembrane distribution prediction of HBsAg were utilized for further validation. Single mutations at 17 sites and 9 combined mutations in GTB indicated a significantly elevated mutation frequency. In GTC, there were single mutations at 16 sites and 9 combined mutations. Several commercial reagents commonly demonstrated limited capacity toward mutant HBsAg with T123A/P, K141C, and P142R/I/K/L (GTB) and S114A/P (GTC). The findings indicated that mutations including T123A/C/K/S, S132G/Y, P142L/R/S/T, T143M, D144G, G145A, K160R+V168A, I4T+V168A, M103I+K122R, and M103I+Q181R (GTB), along with Q101H, M103I, R160K+C221Y (GTC), were associated with reduced levels of HBsAg both extracellularly and intracellularly. Additionally, K160R (GTB) and E2G (GTC) were associated with intracellular aggregation. This study elucidates the mutations associated with decreased extracellular HBsAg with ultrasensitive HBsAg assay, providing insight for further investigation into the mechanisms of OBI.

IMPORTANCE

The sensitivity of HBsAg detection reagents directly impacts the identification of occult hepatitis B virus (HBV) infection (OBI). This study aims to identify high-frequency OBI-related mutations in HBV surface antigen (HBsAg)-negative samples evaluated using a Fujirebio-Lumipulse ultrasensitive HBsAg assay and to investigate the implications of these mutations on the antigenicity of HBsAg, the detection capacities of various HBsAg assays, and the effects on intracellular and extracellular levels of HBsAg. Generally, our study offers a new perspective on OBI-related mutations by ultrasensitive HBsAg assay and lays the groundwork for further research on the OBI mechanism and the enhancement of HBsAg detection reagents.

Prevalence of opportunistic infections in Syrian inflammatory bowel disease patients on biologic therapy: a multi-center retrospective cross-sectional study

BACKGROUND

Hepatitis B, hepatitis C, cytomegalovirus (CMV), and tuberculosis (TB) pose significant risks to patients with inflammatory bowel disease (IBD) receiving biological therapy. However, data on the prevalence of these infections in Syria are scarce.

METHODS

We conducted a retrospective chart review of IBD patients receiving biologic therapy at Damascus Hospital and Ibn Al-Nafees Hospital, two major public institutions in Syria, between January 2021 and November 2024. A minimum sample size of 130 was estimated; however, all available records were reviewed.

RESULTS

Among 185 IBD patients (104 from Damascus and 81 from Ibn Al-Nafees), 51.4% had ulcerative colitis and 47.6% had Crohn's disease. The smoking prevalence was 9.2%, which was higher in Crohn's disease (5.9%) than in ulcerative colitis (3.2%). TST performed in 61.1% of patients, with 4.3% positivity, and interferon-gamma release assay (IGRA) in 8.7% (1.1% positive). Hepatitis B surface antigen (HBsAg) and anti-HBc antibodies were found in 2.7% and 5.4% of the patients, respectively, while hepatitis C seroprevalence was low (0.5%). CMV seropositivity was high in Damascus (50.8%), with two cases (1.1%) of CMV colitis. Biologic therapies included infliximab (42.7%), ustekinumab (24.3%), golimumab (10.8%), and adalimumab (6.5%). Data gaps, particularly in viral serology and TB screening, are notable.

CONCLUSION

This study identifies deficiencies in TB/hepatitis B screening (notably anti-HBs Ab) and elevated CMV seroprevalence among Syrian IBD patients receiving biologics, extending to immunosuppressed cohorts (rheumatology, dermatology, oncology). Insufficient screening heightens occult infection/reactivation risks, necessitating standardized pretreatment protocols to reduce morbidity in high-risk populations.

CLINICAL TRIAL NUMBER

Not applicable.

Real-world clinical data-driven modelling on the initiation time of antiviral prophylaxis among pregnant women with chronic hepatitis B infection

BACKGROUND & AIMS

The risk of mother-to-child transmission for pregnant women with chronic hepatitis B (CHB) still exists, especially for those with high HBV DNA levels. The guidelines for initiating prophylaxis for pregnant women with CHB vary across countries. We aimed to explore the latest prophylaxis initiation time for these women.

METHODS

We collected the real-world clinical data of 328 pregnant women aged 20-49 with CHB, who were treated with telbivudine or tenofovir disoproxil fumarate, from July 2010 to December 2020 in China. A mathematical model was developed to describe the viral kinetics of HBV after prophylaxis. We calculated the time required to reduce viral load below the threshold value of 5.3 log10 IU/ml. We derived the prophylaxis initiation time by subtracting the required time to threshold from the childbirth gestational week.

RESULTS

The median time for 328 women to reduce HBV DNA levels below the threshold of 5.3 log10 IU/ml was 4.2 (range: 0.2-12.8) weeks, corresponding to a prophylaxis initiation time of no later than 35.1 (25.2-41.4) weeks. Specifically, for women with viral loads >8.0 log10 IU/ml, prophylaxis should be initiated before 33.9 (25.2-39.5) weeks, and even before the lower bound of 25.2 weeks, to maximize clinical safety. For women with viral load >7.0 to ≤8.0 log10 IU/ml, prophylaxis should be initiated before 35.5 (28.6-39.8) weeks, and for women with viral load >5.3 to ≤7.0 log10 IU/ml, prophylaxis should be initiated before 36.2 (28.3-41.4) weeks.

CONCLUSION

Pregnant women with HBV DNA levels >5.3 to ≤8.0 log10 IU/ml can initiate prophylaxis before 28 gestational weeks. However, women with HBV DNA >8.0 log10 IU/ml could consider initiating prophylaxis before 25 weeks.

IMPACT AND IMPLICATIONS

This study investigates how long it takes to decrease maternal viral load below a threshold (5.3 log10 IU/ml) after receiving antiviral prophylaxis in pregnant women with different HBV DNA levels based on real-world clinical data and mathematical modelling, which provides quantitative evidence on the initiation time of antiviral prophylaxis. The results show that pregnant women with CHB infection at high HBV DNA levels (>8 log10 IU/ml) should initiate antiviral prophylaxis earlier to decrease the risk of mother-to-child transmission of HBV. Physicians can determine when to begin antiviral prophylaxis for those women according to their maternal HBV DNA levels. Our findings justify the initiation time of antiviral prophylaxis recommended by the Chinese guidelines and will offer new insights for other international guidelines.

Air Pollution Associated With Mortality Among Chronic Hepatitis B Patients Treated With Nucleotide/Nucleoside Analogues

BACKGROUND AND AIMS

Air pollution is associated with advanced liver fibrosis in patients with chronic liver diseases, including chronic hepatitis B (CHB). This study aimed to investigate the association between air pollution and mortality in patients with CHB treated with nucleotide/nucleoside analogues.

METHODS

We enrolled 697 patients with CHB treated with nucleotide/nucleoside analogues and analysed the incidence and risk factors for mortality. Daily air pollutant concentrations were estimated from the year before enrolment.

RESULTS

All-cause mortality showed an annual incidence of 1.1/100 person-years after a follow-up period of 3798.1 person-years. Factors with the strongest association with all-cause mortality were liver cirrhosis (hazard ratio [HR]/95% confidence interval [CI]: 3.95/1.69-9.23; p = 0.02), age ([HR]/CI: 1.07/1.03-1.17, p < 0.001) and pre-treatment gamma-glutamyl transferase (GGT) levels (HR/CI: 1.004/1.001-1.006, p = 0.004). Among patients with cirrhosis, the factors associated with all-cause mortality were age (HR/CI: 1.08/1.04-1.12, p < 0.001), pre-treatment GGT levels (HR/CI: 1.004/1.001-1.008, p = 0.01), platelet count (HR/CI: 0.988/0.977-0.998, p = 0.02) and NOx concentration (per unit increment, ppb) (1.045/1.001-1.091; p = 0.046). The best NOx cut-off value for predicting all-cause mortality in patients with cirrhosis was 25.5 ppb (AUROC 0.63; p = 0.03). NOx levels > 25.5 ppb were associated with a higher incidence of mortality in patients with cirrhosis (HR/CI:2.49/1.03-6.02; p = 0.04).

CONCLUSIONS

Air pollution influences all-cause mortality in patients with CHB receiving nucleotide/nucleoside analogue therapy. Long-term NOx exposure may increase liver-related mortality in patients with chronic hepatitis B and cirrhosis receiving nucleotide/nucleoside analogue treatment.

