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Singh KP, Avihingsanon A, Zerbato JM, Zhao W, Braat S, Tennakoon S, Rhodes A, Matthews GV, Fairley CK, Sasadeusz J, Crane M, Audsley J, Lewin SR. Predictors of liver disease progression in people living with HIV-HBV co-infection on antiretroviral therapy. EBioMedicine 2024; 102:105054. [PMID: 38518655 PMCID: PMC10966452 DOI: 10.1016/j.ebiom.2024.105054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND In people living with HIV-HBV, liver fibrosis progression can occur even with suppressive antiretroviral therapy (ART). We investigated the relationship between liver fibrosis and biomarkers of inflammation, apoptosis, and microbial translocation. METHODS In this observational cohort study adults living with HIV-HBV already on effective ART were recruited in Australia and Thailand and followed for 3 years including 6 monthly clinical review and blood tests and annual transient elastography. Differences in clinical and laboratory predictors of liver fibrosis progression were tested followed by regression analysis adjusted for CD4+ T-cells at study entry. A linear mixed model was fitted to longitudinal data to explore changes over time. FINDINGS 67 participants (85% male, median age 49 y) were followed for 175 person-years. Median duration of ART was 10 years (interquartile range (IQR) 8-16 years). We found 11/59 (19%) participants during 3-years follow-up (6/100 person-years) met the primary endpoint of liver disease progression, defined as increased Metavir stage from baseline to final scan. In regression analysis, progressors compared to non-progressors had higher levels of high mobility group box 1 protein (HGMB1), (median (IQR) 3.7 (2.6-5.0) and 2.4 ng/mL (1.5-3.4) respectively, adjusted relative risk 1.47, 95% CI [1.00, 2.17]) and lower nadir CD4+ T-cell percentage (median 4% (IQR 2-8) and 11% (4-15) respectively (relative risk 0.93, 95% CI [0.88, 0.98]). INTERPRETATION Progression in liver fibrosis occurs in people with HIV-HBV on suppressive ART. Fibrosis progression was associated with higher HMGB1 and lower percentage nadir CD4+ T-cell count, highlighting the importance of early initiation of HBV-active ART. FUNDING This work was supported by NHMRC project grant 1101836; NHMRC practitioner fellowship 1138581 and NHMRC program grant 1149990. The funder had no role in study design, data collection, data analysis, interpretation, writing of this manuscript or decision to submit for publication.
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Affiliation(s)
- Kasha P Singh
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia; Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, 3004, Australia.
| | | | - Jennifer M Zerbato
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Wei Zhao
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, 3053, Australia; MISCH (Methods and Implementation Support for Clinical Health) research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Surekha Tennakoon
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Ajantha Rhodes
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Gail V Matthews
- Kirby Institute, UNSW, Kensington, New South Wales, 2052, Australia
| | | | - Joe Sasadeusz
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia; Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, 3004, Australia
| | - Megan Crane
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Jennifer Audsley
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia; Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, 3004, Australia.
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Yang JS, Sovann S, Shimakawa Y, Nhoueng S, Dim B, Vong C, Sann C, Guillebaud J, Vann D, Touch B, Chea H, Phirum WPC, Rosenthal E, Paul C, Khun L, Yay C, Laurent D, Chhun S, Borand L, Segeral O. Simplified Criteria to Assess Long-Term Antiviral Treatment Indication in Chronic HBV-Infected Pregnant Women in Cambodia. Viruses 2024; 16:194. [PMID: 38399970 PMCID: PMC10891875 DOI: 10.3390/v16020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Pregnant women identified to carry hepatitis B surface antigen (HBsAg) should be linked to care for the determination of the need for long-term antiviral therapy (LTT). We assessed the performance of simplified criteria, free from HBV DNA quantification, to select women eligible for LTT using different international guidelines as a reference. A retrospective analysis of HBV-infected pregnant women enrolled in the phase 4 ANRS TA-PROHM study was conducted in Cambodia. Sensitivity, specificity, and AUROC were computed to compare three simplified criteria (TREAT-B, HBcrAg/ALT, and TA-PROHM) with the American (AASLD) and European (EASL) guidelines as a reference. An additional assessment was performed at 6 months postpartum. Of 651 HBsAg-positive women, 209 (32%) received peripartum antiviral prophylaxis using tenofovir disoproxil fumarate (TDF). During pregnancy, 9% and 12% of women were eligible for LTT according to AASLD and EASL guidelines, respectively; 21% and 24% of women were eligible for prophylactic TDF and 2% and 5% in those ineligible (p < 0.001). Using the AASLD guidelines, the AUROC of TREAT-B, HBcrAg/ALT, and TA-PROHM scores were 0.88 (95%CI, 0.85-0.90), 0.90 (95%CI, 0.87-0.92), and 0.76 (95%CI, 0.73-0.80), respectively. Using the EASL guidelines, the AUROCs were lower: 0.73 (95%CI, 0.69-0.76), 0.76 (95%CI, 0.73-0.80), and 0.71 (95%CI, 0.67-0.74), respectively. Among those ineligible for prophylactic TDF, only 2% to 6% present an indication for LTT at 24 weeks postpartum. Few pregnant women are eligible for LTT, and the use of simplified criteria could represent an efficient triage option in decentralized areas to identify those negative for whom there is no urgent indication for LTT and focus on those positive for whom other exams must be conducted to confirm LTT indication.
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Affiliation(s)
- Jee-Seon Yang
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
- Sorbonne Université, 75013 Paris, France
- Service de Pédiatrie Générale et Aval des Urgences, Hôpital Armand Trousseau, 75012 Paris, France
| | - Saren Sovann
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | - Yusuke Shimakawa
- Institut Pasteur, Unité d’Épidémiologie des Maladies Émergentes, Université Paris Cité, 75015 Paris, France
| | - Sovann Nhoueng
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | - Bunnet Dim
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | | | - Channa Sann
- Calmette Hospital, Phnom Penh 12201, Cambodia
| | - Julia Guillebaud
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
| | - Darapolin Vann
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | - Bunrith Touch
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | - Hyna Chea
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | | | - Eric Rosenthal
- ANRS|Maladies Infectieuses Emergentes, 75000 Paris, France; (E.R.)
- Internal Medicine Department, Université Côte d’Azur, 06000 Nice, France
| | - Christelle Paul
- ANRS|Maladies Infectieuses Emergentes, 75000 Paris, France; (E.R.)
| | | | - Chantana Yay
- Jayavarman VII Hospital, Siem Reap 17259, Cambodia (B.T.)
| | - Denis Laurent
- Direction Department, Foundation Children’s Hospital Kantha Bopha, Phnom Penh 12000, Cambodia
| | | | - Laurence Borand
- Institut Pasteur du Cambodge, Phnom Penh 12201, Cambodia; (J.-S.Y.); (J.G.)
- Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Olivier Segeral
- ANRS|Maladies Infectieuses Emergentes, 75000 Paris, France; (E.R.)
- HIV Unit, Infectious Diseases Department, Geneva University Hospital, 1205 Geneva, Switzerland
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Wang CL, Huang CH, Wu VCC, Wu CL, Huang YT, Chang SH. Prognostic Effects of Liver Fibrosis and Steatosis Determined Using Transient Elastography in Patients with Chronic Hepatitis B or C. Dig Dis Sci 2023; 68:2747-2756. [PMID: 37071242 DOI: 10.1007/s10620-023-07943-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/01/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The prognostic effects of liver fibrosis and steatosis in patients with chronic hepatitis B or C are unclear. We investigated the prognostic effects of liver fibrosis and steatosis determined through transient elastography (TE) in patients with chronic hepatitis B or C. METHODS This retrospective cohort study enrolled 5528 patients with chronic hepatitis B or C who received TE. Multivariate Cox regression was used to evaluate the associations between fibrosis and steatosis grades and the occurrence of hepatic-related events, cardiovascular events, and mortality. Liver stiffness measurements of ≥ 7.1, ≥ 9.5, and ≥ 12.5 kPa were considered to indicate significant fibrosis (≥ F2), advanced fibrosis (≥ F3), and cirrhosis (≥ F4), and controlled attenuation parameters of ≥ 230 and ≥ 264 dB/m were considered to indicate mild (S1) and moderate-to-severe (S2-S3) steatosis, respectively. RESULTS During a median follow-up of 3.1 years, 489 patients died, 814 had hepatic-related events, and 209 had cardiovascular events. The incidences of these outcomes were lowest among individuals with no- or mild-fibrosis (F0-F1), and increased with fibrosis severity. The incidence of adverse outcomes was highest among patients without steatosis (S0) and lowest among those with moderate-to-severe steatosis. Adjusted models indicated that F2, F3, and F4 were independent risk factors and that moderate-to-severe steatosis was a favorable marker for hepatic-related events. Cirrhosis was an independent factor for mortality. CONCLUSIONS According to TE, increasing fibrosis grades and absence of steatosis were associated with higher risks of hepatic-related events, whereas cirrhosis was a risk factor for mortality in patients with chronic hepatitis B or C.
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Affiliation(s)
- Chun-Li Wang
- Cardiovascular Division, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kwei-Shan District, Taoyuan, 33305, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chien-Hao Huang
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- Cardiovascular Division, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kwei-Shan District, Taoyuan, 33305, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chia-Ling Wu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Shang-Hung Chang
- Cardiovascular Division, Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kwei-Shan District, Taoyuan, 33305, Taiwan.
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan.
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
- Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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Christensen PB, Debrabant B, Cowan S, Debrabant K, Øvrehus A, Duberg AS. Hepatitis C time trends in reported cases and estimates of the hidden population born before 1965, Denmark and Sweden, 1990 to 2020. Euro Surveill 2022; 27:2200243. [PMID: 36695470 PMCID: PMC9808318 DOI: 10.2807/1560-7917.es.2022.27.50.2200243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BackgroundAccording to the World Health Organization, hepatitis C virus (HCV) infection should be under control by 2030.AimOur aim was to describe the size and temporal changes in reported cases of chronic HCV infection in Denmark and Sweden and to estimate the size of the hidden (undiagnosed) population born before 1965.MethodsWe extracted all HCV infections reported to national surveillance systems in Denmark and Sweden from 1990 to 2020. Prediction of the size of the hidden HCV-infected population was restricted to the cohort born before 1965 and cases reported up to 2017. We applied a model based on removal sampling from binomial distributions, estimated the yearly probability of diagnosis, and deducted the original HCV-infected population size.ResultsDenmark (clinician-based) reported 10 times fewer hepatitis C cases annually than Sweden (laboratory and clinician-based), peaking in 2007 (n = 425) and 1992 (n = 4,537), respectively. In Denmark, the birth year distribution was monophasic with little change over time. In recent years, Sweden has had a bimodal birth year distribution, suggesting ongoing infection in the young population. In 2017, the total HCV-infected population born before 1965 was estimated at 10,737 living persons (95% confidence interval (CI): 9,744-11,806), including 5,054 undiagnosed, in Denmark and 16,124 (95% CI: 13,639-18,978), including 10,580 undiagnosed, in Sweden.ConclusionsThe reporting of HCV cases in Denmark and Sweden was different. For Denmark, the estimated hidden population was larger than the current national estimate, whereas in Sweden the estimate was in line with the latest published numbers.
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Affiliation(s)
- Peer Brehm Christensen
- Department of Infectious Diseases Q, Odense University Hospital, Denmark,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Birgit Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark,Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Susan Cowan
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Kristian Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
| | - Anne Øvrehus
- Department of Infectious Diseases Q, Odense University Hospital, Denmark,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Sweden
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Sølund C, Hasbak P, Knudsen A, Kjaer A, Lebech AM, Weis N. Myocardial perfusion reserve in patients with chronic hepatitis C before and after direct-acting antiviral treatment-a pilot study. Clin Physiol Funct Imaging 2022; 42:389-395. [PMID: 35766035 PMCID: PMC9795995 DOI: 10.1111/cpf.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Patients with chronic hepatitis C (CHC) have an increased risk of atherosclerotic cardiovascular disease which may be due to inflammation and endothelial dysfunction caused by the chronic infection. In this prospective pilot study, we assessed, for the first time among patients with CHC the myocardial perfusion reserve (MPR) by Rubidium-82 (82 Rb) positron emission tomography (PET)/computed tomography (CT) before and after direct-acting antiviral (DAA) treatment and compared them with biomarkers of systemic inflammation and endothelial dysfunction. METHODS We included 10 patients with CHC who received 8 or 12 weeks of DAA treatment. To obtain the MPR, a cardiac 82 Rb PET/CT scan at rest and adenosine-induced stress was performed at baseline and between 12 and 24 weeks post DAA treatment. Additionally, markers of endothelial dysfunction and inflammation were measured at baseline and 12 weeks after DAA treatment. RESULTS All 10 patients achieved cure and the median age was 50 (range: 40-62 years). The median MPR before treatment was 3.1 (range: 2.3-4.8) compared to 2.9 (range: 2.2-4.1) after DAA treatment p = 0.63. Also, cure after DAA treatment was not associated with an overall significant decrease in markers of endothelial dysfunction and inflammation. DISCUSSION Cure after DAA treatment in patients with CHC did not improve coronary microvascular function nor did it lead to a decrease in soluble markers of cardiovascular risk in the given time frame where the patients were followed. It should be noted, that MPR before DAA treatment was in the normal range. Considering the small sample size and short follow-up time, further studies are warranted to determine if viral clearance has an effect on coronary microvascular function and endothelial dysfunction.
