Severe acute hepatitis B treated with entecavir

Antithrombin as a marker of severe acute hepatitis B

BACKGROUND

Acute hepatitis B (AHB) can run a severe course, which sometimes leads to a fulminant disease with acute liver failure (ALF). Pro-coagulation factors are well-established markers of AHB severity, but less is known about the levels of anti-coagulation parameters in AHB.

METHODS

In this study, we demonstrate that antithrombin (AT) plasma levels were associated with AHB severity in 161 patients.

RESULTS

Nine (6%) patients had severe AHB (i.e. international normalized ratio [INR] ≥ 1.6 and total bilirubin ≥ 10 mg/dL). Coagulopathy (i.e. INR > 1.2 and/or AT < 80%) was observed in 65 (40%) AHB patients on admission. Low initial plasma AT levels (i.e. < 80%) were observed in 56 (35%) patients. In all, plasma AT levels decreased in 91 (57%) patients during their hospital stay. Both baseline and nadir AT levels were significantly lower in severe than in mild and moderate AHB. Moreover, the concentration of AT negatively correlated with INR, aspartate aminotransferase, and total and conjugated bilirubin levels. Interestingly, nadir AT levels positively correlated with the duration of hospitalization.

CONCLUSIONS

These results indicate that plasma AT levels can be used as an additional marker of AHB severity.

2017 European guideline for the screening, prevention and initial management of hepatitis B and C infections in sexual health settings

This guideline updates the 2010 European guideline for the management of hepatitis B and C virus infections. It is primarily intended to provide advice on testing, prevention and initial management of viral hepatitis B and C for clinicians working in sexual health clinical settings in European countries. The guideline is in a new question and answer format based on clinical situations, from which population/intervention/comparison/outcome questions were formulated. Updates cover areas such as epidemiology, point-of-care tests for hepatitis B, hepatitis C risk and 'chemsex', and HIV pre-exposure prophylaxis and hepatitis B. We have also included a short paragraph on hepatitis E noting there is no evidence for sexual transmission. The guideline has been prepared in accordance with the Europe protocol for production available at http://www.iusti.org/regions/europe/pdf/2017/ProtocolForProduction2017.pdf.

Endothelial Nitric Oxide Synthase (eNOS) Gene Polymorphism is Associated with Age Onset of Menarche in Sickle Cell Disease Females of India

Background and Objective

Females with sickle cell disease (SCD) often show late onset of menarche. In transgenic sickle cell mouse, deficiency of gene encoding endothelial nitric oxide synthase (eNOS) has been reported to be associated with late onset of menarche. Thus to explore the possible association of eNOS gene polymorphism with age of onset of menarche in SCD females, 3 important eNOS gene polymorphisms- eNOS 4a/b, eNOS 894G>T (rs1799983) and eNOS-786 T>C (rs2070744) and plasma nitrite levels were tested among three groups of females- SCD late menarche, SCD early menarche and control females.

Methodology

About 39 SCD females comprising of 18 SCD early menarche and 21 SCD late menarche groups were studied along with 48 control females. Genotyping of eNOS gene polymorphisms were done by PCR-RFLP and quantification of plasma nitrite level was performed by ELISA based commercial kits.

Results

SCD late menarche females showed significantly higher prevalence and higher association of heterozygous genotypes, higher frequency of mutant alleles .4a., .T. and .C. as compared to that of control group and SCD early menarche group. The frequency of haplotype .4a-G-C. and haplotype .4b-G-C. (alleles in order of eNOS 4a/b, eNOS 894G>T and eNOS-786 T>C respectively) were found to be significantly high in SCD late menarche compared to combined groups of SCD early menarche and controls. SCD late menarche group had significantly low level of plasma nitrite concentration for all 3 eNOS gene polymorphisms as compared to controls and SCD early menarche females.

Conclusion

eNOS gene polymorphism may influence age of onset of menarche in SCD females.

Tenofovir as rescue therapy following clinical failure to Lamivudine in severe acute hepatitis B

Acute hepatitis B (AHB) is a self-limiting condition in more than 95% of cases. Treatment is however recommended in patients with severe AHB (<1% of cases), aiming to prevent liver failure and death. Various nucleos(t)ide analogues (NA) have been found to be effective in severe AHB, although NA-resistant strains causing AHB have been also recently reported. The use of tenofovir in severe AHB has only been described in 3 cases (1 adult and 1 infant with HBV mono-infection, 1 adult with HBV/HIV co-infection). We hereby report a 47-year-old treatment-naïve male, who developed severe AHB and was initially treated with lamivudine (LMV). Initial rapid biochemical response was followed by biochemical breakthrough after 9 days, suggesting LMV resistance. Rescue therapy with ‘add-on’ tenofovir brought about a sustained improvement in biochemical, serological and virological markers until HBsAg was lost after 4 months. Thus, this is the second adult HBV mono-infected patient, who responded successfully to tenofovir in severe AHB.

KASL Clinical Practice Guidelines: Management of chronic hepatitis B

The guideline on the management of chronic hepatitis B (CHB) was first developed in 2004 and revised in 2007 by the Korean Association for the Study of the Liver (KASL). Since then there have been many developments, including the introduction of new antiviral agents and the publications of many novel research results from both Korea and other countries. In particular, a large amount of knowledge on antiviral resistance--which is a serious issue in Korea--has accumulated, which has led to new strategies being suggested. This prompted the new guideline discussed herein to be developed based on recent evidence and expert opinion.

TARGET POPULATION

The main targets of this guideline comprise patients who are newly diagnosed with CHB and those who are followed or treated for known CHB. This guideline is also intended to provide guidance for the management of patients under the following special circumstances: malignancy, transplantation, dialysis, coinfection with other viruses, pregnancy, and children.

Entecavir as specific antiviral therapy in selected cases of severe acute hepatitis B

The role of specific antiviral treatment in severe acute hepatitis B has been subject to debate during the past few years. We present clinical findings in a series of three cases of severe acute hepatitis B and one case of acute hepatitis B treated with entecavir during 2007-2009, with interesting evolution. Entecavir appeared to improve the clinical evolution in the reported cases. Two of the patients displayed HBsAg to HBsAb seroconversion while another patient went into an inactive HBsAg carrier state. In the case of mild acute hepatitis B, the liver enzymes had returned to normal, symptomatology had receded but HBsAg had remained positive. Without data on viral load, we were unable to determine whether the patient had entered an inactive HBsAg carrier state or had continued into the services of another medical unit, for treatment of chronic HBV infection. We also discuss into detail a case which displayed transient initial HBe seroconversion at 1 week, followed by seroreversion to positive HBeAg and negative HBeAb at week 3, and a new seroconversion at week 7. We assess the possible roles of precore mutations, antibody-dependent cellular cytotoxicity, coinfection with Epstein Barr virus and the function of Kupffer cells.