Comparison of Serological Immune Response to Hepatitis B Vaccine Following Rapid or Standard Regimen in People Who Inject Drugs

Background & Aims

The standard regimen of hepatitis B vaccination, i.e., three doses at 0, 1, and 6 months, protects 90-95% of vaccine recipients. Compliance for three doses, administered over six months, is particularly low among people who inject drugs (PWIDs). To prevent hepatitis B virus (HBV) infection, the World Health Organization has recommend to vaccinate PWIDs with an accelerated regimen, i.e., in a 0-, 7-, and 21-day schedule. We compared the serological immune response with standard and accelerated vaccination regimens in PWIDs.

Methods

PWIDs were vaccinated with three doses of hepatitis B vaccine as a part of routine preventive services in the past, which was not the part of our research work. Each of them had taken a conscious and informed decision to choose either the standard or accelerated regimen at the time of vaccination. For this cross-sectional observational study, anti-HBs (anti-HBs) titers were measured in vaccine recipients at ≥3 months after the administration of the third dose of vaccine. Vaccine-induced seroconversion was defined as presence of detectable anti-HBs titer, and seroprotection was defined as anti-HBs titer measuring ≥10 mIU/mL. Numerical and categorical data are expressed as median (interquartile range) and percentage (proportion), respectively; groups were compared using nonparametric tests.

Results

The study included 567 PWIDs (all men; age: 29 [24-38] years) vaccinated with either the accelerated (n = 356; 62.8%) or standard (n = 211; 37.2%) regimen. Participants' ages were comparable (P = 0.99) in accelerated (29 [24-38.5] years) and standard (29 [24-37] years) groups. The interval between the last dose of vaccine and anti-HBs titer estimation was significantly longer in the accelerated group (487 [422-625]) than in the standard group (176 [105-211] days) (P < 0.001). A higher proportion achieved seroconversion in the standard group than in the accelerated group (99.5% vs 91.9%; P < 0.001). Among those who achieved seroconversion, a larger proportion in the standard group were seroprotected than in the accelerated group (99.5% vs. 92.1%; P < 0.001). Anti-HBs titer was significantly higher in the standard group (2404 [412-12450] mIU/mL) than in the accelerated group (247 [57-1250] mIU/mL) (P < 0.001).

Conclusions

Accelerated regimen of hepatitis B vaccination is well accepted among PWIDs and provides seroprotection to a large proportion of vaccine recipients, though the vaccine-induced antibody titers remain relatively lower. For high-risk groups such as PWIDs and other mobile population groups, an accelerated vaccination regimen may be a reasonable alternative to the standard vaccination schedule.

High Genetic Variability of Hepatitis B Virus in Blood Donors With Surface Antigen Positive But DNA Negative in Southern China

In our previous studies, 45.2% of donations with HBV HBsAg reactive (+) by ELISA but negative (-) by NAT were confirmed to have HBV infections in Shenzhen Blood Center, China. However, the serological and molecular characteristics of this type of HBV infection remain unclear, and several donations with indeterminate results require further investigation. In this current study, blood donations with HBsAg ELISA+/DNA NAT- results were collected and further characterized by various serological tests, quantitative PCR (qPCR) and nested PCR from January, 2019 to December, 2021. Molecular characterizations of HBV DNAs were performed by DNA sequencing. Additionally, donations with indeterminate results were classified through a follow-up study to confirm whether they contain HBV DNA. Of 278 HBsAg ELISA+/DNA NAT- samples identified from the screening of 165 025 blood donations, 82 (82/278, 29.5%, including 52 males and 30 females) were confirmed HBsAg positive, leaving nine donations (9/278, 3.2%) with indeterminate results and 187 (187/278, 67.3%) as no HBV infections. Three serological patterns were observed among these 82 confirmed HBsAg positive donations: 74 samples were HBsAg+/anti-HBe+/anti-HBc+, seven samples were HBsAg+/anti-HBc+, and one sample was HBsAg+ alone. Sequence analysis showed that 45 (45/50, 90%) were genotype B, while 4 (4/50, 8%) were genotype C and 1 (1/50, 2%) was genotype D. Notable mutations such as Q101R, Q129H, M133L/T, F134L, L175S, V177A, and N-glycosylation mutations in S regions of HBV genotype B were observed. Additionally, high frequency mutations such as T1719G (33/35, 94.3%), A1752G/T (11/35, 31.4%), G1896A (26/35, 74.3%), and A1762T/G1764A (7/35, 20%) in the BCP/PC regions were also identified. All these mutations might contribute to low-level HBsAg and/or extremely low viral loads. Six out of nine donations (6/9, 66.7%) with indeterminate results were tested positive for both HBsAg and HBV DNA during 65-192 days of follow-up, and they were then confirmed as HBV infections. 31.7% donations with HBsAg ELISA+/NAT- results were confirmed as HBV infection. Various notable mutations identified in the BCP/PC and S regions may be responsible for the low viral loads and HBsAg level in these donations. Therefore, assays with high sensitivity, specificity, and ability to detect genetic variants (mutations) are essential for accurate blood screening in HBV-endemic countries/regions to prevent the transmission of HBV through blood transfusion.

Aspartate/alanine aminotransferase ratio and development of chronic kidney disease in non-diabetic men and women: a population-based longitudinal study in Kagawa, Japan

BACKGROUND

The relationship between serum aspartate/alanine aminotransferase ratio (AST/ALT) and subsequent development of chronic kidney disease (CKD) in non-diabetic Asian adults has not yet been fully investigated in longitudinal studies.

METHODS

The study included all middle-aged and older non-diabetic Japanese citizens who received health check-ups in Zentsuji, Kagawa, Japan (1998-2023). AST/ALT was classified into three categories: < 1.0 (reference), 1.0- < 1.5, and ≥ 1.5. CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m2. The Weibull accelerated failure time model was used to examine the association between AST/ALT categories and subsequent CKD onset because the proportional hazards assumption was violated.

RESULTS

Of 6309 men and 9192 women, 2966 men and 4395 women remained in the final cohort. After a mean follow-up of 7.50 years for men and 8.34 years for women, 33.7% of men and 34.0% of women developed CKD. Women had higher AST/ALT than men. In women, a dose-response relationship was observed, with a 9% shorter survival time to CKD onset for AST/ALT ≥ 1.5 compared with AST/ALT < 1.0. In contrast, men had a shorter survival time to CKD onset by point estimates, but the 95% confidence intervals crossed 1 in all models.

CONCLUSIONS

In this study comparing the risks of CKD development in non-diabetic men and women by AST/ALT levels, a dose-response relationship was only observed in women. Differences in the distribution of AST/ALT by sex may have affected the results. Therefore, in non-diabetic Japanese women, AST/ALT may be used as an indicator of future CKD development.

Association of nucleos(t)ide analogue therapy with Parkinson disease in chronic hepatitis B patients

Prolonged therapy using nucleos(t)ide analogs (NUC) is inevitable in patients with chronic hepatitis B (CHB) infection, but its long-term impact on Parkinson's disease (PD) risk remains unclear. This study evaluated the association between NUC therapy and PD incidence in a nationwide CHB cohort. The study population comprised the National Health Insurance Service claims database from January 1, 2013, to December 31, 2013, only included treatment naïve CHB patients and those without previously diagnosed with PD. Participants were followed until PD diagnosis or study completion. The primary outcome was PD incidence, comparing patients who initiated NUC therapy at cohort entry with those who did not. Over the 7.9-year study period, the incidence rate of PD in NUC-treated patients was 1.48 per 1000 persons, compared to 1.95 per 1000 persons in the untreated group. In an adjusted competing risk model, the 3-year follow-up showed a statistically significant reduction in risk (hazard ratio [HR]: 0.61; 95% confidence interval [CI] 0.39-0.97). In the propensity score-matched cohort of 18,365 pairs, the cumulative incidence during 2-4 years of follow-up was significantly lower in the NUC-treated group compared to the untreated group. However, no statistically significant difference in cumulative PD incidence was observed between the groups at the early or late stages of the follow-up period. NUC therapy initially reduced PD incidence, but this protective effect diminished over time, indicating a time-varying effect. Regular PD screening may be needed for long-term NUC users.