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Affiliation(s)
- Christina Sølund
- Department of Infectious DiseasesCopenhagen University HospitalHvidovreDenmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET 4011, Cluster of Molecular ImagingCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Andreas Knudsen
- Department of Infectious DiseasesCopenhagen University HospitalHvidovreDenmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET 4011, Cluster of Molecular ImagingCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Anne M. Lebech
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Nina Weis
- Department of Infectious DiseasesCopenhagen University HospitalHvidovreDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Søholm J, Hansen JF, Mössner B, Røge BT, Lauersen A, Hansen JB, Weis N, Barfod TS, Lunding S, Øvrehus A, Mohey R, Thielsen P, Christensen PB. Low incidence of HCC in chronic hepatitis C patients with pretreatment liver stiffness measurements below 17.5 kilopascal who achieve SVR following DAAs. PLoS One 2020; 15:e0243725. [PMID: 33301499 PMCID: PMC7728240 DOI: 10.1371/journal.pone.0243725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS To evaluate the ability of pretreatment liver stiffness measurements (pLSM) to predict hepatocellular carcinoma (HCC), incident decompensation and all-cause mortality in chronic hepatitis C (CHC) patients who achieved sustained virological response (SVR) after treatment with direct-acting antivirals (DAAs). METHODS 773 CHC patients with SVR after DAA treatment and no prior liver complications were identified retrospectively. Optimized cut-off of 17.5 kPa for incident HCC was selected by maximum Youden's index. Patients were grouped by pLSM: <10 kPa [reference], 10-17.4 kPa and ≥17.5 kPa. Primary outcomes were incident hepatocellular carcinoma and secondary outcomes were incident decompensated cirrhosis and all-cause mortality, analyzed using cox-regression. RESULTS Median follow-up was 36 months and 43.5% (336) had cirrhosis (LSM>12.5 kPa). The median pLSM was 11.6 kPa (IQR 6.7-17.8, range 2.5-75) and pLSM of <10 kPa, 10-17.4 kPa and 17.5-75 kPa was seen in 41.5%, 32.2% and 26.3%. During a median follow-up time of 36 months, 11 (1.4%) developed HCC, 14 (1.5%) developed decompensated cirrhosis, and 38 (4.9%) patients died. A pLSM of 17.5 kPa identified patients with a high risk of HCC with a negative predictive value of 98.9% and incidence rate of HCC in the 17.5-75 kPa group of 1.40/100 person years compared to 0.14/100 person years and 0.12/100 person years in the 10-17.4 kPa and <10 kPa groups, p<0.001. CONCLUSION Pretreatment LSM predicts risk of HCC, decompensation and all-cause mortality in patients with SVR after DAA treatment. Patients with a pLSM <17.5 kPa and no other risk factors for chronic liver disease appear not to benefit from HCC surveillance for the first 3 years after treatment. Longer follow-up is needed to clarify if they can be safely excluded from post treatment HCC screening hereafter.
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Affiliation(s)
- Jacob Søholm
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | | | - Belinda Mössner
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Alex Lauersen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Jesper Bach Hansen
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Suzanne Lunding
- Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Hilleroed, Denmark
| | - Anne Øvrehus
- Department of infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rajesh Mohey
- Infectious Disease Unit, Department of Medicine, Herning Hospital, Herning, Denmark
| | - Peter Thielsen
- Department of Gastroenterology, Copenhagen University Hospital, Herlev, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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He T, Li J, Ouyang Y, Lv G, Ceng X, Zhang Z, Ding J. FibroScan Detection of Fatty Liver/Liver Fibrosis in 2266 Cases of Chronic Hepatitis B. J Clin Transl Hepatol 2020; 8:113-119. [PMID: 32832390 PMCID: PMC7438355 DOI: 10.14218/jcth.2019.00053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/18/2020] [Accepted: 03/31/2020] [Indexed: 01/26/2023] Open
Abstract
Background and Aims: FibroScan is used to determine liver stiffness and controlled attenuation parameter (referred to as CAP) scores in patients, including those with chronic hepatitis B (CHB). We used FibroScan to detect the incidence of fatty liver and fibrosis in CHB patients, and to assess the correlation of FibroScan measurements with blood chemistry tests. Methods: CHB patients enrolled in this study were divided independently for three separate analyses (of fibrosis, cirrhosis, and fatty liver) based on FibroScan results. Basic information, blood chemistry test results, liver fibrosis parameters, and FibroScan results were collected. T-tests and Pearson's analyses were used to analyze the correlations between FibroScan liver stiffness measurement/CAP values and liver function, blood fat, uric acid metabolite, fibrosis, and hepatitis B virus load. Results: A total of 2266 CHB patients were enrolled in the study and divided into three groups: non-significant and significant fibrosis; non-cirrhosis and early cirrhosis; and non-fatty and fatty liver. Spearman's statistical analyses showed that liver stiffness measurement or CAP values correlated with sex (r=0.137), age (r=0.119),glutamic-pyruvic transaminase (r=0.082), glutamic-oxaloacetic transaminase (r=-0.172), gamma-glutamyltransferase (r=0.225), albumin (r=0.150), globulin (r=-0.107), total bilirubin (r=-0.132), direct bilirubin (r=-0.145), white blood cell count (r=0.254), hemoglobin (r=0.205), platelets (r=0.206), total cholesterol (r=0.214), high density lipoprotein (r=-0.243), low density lipoprotein (r=0.255), apolipoprotein B (r=0.217), hyaluronic acid (r=-0.069), laminin (r=-0.188), procollagen type IV (r=-0.067)and hepatitis B viral DNA load (r=-0.216). Conclusions: FibroScan is a non-invasive device that can detect the occurrence of fatty liver or liver fibrosis in CHB patients.
