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Kumari S, Gautam BK, Singh AK, Gaur V, Kumar A. Diagnostic precision of Truenat® technique and co-relation of ALT levels with HBV-DNA viral load among HBsAg positive patients at a tertiary care hospital in Eastern Uttar Pradesh. IRANIAN JOURNAL OF MICROBIOLOGY 2024; 16:132-138. [PMID: 38682056 PMCID: PMC11055448 DOI: 10.18502/ijm.v16i1.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background and Objectives In India, it is estimated that there are 40 million people suffering from Hepatitis B virus (HBV). Quantification of the viral burden is an important laboratory tool in the management. However, widespread use of different HBV-DNA assays is still affected by the high cost and variable diagnostic precision. The present study was conducted to evaluate the diagnostic precision and co-relation of ALT levels with HBV-DNA by Truenat®-PCR. Materials and Methods In this prospective cross-sectional study a total of 567 serums were collected from patients by rapid HBsAg, and processed for liver function tests (LFT). The viral HBV-DNA amplification detection was carried out through by Truenat®-PCR test. Results Out of 567 samples, 452 samples were found to be positive by both rapid and Truenat®-PCR and 106 were negative for HBV-DNA followed by 9 invalid. High ALT level found in 73% of positive patients who had HBV-DNA level (>100000 copies/ml) which is significantly higher in 447 patients as compared to those have below ≤100000 copies/ml. Conclusion Truenat®-PCR technique is a highly sensitive and can be performed with low resources for effective control of HBV infection. Evaluation of HBV-DNA levels and serum ALT levels showed a significant proportion of patient harbored ongoing viral replication and disease progression.
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Affiliation(s)
- Sarita Kumari
- State Reference Laboratory, Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur Uttar Pradesh, India
| | - Bechan Kumar Gautam
- Model Treatment Centre, Department of Medicine, Baba Raghav Das Medical College, Gorakhpur Uttar Pradesh, India
| | - Amresh Kumar Singh
- State Reference Laboratory, Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur Uttar Pradesh, India
| | - Vivek Gaur
- State Reference Laboratory, Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur Uttar Pradesh, India
| | - Ankur Kumar
- State Reference Laboratory, Department of Microbiology, Baba Raghav Das Medical College, Gorakhpur Uttar Pradesh, India
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Manea M, Apostol D, Constantinescu I. A MicroRNA-Based Method for High-Viremia Detection-A New Approach on a Romanian Lot of Chronically Infected Patients with Hepatitis B Virus. Diagnostics (Basel) 2023; 13:3425. [PMID: 37998561 PMCID: PMC10670501 DOI: 10.3390/diagnostics13223425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
The HBV (hepatitis B virus) infection is intended for elimination, but evaluating patients is both costly and insufficiently applied in several countries. An expensive analysis in Romania is HBV-DNA quantification, with a limited prognostic potential. Our study intended to find new predictors for high viremia in HBV patients, using molecules involved in the multiple assessment of various HBV complications, such as microRNAs. A total of 61 subjects (48 patients with chronic HBV infection and 13 healthy subjects) were generally evaluated. Using a RT-PCR method, with a 2-ΔΔCT algorithm, we detected the expressions of miR-122 and miR-146a in 33 subjects. MiR-21 was the internal control. The results were analyzed with the R 4.2.2. software. Kruskal-Wallis's comparisons, Spearman correlations, and several logistic regression methods were applied. The median age of the patients was over 40 years. Without microRNAs, we could not obtain a good prediction formula. The combination of miR-122 and age proved to be the best prediction method for high viremia, with an AUC of 0.827, and a sensitivity of 89.5%. This is the first study which included age and miR-122 as independent predictors for high viremia in Romanian HBV-positive patients. MiR-122 is a new potential biomarker in the evaluation of Romanian patients.