Clinical correlation and survival analysis of hepatitis B virus infection in oral squamous cell carcinoma: a retrospective study of 1373 patients

BACKGROUND

Chronic hepatitis B virus (HBV) infection poses a significant global public health challenge and is found closely related to extrahepatic cancers, including head and neck cancer. Oral squamous cell carcinoma (OSCC) is the major category of head and neck cancer. This retrospective study was conducted to explore the clinical correlation and survival analysis of OSCC patients with HBV.

METHODS

The study involved 1,373 patients with OSCC treated at the Hospital of Stomatology, Sun Yat-sen University from 2012 to 2022. Propensity score matching was used to analyze the clinical correlations and survival outcomes, specifically overall survival (OS) and disease-free survival (DFS), in patients with or without hepatitis B surface antigen (HBsAg) seropositivity. Subgroup analyses were conducted for both the early and advanced stages of OSCC. The benefits of neck dissection in OSCC patients with HBV infection were further investigated.

RESULTS

The prevalence of HBV infection in our cohort was 12.0%. The HBsAg (+) group had a higher percentage of individuals under 60 (73.3% versus 63.7%, p = 0.016). Post-matching for age, sex, pathological T category, pathological N category, and neck dissection, the OSCC patients with HBsAg (+) had lower 5-year OS and DFS rates rather than HBsAg (-) patients, especially those with advanced stage and cervical lymph node metastasis. HBsAg (-) was confirmed as an independent protective prognostic indicator for both OS (hazard ratio [HR] = 0.52; 95% confidence interval [CI] = 0.34-0.79; p = 0.002) and DFS (HR = 0.69, 95% CI = 0.50-0.96; p = 0.027). Notably, elective neck dissection was recognized as an independent protective factor influencing 5-year OS and DFS. While DOI and pathological N category were both confirmed as the risk factors for prognosis.

CONCLUSIONS

HBsAg is a potential prognostic marker for OSCC. It is essential to screen for HBV infection prior to initiating tumor treatment. Additionally, serological testing, antiviral prophylaxis and therapy play crucial roles in preventing HBV reactivation during the course of tumor treatment. In cases of early OSCC associated with HBV infection, elective neck dissection has been shown to reduce the rates of recurrence and metastasis significantly.

Role of etiological therapy in achieving recompensation of decompensated liver cirrhosis

The traditional view of the decompensated stage as a point of no return in the natural history of liver cirrhosis (LC) is currently being questioned. This is due to the appearance of data indicating the possibility of restoring the structure and function of the liver, reducing the portal pressure with a positive effect on complications associated with portal hypertension and decreasing the risk of developing hepatocellular carcinoma after elimination of the etiological factor. To create a unified understanding the recompensation of decompensated LC, at the Baveno VII consensus workshop were developed criteria confirming it. At the moment, the efficacy of etiological therapy in achieving established criteria for recompensation has been evaluated only in patients with alcohol-related, as well as hepatitis B virus-related and hepatitis C virus-related decompensated LC. The purpose of the review is to provide up-to-date information on the role of etiological therapy in achieving recompensation of decompensated LC according to Baveno VII criteria. So far, only the first steps have been taken in studying this problem. To further understand it, research is needed to identify pathophysiological mechanisms, modifying factors, predictors, and potential noninvasive biomarkers of recompensation of decompensated LC.

Hepatitis B virus: Prevalence, vaccination coverage and immune responses to immunization among healthcare workers at Muhimbili National Hospital

BACKGROUND

Healthcare workers (HCWs) are at an increased risk of contracting and transmitting the hepatitis B virus (HBV). Vaccination coverage against HBV a cost- effective prevention, remains low among HCWs in some settings.

OBJECTIVE

To determine the prevalence of HBV infection, vaccination coverage, and immune responses to HBV vaccine among HCWs at Muhimbili National Hospital (MNH) in Dar es Salaam.

METHODOLOGY

This cross-sectional study used a proportional probability systematic sampling to recruit HCWs from MNH in Dar es Salaam. A structured questionnaire was used to collect social demographic characteristics, infection prevention and control practices, HBV vaccination status and reasons for not vaccinating. Five mLs of a peripheral venous sample was obtained from each participant, the sample was used to test for HBV surface antigen, HBV surface antibody and HBV core antibody for assessing for infection, and vaccine immunity respectively. A Robust Poisson Regression analysis was used to assess factors associated with not vaccinating.

RESULTS

The prevalence of HBV infection was 5 (1.2%) among the 415 recruited HCWs. Only 192 (46.3%) HCWs were vaccinated and 169 (96%) had protective immunity against HBV infection among 176 participants who had received at least two vaccine doses. HCWs who were laboratory scientist aPR = 2.01, 95% CI (1.35-3.00) and had < 10 years of employment aPR = 1.62, 95% CI (1.04-2.50) were unlikely to vaccinate against HBV. Vaccine unavailability 114 (51.1%), hesitancy 42 (18.8%), time constraints 41 (18.4%) and financial constraints 26 (11.7%) were factors associated with not vaccinating.

CONCLUSION

Vaccine coverage against HBV among HCWs at MNH is alarmingly low. Vaccine access, subsidizing cost, protecting time for vaccination could improve vaccination uptake. Qualitative studies are needed to assess for reasons for vaccine hesitancy among HCWs.

Impact of nucleos(t)ide analogue therapy on the incidence of Alzheimer's disease in patients with chronic hepatitis B virus infection

BACKGROUND

Long-term therapy with nucleos(t)ide analogs (NUCs) is inevitable for chronic hepatitis B (CHB) patients. However, how NUC therapy on the developing Alzheimer's disease (AD) in these patients remains controversial.

METHODS

This retrospective cohort study used the Korean National Health Insurance Service claims database from January 1, 2013, to December 31, 2013, treatment naïve CHB patients and those without previously diagnosed with AD. Participants were followed from the index date until either the diagnosis of AD or the study's conclusion on December 31, 2021. The primary outcome was the incidence of AD, compared between the group with initiated NUC therapy (n = 18,365) at cohort entry and the group without NUC therapy (n = 212,820).

RESULTS

During the study, 416 patients were diagnosed with AD. After propensity-score matching (18,365 pairs), the 5- to 7-year follow-up showed a significantly lower hazard ratio (HR) in the NUC-treated group compared to the untreated group (HR 0.31-0.40), with HRs remaining constant over time. Subgroup analysis showed more pronounced benefits of NUC therapy in patients under 65 years (HRs: 0.22 vs. 1.23; P < 0.05) and those without dyslipidemia (HRs: 0.14 vs. 1.09; P < 0.05). Protective effects were also observed across subgroups with hypertension, chronic kidney disease, heart disease, and a history of brain trauma, consistent with AD risk factor trends.

CONCLUSIONS

Our study analyses suggest that NUC therapy appears to have a protective effect against the development of AD in patients with CHB.

Health economic evaluation of newborn hepatitis B immunization prevention strategies in Ningbo: a Markov modeling study

Background

Hepatitis B virus (HBV) infection poses a significant public health challenge in China. The Prevention of mother-to-child Transmission (PMTCT) strategy of combining universal hepatitis B vaccination with hepatitis B immunoglobulin (HBIG) for newborns is crucial in preventing widespread infection. In this study, we conduct health economic evaluation of three strategies: PMTCT, universal vaccination, and non-vaccination for newborns in Ningbo, China.

Methods

This study developed a decision-Markov model and simulated a cohort of 100,000 newborns to assess the cost-effectiveness and cost-benefit of three strategies from a healthcare system perspective. The primary outputs included total costs, life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), benefit-cost ratios (BCRs). One-way and probabilistic sensitivity analyses (PSA) were performed to verify the robustness of the model.

Results

Among the three strategies, the PMTCT results in the least disease burden and mortality related to hepatitis B. In comparison to a cohort of 100,000 unvaccinated infants, the PMTCT is expected to prevent 6,029 cases of acute symptomatic infections, 27,348 HBV carriers, 4,170 chronic infections, 3,597 cases of cirrhosis, 2,911 cases of hepatocellular carcinoma (HCC), and 3,930 HBV-related deaths. The ICERs for PMTCT and universal vaccination were - 56,371.77 yuan/QALY and - 56,654.77 yuan/QALY, respectively. The BCRs for PMTCT and universal vaccination were 19.13 and 15.95, respectively, when compared to no vaccination. The PSA revealed that all ICER scatter points are situated within the fourth quadrant, and the probability of PMTCT being cost-effective exceeds 90%.

