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KASL clinical practice guidelines for management of chronic hepatitis B. Clin Mol Hepatol 2019; 25:93-159. [PMID: 31185710 PMCID: PMC6589848 DOI: 10.3350/cmh.2019.1002] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023] Open
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Arientová S, Beran O, Chalupa P, Kořínková M, Holub M. Antithrombin as a marker of severe acute hepatitis B. Indian J Gastroenterol 2019; 38:143-149. [PMID: 31090040 DOI: 10.1007/s12664-019-00948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/13/2019] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Simona Arientová
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - O Beran
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - P Chalupa
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.,Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - M Kořínková
- Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - M Holub
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Buti M, Manzano ML, Morillas RM, García-Retortillo M, Martín L, Prieto M, Gutiérrez ML, Suárez E, Gómez Rubio M, López J, Castillo P, Rodríguez M, Zozaya JM, Simón MA, Morano LE, Calleja JL, Yébenes M, Esteban R. Randomized prospective study evaluating tenofovir disoproxil fumarate prophylaxis against hepatitis B virus reactivation in anti-HBc-positive patients with rituximab-based regimens to treat hematologic malignancies: The Preblin study. PLoS One 2017; 12:e0184550. [PMID: 28898281 PMCID: PMC5595327 DOI: 10.1371/journal.pone.0184550] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/10/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) reactivation in patients with resolved HBV infection (HBsAg negative, antiHBc positive) is uncommon, but potentially fatal. The role of HBV prophylaxis in this setting is uncertain. The aim of this study was to compare the efficacy of tenofovir disoproxil fumarate (TDF) prophylaxis versus close monitoring in antiHBc-positive, HBsAg-negative patients under treatment with rituximab (RTX)-based regimens for hematologic malignancy. METHODS PREBLIN is a phase IV, randomized, prospective, open-label, multicenter, parallel-group trial conducted in 17 hospitals throughout Spain. Anti-HBc-positive, HBsAg-negative patients with undetectable HBV DNA were randomized to receive TDF 300 mg once daily (Group I) or observation (Group II). The primary endpoint was the percentage of patients showing HBV reactivation during 18 months following initiation of RTX treatment. Patients with detectable HBV DNA (Group III) received the same dose of TDF and were analyzed together with Group I to investigate TDF safety. RESULTS Sixty-one patients were enrolled in the study, 33 in the TDF treatment group and 28 in the observation group. By ITT analysis, HBV reactivation was 0% (0/33) in the study group and 10.7% (3/28) in the observation group (p = 0.091). None of the patients in either group showed significant differences in liver function parameters between baseline and the last follow-up sample. TDF was generally well tolerated and there were no severe treatment-related adverse events. CONCLUSION In patients with hematological malignancy and resolved hepatitis B infection receiving RTX-based regimens, HBV reactivation did not occur in patients given TDF prophylaxis.
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Affiliation(s)
- María Buti
- Liver Unit, Hospital Vall Hebron and CIBEREHD del Instituto Carlos III, Barcelona, Spain
| | - María L. Manzano
- Department of Hepatology, Hospital Doce de Octubre, Madrid, Spain
| | - Rosa M. Morillas
- Department of Hepatology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Leticia Martín
- Department of Hepatology, Hospital de Donostia, San Sebastián, Spain
| | - Martín Prieto
- Department of Hepatology, Hospital Universitario i Politécnico La Fe, Valencia, Spain
| | | | - Emilio Suárez
- Department of Hepatology, Hospital Nuestra Señora de Valme, Seville, Spain
| | | | - Javier López
- Department of Hematology, Hospital Ramón y Cajal, Madrid, Spain
| | - Pilar Castillo
- Department of Hepatology, Hospital La Paz, Madrid, Spain
| | - Manuel Rodríguez
- Department of Hepatology, Hospital Central de Asturias, Oviedo, Spain
| | - José M. Zozaya
- Department of Gastroenterology, Hospital de Navarra, Pamplona, Spain
| | - Miguel A. Simón
- Department of Hepatology, Hospital Clínico Lozano Blesa, Zaragoza, Spain
| | - Luis E. Morano
- Department of Infectious Diseases, Hospital do Meixoeiro, Vigo, Spain
| | - José L. Calleja
- Department of Gastroenterology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - María Yébenes
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
| | - Rafael Esteban
- Liver Unit, Hospital Vall Hebron and CIBEREHD del Instituto Carlos III, Barcelona, Spain
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Zhou J, Liu YY, Lian JS, Pan LF, Yang JL, Huang JR. Efficacy and Safety of Tenofovir Disoproxil Treatment for Chronic Hepatitis B Patients with Genotypic Resistance to Other Nucleoside Analogues: A Prospective Study. Chin Med J (Engl) 2017; 130:914-919. [PMID: 28397720 PMCID: PMC5407037 DOI: 10.4103/0366-6999.204107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Tenofovir disoproxil (TDF) is a promising salvage therapy for patients with chronic hepatitis B (CHB) who failed regimens of other nucleoside analogues (NAs). In this study, we aimed to investigate the clinical efficacy and safety of TDF monotherapy in Chinese CHB patients with genotypic resistance. Methods: A total of 33 CHB patients who had failed treatment with other NAs and had genotypic resistance were switched to TDF monotherapy for 48 weeks. Patients’ demographic data (age, sex, history of hepatitis B virus [HBV] therapy), laboratory testing results (hepatitis B e antigen [HBeAg] status, HBV DNA levels, alanine aminotransferase [ALT] levels, serum creatinine, urinary protein, genotypic assay), clinical symptoms, and liver color ultrasound examinations were collected for evaluation at day 0 (baseline) and the 12th, 24th, 36th, and 48th weeks after initiating treatment. Statistical analyses were carried out using rank sum test or rank correlation. Results: With regard to efficacy, the study found that all patients who switched to TDF monotherapy had undetectable HBV DNA levels after 48 weeks. In addition, patients with lower baseline HBV DNA levels realized earlier virological undetectability (rs = 0.39, P = 0.030). ALT levels were normal in 30 of 33 patients (91%). HBeAg negative conversion occurred in 7 of 25 patients (28%), among whom HBeAg seroconversion (12%) and HBeAg seroclearance (16%) occurred. The time of complete virological response was significantly affected by the number of resistance loci (rs = 0.36, P = 0.040). Concerning safety, the study found that no adverse events were observed during the 48 weeks. Conclusion: TDF monotherapy is an effective and safe salvage treatment for CHB patients who are resistant to other NAs.