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Affiliation(s)
- Tingshan He
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
| | - Jing Li
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
| | - Yanling Ouyang
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
| | - Guotao Lv
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
| | - Xiaofeng Ceng
- Department of Pathology, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
| | - Zhiqiao Zhang
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
- Correspondence to: Jianqiang Ding, Department of Infectious Diseases, Shunde Hospital, Southern Medical University, 1Jiazi Road, Shunde, Guangdong 528308, China. Tel: +86-15218853076, E-mail: ; Zhiqiao Zhang, Department of Infectious Diseases, Shunde Hospital, Southern Medical University, 1Jiazi Rd, Shunde, Guangdong 528308, China. Tel: +86-15876129625, E-mail:
| | - Jianqiang Ding
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, China
- Correspondence to: Jianqiang Ding, Department of Infectious Diseases, Shunde Hospital, Southern Medical University, 1Jiazi Road, Shunde, Guangdong 528308, China. Tel: +86-15218853076, E-mail: ; Zhiqiao Zhang, Department of Infectious Diseases, Shunde Hospital, Southern Medical University, 1Jiazi Rd, Shunde, Guangdong 528308, China. Tel: +86-15876129625, E-mail:
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Hansen JF, Christiansen KM, Staugaard B, Moessner BK, Lillevang S, Krag A, Christensen PB. Combining liver stiffness with hyaluronic acid provides superior prognostic performance in chronic hepatitis C. PLoS One 2019; 14:e0212036. [PMID: 30742668 PMCID: PMC6370278 DOI: 10.1371/journal.pone.0212036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/26/2019] [Indexed: 12/15/2022] Open
Abstract
Background Non-invasive methods are the first choice for liver fibrosis evaluation in chronic liver diseases, but few studies investigate the ability of combined methods to predict outcomes. Methods 591 chronic hepatitis C patients with baseline liver stiffness (LSM) by FibroScan and hyaluronic acid measurements were identified retrospectively. The patients were grouped by baseline LSM: < 10kPa, 10–16.9kPa, and 17-75kPa. Primary outcomes were all-cause mortality and liver-related mortality, analyzed using cox regression and competing risk regression models, respectively. Results Median follow-up was 46.1 months. Prevalence of cirrhosis at baseline was 107/591 (18.1%). Median LSM was 6.8kPa (IQR 5.3–11.6) and divided into groups, 404/591 (68.4%) had a LSM < 10kPa, 100/591 (16.9%) had a LSM between 10–16.9kPa and 87/591 (14.7%) had a LSM between 17-75kPa. There were 69 deaths, 27 from liver-related disease. 26 patients developed cirrhosis and 30 developed complications of cirrhosis. The mortality rate in the 17-75kPa group was 9.7/100 person-years, compared to 2.2/100 person-years and 1.1/100 person-years in the 10–16.9kPa and <10kPa groups (p<0.005). Liver-related mortality increased 10-fold for each group (p<0.005). Cirrhotic complications occurred almost exclusively in the 17-75kPa group, with an incidence of 10.3/100 person-years, compared to 1.8/100 person-years and 0.2/100 person-years in the 10–16.9kPa and <10kPa groups (p<0.005). Median hyaluronic acid in the 17-75kPa group was approximately 200ng/mL. Patients with a LSM 17-75kPa had significantly higher risks of death, liver-related death, and complications to cirrhosis if their hyaluronic acid measurement was more than or equal to 200ng/mL at baseline, with hazard ratios of 3.25 (95% CI 1.48–7.25), 7.7 (95% CI 2.32–28), and 3.2 (95% CI 1.35–7.39), respectively. Conclusions The combination of LSM and circulating hyaluronic acid measurements significantly improved prognostic ability, relative to LSM alone. Combined static and dynamic markers of liver fibrosis could provide superior risk prediction.
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Affiliation(s)
- Janne Fuglsang Hansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | | | - Benjamin Staugaard
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | - Søren Lillevang
- Clinical Immunological Department, Odense University Hospital, Odense, Denmark
| | - Aleksander Krag
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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9
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Sølund C, Hallager S, Pedersen MS, Fahnøe U, Ernst A, Krarup HB, Røge BT, Christensen PB, Laursen AL, Gerstoft J, Bélard E, Madsen LG, Schønning K, Pedersen AG, Bukh J, Weis N. Direct acting antiviral treatment of chronic hepatitis C in Denmark: factors associated with and barriers to treatment initiation. Scand J Gastroenterol 2018; 53:849-856. [PMID: 29720023 DOI: 10.1080/00365521.2018.1467963] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We describe factors associated with and barriers to initiation of Direct Acting Antiviral (DAA) treatment in patients with chronic hepatitis C, who fulfill national fibrosis treatment guidelines in Denmark. MATERIALS AND METHODS In this nationwide cohort study, we included patients with chronic hepatitis C from The Danish Database for Hepatitis B and C (DANHEP) who fulfilled fibrosis treatment criteria. Factors associated with treatment initiation and treatment failure were determined by logistic regression analyses. Medical records were reviewed from patients who fulfilled fibrosis treatment criteria, but did not initiate DAA treatment to determine the cause. RESULTS In 344 (49%) of 700 patients, who fulfilled treatment criteria, factors associated with DAA treatment initiation were transmission by other routes than injecting drug use odds ratio (OR) 2.13 (CI: 1.38-3.28), previous treatment failure OR 2.58 (CI: 1.84-3.61) and ALT above upper limit of normal OR 1.60 (CI: 1.18-2.17). The most frequent reasons for not starting treatment among 356 (51%) patients were non-adherence to medical appointments (n = 107/30%) and ongoing substance use (n = 61/17%). Treatment failure with viral relapse occurred in 19 (5.5%) patients, who were more likely to have failed previous treatment OR 4.53 (CI: 1.59-12.91). CONCLUSIONS In this nationwide cohort study, we found non-adherence to medical appointments and active substance use to be major obstacles for DAA treatment initiation. Our findings highlight the need for interventions that can overcome these barriers and increase the number of patients who can initiate and benefit from curative DAA treatment.
