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Wang L, Wang J, Zhao K, Jiang L, Zhang X, Zhao J, Li J, Lu F. The Relationship between Viral Replication and the Severity of Hepatic Necroinflammatory Damage Changed before HBeAg Loss in Patients with Chronic Hepatitis B Virus Infection. J Clin Transl Hepatol 2024; 12:381-388. [PMID: 38638381 PMCID: PMC11022060 DOI: 10.14218/jcth.2023.00378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/31/2023] [Accepted: 01/01/2024] [Indexed: 04/20/2024] Open
Abstract
Background and Aims Disease progression of chronic hepatitis B virus (HBV) infection is driven by the interactions between viral replication and the host immune response against the infection. This study aimed to clarify the relationship between HBV replication and hepatic inflammation during disease progression. Methods Two cross-sectional, one validation cohort, and meta-analyses were used to explore the relationship between HBV replication and liver inflammation. Spearman analysis, multiple linear regression, and logistic regression were used to explore the relationship between variables. Results In the cross-sectional cohorts A and B including 1,350 chronic hepatitis B patients, Spearman analysis revealed a negative relationship between HBV replication (such as HBV DNA) and liver inflammation (such as ALT) in HBeAg-positive patients with higher HBV DNA >2×106 IU/mL (rho=-0.160 and -0.042) which turned to be positive in HBeAg-positive patients with HBV DNA ≤2×106 IU/mL (rho=0.278 and 0.260) and HBeAg-negative patients (rho=0.450 and 0.363). After adjustment for sex, age, and anti-HBe, results from logistic regression and multiple linear regression showed the opposite relationship still existed in HBeAg-positive patients with different DNA levels; the opposite relationship in HBeAg-positive patients with different DNA levels was validated in a third cohort; the opposite relationship in patients with different HBeAg status was partially confirmed by meta-analysis (overall R: -0.004 vs 0.481). Conclusions These results suggested a negative relationship between viral replication and liver inflammation in HBeAg-positive patients with high HBV DNA, which changed to a positive relationship for those HBeAg-positive patients with DNA less than 2×106 IU/mL and HBeAg-negative patients.
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Affiliation(s)
- Leijie Wang
- Department of Microbiology and Immunology, College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Kunyu Zhao
- Department of Microbiology and Immunology, College of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Lina Jiang
- Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Xinxin Zhang
- Department of Infectious Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingming Zhao
- Department of Pathology and Hepatology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jie Li
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Fengmin Lu
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University, Beijing, China
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Tan M, Bhadoria AS, Cui F, Tan A, Van Holten J, Easterbrook P, Ford N, Han Q, Lu Y, Bulterys M, Hutin Y. Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:106-119. [PMID: 33197397 PMCID: PMC7801814 DOI: 10.1016/s2468-1253(20)30307-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2016, of the estimated 257 million people living with chronic hepatitis B virus (HBV) infection worldwide, only a small proportion was diagnosed and treated. The insufficiency of information on the proportion of people infected with HBV who are eligible for treatment limits the interpretation of global treatment coverage. We aimed to estimate the proportion of people with chronic HBV infection who were eligible for antiviral treatment worldwide, based on the WHO 2015 guidelines. METHODS In this systematic review and meta-analysis, we searched Medline, EMBASE, and the Cochrane databases from Jan 1, 2007, to Jan 31, 2018, for studies describing HBsAg-positive people in the population or health-care facilities. We extracted information from published studies using a standardised form to estimate the frequency of cirrhosis, abnormal alanine aminotransferase (ALT), HBV DNA exceeding 2000 IU/mL or 20 000 IU/mL, presence of HBeAg, and eligibility for treatment as per WHO and other guidelines as reported in the studies. We pooled proportions through meta-analysis with random effects. The study was registered with PROSPERO, CRD42020132345. FINDINGS Of the 13 497 studies, 162 were eligible and included in our analysis. These studies included 145 789 participants. The pooled estimate of the proportion of cirrhosis was 9% (95% CI 8-10), ranging from 6% (4-8) in community settings to 10% (9-11) in clinic settings. Examining the proportion of participants who had characteristics used to determine eligibility in the WHO guidelines, 1750 (10·1%) of 17 394 had HBV DNA exceeding 20 000 IU/mL, and 20 425 (30·8%) of 66 235 had ALT above the upper limit of normal. 32 studies reported eligibility for treatment according to WHO or any other guidelines, with a pooled estimate of eligibility at 19% (95% CI 18-20), ranging from 12% (6-18) for studies in community settings to 25% (19-30) in clinic settings. INTERPRETATION Many studies described people with HBV infection, but few reported information in a way that allowed assessment of eligibility for treatment. Although about one in ten of the 257 million people with HBV infection (26 million) might be in urgent need of treatment because of cirrhosis, a larger proportion (12-25%) is eligible for treatment in accordance with different guidelines. Future studies describing people with HBV infection should report on treatment eligibility, according to broadly agreed definitions. FUNDING WHO and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Mingjuan Tan
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland; Department of Medicine, National University Health System, Singapore
| | - Ajeet S Bhadoria
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Fuqiang Cui
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | | | - Judith Van Holten
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | | | - Nathan Ford
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Qin Han
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Ying Lu
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Marc Bulterys
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland
| | - Yvan Hutin
- Department of HIV/AIDS and Global Hepatitis Programme, WHO, Geneva, Switzerland.