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Affiliation(s)
- Marina Manea
- Deparment of Immunology and Transplant Immunology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Dimitri Apostol
- Deparment of Immunology and Transplant Immunology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Ileana Constantinescu
- Deparment of Immunology and Transplant Immunology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Ruta S, Grecu L, Iacob D, Cernescu C, Sultana C. HIV-HBV Coinfection-Current Challenges for Virologic Monitoring. Biomedicines 2023; 11:biomedicines11051306. [PMID: 37238976 DOI: 10.3390/biomedicines11051306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
HIV-HBV coinfected patients have higher rates of liver-related morbidity, hospitalizations, and mortality compared to HBV or HIV mono-infected ones. Clinical studies have shown an accelerated progression of liver fibrosis and an increased incidence of HCC, resulting from the combined action of HBV replication, immune-mediated hepatocytolysis, and HIV-induced immunosuppression and immunosenescence. Antiviral therapy based on dually active antiretrovirals is highly efficient, but late initiation, global disparities in accessibility, suboptimal regimens, and adherence issues may limit its impact on the development of end-stage liver disease. In this paper, we review the mechanisms of liver injuries in HIV-HBV coinfected patients and the novel biomarkers that can be used for treatment monitoring in HIV-HBV coinfected persons: markers that assess viral suppression, markers for liver fibrosis evaluation, and predictors of oncogenesis.
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Affiliation(s)
- Simona Ruta
- Virology Discipline, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Emerging Viral Diseases, "Stefan S. Nicolau" Institute of Virology, 030304 Bucharest, Romania
| | - Laura Grecu
- Department of Emerging Viral Diseases, "Stefan S. Nicolau" Institute of Virology, 030304 Bucharest, Romania
| | - Diana Iacob
- Department for the Prevention and Control of Healthcare Associated Infections, Emergency University Hospital, 050098 Bucharest, Romania
| | | | - Camelia Sultana
- Virology Discipline, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Emerging Viral Diseases, "Stefan S. Nicolau" Institute of Virology, 030304 Bucharest, Romania
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E B, Ko K, Kim R, Nagashima S, Ouoba S, Hussain MRA, Sato T, Chuon C, Abe K, Sugiyama A, Takahashi K, Akita T, Tung R, Ork V, Hossain MS, Saphonn V, Tanaka J. Residual risk of mother-to-child transmission of HBV despite timely Hepatitis B vaccination: a major challenge to eliminate hepatitis B infection in Cambodia. BMC Infect Dis 2023; 23:261. [PMID: 37101167 PMCID: PMC10131410 DOI: 10.1186/s12879-023-08249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND In countries with intermediate or high hepatitis B virus (HBV) endemicity, mother-to-child transmission (MTCT) represents the main route of chronic HBV infection. There is a paucity of information on HBV MTCT in Cambodia. This study aimed to investigate the prevalence of HBV infection among pregnant women and its MTCT rate in Siem Reap, Cambodia. METHODS This longitudinal study included two parts, study-1 to screen HBsAg among pregnant women and study-2 to follow up babies of all HBsAg-positive and one-fourth of HBsAg-negative mothers at their delivery and six-month post-partum. Serum or dried blood spot (DBS) samples were collected to examine HBV sero-markers by chemiluminescent enzyme immunoassay (CLEIA), and molecular analyses were performed on HBsAg-positive samples. Structured questionnaires and medical records were used to examine the risk factors for HBV infection. MTCT rate was calculated by HBsAg positivity of 6-month-old babies born to HBsAg-positive mothers and ascertained by the homology of HBV genomes in mother-child pair at 6-month-old. RESULTS A total of 1,565 pregnant women were screened, and HBsAg prevalence was 4.28% (67/1565). HBeAg positivity was 41.8% and was significantly associated with high viral load (p < 0.0001). Excluding subjects who dropped out due to restrictions during COVID-19, one out of 35 babies born to HBsAg-positive mothers tested positive for HBsAg at 6 months of age, despite receiving timely HepB birth dose and HBIG, followed by 3 doses of HepB vaccine. Hence the MTCT rate was 2.86%. The mother of the infected baby was positive for HBeAg and had a high HBV viral load (1.2 × 109 copies/mL). HBV genome analysis showed 100% homology between the mother and the child. CONCLUSIONS Our findings illustrate the intermediate endemicity of HBV infection among pregnant women in Siem Reap, Cambodia. Despite full HepB vaccination, a residual risk of HBV MTCT was observed. This finding supports the recently updated guidelines for the prevention of HBV MTCT in 2021, which integrated screening and antiviral prophylaxis for pregnant women at risk of HBV MTCT. Furthermore, we strongly recommend the urgent implementation of these guidelines nationwide to effectively combat HBV in Cambodia.
