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Park J, Le AK, Tseng TC, Yeh ML, Jun DW, Trinh H, Wong GLH, Chen CH, Peng CY, Kim SE, Oh H, Kwak MS, Cheung KS, Toyoda H, Hsu YC, Jeong JY, Yoon EL, Ungtrakul T, Zhang J, Xie Q, Ahn SB, Enomoto M, Shim JJ, Cunningham C, Jeong SW, Cho YK, Ogawa E, Huang R, Lee DH, Takahashi H, Tsai PC, Huang CF, Dai CY, Tseng CH, Yasuda S, Kozuka R, Li J, Wong C, Wong CC, Zhao C, Hoang J, Eguchi Y, Wu C, Tanaka Y, Gane E, Tanwandee T, Cheung R, Yuen MF, Lee HS, Yu ML, Kao JH, Yang HI, Nguyen MH. Progression Rates by Age, Sex, Treatment, and Disease Activity by AASLD and EASL Criteria: Data for Precision Medicine. Clin Gastroenterol Hepatol 2022; 20:874-885.e4. [PMID: 34089852 DOI: 10.1016/j.cgh.2021.05.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/05/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antiviral treatment criteria are based on disease progression risk, and hepatocellular carcinoma (HCC) surveillance recommendations for patients with chronic hepatitis B (CHB) without cirrhosis is based on an annual incidence threshold of 0.2%. However, accurate and precise disease progression estimate data are limited. Thus, we aimed to determine rates of cirrhosis and HCC development stratified by age, sex, treatment status, and disease activity based on the 2018 American Association for the Study of Liver Diseases and 2017 European Association for the Study of the Liver guidelines. METHODS We analyzed 18,338 patients (8914 treated, 9424 untreated) from 6 centers from the United States and 27 centers from Asia-Pacific countries. The Kaplan-Meier method was used to estimate annual progression rates to cirrhosis or HCC in person-years. RESULTS The cohort was 63% male, with a mean age of 46.19 years, with baseline cirrhosis of 14.3% and median follow up of 9.60 years. By American Association for the Study of Liver Diseases criteria, depending on age, sex, and disease activity, annual incidence rates ranged from 0.07% to 3.94% for cirrhosis, from 0.04% to 2.19% for HCC in patients without cirrhosis, and from 0.40% to 8.83% for HCC in patients with cirrhosis. Several subgroups of patients without cirrhosis including males younger than 40 years of age and females younger than 50 years of age had annual HCC risk near or exceeding 0.2%. Similar results were found using European Association for the Study of the Liver criteria. CONCLUSION There is great variability in CHB disease progression rates even among "lower-risk" populations. Future CHB modeling studies, public health planning, and HCC surveillance recommendation should be based on more precise disease progression rates based on sex, age, and disease activity, plus treatment status.
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Affiliation(s)
- Jiyoon Park
- Department of Medicine, Santa Clara Valley Medical Center, Santa Clara, California; Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - Tai-Chung Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dae Won Jun
- Department of Gastroenterology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Huy Trinh
- San Jose Gastroenterology, San Jose, California
| | - Grace L H Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chien-Hung Chen
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Yuan Peng
- Department of Gastroenterology, China Medical University Hospital, Taichung, Taiwan
| | - Sung Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Hyunwoo Oh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min-Sun Kwak
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ka Shing Cheung
- Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Jae Yoon Jeong
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Eileen L Yoon
- Department of Gastroenterology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jian Zhang
- Chinese Hospital, San Francisco, California
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sang Bong Ahn
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chris Cunningham
- Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Dong-Hyun Lee
- Department of Gastroenterology, Good Gang-An Hospital, Busan, Republic of Korea
| | | | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Satoshi Yasuda
- Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ritsuzo Kozuka
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Jiayi Li
- Palo Alto Medical Foundation, Mountain View Division, Mountain View, California
| | | | - Clifford C Wong
- Wong Clinics, San Francisco, California; Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Joseph Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - Yuichiro Eguchi
- Department of Internal Medicine, Saga University Hospital, Saga, Japan
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Tawesak Tanwandee
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California
| | - Man-Fung Yuen
- Department of Medicine, the University of Hong Kong, Hong Kong SAR, China
| | - Hyo-Suk Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, California; Department of Epidemiology and Population Health, Stanford University, Stanford, California.