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Affiliation(s)
- Christina Sølund
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Sofie Hallager
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark
| | - Martin S Pedersen
- b Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.,c Department of Clinical Microbiology , Copenhagen University Hospital , Hvidovre , Denmark.,d Department of Science and Environment , Roskilde University , Roskilde , Denmark
| | - Ulrik Fahnøe
- b Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Anja Ernst
- e Department of Molecular Diagnostics , Aalborg University Hospital , Aalborg , Denmark
| | - Henrik B Krarup
- e Department of Molecular Diagnostics , Aalborg University Hospital , Aalborg , Denmark.,f Department of Medical Gastroenterology , Aalborg University Hospital , Aalborg , Denmark
| | - Birgit T Røge
- g Department of Medicine , Lillebaelt Hospital , Kolding , Denmark
| | - Peer B Christensen
- h Department of Infectious Diseases , Odense University Hospital , Odense , Denmark.,i Department of Clinical Research, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark
| | - Alex L Laursen
- j Department of Infectious Diseases , Aarhus University Hospital , Skejby , Denmark
| | - Jan Gerstoft
- k Department of Infectious Diseases , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark.,l Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Erika Bélard
- m Department of Gastroenterology , Copenhagen University Hospital , Herlev , Denmark
| | - Lone G Madsen
- l Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark.,n Department of Medical Gastroenterology , Zealand University Hospital , Køge , Denmark
| | - Kristian Schønning
- c Department of Clinical Microbiology , Copenhagen University Hospital , Hvidovre , Denmark.,l Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Anders G Pedersen
- o DTU Bioinformatics , Technical University of Denmark , Lyngby , Denmark
| | - Jens Bukh
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Copenhagen Hepatitis C Program (CO-HEP), Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre and Department of Immunology and Microbiology, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Nina Weis
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,l Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
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10
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Outcome and adverse events in patients with chronic hepatitis C treated with direct-acting antivirals: a clinical randomized study. Eur J Gastroenterol Hepatol 2018; 30:1177-1186. [PMID: 29994874 DOI: 10.1097/meg.0000000000001192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE New potent direct-acting antiviral (DAA) regimens against hepatitis C virus have been approved in recent years. However, information about the rate of adverse events (AEs) across different DAA regimens is limited. We aimed to evaluate differences in AEs and treatment efficacy in patients with chronic hepatitis C (CHC), genotype (GT) 1 or 3, randomized to two different treatment arms, correspondingly. PATIENTS AND METHODS We randomly assigned 96 patients in a 1 : 1 ratio, to treatment for 12 weeks with either paritaprevir/ombitasvir/ritonavir/dasabuvir/ribavirin (RBV) or ledipasvir/sofosbuvir (SOF)/RBV if infected with GT1 (72 patients) or to daclatasvir/SOF/RBV for 12 weeks or SOF/RBV for 24 weeks, if infected with GT3 (24 patients). Data on AEs were collected throughout the entire study period. RESULTS A total of 70 (97%) patients with CHC with GT1 and 20 (83%) patients with GT3 achieved cure. The GT3 treatment arm was prematurely terminated, owing to change in national treatment guidelines. Thus, only AEs for GT1 patients are described. AEs occurred in 70 (97%) GT1 patients, and most common AEs were anemia (n=56/78%), fatigue (n=53/74%), and headache (n=33/46%). No difference was observed in relation to treatment group (P=1.0), anemia (P=1.0), or liver cirrhosis (P=0.53). In seven (11%) patients, AEs assessed by the investigator to be possibly related to the DAA regimen were still present 12 weeks after treatment. CONCLUSIONS We found no difference in AEs possibly related to the DAA regimen in patients with CHC, but surprisingly, AEs possibly related to the DAA regimen persisted in a significant number of patients after treatment. This finding can be of importance for clinicians in relation to patient information concerning AEs possibly related to DAA treatment.
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11
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Navrotsky AN. [Diagnostic possibilities of methods for the evaluation of liver fibrosis in chronic viral hepatitis]. TERAPEVT ARKH 2018. [PMID: 28635835 DOI: 10.17116/terarkh20168811149-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The paper reviews the diagnostic possibilities of different methods for the evaluation of liver fibrosis in chronic viral hepatitis from the point of view of their clinical application. Histological examination retains its value as the gold standard method in evaluating the liver. Transient elastography is a rather effective tool for identifying severe liver fibrosis.
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Affiliation(s)
- A N Navrotsky
- Omsk State Medical University, Ministry of Health of Russia, Omsk, Russia
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12
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Nevola R, Adinolfi LE, Rinaldi L. How does antiviral therapy for hepatitis B influence liver stiffness? Future Virol 2018. [DOI: 10.2217/fvl-2018-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Riccardo Nevola
- Department of Medical, Surgical, Neurological, Metabolic & Aging Science, University of Campania, Luigi Vanvitelli, Piazza Miraglia, 80138, Naples, Italy
| | - Luigi E Adinolfi
- Department of Medical, Surgical, Neurological, Metabolic & Aging Science, University of Campania, Luigi Vanvitelli, Piazza Miraglia, 80138, Naples, Italy
| | - Luca Rinaldi
- Department of Medical, Surgical, Neurological, Metabolic & Aging Science, University of Campania, Luigi Vanvitelli, Piazza Miraglia, 80138, Naples, Italy
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13
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Ultrasound-Based Liver Stiffness Surveillance in Patients Treated for Chronic Hepatitis B or C. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8040626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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14
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Facciorusso A, Del Prete V, Turco A, Buccino RV, Nacchiero MC, Muscatiello N. Long-term liver stiffness assessment in hepatitis C virus patients undergoing antiviral therapy: Results from a 5-year cohort study. J Gastroenterol Hepatol 2018; 33:942-949. [PMID: 28976021 DOI: 10.1111/jgh.14008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Observational studies showed significant liver stiffness regression after sustained virological response, but long-term effects of antiviral therapy are still unknown. The aim of this study was to assess the magnitude of change in stiffness up to 5 years after therapy in hepatitis C patients undergoing antiviral treatment. METHODS Data of 153 patients were retrieved. Stiffness was assessed by Fibroscan at baseline, end of treatment, 6 months after treatment, and every year hereafter up to 5 years. RESULTS Seventy patients were treated with interferon-based regimens and 83 with direct antiviral agents. Baseline cirrhosis was diagnosed in 53 (34.6%) patients. Sustained virological response was achieved in 112 patients, whereas 41 were non-responders. In responders, stiffness decreased from 12.3 kPa (9-17.8) to 6.6 kPa (5.3-7.4) at 5 years. A sharper decline was observed immediately after treatment (-2.5 kPa at the end of treatment and -3.7 kPa at 6 months), while from 1 year onwards, the magnitude of stiffness decrease was progressively lower. In non-responders, stiffness showed a slight decrease at the end of treatment (from 19.2 to 18.1 kPa), then returned to baseline levels at 6 months (19.4 kPa), and finally increased over time up to 23.7 kPa (15-32.5) at 5 years. The proportion of cirrhotic patients decreased by 50% at 6 months and finally fell < 5% at 4 years after treatment. CONCLUSIONS Stiffness declines significantly after achieving response, and the magnitude of decline is greater in the first year after treatment, while it tends to plateau from 1 year onwards.