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Affiliation(s)
- Bunthen E
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
- Payment Certification Agency (PCA), Ministry of Health, Phnom Penh, Cambodia
| | - Ko Ko
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Rattana Kim
- National Maternal and Child Health Center (NMCHC), Ministry of Health, Phnom Penh, Cambodia
| | - Shintaro Nagashima
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Serge Ouoba
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
- Unité de Recherche Clinique de Nanoro (URCN), Institut de Recherche en Sciences de La Santé (IRSS), Nanoro, Burkina Faso
| | - Md Razeen Ashraf Hussain
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tomoki Sato
- Hiroshima City Funairi Citizens Hospital, Hiroshima, Japan
| | - Channarena Chuon
- Doctor Alliance of Union of Youth Federation of Cambodia (DAUYFC), Phnom Penh, Cambodia
| | - Kanon Abe
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Aya Sugiyama
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kazuaki Takahashi
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tomoyuki Akita
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | | | - Vichit Ork
- National Immunization Program (NIP), Ministry of Health, Phnom Penh, Cambodia
| | - Md Shafiqul Hossain
- Expanded Program On Immunization, World Health Organization Country Office, Phnom Penh, Cambodia
| | | | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
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Gabr AK, Hawash NI, Abd-Elsalam S, Badawi R, Soliman HH. Diagnostic Accuracy of Red Cell Distribution Width to Platelet Ratio for Detection of Liver Fibrosis Compared with Fibroscan in Chronic Hepatitis B Egyptian patients. THE OPEN BIOMARKERS JOURNAL 2022; 12. [DOI: 10.2174/18753183-v12-e2208150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/22/2022] [Indexed: 09/01/2023]
Abstract
Background and Aims:
The decision to treat chronic hepatitis B Virus infection (CHB) may necessitate an assessment of the degree of liver fibrosis. Guidelines recommend Fibroscan examination in such cases. However, it is costly and not widely available. Red cell distribution width (RDW) and platelet count are simple parameters obtained from the blood pictures; and their ratio RDW to platelet ratio (RPR) was claimed to correlate with liver fibrosis. We aimed to assess the ability of RPR to replace the costly fibroscan in the detection of significant fibrosis in chronic hepatitis B patients.
Patients and Methods:
This cross-sectional study was conducted in the Tropical medicine department, Tanta University, Egypt, between December 2018 and September 2019. One hundred and twenty-five patients with CHB were included and divided according to the fibroscan examination into: Group I: patients with no significant fibrosis (n=66), Group II: patients with significant (≥ F2) fibrosis (n=59). RPR was calculated for all patients and tested against Fibroscan results.
Results:
Both groups were matched in regards to age, sex, viral load, and steatosis. There was a significant positive correlation between the degree of stiffness measured by FibroScan in patients with a significant degree of fibrosis and serum bilirubin, a quantitative polymerase chain reaction of hepatitis B virus DNA (HBV DNA PCR), and fibrosis-4 score (FIB-4 score) (P value= 0.020, 0.049, and 0.0402, respectively). However, RPR was not correlated to the degree of fibrosis in fibroscan examination.
Conclusions:
The accuracy of RDW to platelet ratio (RPR) for the detection of fibrosis in CHB patients is questionable. FIB-4 is correlated with liver stiffness measurement (LSM) in patients with significant fibrosis (F2 or more). Neither RPR, AST to Platelet Ratio Index (APRI) or FIB4 can replace fibroscan for grading of fibrosis in CHB patients for evaluation to start therapy.