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Li J, Yang HI, Yeh ML, Le MH, Le AK, Yeo YH, Dai CY, Barnett S, Zhang JQ, Huang JF, Trinh HN, Wong C, Wong C, Hoang JK, Cheung R, Yu ML, Nguyen MH. Association Between Fatty Liver and Cirrhosis, Hepatocellular Carcinoma, and Hepatitis B Surface Antigen Seroclearance in Chronic Hepatitis B. J Infect Dis 2021; 224:294-302. [PMID: 33249474 DOI: 10.1093/infdis/jiaa739] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/25/2020] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Chronic hepatitis B (CHB) and fatty liver (FL) are common, natural history data on concurrent FL and CHB (FL-CHB) are limited. This study aimed to evaluate the effect of FL on cirrhosis, hepatocellular carcinoma (HCC), and hepatitis B surface antigen (HBsAg) seroclearance incidence in CHB patients. METHODS In a retrospective cohort study of 6786 adult CHB patients, we used propensity score matching (PSM) to balance the FL-CHB and non-FL CHB groups. Kaplan-Meier methods were used to compare cumulative cirrhosis, HCC, and HBsAg seroclearance rates between subgroups. RESULTS Before PSM, compared to non-FL CHB, FL-CHB patients had lower 10-year cumulative rates of cirrhosis, HCC, and a higher HBsAg seroclearance rate. Similar results were found in the matched FL-CHB and non-FL CHB patients, as well as in the antiviral-treated PSM cohort. Cox proportional hazards model indicated FL to remain significantly and strongly associated with lower risk of cirrhosis and HCC (hazard ratio [HR], 0.19 [95% confidence interval {CI}, .12-.33], P < .001 and HR, 0.21 [95% CI, .09-.51], P = .001, respectively) in antiviral-treated patients but not in untreated patients. CONCLUSIONS FL was significantly associated with lower cirrhosis and HCC risk and higher HBsAg seroclearance. Further studies are needed to confirm our funding and investigate the mechanisms underlying the impact of FL on CHB.
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Affiliation(s)
- Jie Li
- Department of Infectious Disease, Shandong Provincial Hospital affiliated to Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
- Department of Infectious Disease, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Cancer Research and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Michael H Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Yee Hui Yeo
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Chia-Yen Dai
- Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Cancer Research and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Scott Barnett
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Jian Q Zhang
- Chinese Hospital, San Francisco, California, USA
| | - Jee-Fu Huang
- Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Cancer Research and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huy N Trinh
- San Jose Gastroenterology, San Jose, California, USA
| | | | | | - Joseph K Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Ming-Lung Yu
- Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Hepatitis Research Center, College of Medicine and Center for Cancer Research and Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, USA
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3
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Le AK, Yang HI, Yeh ML, Jin M, Trinh HN, Henry L, Liu A, Zhang JQ, Li J, Wong C, Wong C, Cheung R, Yu ML, Nguyen MH. Development and Validation of a Risk Score for Liver Cirrhosis Prediction in Untreated and Treated Chronic Hepatitis B. J Infect Dis 2021; 223:139-146. [PMID: 32525978 DOI: 10.1093/infdis/jiaa330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/05/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic hepatitis B (CHB) can progress to cirrhosis, but there are limited noninvasive tools available to estimate cirrhosis risk, including in patients receiving antiviral therapy. This study developed and validated a simple model to assess risk in CHB patients. METHODS The derivation cohort included 3000 CHB patients from 6 centers in the United States, with 52.60% receiving antiviral therapy. External validation was performed for 4552 CHB individuals from similar cohorts in Taiwan, with 21.27% receiving therapy. Cox proportional hazards regression analyses were used to screen predictors and develop the risk score for cirrhosis. Areas under receiver operating characteristic curves (AUROCs) were calculated for predictive value. RESULTS Sex, age, diabetes, antiviral treatment status/duration, hepatitis B e-antigen, and baseline alanine aminotransferase/aspartate aminotransferase levels were significantly associated with increased cirrhosis risk. A 13-point risk score was developed based on these predictors. The AUROCs for predicting cirrhosis risk were 0.82 at 3 years, 0.85 at 5 years, and 0.89 at 10 years in the derivation cohort, and 0.82, 0.79, and 0.77 in the validation cohort, respectively. CONCLUSIONS We developed and validated a simple cirrhosis prediction model with an independent external cohort that can be applied to both treatment-naive and treatment-experienced CHB patients in diverse settings and locations.