Conclusion

Implementing universal hepatitis B vaccination with HBIG for newborns in Ningbo demonstrated high cost-effectiveness, making the continuation of the PMTCT strategy highly recommended.

Virological and Biochemical Effects of Tenofovir Alafenamide in Different Patient Groups With Chronic Hepatitis B Virus Infection in Real-World Cohort

Hepatitis B virus (HBV) infection is an important health concern worldwide. HBV infection can lead to acute hepatitis, cirrhosis, hepatocellular carcinoma, liver failure, and death. Nucleos(t)ide analogs (NAs) form the core of the HBV treatment. The safety and efficacy of NAs in long-term follow-up are still critical issues. We enrolled 225 consecutive patients with at least 12 months of longitudinal follow-up using tenofovir alafenamide (TAF), including 39 antiviral naïve and 186 antiviral experienced patients. In the treatment-experienced group, the main reasons for switching from other NAs to TAF were renal dysfunction and osteoporosis. Renal outcome, lipid profile, virological response, and ALT normalization under the TAF treatment were evaluated. Age > 60 years, liver transplant recipients, and patients with decompensated cirrhosis were evaluated separately, as well as the total cohort. Phosphorus levels increased especially in hypophosphatemic individuals, eGFR levels also increased slightly but statistically significantly, and the remarkable improvement in eGFR stages was observed in the eGFR < 60 mL/min/1.73 m2 group. A minimal increase in LDL-c levels occurred after TAF treatment, which did not reach statistical significance. Total cholesterol and HDL-c levels increased significantly, while triglyceride levels remained unchanged. In the total cohort, HBV-DNA was strongly suppressed in either treatment-naïve or experienced patients. ALT and AST levels decreased with the TAF treatment, but ALT normalization rate did not change significantly. No serious adverse events associated with TAF occurred, and discontinuation was not required in the total cohort. Our findings support that TAF treatment is well-tolerated and effective in patients with chronic HBV infection.

Risk Stratification of Metabolic Risk Factors and Statin Use Associated With Liver and Nonliver Outcomes in Chronic Hepatitis B

BACKGROUND

We investigated the association of metabolic risk factors (MRFs) and statin use with liver and nonliver outcomes in a nationwide cohort of patients with chronic hepatitis B (CHB) in the United States.

METHODS

We conducted a retrospective cohort study of adult patients with CHB using the MarketScan Databases (January 2007-December 2021). Incidence of liver and nonliver outcomes (cardiovascular disease, chronic kidney disease, and extrahepatic cancer) was analyzed. MRFs included diabetes mellitus (DM), hypertension, hyperlipidemia, and obesity.

RESULTS

The study included 52 277 patients with CHB, and 1:1 propensity score matching yielded 16 696 pairs of matched patients with and without MRFs for analysis. When compared with those without MRFs, patients with DM and all 3 other MRFs had the highest adjusted hazard ratio (95% CI) for any liver outcome at 2.08 (1.22-3.52), followed by 12.98 (7.73-21.80) for cardiovascular disease, 9.25 (5.46-15.66) for chronic kidney disease, and 2.01 (1.00-4.04) for extrahepatic cancer. Increased metabolic burden was associated with liver and nonliver outcomes except for comparison between patients without MRFs and those with MRFs but no DM (P > .2 for all liver outcomes). Among lower metabolic burden (≤2 MRFs), statin use was associated with a 15% lower risk of any liver outcomes, 35% reduced risk of HCC, and 15% lower risk of cirrhosis but not among those with higher metabolic burden (≥3 MRFs).

CONCLUSIONS

Higher metabolic burden was associated with a greater risk for liver and nonliver complications in patients with CHB, with DM having the highest impact among other MRFs. Statin use was associated with a reduced risk of liver outcomes among lower metabolic burden.

Hepatitis B virus infection after immunization: How serious it is? An updated review

Infection with hepatitis B virus (HBV) is one of the significant challenges worldwide. Despite the availability of antiviral drugs against this virus, the most critical strategy to prevent HBV infection is HB vaccination. Basically, despite widespread conventional HB vaccination, due to various reasons, including waning of hepatitis B surface antibody (HBsAb) titer after vaccination, the emergence of vaccine-escape mutants, failure to respond to the vaccine due to viral and host factors, levels of response in high-risk individuals and non-responders to conventional HB vaccination remains a major, unsolved and severe concern. This review focuses on the underlying reasons for conventional hepatitis B vaccination failures. It also suggests solutions to overcome these failures by highlighting significant advances in vaccination, including hepatitis B third-generation vaccines and adjuvanted hepatitis B vaccines as efficient alternatives to second-generation vaccines. Potentially, these new strategies will compensate for the shortcomings caused by second-generation vaccines. Adherence to these denouements has a significant role in preventing the circulation of HBV among individuals and reducing the global burden of HBV-related diseases.

Spatial and temporal distribution patterns and factors influencing hepatitis B in China: a geo-epidemiological study

BACKGROUND

China is a country with an extremely high disease burden of hepatitis B. Spatiotemporal analysis of hepatitis B from a socioeconomic perspective is of great significance for reducing the disease burden, but there is still a relative lack of research.

METHODS

The age-period-cohort model and spatial distribution maps describe the three-dimensional distribution characteristics of hepatitis B. Spatial autocorrelation analysis and spatiotemporal scanning were used to analyze the spatiotemporal distribution characteristics. The random forest algorithm was used to screen the potential influencing factors. The geographic detector model was used to analyze the interaction patterns of variables. Finally, a geographically and temporally weighted regression model was established to analyze the effects of variables on the incidence rate of hepatitis B at different spatiotemporal scales.

RESULTS

From 2004 to 2023, a total of 20,376,898 cases of hepatitis B were reported in China. The incidence rate of hepatitis B decreased at a rate of 3.31% per year, and hepatitis B vaccination has led to this downward trend, accompanied by a significant birth cohort effect. And it shows an aggregated characteristic, which highlights the inequality of geographical distribution. Stronger explanations for the incidence of hepatitis B were found for the number of people at the end of each year (q = 0.1949; where q value refers to the explanatory ability of the independent variable for the dependent variable) and the proportion of rural population (q = 0.1895), with an even stronger explanation for the interaction (q = 0.5366). The magnitude and direction of the effect of factors influencing hepatitis B also varied in different regions, and the effect of each factor on the incidence of hepatitis B was not an independent event.

CONCLUSIONS

The later people are born, the lower the incidence of hepatitis B. The northwest and southwest regions are the main hotspots, but there is a tendency to spread to southern China. The number of beds in medical institutions should be increased in densely populated areas, and economic development should be accelerated in sparsely populated areas. Hepatitis B prevention and control should be prioritized in geographic hotspots, coupled with enhanced awareness campaigns in rural areas and catch-up vaccination programs targeting high-risk populations.

Comparative efficacy and safety of pegylated interferon-alpha monotherapy vs combination therapies with entecavir or tenofovir in chronic hepatitis B patients

Current treatments for chronic hepatitis B (CHB) virus involve nucleos(t)ide analogs and pegylated interferon-alpha (PEG-IFNα). This study compares the efficacy and safety of PEG-IFNα monotherapy with its combinations with entecavir (ETV) and tenofovir disoproxil fumarate (TDF) in managing CHB. We included 147 treatment-naïve patients divided into three groups: Group A (PEG-IFNα-2b with ETV), Group B (PEG-IFNα-2b with TDF), and Group C (PEG-IFNα-2b monotherapy). Evaluations occurred every 12 weeks up to 48 weeks. The Kaplan-Meier method showed no significant differences in cumulative HBsAg loss, but HBV DNA clearance rates were higher in the TDF group than in the ETV group (P = 0.01). Higher incidences of elevated alanine aminotransferase (ALT), aspartate aminotransferase, and thrombocytopenia were observed in the TDF group compared to other groups. After propensity score matching, the TDF group had a higher undetectable HBV DNA rate than the IFN group, but no significant differences in HBsAg clearance rates. Both TDF and ETV groups achieved more significant HBsAg reductions from baseline to week 48 than the IFN group (P < 0.05). ETV showed a lower HBeAg clearance rate (30.00% vs 87.50%, P < 0.05) but higher ALT normalization (76.92% vs 45.45%, P < 0.05). In the TDF group, patients with lower baseline HBsAg levels, high ALT levels, and lower aspartate aminotransferase-to-platelet ratio index (APRI) scores were more likely to achieve HBsAg loss. These findings suggest that TDF and ETV are effective for viral suppression, with TDF showing superior HBV DNA clearance but more adverse events.