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Affiliation(s)
| | | | - Antonio Turco
- Gastroenterology Unit, University of Foggia, Foggia, Italy
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15
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Rinaldi L, Ascione A, Messina V, Rosato V, Valente G, Sangiovanni V, Zampino R, Marrone A, Fontanella L, de Rosa N, Orabona P, Buonomo C, Chirianni A, Adinolfi LE, Piai G. Influence of antiviral therapy on the liver stiffness in chronic HBV hepatitis. Infection 2018; 46:231-238. [PMID: 29335905 DOI: 10.1007/s15010-017-1113-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of antiviral therapy on liver stiffness measurement (LSM). METHODS Two hundred HBV patients were enrolled from four hospital centers in southern Italy; median age was 50.7 (25-75) males were 68%; 171 patients underwent to liver biopsy and 200 patients had LSM at baseline and 189 at the end of follow-up. One hundred and forty-nine patients were treated with nucleos(t)ide analogs, while 51 patients were untreated. The cutoffs of the LSM, related to the fibrosis stages, were as follows: non-advanced fibrosis ≤ 8.1 kPa and advanced fibrosis ≥ 8.2 Kpa. RESULTS At baseline, the median value of LSM was 14.1 kPa for advanced fibrosis/cirrhosis and 6.9 kPa for non-advanced fibrosis. LSM was performed at 24 months from the start of therapy. The treated patients (68% received Entecavir and 32% Tenofovir) showed a decrease in liver stiffness measurement of 1.5 kPa (p < 0.001) in non-advanced fibrosis and of 6 kPa (p < 0.001) in advanced fibrosis/cirrhosis. In the patients not undergoing antiviral treatment, no statistically significant change of the LSM was observed (p = 0.26). A logistic binary regression model showed that the only independent factor associated with a significant change in the LSM was the liver stiffness value at baseline (odd ratio 2.855; 95% CI 1.456-5.788; (p = 0.007). CONCLUSION Long-term antiviral therapy induced a significant reduction of liver stiffness measurement and this result may be related to the reduction of liver fibrosis.
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Affiliation(s)
- Luca Rinaldi
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy.
| | - Antonio Ascione
- Department of Internal Medicine, Centre for Liver Diseases, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy
| | - Vincenzo Messina
- Infectious Diseases C.O. Unit, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Valerio Rosato
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Giovanna Valente
- Department of Medical Sciences, AORN S.Anna e S. Sebastiano, Caserta, Italy
| | - Vincenzo Sangiovanni
- Department of Infectious Emergencies and Infectious Diseases, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Rosa Zampino
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Aldo Marrone
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Luca Fontanella
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Nicolina de Rosa
- Department of Diagnostic Service, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Pasquale Orabona
- Department of Service, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Carmela Buonomo
- Department of Service, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Antonio Chirianni
- Department of Infectious Emergencies and Infectious Diseases, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Medical, Surgical, Neurological, Metabolic, and Geriatric Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Guido Piai
- Department of Medical Sciences, AORN S.Anna e S. Sebastiano, Caserta, Italy
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16
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Hallager S, Ladelund S, Kjaer M, Madsen LG, Belard E, Laursen AL, Gerstoft J, Røge BT, Grønbaek KE, Krarup HB, Christensen PB, Weis N. Hepatocellular carcinoma in patients with chronic hepatitis C and cirrhosis in Denmark: A nationwide cohort study. J Viral Hepat 2018; 25:47-55. [PMID: 28750141 DOI: 10.1111/jvh.12764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/23/2017] [Indexed: 12/17/2022]
Abstract
Cirrhosis in patients with chronic hepatitis C increases the risk of hepatocellular carcinoma (HCC), and surveillance with ultrasound (US) and alpha-fetoprotein (AFP) is recommended. This study aimed to estimate changes in the HCC incidence rate (IR) over time, HCC stage and prognosis, and AFP and US performed in patients with hepatitis C and cirrhosis. Eligible patients were identified in the Danish Database for Hepatitis B and C, and data from national health registries and patient charts were obtained. Tumour stage was based on Barcelona-Clinic Liver Cancer stage, TNM classification and size and number of lesions combined into stages 0-3. We included 1075 patients with hepatitis C and cirrhosis, free of HCC and liver transplant at baseline. During 4988 person years (PY), 115 HCC cases were diagnosed. The HCC incidence rate increased from 0.8/100 PY [CI95% 0.4-1.5] in 2002-2003 to 2.9/100 PY [2.4-3.4] in 2012-2013. One-year cumulative incidence of at least one AFP or US was 53% among all patients. The positive predictive value of an AFP ≥ 20 ng mL-1 was 17%. Twenty-three (21%) patients were diagnosed with early-stage HCC (stage 0/1) and 84 (79%) with late stage. Median survival after HCC for early-stage HCC disease was 30.1 months and 7.4 months for advanced HCC (stage 2/3). The incidence rate of HCC increased over time among patients with hepatitis C and cirrhosis in Denmark. Application of AFP and US was suboptimal, and most patients were diagnosed with advanced HCC with a poor prognosis.
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Affiliation(s)
- S Hallager
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - S Ladelund
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | - M Kjaer
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L G Madsen
- Department of Gastroenterology, Zealand University Hospital, Køge, Denmark
| | - E Belard
- Department of Gastroenterology, Copenhagen University Hospital, Herlev, Denmark
| | - A L Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - J Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - B T Røge
- Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
| | - K E Grønbaek
- Department of Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark
| | - H B Krarup
- Section of Molecular Diagnostics, Clinical Biochemistry and Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - P B Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - N Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hallager S, Ladelund S, Christensen PB, Kjær M, Thorup Roege B, Grønbæk KE, Belard E, Barfod TS, Madsen LG, Gerstoft J, Tarp B, Krarup HB, Weis N. Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response. Clin Epidemiol 2017; 9:501-516. [PMID: 29123424 PMCID: PMC5661446 DOI: 10.2147/clep.s132072] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained virologic response (SVR). Furthermore we aimed to estimate the rate of hepatocellular carcinoma (HCC) and decompensation associated with certain prognostic factors. MATERIALS AND METHODS Patients with CHC and cirrhosis registered in the Danish Database for Hepatitis B and C were eligible. Cirrhosis was based on liver biopsy, transient elastography, and clinical cirrhosis. Data were extracted from nationwide registries. The study period was from 2002 until 2013. RESULTS Of 1,038 patients included, 716 (69%) were male and the median age was 52 years. Median follow-up was 3.8 years, 360 patients died, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted mortality rate ratio 0.68 [95% CI 0.43-1.09]) and liver-related mortality (mortality rate ratio 0.6 [95% CI 0.36-1]), as well as liver-related morbidity with adjusted IR ratios of 0.37 (95% CI 0.22-0.62) for HCC and 0.31 (95% CI 0.17-0.57) for decompensation. The IRs of HCC and decompensation remained elevated in patients with alcohol overuse after SVR. CONCLUSION Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients with alcohol overuse should continue after SVR.