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Affiliation(s)
- An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohiung Medical University, Kaohsiung, Taiwan
| | - Mingjuan Jin
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, China
| | - Huy N Trinh
- San Jose Gastroenterology, San Jose, California, USA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Anne Liu
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jian Q Zhang
- Chinese Hospital, San Francisco, California, USA
| | - Jiayi Li
- Palo Alto Medical Foundation, Mountain View Division, Mountain View, California, USA
| | | | | | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.,Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohiung Medical University, Kaohsiung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
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4
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Ramrakhiani NS, Le MH, Yeo YH, Le AK, Maeda M, Nguyen MH. Validity of International Classification of Diseases, Tenth Revision, Codes for Cirrhosis. Dig Dis 2021; 39:243-246. [PMID: 32814313 PMCID: PMC8220916 DOI: 10.1159/000510981] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/17/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Accurate identification of patients with cirrhosis is important for research using administrative databases. We aimed to examine the accuracy of several major ICD-10 codes for cirrhosis diagnosis in a large and diverse patient cohort; there is little existing research on this topic. METHODS Using data from 3,396 patients with chronic liver disease (hepatitis B or C or nonalcoholic fatty liver disease) from 1 university and several community medical centers, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value, and area under the receiver operating characteristic curve (AUROC) for several major ICD-10 codes for cirrhosis, which was verified by individual chart review. We performed a secondary validation in a general cohort of 1,560 randomly selected patients. RESULTS While each of the individual study ICD-10 codes were specific (98.08-100%), none of the codes were sufficiently sensitive (0.27-55.70%). PPVs were high in the chronic liver disease cohort (88.41-100%) but lower in the general population (55.53-66.76%). The AUROC for having at least 1 code was higher (0.79) than any code alone (0.50-0.65). DISCUSSION/CONCLUSION Individual ICD-10 codes are suboptimal for identifying patients with cirrhosis in the general patient population. We recommend conditioning ICD-10 code searches with a chronic liver disease diagnosis code and/or combining diagnostic codes to maximize performance.