IMPORTANCE

This study investigates how different treatments for chronic hepatitis B (CHB), a widespread liver infection, compare in effectiveness and safety. By evaluating the use of pegylated interferon-alpha alone and in combination with two other drugs, entecavir and tenofovir disoproxil fumarate (TDF), researchers found that TDF offers better viral suppression but also comes with more side effects. For patients receiving TDF combined with PEG-IFN therapy, low HBsAg levels, elevated alanine aminotransferase levels, and lower APRI scores were associated with a higher likelihood of achieving HBsAg loss. Consistent with previous findings, this study confirms the benefits of nucleos(t)ide analog plus PEG-IFN therapy for CHB treatment and further explores which patients are more likely to benefit from combination therapy. Furthermore, this study underscores the importance of further monitoring adverse events in patients receiving combination therapy.

Assessing the virological response to direct-acting antiviral therapies in the HBV cure programme

Hepatitis B virus (HBV) is a global health problem with over 250 million people affected worldwide. Nucleos(t)ide analogues remain the standard of care and suppress production of progeny virions; however, they have limited effect on the viral transcriptome and long-term treatment is associated with off-target toxicities. Promising results are emerging from clinical trials and several drug classes have been evaluated, including capsid assembly modulators and RNA interfering agents. Whilst peripheral biomarkers are used to monitor responses and define treatment endpoints, they fail to reflect the full reservoir of infected hepatocytes. Given these limitations, consideration should be given to the merits of sampling liver tissue, especially in the context of clinical trials. In this review article, we will discuss methods for profiling HBV in liver tissue and their value to the HBV cure programme.

Estimating Prevalence and Number of People With Chronic Hepatitis B: A Multiplier Method Based on Public Health Surveillance Data in UK (2015-2021)

Estimates of chronic hepatitis B virus (HBV) prevalence and critically the amount of infection that is undiagnosed or unlinked to care are uncertain-even in countries like UK where vertical transmission and overall prevalence are very low. In the absence of country of birth data, we aim to estimate HBV prevalence through combining public health surveillance data on antenatally screened women by ethnic group and multipliers generated from non-antenatally screened populations by ethnic group with English population denominators. Of 714,287 women aged 16-49 years with ethnic group data tested as part of antenatal care between 2015 and 2021, 4174 (0.6%) were HBsAg-positive; 94% in people of ethnic groups other than White British. Of 1,447,467 people tested for HBsAg with ethnic group data from other testing sources (primary and secondary care excluding occupational health and renal services), 27,628 (1.9%) were HBsAg-positive; 87% in people of ethnic groups other than White British. We estimate that the overall number and prevalence of people with chronic hepatitis B in England is 268,767 (95% CI: 227,896-314,044) and 0.58% (95% CI: 0.50-0.68). Approximately two-thirds were male, one-third female, and 68% were aged under 50. We estimate that over 83% of HBV infections are in people of ethnic groups other than White British, with 23% in people from Black ethnic groups, 21% from other White ethnic groups and 19% in Asian ethnic groups. These estimates are the first step towards establishing whether England can meet World Health Organisation targets to eliminate HBV as a public health problem-using methods that can also be used by other countries.

Diversity and inclusion in chronic hepatitis B randomised controlled trials: A systematic meta-epidemiological review

Background & Aims

Chronic hepatitis B (CHB) affects global populations unequally, with variable prevalence and pathophysiology. Clinical trials must balance efficiency with adequate representation of the populations most likely to benefit from the interventions they test. We aimed to investigate diversity and inclusion in CHB trials.

Methods

We performed a meta-epidemiological study of randomised controlled trials recruiting people with CHB published in MEDLINE and Embase, January 2010 to July 2023. We extracted participant age, sex, country of recruitment, race and ethnicity, and hepatitis B genotype. We calculated proportions of trials reporting participant demographics and results by demographics (transparency). We compared participants proportionately to global populations affected by CHB of different demographics (representation), and examined demographic-based trial exclusion criteria.

Results

Among 287 trials (81.9% single-country, 18.1% multinational) with 57,503 participants (median size: 102, IQR: 60-185), 97.9% tested drug interventions. Most trials reported participants' age distribution (285, 99.3%) and sex (278, 96.9%). However, only 37.3% (107) trials reported race and ethnicity, 84 (29.3%) reported genotype, and, among multinational trials, only 19 (36.5%) reported recruitment numbers by country. Less than 3% trials reported demography-stratified results. Female sex was under-represented (42.0% people with CHB, 28.7% trial participants). Geographic disparities between those affected by CHB and trial participation were marked for Africa (31.0% vs. 0.01%; under-representation), and Americas or Europe (5.7% vs. 14.0%; over-representation). Many trials had exclusion criteria based on age (71.4% children, 41.5% older adults) or sex-related (157, 54.7%), mostly excluding women who were pregnant, breastfeeding, or of reproduction potential.

Conclusions

Clinical trials for CHB are not inclusive of women and people in Africa. Researchers, funders, and publishers should actively consider diversity and inclusion of trials.

Impact and implications

Clinical trials must balance the need to recruit homogenous participants to efficiently measure an intervention's effectiveness, with the need to produce evidence that can be applied to the whole population affected by a disease. We found chronic hepatitis B (CHB) clinical trials often failed to report basic demographic characteristics of participants, and had under-representation of women and people living in Africa. Given varied disease pathophysiology and treatment needs among different groups, this suggest a mismatch of evidence generation compared with the populations needing treatment, whereby the benefits and harms of different interventions across populations are not being adequately studied. We suggest relevant stakeholders, including researchers, funders, and publishers of CHB clinical trials, should actively recruit under-represented populations, target interventions to those most at need, and either consider demographic factors in results reporting and analysis, or make data easily available for interrogation.

Metabolic dysfunction-associated steatohepatitis reduces interferon and macrophage liver gene signatures in patients with chronic hepatitis B

BACKGROUND & AIMS

Patients with chronic HBV infection and concomitant metabolic dysfunction-associated steatohepatitis (MASH) have been shown to develop more severe liver disease than patients with chronic HBV alone. However, our understanding of the underlying mechanisms is limited. Herein, we study how comorbid MASH impacts immune activity in the livers of patients with chronic HBV infection.

METHODS

Bulk RNA sequencing was performed on liver biopsies from patients with only MASH (n = 10), only HBeAg-negative chronic HBV (ENEG; n = 11), combined MASH/ENEG (n = 9) and healthy controls (n = 9). Biopsies with no or minimal fibrosis (≤F2) were selected to avoid confounding effects of fibrosis. We compared whole transcriptome data from patients with MASH/ENEG to those with ENEG alone to determine the impact of comorbid MASH on chronic hepatitis B.

RESULTS

There is a high degree of overlap of liver gene expression profiles in patients with only ENEG vs. those with only MASH compared to healthy controls, suggesting a largely shared mechanism of liver dysfunction and immune activity for these distinct conditions. In patients with ENEG, comorbid MASH was associated with significantly reduced interferon pathway activity (normalized enrichment score = 2.03, p.adj = 0.0251), the expression of interferon-stimulated genes (e.g., IFIT2, IFI27, IFITM1, IFI6), and macrophage gene signatures (e.g., MARCO, CD163, CD5L, CD63), when compared to patients with ENEG alone.

CONCLUSIONS

Transcriptomic profiling of the liver suggests that MASH negatively impacts interferon-stimulated gene expression and macrophage gene signatures in the livers of patients with ENEG, which may affect antiviral immune pathways, viral replication and inflammatory responses, resulting in an increased risk of advanced fibrosis in patients with chronic hepatitis B. Our study provides valuable insights for guiding future research aimed at developing effective, tailored strategies for managing patients with both conditions.