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Jia J, Li Y, Wei C, Guo R, Xu H, Jia Y, Wu Y, Li Y, Wei Z, Qi X, Li Z, Gao X. Factors associated with disease progression and viral replication in patients with chronic hepatitis B virus infection. Exp Ther Med 2019; 17:4730-4740. [PMID: 31086607 DOI: 10.3892/etm.2019.7482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/07/2019] [Indexed: 12/26/2022] Open
Abstract
Hepatitis B virus (HBV) infection remains a severe clinical concern in China. Of note, the progression of HBV infection varies between different populations. To identify the factors that influence the disease progression and prognosis, a total of 478 chronic HBV-infected patients were enrolled, and liver function parameters, HBV DNA levels and hepatic fibrosis indices were analyzed. First, the results demonstrated a significant difference in hepatitis B e antigen (HBeAg) expression between male and female patients (χ2=4.061, P=0.044). Furthermore, when comparing either HBeAg-negative or -positive male and female patients, males exhibited a greater variation in HBV DNA levels. Although significant differences between male and female patients in certain abnormal ratios of liver function parameters were identified, a trend in the differences was observed in the HBeAg-negative and -positive groups. When considering age, the results of the present study confirmed that HBV DNA levels decreased with advanced age, and the values of the majority of biomarkers exhibited an evident decreasing trend with increasing age. In addition, it was demonstrated that all HBeAg seropositive patients had higher levels of hepatic fibrosis indexes and higher abnormal ratios of hepatic fibrosis values in their serum when compared with those of HBeAg seronegative patients, particularly with regard to serum IV collagen. The present results revealed that HBV DNA replication was closely associated with liver function; however, it was notable that in HBeAg-negative patients, the association between HBV DNA levels and liver function was particularly significant among subjects aged <61. Furthermore, this result was not observed in HBeAg-positive patients. In conclusion, the present study indicated the importance of host factors (including sex and age) and viral factors (including HBeAg expression pattern and HBV DNA levels) in the progression of chronic HBV infection, and its influence regarding prognosis and treatment. The present results provide a foundation for clinical management strategies for chronic HBV infection, particularly in individual schemes.
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Affiliation(s)
- Jing Jia
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yonghong Li
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Chaojun Wei
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Rui Guo
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Hui Xu
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yanjuan Jia
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yu Wu
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Yuanting Li
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Zhenhong Wei
- Department of Blood Transfusion, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Xiaoming Qi
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Zhenhao Li
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
| | - Xiaoling Gao
- Institute of Clinical Research and Translational Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, P.R. China
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Jun CH, Kim BS, Oak CY, Lee DH, Cho E, Cho SB, Choi SK, Park CH, Joo YE, Lee JJ, Kim HJ. HBV reactivation risk factors in patients with chronic HBV infection with low replicative state and resolved HBV infection undergoing hematopoietic stem cell transplantation in Korea. Hepatol Int 2016; 11:87-95. [PMID: 27351765 DOI: 10.1007/s12072-016-9747-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/27/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE To elucidate the rate and risk factors of HBV reactivation in patients with chronic HBV infection with low replicative state and resolved HBV infection undergoing allogenic/autologous hematopoietic stem-cell transplantation (HSCT) in Korea. METHODS The medical charts of 506 patients who underwent allogenic/autologous HSCT from January 2008 to December 2013 were analyzed retrospectively. We examined the reactivation rate and variables related to the risk of HBV reactivation, with a median follow-up period of 41.8 (1-245) months. Univariate analysis was used to identify any factors associated with HBV reactivation. Factors that were significant in the univariate analysis were entered into a stepwise multivariate analysis to find the most significant risk factors associated with HBV reactivation. RESULTS The reactivation rate of HBV in patients who underwent HSCT was 4.2 % (21/506). In subgroup analysis, the HBV reactivation rate (14.3 %) was the highest among HBsAg(+) patients (5/35). The reactivation rate of HBV in patients with resolved HBV infection [HBsAg(-)/HBcAb(+) with or without anti-HBs antibody] was 5.9 % (10/171). In univariate analysis for risk factors of HBV reactivation in patients who underwent HSCT, initial detectable HBV DNA (p = 0.004), age (≥60 years) (p = 0.012), recipient hepatitis B surface antigen-positive (HbsAg)(+) before HSCT (p = 0.004), recipient hepatitis B surface antibody-negative (HBsAb)(-) before HSCT (p = 0.005), recipient hepatitis B core antibody-positive (HbcAb)(+) before HSCT (p = 0.013), and donor HBsAg(+) (p < 0.001) were associated with reactivation of HBV. In multivariate analysis, significant risk factors of HBV reactivation in patients who underwent HSCT were old age (≥60 years) (p = 0.032) and donor HBsAg(+) (p = 0.026). CONCLUSION Old age (≥60 years) and donor HBsAg(+) were risk factors for HBV reactivation in HSCT patients. Preemptive antiviral treatment should be considered in these patients.