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Affiliation(s)
| | | | | | | | | | - Mindie H. Nguyen
- *Mindie H. Nguyen, GI, Hepatology & Liver Transplant, Stanford University Medical Center, 750 Welch Road, Palo Alto, CA 94304 (USA),
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Chen VL, Yeh ML, Yang JD, Leong J, Huang DQ, Toyoda H, Chen YL, Guy J, Maeda M, Tsai PC, Huang CF, Yasuda S, Le AK, Dang H, Giama NH, Ali HA, Zhang N, Wang X, Jun DW, Tseng CH, Hsu YC, Huang JF, Dai CY, Chuang WL, Zhu Q, Dan YY, Schwartz M, Roberts LR, Yu ML, Nguyen MH. Effects of Cirrhosis and Diagnosis Scenario in Metabolic-Associated Fatty Liver Disease-Related Hepatocellular Carcinoma. Hepatol Commun 2021; 5:122-132. [PMID: 33437906 PMCID: PMC7789832 DOI: 10.1002/hep4.1606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/02/2020] [Accepted: 08/08/2020] [Indexed: 12/15/2022] Open
Abstract
Metabolic-associated fatty liver disease (MAFLD) is a major cause of liver-related complications, including hepatocellular carcinoma (HCC). While MAFLD-related HCC is known to occur in the absence of cirrhosis, our understanding of MAFLD-related HCC in this setting is limited. Here, we characterize MAFLD-related HCC and the impact of cirrhosis and screening on survival. This was a multicenter, retrospective, cohort study of MAFLD-related HCC. MAFLD was defined based on the presence of race-adjusted overweight, diabetes, or both hypertension and dyslipidemia in the absence of excess alcohol use or other underlying cause of liver disease. The primary outcome of interest was overall survival, and the primary dependent variables were cirrhosis status and prior HCC screening. We used Kaplan-Meier methods to estimate overall survival and Cox proportional hazards models and random forest machine learning to determine factors associated with prognosis. This study included 1,382 patients from 11 centers in the United States and East/Southeast Asia. Cirrhosis was present in 62% of patients, but under half of these patients had undergone imaging within 12 months of HCC diagnosis. Patients with cirrhosis were more likely to have early stage disease but less often received curative therapy. After adjustment, cirrhosis was not associated with prognosis, but the presence of cancer-related symptoms at diagnosis was associated with poorer prognosis. Conclusion: Cirrhosis was not associated with overall survival in this cohort of MAFLD-related HCC, while diagnosis in the presence of symptoms was associated with poorer prognosis. The HCC surveillance rate in patients with MAFLD-related HCC was disappointingly low in a multicenter cohort.
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Affiliation(s)
- Vincent L Chen
- Division of GastroenterologyUniversity of Michigan Health SystemAnn ArborMIUSA
| | - Ming-Lun Yeh
- Hepatobiliary DivisionKaohsiung Medical University HospitalKaohsiungTaiwan.,Hepatitis Research CenterCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan.,Center for Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Ju Dong Yang
- Comprehensive Transplant CenterCedars Sinai Medical CenterLos AngelesCAUSA
| | - Jennifer Leong
- Division of Liver DiseasesRecanati/Miller Transplantation InstituteIcahn School of MedicineNew YorkNYUSA
| | - Daniel Q Huang
- Division of Gastroenterology and HepatologyDepartment of MedicineNational University Health SystemSingaporeSingapore.,Department of MedicineNational University of SingaporeSingaporeSingapore
| | - Hidenori Toyoda
- Department of GastroenterologyOgaki Municipal HospitalOgakiJapan
| | - Yao-Li Chen
- Department of SurgeryChanghua Christian HospitalChanghuaTaiwan
| | - Jennifer Guy
- Division of Gastroenterology and HepatologyCalifornia Pacific Medical CenterSan FranciscoCA
| | - Mayumi Maeda
- Division of Gastroenterology and HepatologyStanford University Medical CenterStanfordCA
| | - Pei-Chien Tsai
- Hepatobiliary DivisionKaohsiung Medical University HospitalKaohsiungTaiwan.,Hepatitis Research CenterCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan.,Center for Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chung-Feng Huang
- Hepatobiliary DivisionKaohsiung Medical University HospitalKaohsiungTaiwan.,Hepatitis Research CenterCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan.,Center for Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Satoshi Yasuda
- Department of GastroenterologyOgaki Municipal HospitalOgakiJapan
| | - An K Le
- Division of Gastroenterology and HepatologyStanford University Medical CenterStanfordCA