IMPACT AND IMPLICATIONS

In recent decades, obesity and associated health issues have reached epidemic levels, with steatotic liver disease affecting up to 30% of adults in developed countries, and this trend is also observed among patients with chronic hepatitis B. Given the high and rising prevalence of steatotic liver disease and its frequent co-occurrence in patients with chronic hepatitis B, it is essential to understand how conditions such as metabolic dysfunction-associated steatohepatitis (MASH) impact immune responses in the liver. This study provides unique insights into the impact of MASH on HBV antiviral immune activity in the livers of patients with chronic hepatitis B. The rising number of patients with both conditions affects treatment outcomes and highlights the urgent need for novel, tailored therapeutic strategies. Our study holds significant relevance for guiding future research on developing treatment strategies for patients with both MASH and chronic hepatitis B.

In virto priming of the STING signaling pathway enhances the maturation and activation of dendritic cells induced by hepatitis B vaccine

This study investigates the role of the STING signaling pathway in enhancing dendritic cells (DCs) maturation and activation in response to the hepatitis B vaccine. By analyzing the GSE52894 dataset, we compared differentially expressed genes between mature dendritic cells (mDCs) and immature dendritic cells (iDCs). In vitro, iDCs were treated with the STING agonist 2'3'-cGAMP, either alone or in combination with lipopolysaccharide (LPS) or the hepatitis B vaccine, to assess the expression of costimulatory molecules and key signaling molecules in the STING pathway, including STING, pNF-κBp65, and pIRF3. The results indicated that mDCs expressed significantly higher levels of STING mRNA compared to iDCs (P < 0.01). Treatment with 2'3'-cGAMP increased STING expression and activated downstream signaling molecules pNF-κBp65 and pIRF3. Co-treatment with 2'3'-cGAMP and LPS upregulated costimulatory molecules (CD80, CD86, HLA-DR, CD11c) more effectively than LPS alone (P < 0.05). Co-treatment with 2'3'-cGAMP and the hepatitis B vaccine resulted in significantly higher expression of costimulatory molecules compared to vaccine-only treatment. Furthermore, co-treatment with 2'3'-cGAMP and the hepatitis B vaccine enhanced STING, pNF-κBp65, and pIRF3 expression relative to vaccine alone. Mixed lymphocyte reaction assays demonstrated that the 2'3'-cGAMP and hepatitis B vaccine co-treatment group had a significantly stronger effect on the proliferation of CD4+T cells compared to the vaccine-only treatment group. In conclusion, 2'3'-cGAMP enhances DCs maturation and promotes CD4+T cells proliferation in response to the hepatitis B vaccine by activating the STING/IRF3 and STING/NF-κB pathways, highlighting its potential as an adjuvant to improve vaccine efficacy.

Global, regional, and national temporal trends in incidence and mortality for liver cancer due to hepatitis B, 1990-2021: a decomposition and age-period-cohort analysis for the Global Burden of Disease Study 2021

OBJECTIVE

This study comprehensively assessed the burden of liver cancer due to hepatitis B (LCHB) from 1990 to 2021, analyzing temporal trends in disease burden and associations with age, period and birth cohort.

METHODS

Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) of LCHB from 1990 to 2021 were collected from the Global Burden of Disease (GBD) 2021. Joinpoint regression analysis estimated long-term trends. Age-period-cohort analysis evaluated the independent effects of age, period and cohort. Decomposition analysis elucidated the impact of population growth, aging and epidemiological changes on the burden.

RESULTS

Between 1990 and 2019, the ASIR and ASMR of LCHB witnessed an overall declining trend worldwide, with a notably higher burden in males compared to females. The highest ASIR and ASMR were observed in the middle socio-demographic index (SDI) region, while the lowest were in the low-middle SDI region, with substantial differences across countries. Age-period-cohort analysis revealed an initial increase in risk followed by a decline with advancing age, with the burden primarily affecting the elderly. Decomposition analysis indicated that population growth and aging were the primary drivers of the increase in incident cases and deaths.

CONCLUSIONS

From 1990 to 2021, the ASIR and ASMR of LCHB decreased globally. However, population growth and aging contributed to an increase in the absolute numbers of incident cases and deaths. The risk burden increased with age, and favourable period and cohort effects were found in all SDI regions.

Proportion of hepatitis B virus infection, vaccine awareness, and coverage among pregnant mothers attending a tertiary care hospital in Odisha - A cross-sectional study

Background

Knowledge regarding the hepatitis B vaccination is crucial for eliminating hepatitis B. We aimed to estimate the proportion of hepatitis B infection among pregnant mothers attending a tertiary care hospital in eastern India, along with an assessment of knowledge on hepatitis B infection and preventive measures among them. We also aimed to estimate the coverage of the hepatitis B vaccine and the factors responsible for the nonacceptance of the vaccine.

Methodology

We conducted a cross-sectional study at All India Institute of Medical Sciences, Bhubaneswar, for a year from 1 May 2017 to 30 April 2018. Study participants were selected from pregnant women coming to the outpatient department (OPD) of the Department of Obstetrics and Gynaecology for routine antenatal check-ups who were willing to participate and consented to the study. A pre-designed, pre-tested questionnaire was used to collect data regarding the level of knowledge on hepatitis B infection and vaccination. We also collected venous blood samples for the detection of Hepatitis B Surface Antigen (HBsAg).

Results

A total of 510 pregnant women were recruited for 1 year. The mean age of the study participants was 27.2 years (±4.7 years). Only 2 (0.3%) out of 510 study participants were HBsAg-positive. Around two-thirds of study participants, that is, 324 (63.5%), had heard of hepatitis B. When enquired about the source of information, radio and television were mentioned by 24% of participants. Another 11% mentioned they received information from doctors. Only 12.4 % of participants received the Hep-B vaccine, 85.9% did not, and 1.8% were unaware of their vaccination status.

Conclusion

It was revealed that the proportion of hepatitis B among pregnant women was below the national level. The level of knowledge among the beneficiaries was not satisfactory. Organised health education through mass media has to be enhanced to increase awareness among the general population regarding the hepatitis B vaccination.

Impact of metformin on HBV replication: No evidence of suppression in vitro

BACKGROUND

Outcomes of chronic Hepatitis B (CHB) infection have been increasingly associated with various metabolic syndromes, including metabolic-dysfunction associated steatotic liver disease (MASLD), with a potential for impact on liver disease progression. There is some evidence that metformin, a widely used anti-diabetic drug, may reduce hepatocellular carcinoma (HCC) incidence in people living with Hepatitis B Virus (HBV), but with little to no evidence of impact on the virus itself in vivo. However, previous in vitro studies suggest metformin may have a direct impact on HBV replication, although the mechanism remains unclear.

OBJECTIVES

We aimed to investigate the impact of metformin on HBV replication in vitro.

STUDY DESIGN

Hepatocyte cell lines constitutively expressing HBV (HepAD38) were treated once or thrice with escalating doses of metformin, using lamivudine and water as controls. We monitored cellular cytotoxicity as well as HBV biomarkers (HBeAg, HBsAg, HBV DNA and RNA) throughout the assay.

RESULTS

We did not observe any impact of metformin on HBV replication after a single dose or three repeated treatments.

CONCLUSIONS

In HepAD38 cells, HBV replication is not impacted by metformin treatment. This contrasts with prior in vitro data but is in line with clinical evidence that suggests metformin acts through an influence on liver disease progression rather than a direct antiviral impact on HBV itself.

Evaluation of preventive medicine amongst people living with human immunodeficiency virus attending a hospital-based care setting

BACKGROUND

With improved outcomes in human immunodeficiency virus (HIV) due to the use of anti-retroviral therapy, ensuring adequate preventative healthcare and management of HIV-related comorbidities is essential.

AIMS

To evaluate adherence with recommended guidelines for comorbidity and immunisation status screening amongst people living with HIV within a hospital-based setting across two timepoints.

METHODS

A single-centre retrospective case series was conducted at a hospital between 2011 and 2021. Inclusion criteria were ≥18 years, confirmed diagnosis of HIV and commencement of care within study period. Medical data were reviewed over two 12-month periods to capture comorbidity screening and vaccination adherence using established guidelines (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Alfred Screening tool and Australian Technical Advisory Group recommendations). Descriptive statistics were obtained with IBM spss (version 29.0).

RESULTS

Of 102 patients, 82 (80.4%) were male and 55 (53.9%) born overseas. Nineteen (18.6%) patients entered in 2011, with a median of 36.5 months from service entry to exit. Within 12 months of entry 56 (55.4%) participants had influenza vaccination recorded. Within the last 12 months, 94.8% had recorded COVID-19 vaccination, with improvements in pneumococcal (72.3%) and hepatitis B (82.8%) since service entry. Recording of comorbidity screening was >90% for blood pressure, weight and renal function at both timepoints, however, suboptimal (<10%) for substance misuse, cognitive and osteoporosis screening.