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Affiliation(s)
- Sofie Hallager
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Steen Ladelund
- Clinical Research Center, Copenhagen University Hospital, Hvidovre
| | - Peer Brehm Christensen
- Department of Infectious Diseases and Clinical Institute, Odense University Hospital, University of Southern Denmark, Odense
| | - Mette Kjær
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | | | | | - Erika Belard
- Department of Gastroenterology, Copenhagen University Hospital, Herlev
| | - Toke S Barfod
- Department of Internal Medicine, Zealand University Hospital, Roskilde
| | | | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Britta Tarp
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg
| | - Henrik Bygum Krarup
- Section of Molecular Diagnostics, Clinical Biochemistry and Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
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Rinaldi L, Valente G, Piai G. Serial Liver Stiffness Measurements and Monitoring of Liver-Transplanted Patients in a Real-Life Clinical Practice. HEPATITIS MONTHLY 2016; 16:e41162. [PMID: 28123442 PMCID: PMC5237578 DOI: 10.5812/hepatmon.41162] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/15/2016] [Accepted: 10/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver transplanted patients need close surveillance for early signs of graft disease. OBJECTIVES Transient elastography can safely be repeated over time, offering serial liver stiffness measurement values. Serial stiffness measurements were compared to single baseline stiffness measurements in predicting the appearance of liver-related clinical events and guiding subsequent clinical decisions. METHODS One hundred and sixty liver transplanted patients were observed for three years in our real-life practice. RESULTS Liver stiffness measurements were stable in 75% of patients, decreased in 4% of patients, and increased in 21% of patients. The pattern of increased stiffness measurements was associated with both HCV-RNA positive status and the presence of an active biliary complication of liver transplantation and was more predictive of a clinically significant event resulting from any disease of the transplanted liver when compared to a stable pattern or to a single liver stiffness measurement. The procedures that were consequently performed were often diagnostic for unexpected situations, both in HCV-RNA positive and HCV-RNA negative patients. CONCLUSIONS The pattern of longitudinally increased liver stiffness measurements efficiently supported clinical decisions for individualized management strategies. Repeated transient elastography in real-life clinical practice appears to have a practical role in monitoring liver transplanted patients.
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Affiliation(s)
- Luca Rinaldi
- Department of Medical and Surgical Oncology, Liver Unit, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Giovanna Valente
- Department of Medical and Surgical Oncology, Liver Unit, AORN S. Anna and S. Sebastiano, Caserta, Italy
| | - Guido Piai
- Department of Medical and Surgical Oncology, Liver Unit, AORN S. Anna and S. Sebastiano, Caserta, Italy
- Corresponding Author: Guido Piai, MD, Liver Unit (SATTE), Department of Medical and Surgical Oncology, AORN Sant’Anna e San Sebastiano, via Palasciano, 81100 Caserta, Italy. Tel: +39-0823232366, Fax: +39-08231761357, E-mail:
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Cheng JYK, Wong VWS, Tse YK, Chim AML, Chan HLY, Wong GLH. Metabolic syndrome increases cardiovascular events but not hepatic events and death in patients with chronic hepatitis B. Hepatology 2016; 64:1507-1517. [PMID: 27680510 DOI: 10.1002/hep.28778] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022]
Abstract
UNLABELLED Metabolic syndrome is an independent risk factor of liver cirrhosis in chronic hepatitis B (CHB). Whether metabolic syndrome affects the long-term prognosis of CHB patients in terms of hepatic events, cardiovascular events, and death remains unknown. We aimed to determine the incidences of hepatic events, cardiovascular events, and death in CHB patients with or without metabolic syndrome. From 2006 to 2008, we prospectively recruited 1,466 CHB patients for liver stiffness measurement (LSM) with transient elastography together with detailed metabolic profiling as baseline assessment. Patients were prospectively followed for any clinical events. The impact of LSM and metabolic syndrome on hepatic events, cardiovascular events, and death was evaluated. At baseline visit, the mean age was 46 ± 12 years, LSM value was 8.4 ± 6.3 kPa, and 188 patients (12.8%) had metabolic syndrome. At a mean follow-up of 88 ± 20 months, 93 and 44 patients developed hepatic and cardiovascular events, respectively; 70 patients died. Patients with baseline LSM >8.0 kPa had higher cumulative probability of hepatic events than those with LSM ≤8.0kPa at 8 years (12.3% versus 3.1%, P < 0.001). Patients with metabolic syndrome had higher cumulative probability of cardiovascular events than those without (8.0% versus 2.1%, P < 0.001). High LSM had no impact on cardiovascular events; neither did metabolic syndrome on hepatic events. LSM >8.0 kPa but not metabolic syndrome was an independent risk factor of death, with adjusted hazard ratios of 1.9 (95% confidence interval 1.1-3.2, P = 0.023) and 1.3 (95% confidence interval 0.8-2.4, P = 0.310), respectively. CONCLUSIONS Metabolic syndrome increased the risk of cardiovascular events but not hepatic events and death; LSM was the important risk factor of hepatic events and death in CHB patients. (Hepatology 2016;64:1507-1517).
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Affiliation(s)
- Jenny Yeuk-Ki Cheng
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Vincent Wai-Sun Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Yee-Kit Tse
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Angel Mei-Ling Chim
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Henry Lik-Yuen Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Grace Lai-Hung Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
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Pons M, Simón-Talero M, Millán L, Ventura-Cots M, Santos B, Augustin S, Genescà J. Basal values and changes of liver stiffness predict the risk of disease progression in compensated advanced chronic liver disease. Dig Liver Dis 2016; 48:1214-9. [PMID: 27388262 DOI: 10.1016/j.dld.2016.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Transient elastography has been proposed as a tool to predict the risk of decompensation in patients with chronic liver disease. We aimed to identify risk groups of disease progression, using a combination of baseline liver stiffness measurement (LSM) and its change over time (delta-LSM) in patients with compensated advanced chronic liver disease (cACLD). METHODS Ninety-four patients with baseline LSM ≥10kPa, Child-Pugh score 5 and without previous decompensation were included. A second LSM was performed during follow-up and data on liver function and liver-related events were collected. The primary endpoint was a composite that included death, liver decompensation and impairment in at least 1 point in Child-Pugh score. RESULTS After a median follow-up of 43.6 months, 15% of patients presented the primary endpoint. Multivariate analysis identified baseline LSM (OR 1.12, P=0.002) and delta-LSM (OR 1.02, P=0.048) as independent predictors of the primary endpoint. A high risk group represented by patients with baseline LSM ≥21kPa and delta-LSM ≥10% (risk of progression 47.1%, 95% CI: 23-71%) was identified, while patients with LSM <21kPa and delta-LSM <10% presented zero risk of progression (P=0.03). CONCLUSIONS Simple classification rules using baseline LSM and delta-LSM identify cACLD patients at low or high risk of disease progression.