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Wei S, Hu M, Chen H, Xie Q, Wang P, Li H, Peng J. Effectiveness of antiviral treatment in HBeAg-negative chronic hepatitis B patients with normal or mildly elevated alanine aminotransferase: a retrospective study. BMC Gastroenterol 2022; 22:387. [PMID: 35978283 PMCID: PMC9387004 DOI: 10.1186/s12876-022-02471-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background There are inadequate data and no histological evidence regarding the effects of antiviral treatment for hepatitis B e-antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with normal or mildly elevated alanine aminotransferase (ALT). This study investigated the effects of antiviral treatment on these patients. Methods We retrospectively analysed the outcomes of antiviral treatment for HBeAg-negative CHB patients with normal or mildly elevated ALT who were treated with nucleoside/nucleotide analogues (NAs) for up to 96 weeks. Results A total of 128 patients were enrolled; 74 patients had normal ALT and 54 patients had mildly elevated ALT. The total cumulative rates of viral suppression were 64.06%, 81.97%, and 96.39%, at weeks 24, 48, and 96, respectively. The cumulative rates of viral suppression for the normal and mildly elevated ALT groups were 67.85% and 58.97%, 86.39% and 76.31%, and 93.13% and 97.04% at weeks 24, 48, and 96, respectively. The serum HBV DNA levels at week 12 and hepatitis B surface antigen (HBsAg) levels at week 24 were significant predictors of the 96-week virological response. Of the 128 patients, 54 with normal ALT and 33 with mildly elevated ALT underwent FibroScan at baseline. Significant fibrosis (F ≥ 2) was found in 44.4% (n = 24) and 51.5% (n = 17) of the patients in the normal ALT group and mildly elevated ALT group, respectively. Compared with the values at baseline, liver stiffness values significantly decreased at week 48 (8.12 kPa vs. 6.57 kPa; p < 0.001) and week 96 (8.87 kPa vs. 6.43 kPa; p < 0.001), respectively. Conclusions HBeAg-negative CHB patients with normal ALT could benefit from antiviral therapy with NAs, similar to patients with mildly elevated ALT. Antiviral treatment is strongly recommended for HBeAg-negative CHB patients with normal ALT. Additionally, significant liver fibrosis is not rare in HBeAg-negative CHB patients with ALT less than two-times the upper limit of normal, and FibroScan should be performed regularly for these patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02471-y.
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Affiliation(s)
- Sufang Wei
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510080, China
| | - Meixin Hu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510080, China
| | - Hongjie Chen
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510080, China
| | - Qiuli Xie
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Foshan, 528300, China
| | - Peng Wang
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Foshan, 528300, China
| | - Hong Li
- Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Foshan, 528300, China
| | - Jie Peng
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510080, China.
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Jia N, Gao W, Fan X, Gao H, Li X, Mi B, Yang J. Clinical Efficacy of PEG-IFN α-2a and PEG-IFN α-2b in the Treatment of Hepatitis B e Antigen-Positive Hepatitis B and Their Value in Improving Inflammatory Factors and Hemodynamics in Patients: A Comparative Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3185320. [PMID: 35726331 PMCID: PMC9206564 DOI: 10.1155/2022/3185320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the merits and demerits of PEG-IFNα-2a and PEG-IFNα-2b for the treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB). Methods Clinical files from eighty-four CHB patients admitted to the Second Hospital of Shanxi Medical University between January 2018 and January 2019 were retrospectively analyzed and assigned to two groups: group 2a treated with PEG-IFNα-2a and group 2b treated with PEG-IFNα-2b. The clinical efficacy was compared between the above two arms, and the liver function (ALT, AST, HA, LN, and IV-C), HBV-DNA, HBsAg, HBeAg, and inflammatory factors (IFs, IL-1β, IL-6, IL-8, and TNF-α) were tested at 12 weeks (T1), 24 weeks (T2), and 48 weeks (T3). The alterations of hemodynamics (SBP, DBP, MAP, and CVP), cardiac function (LVEF and BNP), and the incidence of adverse reactions (ARs) during treatment were recorded. Finally, the patients were followed up for 2 years to investigate the quality of life (QOL) as well as the positive seroconversion rate of HBsAg and HBeAg. Results The overall response rate was similar in the two arms (P > 0.05). After treatment, the liver function, HBV-DNA, HBsAg, HBeAg, IFs, hemodynamics, and cardiac function were enormously improved (P < 0.05), with faster improvement in group 2b compared with group 2a (P < 0.05). The investigation of ARs identified notably lower incidence rates of alopecia, thrombocytopenia, and granulocytopenia in group 2a as compared to group 2b (P < 0.05). The prognostic follow-up results revealed no distinct difference in the QOL score and the positive seroconversion rate of HBsAg and HBeAg (P > 0.05); however, the quantitative results of HBV-DNA, HBsAg, and HBeAg in group 2b were lower than those in group 2a (P < 0.05). Conclusions Both PEG-IFNα-2a and PEG-IFNα-2b have excellent and stable therapeutic effects on HBeAg-positive CHB, among which PEG-IFNα-2b renders a faster treatment process but higher side effects, which can provide valuable references when choosing a treatment plan for CHB.