CONCLUSIONS

There is a disparity amongst comorbidity screening and documentation of vaccination status. Further measures are required to target improvements in immunisation, bone health, substance misuse and cognitive impairment screening.

An Investigative Study of LGALSL and HLA-DRB1 as Prognostic Biomarkers and Therapeutic Targets in Chronic Hepatitis B Patients With Persistent HBV DNA Viremia Under Entecavir Treatment

Despite significant advances in chronic hepatitis B (CHB) treatment, some patients receiving entecavir (ETV) still experience poor clinical outcomes. Identifying host factors contributing to ETV anti-HBV failure in CHB patients with persistent HBV DNA positivity is crucial for developing targeted therapies. We conducted a comprehensive study using univariate and reverse Mendelian randomization (MR), incorporating sequencing data and publicly available genetic data, followed by gene set variation analysis (GSVA), gene set enrichment analysis (GSEA) and immune cell infiltration analysis to systematically explore causal associations between host factors and CHB. Univariate MR analyses revealed a significant inverse association between increased HLA-DRB1 levels and CHB risk (odds ratio [OR] 0.607, 95% confidence interval [CI] 0.478-0.771, p = 0.00004), while increased LGALSL levels were significantly associated with a heightened risk of poor CHB prognosis (OR 1.110, 95% CI: 1.017-1.212, p = 0.01885), as estimated using the inverse variance weighting (IVW) method. Analysis of immune cell infiltration showed significantly higher HLA and mast cell levels in the poor prognosis group. HLA-DRB1 showed a significant positive correlation with HLA, whereas LGALSL showed a significant negative correlation. Compared to patients with favorable prognoses, those with poor prognoses exhibited significantly higher serum LGALSL levels (ELISA), lower HLA-DRB1 expression in peripheral blood mononuclear cells (PBMCs) (qPCR), and significantly increased LGALSL expression in liver tissue (IHC). Therefore, LGALSL and HLA-DRB1 may serve as potential prognostic biomarkers for CHB patients receiving ETV, providing novel avenues for diagnosis and treatment.

Global Burden of Major Chronic Liver Diseases in 2021

BACKGROUND

This study utilised the Global Burden of Disease data (2010-2021) to analyse the rates and trends in point prevalence, annual incidence and years lived with disability (YLDs) for major chronic liver diseases, such as hepatitis B, hepatitis C, metabolic dysfunction-associated liver disease, cirrhosis and other chronic liver diseases.

METHODS

Age-standardised rates per 100,000 population for prevalence, annual incidence and YLDs were compared across regions and countries, as well as the socio-demographic index (SDI). Trends were expressed as percentage changes (PC) and estimates were reported with uncertainty intervals (UI).

RESULTS

Globally, in 2021, the age-standardised rates per 100,000 population for the prevalence of hepatitis B, hepatitis C, MASLD and cirrhosis and other chronic liver diseases were 3583.6 (95%UI 3293.6-3887.7), 1717.8 (1385.5-2075.3), 15018.1 (13756.5-16361.4) and 20302.6 (18845.2-21791.9) respectively. From 2010 to 2021, the PC in age-standardised prevalence rates were-20.4% for hepatitis B, -5.1% for hepatitis C, +11.2% for MASLD and + 2.6% for cirrhosis and other chronic liver diseases. Over the same period, the PC in age-standardized incidence rates were -24.7%, -6.8%, +3.2%, and +3.0%, respectively. Generally, negative associations, but with fluctuations, were found between age-standardised prevalence rates for hepatitis B, hepatitis C, cirrhosis and other chronic liver diseases and the SDI at a global level. However, MASLD prevalence peaked at moderate SDI levels.

CONCLUSIONS

The global burden of chronic liver diseases remains substantial. Hepatitis B and C have decreased in prevalence and incidence in the last decade, while MASLD, cirrhosis and other chronic liver diseases have increased, necessitating targeted public health strategies and resource allocation.

Impact of Tenofovir Alafenamide on Lipid Profiles in Chronic Hepatitis B Patients: Systematic Review and Meta-Analysis

Tenofovir alafenamide (TAF) is widely used for chronic hepatitis B (CHB) treatment due to its improved renal and bone safety compared to tenofovir disoproxil fumarate (TDF). However, emerging evidence suggests that TAF may adversely affect lipid metabolism, raising concerns about potential cardiovascular risks. A systematic review and meta-analysis following PRISMA guidelines was conducted. Studies comparing lipid profile changes in CHB patients receiving TAF, TDF, or entecavir (ETV) were retrieved from PubMed, Cochrane, and Embase. Primary outcomes included changes in total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Sensitivity analyses were performed to assess potential confounders, including lipid-lowering therapy. Trial sequential analysis (TSA) was used to evaluate the sufficiency of evidence. A total of 23 studies (5 RCTs, 18 observational) were included. Observational data showed significant increases in TC (MD = 10.74 mg/dL), TG (MD = 11.56 mg/dL), LDL (MD = 3.08 mg/dL), and HDL (MD = 7.51 mg/dL) with TAF versus TDF. Meta-analysis of RCTs confirmed these findings, showing TC (MD = 18.28 mg/dL), LDL (MD = 13.09 mg/dL), and HDL (MD = 4.95 mg/dL) elevations. TAF is associated with increased lipid levels, likely due to the loss of TDF's lipid-lowering effect. While its cardiovascular risk remains uncertain, clinicians should monitor lipid profiles in CHB patients on TAF, particularly those at high cardiovascular risk.

Hepatocellular Carcinoma with Vascular and Cardiac Involvement in a Young Patient with Non-Cirrhotic Hepatitis B: A Case Report

Introduction

Hepatocellular carcinoma (HCC) is a highly vascular malignancy with the potential for intravascular invasion. However, vascular extension into the cardiac chambers is extremely rare.

Case Presentation

We present a 25-year-old male patient in whom the investigation of a cardiac murmur led to the discovery of an intracardiac mass that proved to be advanced-stage HCC with vascular invasion of the right heart. The patient had a previously unknown non-cirrhotic chronic hepatitis B virus (HBV) infection. Despite antiviral therapy and systemic treatment for HCC, he eventually died about 1 month later due to disease progression.

Conclusion

This report highlights the importance of early HBV diagnosis and treatment for timely detection and management of HCC. Advanced-stage HCC, particularly with cardiac involvement, has an extremely poor prognosis.

Effectiveness and Safety of Tenofovir Amibufenamide in the Treatment of Chronic Hepatitis B: A Real-world, Multicenter Study

Background and Aims

Chronic hepatitis B (CHB) remains a significant global health challenge, and effective antiviral therapies are essential for long-term management. This study aimed to evaluate the real-world effectiveness and safety of tenofovir amibufenamide (TMF) in a cohort of patients with chronic hepatitis B (CHB).

Methods

In this multicenter, prospective, real-world cohort study, 194 CHB patients were recruited from four hospitals between August 2021 and August 2022. Patients were divided into treatment-naïve (TN, n = 123) and treatment-experienced (TE, n = 71) groups. The TN group was further subdivided into TMF (n = 63) and tenofovir disoproxil fumarate (TDF, n = 60) subgroups. In the TE group, patients transitioned from prior antiviral therapies (entecavir or TDF) to TMF after meeting criteria for poor virological response or safety concerns. Treatment response was evaluated in terms of virological effectiveness and alanine transaminase normalization rates. Virological response (VR), ALT normalization rates, renal function markers, and lipid profiles were monitored.

Results

In the TN cohort, VR rates at 24 and 48 weeks were 42.86% and 90.48% for TMF, and 60.00% and 83.33% for TDF. ALT normalization rates at 24 and 48 weeks for TMF were 56.82% and 70.45% (according to AASLD 2018 standards). In the TE group, VR rates at 24 and 48 weeks were 83.1% and 91.55%, respectively. ALT normalization rates were 86.67% and 93.33% (local standards), and 66.67% and 76.67% (AASLD 2018 standards) (z = -2.822, P = 0.005). Additionally, TMF showed improved renal safety over TDF, with no significant differences in lipid concentrations.