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Affiliation(s)
- Mònica Pons
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Macarena Simón-Talero
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Millán
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meritxell Ventura-Cots
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Santos
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Salvador Augustin
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Joan Genescà
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Tama M, Naylor P, Patel S, Altawil J, Gulati D, Antaki F, Mutchnick MG, Ehrinpreis M. Overestimate of Fibrosis by FIBROSpect® II in African Americans Complicates the Management of their Chronic Hepatitis C. J Clin Transl Hepatol 2016; 4:12-9. [PMID: 27047767 PMCID: PMC4807138 DOI: 10.14218/jcth.2015.00053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evaluation of advanced fibrosis in patients with hepatitis C virus (HCV) infection is used to facilitate decisions on treatment strategy and to initiate additional screening measures. Unfortunately, most studies have predominately Caucasian (Cau) patients and may not be as relevant for African Americans (AA). AIMS This study specifically addresses the issue of defining minimal vs. significant fibrosis in African Americans (AA) with chronic hepatitis C (CHC) using noninvasive assays. METHODS All patients (n = 319) seen between 1 January 2008 and 30 June 2013 for whom a FibroSpect II® (FSII) assay was performed and had data for calculation of aspartate aminotransferase (AST) platelet ratio index (APRI) and Fibrosis-4 (FIB-4) were identified using the medical records. RESULTS When liver biopsy score and FSII assay results for the AA patients with CHC were compared, 31% of AA had advanced FSII fibrosis scores (F2-F4) despite a biopsy score of F0-F1. In contrast, 10% of Cau over-scored. The AA false positive rate was 14% for APRI and 34% for FIB-4. Combining FSII with either APRI (7% false positive) or FIB-4 (10% false positive) improved the false positive rate in AA to 7% (FSII + APRI) and 10% (FSII + FIB-4) but reduced the sensitivity for significant fibrosis. CONCLUSIONS The FSII assay overestimates fibrosis in AA and should be used with caution since these patients may not have significant fibrosis. If the APRI or FIB-4 assay is combined with the FSII assay, minimal fibrosis in AA can be defined without subjecting the patients to a subsequent biopsy.
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Affiliation(s)
- Maher Tama
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Paul Naylor
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
- Correspondence to: Paul Naylor, Gastroenterology, 603 Hudson Bldg, Harper University Hospital, 3990 John R, Detroit, MI 48201, USA. Tel: +1-313-745-8601, Fax: +1-313-745-8843, E-mail:
| | - Suhag Patel
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Johnny Altawil
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Dhiraj Gulati
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Fadi Antaki
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Milton G. Mutchnick
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
| | - Murray Ehrinpreis
- Wayne State University School of Medicine, Department of Internal Medicine, Division of Gastroenterology, Detroit, MI, USA
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22
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Lee HW, Kang W, Kim BK, Kim SU, Park JY, Kim DY, Ahn SH, Park YN, Han KH. Red cell volume distribution width-to-platelet ratio in assessment of liver fibrosis in patients with chronic hepatitis B. Liver Int 2016; 36:24-30. [PMID: 25966326 DOI: 10.1111/liv.12868] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/09/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Precise assessment of liver fibrosis is necessary in patients with chronic liver disease. We investigated the performance of red cell volume distribution width-to-platelet ratio for the assessment of liver fibrosis in patients with chronic hepatitis B. METHODS A total of 482 consecutive patients with chronic hepatitis B who underwent liver biopsy between October 2005 and May 2014 were recruited. Liver stiffness was measured using transient elastography. FIB-4 score, red cell volume distribution width-to-platelet ratio and the aspartate aminotransferase-to-platelet ratio index were also assessed. RESULTS A total of 271 (56.2%) patients were males. The median age was 44 years. F1, F2, F3 and F4 fibrosis stages were identified in 68 (14.1%), 137 (28.4%), 64 (13.3%) and 213 (44.2%) of the patients respectively. The mean red cell volume distribution width-to-platelet ratio increased with liver fibrosis severity: F1, 0.065; F2, 0.077; F3, 0.097 and F4, 0.121 (P < 0.01). The area under the receiver operating characteristic curve of the red cell volume distribution width-to-platelet ratio for predicting significant fibrosis (≥F2) was 0.747. This result was inferior to transient elastography (0.866, P = 0.004), but comparable to FIB-4 (0.782, P = 0.427) and aspartate aminotransferase-to-platelet ratio index (0.716, P = 0.507). The area under the receiver operating characteristic curve of red cell volume distribution width-to-platelet ratio for predicting cirrhosis (F4) was 0.811, which was inferior to liver stiffness (0.915, P < 0.001), but comparable to FIB-4 (0.804, P = 0.805) and superior to aspartate aminotransferase-to-platelet ratio index (0.680, P < 0.001). CONCLUSIONS The accuracy of red cell volume distribution width-to-platelet ratio was acceptable for the assessment of liver fibrosis in patients with chronic hepatitis B. When transient elastography is not available, red cell volume distribution width-to-platelet ratio assessment is a simple method that can be used to reduce the need for liver biopsy.
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Affiliation(s)
- Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wonseok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
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Zhao XH, Cao ZY, Shen Y, Lv YF, Tao GR, Chen S. Influence of Chongcao Yigan Capsule on function of intestinal flora and chemoprevention for patients with chronic hepatitis B-induced liver fibrosis. Asian Pac J Cancer Prev 2015; 15:9423-6. [PMID: 25422235 DOI: 10.7314/apjcp.2014.15.21.9423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Hapatitis B visus (CHB)-induced fibrosis is a precancerous condition of liver. To explore the influence of Chongcao Preparation (Chongcao Yigan Capsule) on the function of intestinal flora and chemoprevention for patients with CHB-induced liver fibrosis. METHODS A total of 136 patients with CHB-induced liver fibrosis were randomly divided into control group treated with lamivudine (LAM) and research group added with Chongcao Yigan Capsule for totally 48 weeks. The changes of intestinal flora, secretory immunoglobin A (SIgA), serum albumin (ALB), prealbumin (PALB), IgA and IgG at different time points in both groups were observed. RESULTS Before treatment, there was no significant difference between two groups in each index (P>0.05). After treatment, the intestinal flora were evidently optimized in research group than treatment before (P<0.05 or P<0.01), and were apparently better than those in control group (P<0.05 or P<0.01); SIgA was obviously increased and ALB, PALB, IgA and IgG were markedly improved in research group than treatment before (P<0.05 or P<0.01), and were significantly better than those in control group (P<0.05 or P<0.01). CONCLUSIONS Chongcao Yigan Capsule could regulate the intestinal flora, increase SIgA, serum ALB and PALB concentrations and significantly improve serum IgA and IgG as well as strengthen the immunological function and autologous repair capacity of patients with CHB-induced liver fibrosis.
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Affiliation(s)
- Xiao-Hu Zhao
- Department of Infection, Huai'an Hospital, Nanjing Medical University, Huai'an, China E-mail :
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24
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Harrison SA. Utilization of FibroScan Testing in Hepatitis C Virus Management. Gastroenterol Hepatol (N Y) 2015; 11:187-189. [PMID: 27099589 PMCID: PMC4836588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Stephen A Harrison
- Chief of Hepatology Division of Gastroenterology and Hepatology Department of Medicine San Antonio Military Medical Center Fort Sam Houston, Texas
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