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Affiliation(s)
- Jing Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003; Department of Infectious Disease, The First People's Hospital of Yongkang, Jinhua, Zhejiang 321300, China
| | - Yue-Ying Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, China
| | - Jiang-Shan Lian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, China
| | - Li-Fang Pan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, China
| | - Jian-Le Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, China
| | - Jian-Rong Huang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310003, China
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Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HLY, Chen CJ, Chen DS, Chen HL, Chen PJ, Chien RN, Dokmeci AK, Gane E, Hou JL, Jafri W, Jia J, Kim JH, Lai CL, Lee HC, Lim SG, Liu CJ, Locarnini S, Al Mahtab M, Mohamed R, Omata M, Park J, Piratvisuth T, Sharma BC, Sollano J, Wang FS, Wei L, Yuen MF, Zheng SS, Kao JH. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 2016; 10:1-98. [PMID: 26563120 PMCID: PMC4722087 DOI: 10.1007/s12072-015-9675-4] [Citation(s) in RCA: 1704] [Impact Index Per Article: 213.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023]
Abstract
Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts' personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.
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Affiliation(s)
- S K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - M Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - G K Lau
- Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China
- The Institute of Translational Hepatology, Beijing, China
| | - Z Abbas
- Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - H L Y Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - C J Chen
- Genomics Research Center, Academia Sinica, National Taiwan University, Taipei, Taiwan
| | - D S Chen
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - H L Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - P J Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Chang Gung Memorial Hospital and University, Chilung, Taiwan
| | - A K Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - J L Hou
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Guangzhou, China
| | - W Jafri
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - J Jia
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - C L Lai
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - H C Lee
- Internal Medicine Asan Medical Center, Seoul, Korea
| | - S G Lim
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
| | - C J Liu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - S Locarnini
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia
| | - M Al Mahtab
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - R Mohamed
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - M Omata
- Yamanashi Hospitals (Central and Kita) Organization, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan
| | - J Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - T Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Prince of Songkla University, Songkhla, Thailand
| | - B C Sharma
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India
| | - J Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - F S Wang
- Treatment and Research Center for Infectious Diseases, Beijing 302 Hospital, Beijing, China
| | - L Wei
- Peking University Hepatology Institute, Beijing, China
| | - M F Yuen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Hong Kong, Pofulam, Hong Kong
| | - S S Zheng
- Department of Hepatobiliary and Pancreatic Surgery, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - J H Kao
- Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
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High Level of HBV DNA Virus in the Breast Milk Seems not to Contraindicate Breastfeeding. Mediterr J Hematol Infect Dis 2015; 7:e2015042. [PMID: 26185607 PMCID: PMC4500470 DOI: 10.4084/mjhid.2015.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/11/2015] [Indexed: 11/21/2022] Open
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Huang M, Jie Y, Shi H, Li X, Li X, Wu Y, Lin G, Chong Y. Comparison of the efficacy of tenofovir disoproxil fumarate and entecavir for initial treatment of patient with chronic hepatitis B in China. Int J Clin Exp Med 2015; 8:666-673. [PMID: 25785042 PMCID: PMC4358497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have been accepted as the standard treatment drugs for hepatitis B virus (HBV) reactivation. We aim to compare the efficacy and safety of TDF and ETV initial treatment of chronic hepatitis B (CHB) patients. METHODS We retrospectively analyzed the efficacy and safety of TDF treatment on 33 CHB patients and of ETV treatment on 65 CHB patients by comparing the HBV DNA levels, HBV DNA undetectable rate, HBV DNA negative conversion multi-factor analysis, alanine amino transferase (ALT) normalization rate, and the adverse event incidence at weeks 4, 12, 24, 36, 48, 72 before and after treatment in each group. RESULTS The HBV DNA levels in the ETV group were significantly lower than that in the TDF group at week 4 (95.05 ± 39.49 versus 103.3 ± 80.25 U/L, P = 0.005). The differences in HBV DNA levels at the other times between these two treatment groups were not statistically significant. No significant differences were observed with HBV DNA undetectable rate and ALT normalization rate between the two groups (P = 0.114, 0.656, respectively). HBV DNA negativity multi-factor analysis showed that the differences in TDF and ETV treatment were not statistically significant (P = 0.116). Therefore, the proportion of Creatine Kinase (CK) levels that were 2 times over the upper limit of normal (2ULN) showed no significant differences in any time points between the two groups (P > 0.05). CONCLUSION TDF and ETV treatment both exhibited rapid inhibiting effects on HBV DNA replication in the early phase of naïve CHB patients in Mainland China.
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Affiliation(s)
- Mingxing Huang
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China ; Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-Sen University Meihua Dong Road No. 52, Zhuhai 519000, China
| | - Yusheng Jie
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China
| | - Hong Shi
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China
| | - Xinhua Li
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China
| | - Xiangyong Li
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China
| | - Yuankai Wu
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China
| | - Guoli Lin
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China
| | - Yutian Chong
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University Tianhe Road No. 600, Guangzhou 510630, China
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