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Affiliation(s)
- Chung Hwan Jun
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Ban Suk Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Chan Young Oak
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Du Hyeon Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Sung Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Sung Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea.
| | - Chang Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Young Eun Joo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Je-Jung Lee
- Division of Hematology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jaebong-ro, Dong-Ku, Gwangju, 501-757, Korea
| | - Hyeoung-Joon Kim
- Division of Hematology, Department of Internal Medicine, Chonnam National University Medical School, 42, Jaebong-ro, Dong-Ku, Gwangju, 501-757, Korea
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Birku T, Gelaw B, Moges F, Assefa A. Prevalence of hepatitis B and C viruses infection among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia. BMC Res Notes 2015; 8:737. [PMID: 26625733 PMCID: PMC4666071 DOI: 10.1186/s13104-015-1719-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 11/19/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Military personnel are high-risk people for parenteral and sexually transmitted diseases such as hepatitis B virus (HBV) and hepatitis C virus (HCV). Data regarding HBV and HCV prevalence among military personnel in Ethiopia is limited. Hence, the study aimed to determine sero-prevalence and associated risk factors of HBV and HCV among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia. METHODS A cross-sectional study was conducted in a total of 403 military personnel from February to May 2015. Socio-demographic characteristics and risk factors were collected through face to face interview using structured questionnaire. HBV and HCV infection was determined using HBsAg and anti-HCV antibody rapid tests. Logistic regression analysis was employed to assess possible risk factors for HBV and HCV infections. RESULTS The sero-prevalence of HBV and HCV infection were 4.2 and 0.2%, respectively. None of the study subjects were co-infected with HBV and HCV. Higher prevalence of HBV infection (11.3%) was observed in the age group of 40 and above. Being at the age of 40 years and above (COR 7.6; 95% CI 2.0-29.0, p = 0.003), history of nose piercing (COA 5.9; 95% CI 1.2-29.9, p = 0.033) and sexually transmitted infection (COR 4.3; 95% CI 1.1-16.4, p = 0.03) were significantly associated with these viral hepatitis infections. CONCLUSION Intermediate prevalence of HBV and low prevalence of HCV were observed among military personnel. Strengthening HBV screening strategies among military personal may further reduce these viral diseases.
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Affiliation(s)
- Tigist Birku
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abate Assefa
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Assis DRD, Tenore SDB, Pinho JRR, Lewi DS, Ferreira PRA. Characteristics of an outpatient chronic hepatitis B virus infection cohort. EINSTEIN-SAO PAULO 2015; 13:189-95. [PMID: 26154539 PMCID: PMC4943808 DOI: 10.1590/s1679-45082015ao3269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/06/2015] [Indexed: 02/07/2023] Open
Abstract
Objective: To characterize a chronic hepatitis B cohort based on initial and follow-up clinical evaluations. Methods: A retrospective and descriptive analysis of clinical and laboratory data from chronic HBsAg adult carriers, without HIV, unexposed to treatment, with at least two outpatient visits, between February 2006 and November 2012. Fisher´s exact test, χ², Wilcoxon, Spearman, multiple comparisons and Kappa tests were applied, the level of significance adopted was 5%, with a 95% confidence interval. Results: 175 patients with mean age of 42.95±12.53 years were included: 93 (53.1%) were men, 152 (86.9%) were negative for hepatitis B e-antigen (HBeAg), 3 (1.7%) had hepatitis C coinfection, 15 (8.6%) had cirrhosis, and 2 (1.1%) had hepatocellular carcinoma. Genotype A predominated. Sixty-six patients (37.7%) had active hepatitis, 6 (3.4%) presented immune tolerance, and 38 (21.7%) were inactive carriers. Exacerbations and/or viral breakthrough were detected in 16 patients (9.1%). In 32 patients (18.3%), hepatitis B virus DNA remained persistently elevated and alanine aminotransferase levels were normal, whereas in 17 (9.7%), there was low hepatitis B virus DNA and alterated alanine aminotransferase. If only initial alanine aminotransferase and hepatitis B virus DNA values were considered, 15 cases of active hepatitis would not have been detected. Advanced fibrosis was more common in HBeAg-positive patients, and it was significantly associated with transaminases, hepatitis B virus DNA, and age. Conclusion: Many patients had active hepatitis, but almost 25%, who were HBeAg non-reactive, were only identified because of combined analyses of the hepatitis B virus DNA and transaminases levels, sometimes associated with histological data, after clinical follow-up.
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