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Affiliation(s)
- Nina Jia
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, China
| | - Wei Gao
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, China
| | - Xiaohong Fan
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, China
| | - Hong Gao
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, China
| | - Xueqing Li
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, China
| | - Biantao Mi
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, China
| | - Jie Yang
- Department of Gastroenterology, The Second Hospital of Shanxi Medical University, Taiyuan, 030001 Shanxi, China
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Akbar SMF, Al Mahtab M, Cesar Aguilar J, Uddin MH, Khan MSI, Yoshida O, Penton E, Gerardo GN, Hiasa Y. Exploring evidence-based innovative therapy for the treatment of chronic HBV infection: experimental and clinical. EXPLORATION OF MEDICINE 2021. [DOI: 10.37349/emed.2021.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
With the advent of various vaccines and antimicrobial agents during the 20th century, the control and containment of infectious diseases appeared to be a matter of time. However, studies unveiled the diverse natures of microbes, their lifestyle, and pathogenetic potentials. Since the ground-breaking discovery of the hepatitis B virus (HBV) by Baruch Blumberg and the subsequent development of a vaccine in the early 1980s, the main task of the scientific community has been to develop a proper management strategy for HBV-induced chronic liver diseases. In the early 1980’s, standard interferon (IFN) induced a reduction of HBV DNA levels, followed by the normalization of serum transaminases (alanine aminotransferase, ALT), in some chronic hepatitis B (CHB) patients. However, in the course of time, the limitations of standard IFN became evident, and the search for an alternative began. In the late 1980’s, nucleoside analogs entered the arena of CHB treatment as oral drugs with potent antiviral capacities. At the beginning of the 21st century, insights were developed into the scope and limitations of standard IFN, pegylated-IFN as well as nucleoside analogs for treating CHB. Considering the non-cytopathic nature of the HBV, the presence of covalently closed circular DNA (cccDNA) in the nucleus of the infected hepatocytes and HBV-induced immune-mediated liver damages, a new field of CHB management was initiated by modulating the hosts’ immune system through immune therapy. This review will discuss the nature and design of innovative immune therapy for CHB.
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Affiliation(s)
- Sheikh Mohammad Fazle Akbar
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime 7910295, Japan
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh
| | - Julio Cesar Aguilar
- Center for Genetic Engineering and Biotechnology, Havana, Havana 10600, Cuba
| | | | - Md. Sakirul Islam Khan
- Department of Anatomy and Embryology, Ehime University Graduate School of Medicine, Ehime 7910295, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime 7910295, Japan
| | - Eduardo Penton
- Center for Genetic Engineering and Biotechnology, Havana, Havana 10600, Cuba
| | | | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime 7910295, Japan
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Nana J, Skaare K, Bosson JL, Leroy V, Asselah T, Adler M, Sturm N, Zarski JP. EASL-ALEH 2015 algorithm for the use of transient elastography in treatment-naive patients with hepatitis B: An independent validation. J Viral Hepat 2021; 28:1169-1176. [PMID: 34002927 DOI: 10.1111/jvh.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/28/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
Various non-invasive methods have been evaluated in chronic hepatitis B, but none of them have been fully validated for the assessment of liver fibrosis. The issued EASL-ALEH 2015 guidelines provide detailed algorithms based on LSM and ALT serum levels. The aim of our study was to validate the diagnostic accuracy of this algorithm and to better understand discrepancies. Four hundred and thirteen patients from 3 centres were retrospectively included. All included patients were classified for fibrosis stage according to results of a liver biopsy. The overall diagnostic value was expressed with AUROCs given with 95% confidence intervals for the diagnostic targets. For each diagnostic target, optimal cut-offs were determined according to the Youden method. For the population of patients with ALT<N (n = 65), the AUROCs of TE were 0.75 (0.62-0.88) and 0.72 (0.56-0.88) for F ≥ 2 and F ≥ 3 diagnostic targets. Taking the EASL cut-offs, the prevalence of significant fibrosis was 8%, 38% and 67% when LSM was <6kPa, between 6 and 9 kPa or >9 kPa, respectively. For patients with ALT>N but ≤5N (n = 306), AUROCs of transient elastography were 0.79 (0.73-0.84) and 0.84 (0.75-0.92) for F ≥ 2 and F ≥ 3 diagnostic targets. The prevalence of significant fibrosis was, respectively, 15%, 52% and 85% when LSM was <6kPa, between 6 and 12 kPa or >12 kPa. Our study independently validates the EASL-ALEH algorithm based on ALT levels and LSM assessed by transient elastography.