Conclusions

TMF is comparable to TDF in terms of CHB treatment effectiveness, with better renal safety and no impact on lipid levels. In TE patients, transitioning to TMF therapy does not affect antiviral treatment outcomes.

Cardiometabolic Comorbidities in Patients With Chronic Hepatitis B and Impact on Incidence of Liver Complications. A Danish Nationwide Cohort Study

Purpose

To evaluate liver complications in patients with chronic hepatitis B, both with and without cardiometabolic comorbidities, and to compare the incidence of cardiometabolic comorbidities in these patients with that of the general population.

Study Population and Methods

This nationwide registry-based cohort study included data from 2002-2020. In the primary analysis, we used multivariate Poisson regression to estimate the incidence rate and incidence rate ratio of liver complications in patients with chronic hepatitis B, stratified by the presence of cardiometabolic comorbidities. In the secondary analysis, we compared the incidence rate of developing cardiometabolic comorbidities in patients with chronic hepatitis B to those of the general population. Both analyses were adjusted for sex, age, and country of origin, while the primary analysis was additionally adjusted for time since cardiometabolic comorbidity diagnosis and calendar year.

Results

The primary analysis included 4731 patients with chronic hepatitis B, of whom 532 (11%) had at least one cardiometabolic comorbidity. The unadjusted overall incidence rate of liver complications in patients with cardiometabolic comorbidities was 1.0 per 100 person-years (95% confidence intervals: 0.84-1.30) compared to 0.4 per 100 person-years (95% confidence intervals: 0.30-0.42) in those without. The incidence rate ratio for liver complications was highest in the first year following the diagnosis of cardiometabolic comorbidity. The incidence rate ratio for developing cardiometabolic comorbidities in the chronic hepatitis B cohort compared to the general population, was 1.10 (95% confidence intervals: 1.02-1.19). Sensitivity analyses revealed a higher incidence rate ratio for type 2 diabetes and hypertension but a lower incidence rate ratio for hypercholesterolemia.

Conclusion

Patients with chronic hepatitis B and cardiometabolic comorbidities exhibit a higher incidence of liver complications, particularly in the first year following comorbidity diagnosis compared to those without comorbidities. Furthermore, patients with chronic hepatitis B have a higher incidence of cardiometabolic comorbidities than the general population.

Prognostic Value of the Vascular Lake Phenomenon in Large Hepatocellular Carcinoma Following Conventional TACE: A Retrospective Study

RATIONALE AND OBJECTIVES

The study aimed to evaluate risk factors related to the vascular lake phenomenon (VLP) and its impact on prognosis in patients with large hepatocellular carcinoma (HCC) (≥5 cm) undergoing Conventional transarterial chemoembolization (cTACE).

PATIENTS AND METHODS

This study included 149 patients with large HCC who initially underwent cTACE from July 2021 to July 2023. The univariate and multivariate analyses were conducted to find risk factors related to VLP. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and postoperative complications were compared between the VLP group and the non-VLP group. The propensity score matching (PSM) was used to reduce selection bias.

RESULTS

Among the 149 patients (mean age 65±12 years; 120 male), 50 patients were in the VLP group. The VLP group had a significantly higher positive rate of Hepatitis B surface Antigen (HBsAg) (p=.006). After PSM, VLP was an independent factor associated with OS (p=.002, HR 0.39, 95% CI: 0.21, 0.72) and PFS (p=.002, HR 0.50, 95% CI: 0.32, 0.78). The VLP group showed significantly longer OS (19.1 months vs. 13.4 months, p=.005), longer PFS (11.2 months vs. 6.5 months, p=.006), higher ORR (34.0% vs 14.0%, p=.019), and higher DCR (62.0% vs 26.0%, p<.001) than the non-VLP group.

CONCLUSION

The presence of VLP in large HCC may correlate with a higher rate of HBsAg positivity. It can indicate improved survival outcomes and treatment response underwent cTACE treatment.

SUMMARY

In hepatocellular carcinoma with a diameter greater than 5 cm, the presence of preoperative vascular lake phenomenon indicates better transarterial chemoembolization efficacy.

Altered LY6E and TRIM6 expression in PBMCs correlated with HBsAg clearance and response to Peg-IFN-α treatment in HBeAg-negative chronic hepatitis B patients

BACKGROUND

Pegylated interferon alpha (Peg-IFN-α) has the potential to eradicate hepatitis B surface antigen (HBsAg). This study aimed to investigate whether the expression levels of lymphocyte antigen 6 family member E (LY6E) and tripartite motif-containing protein 6 (TRIM6) mRNAs in peripheral blood mononuclear cells (PBMCs) of hepatitis B e antigen (HBeAg)-negative chronic hepatitis B virus (HBV) patients is associated with the response to Peg-IFN-α treatment and HBsAg clearance.

METHODS

In this prospective study, HBeAg-negative chronic HBV patients treated with Peg-IFN-α were followed for 48 weeks. The participants were classified into two groups, the virological response (VR) group and nonvirological response (NVR) group, according to the changes in HBV DNA and HBsAg levels observed at week 48 of treatment. Furthermore, these patients were divided into a serological response (SR) group and a nonserological response (NSR) group, depending on whether they exhibited a loss of serum HBsAg or evidence of seroconversion. The expression levels of LY6E and TRIM6 mRNAs in PBMCs were evaluated using real-time quantitative PCR with fluorescence detection. The diagnostic performance of LY6E and TRIM6 was assessed by analyzing the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC).

RESULTS

After the treatment period, the observed VR and SR rates were 44.64% and 28.57%, respectively. Dynamic changes in LY6E and TRIM6 mRNA levels were significantly different between the VR and NVR groups and between the SR and NSR groups. Multivariate analysis revealed that TRIM6 was independently associated with VR at weeks 12 and 24 of Peg-IFN-α therapy and with SR at week 12; in addition, LY6E was independently associated with VR at week 12 and SR at week 24. At week 24, the area under the curve (AUC) for LY6E in the prediction of VR was 0.6942, and the AUC for the prediction of SR was 0.7766; at week 12, TRIM6 had AUCs of 0.7600 for the prediction of VR and 0.8469 for the prediction of SR.

CONCLUSIONS

LY6E and TRIM6 are important biomarkers for early therapeutic responses to Peg-IFN-α and HBsAg clearance.

TRIAL REGISTRATION

Registration number: 2023 - 311. Date of registration: 1 October 2023.

The role of immune regulation in HBV infection and hepatocellular carcinogenesis

Hepatitis B virus (HBV) infection is a well-documented independent risk factor for developing hepatocellular carcinoma (HCC). Consequently, extensive research has focused on elucidating the mechanisms by which HBV induces hepatocarcinogenesis. The majority of studies are dedicated to understanding how HBV DNA integration into the host genome, viral RNA expression, and the resulting protein transcripts affect cellular processes and promote the malignant transformation of hepatocytes. However, considering that most acute HBV infections are curable, immune suppression potentially contributes to the critical challenges in the treatment of chronic infections. Regulatory T cells (Tregs) are crucial in immune tolerance. Understanding the interplay of Tregs within the liver microenvironment following HBV infection could offer novel therapeutic approaches for treating HBV infections and preventing HBV-related HCC. Two viewpoints to targeting Tregs in the liver microenvironment include means of reducing their inhibitory function and decreasing Treg frequency. As these strategies may disrupt the immune balance and lead to autoimmune responses, careful and comprehensive profiling of the patient's immunological status and genetic factors is required to successfully employ this promising therapeutic approach.

Liver Cirrhosis: ancient disease, new challenge

Liver cirrhosis is a common cause of morbidity and mortality worldwide. Excessive alcohol consumption and metabolic associated steatotic liver disease are the most common etiological factors of cirrhosis in our region. Cirrhosis occurs in two well-differentiated phases, compensated and decompensated, depending on the absence or presence of complications, respectively. Current therapeutic strategies are aimed at controlling these complications (such as ascites, hepatic encephalopathy, bacterial infections, or digestive hemorrhage, among others) or performing a liver transplant if there are no contraindications. However, it is important to eliminate the etiological factor responsible for the disease, as this can lead to the disappearance of complications, a state known as recompensation. This article proposes an updated review of the epidemiology of cirrhosis and its main causes, and offers an overview of the clinical features and treatment of the disease's complications, in addition to outlining future lines of research in this field.