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Affiliation(s)
- Jean Nana
- Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, Centre Hospitalier Universitaire Grenoble Alpes Hôpital Michallon, La Tronche, France.,TIMC-IMAG UMR 5525, équipe ThEMAS (techniques pour l'évaluation et la modélisation des actions de santé), Université Grenoble-Alpes, La Tronche, France
| | - Kristina Skaare
- Pôle santé publique, Centre Hospitalier Universitaire Grenoble Alpes Hôpital Michallon, La Tronche, France
| | - Jean Luc Bosson
- TIMC-IMAG UMR 5525, équipe ThEMAS (techniques pour l'évaluation et la modélisation des actions de santé), Université Grenoble-Alpes, La Tronche, France.,Pôle santé publique, Centre Hospitalier Universitaire Grenoble Alpes Hôpital Michallon, La Tronche, France
| | - Vincent Leroy
- Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, Centre Hospitalier Universitaire Grenoble Alpes Hôpital Michallon, La Tronche, France.,Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France
| | - Tarik Asselah
- Service d'Hépatologie, Hôpital Beaujon, Paris, France
| | - Michael Adler
- Service d'Hépato-Gastro-Entérologie, Hôpital Erasme, Cliniques Universitaires de Bruxelles, Bruxelles, Belgium
| | - Nathalie Sturm
- Département Anatomie et Cytologie Pathologiques, Centre Hospitalier Universitaire Grenoble Alpes Hôpital Michallon, La Tronche, France
| | - Jean-Pierre Zarski
- Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, Centre Hospitalier Universitaire Grenoble Alpes Hôpital Michallon, La Tronche, France.,Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France
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Thijssen M, Tacke F, Beller L, Deboutte W, Yinda KC, Nevens F, Laleman W, Van Ranst M, Pourkarim MR. Clinical relevance of plasma virome dynamics in liver transplant recipients. EBioMedicine 2020; 60:103009. [PMID: 32979836 PMCID: PMC7519289 DOI: 10.1016/j.ebiom.2020.103009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of the microbiome in liver transplantation (LT) outcome has received a growing interest in the past decades. In contrast to bacteria, the role of endogenous viral communities, known as the virome, is poorly described. Here, we applied a viral metagenomic approach to study the dynamic evolution of circulating viruses in the plasma of LT recipients and its effect on the clinical course of patients. METHODS Patients chronically infected with hepatitis B virus (HBV) that received a LT due to endstage liver disease were included in this study. Longitudinal plasma samples were collected pre- and post-LT. Intact viral particles were isolated and sequenced on an Illumina HiSeq 2500 platform. Short read libraries were analysed with an in-house bioinformatics pipeline. Key endpoints were the dynamics of viral families and post-LT complications. FINDINGS The initiation of immunosuppression induced a bloom of the Anelloviridae that dominated the post-LT plasma virome. A variety of post-LT complication were observed. Nephrotoxicity was reported in 38% of the patients and was associated with a high abundance of anelloviruses. Besides nephrotoxicity, 16 (67%) patients experienced flares of viral or bacterial infections in post-transplant follow-up. These flares were recognized by an increased burden of anelloviruses (p < 0.05). Interestingly, no mortality was observed in patients infected with human pegivirus. INTERPRETATION These findings suggest a diagnostic potential for the Anelloviridae family in post-LT complications. Furthermore, the impact of human pegivirus infection on post-transplant survival should be further investigated. FUNDING This trial was supported by Gilead Sciences grant number BE-2017-000133.
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Affiliation(s)
- Marijn Thijssen
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Leen Beller
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Ward Deboutte
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Kwe Claude Yinda
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Van Ranst
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Mahmoud Reza Pourkarim
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium; Health Policy Research Centre, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran; Blood Transfusion Research Centre, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
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