| | - Hansen Dang
- Division of Gastroenterology and HepatologyStanford University Medical CenterStanfordCA
| | - Nasra H Giama
- Department of Gastroenterology and HepatologyMayo ClinicRochesterMN
| | - Hamdi A Ali
- Department of Gastroenterology and HepatologyMayo ClinicRochesterMN
| | - Ning Zhang
- Department of Gastroenterology and HepatologyMayo ClinicRochesterMN
| | - Xiaozhong Wang
- Division of Gastroenterology and HepatologyTraditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous RegionUrumqiChina
| | - Dae Won Jun
- Division of GastroenterologyHanyang University Medical CenterSeoulRepublic of Korea
| | - Cheng-Hao Tseng
- Division of Gastroenterology and HepatologyE-Da Cancer Hospital/I-Shou UniversityKaohsiungTaiwan
| | - Yao-Chun Hsu
- Division of Gastroenterology and HepatologyE-Da Cancer Hospital/I-Shou UniversityKaohsiungTaiwan
| | - Jee-Fu Huang
- Hepatobiliary DivisionKaohsiung Medical University HospitalKaohsiungTaiwan.,Hepatitis Research CenterCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan.,Center for Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Chia-Yen Dai
- Hepatobiliary DivisionKaohsiung Medical University HospitalKaohsiungTaiwan.,Hepatitis Research CenterCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan.,Center for Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Wan-Long Chuang
- Hepatobiliary DivisionKaohsiung Medical University HospitalKaohsiungTaiwan.,Hepatitis Research CenterCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan.,Center for Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Qiang Zhu
- Division of Gastroenterology and HepatologyShandong Provincial Hospital Affiliated to Shandong UniversityJinanChina
| | - Yock Young Dan
- Division of Gastroenterology and HepatologyDepartment of MedicineNational University Health SystemSingaporeSingapore.,Department of MedicineNational University of SingaporeSingaporeSingapore
| | - Myron Schwartz
- Division of Liver DiseasesRecanati/Miller Transplantation InstituteIcahn School of MedicineNew YorkNYUSA
| | - Lewis R Roberts
- Comprehensive Transplant CenterCedars Sinai Medical CenterLos AngelesCAUSA
| | - Ming-Lung Yu
- Hepatobiliary DivisionKaohsiung Medical University HospitalKaohsiungTaiwan.,Hepatitis Research CenterCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan.,Center for Cancer ResearchKaohsiung Medical UniversityKaohsiungTaiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and HepatologyStanford University Medical CenterStanfordCA
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Abstract
Liver cirrhosis is one of the leading causes of death in adults worldwide. It is highly prevalent in developing countries and is growing in prevalence in developed countries mostly because of chronic liver diseases, such as chronic hepatitis B and C and alcoholic and nonalcoholic fatty liver disease. However, the prevalence of cirrhosis may be highly underestimated because early stages are asymptomatic and current early detection methods are inadequate. Here, we evaluate the potential of a set of novel cirrhotic protein biomarkers, including soluble intercellular adhesion molecule-1 and mac-2 binding protein glycosylation isomer, for early detection of cirrhosis in a multiplexed assay using our giant magnetoresistive (GMR) sensor arrays. We evaluated the diagnostic performance of the biomarkers, individually and in combination, using multivariate logistic regression and random forest in a blinded proof-of-concept retrospective case-controlled study. The biomarkers in combination exhibited high diagnostic performance in both logistic regression and random forest models, with an area under the curve of 0.98 (0.94-1.00). In addition, the combination of biomarkers resulted in a high sensitivity of 0.97 (0.95-1.00) and a high specificity of 1.00. We showed that the diagnostic performance of our novel set of cirrhotic protein biomarkers on our multiplexed GMR sensor arrays is higher than the performance of currently used clinical biomarkers and factors (i.e., age, sex, alanine aminotransferase, aspartate aminotransferase, etc.). With this combination of novel biomarkers and GMR technology, we could potentially boost the diagnostic power of early cirrhosis detection.
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Affiliation(s)
- Elaine Ng
- Department of Bioengineering, Stanford University, Stanford, California 94305, United States
- Department of Materials Science and Engineering, Stanford University, Stanford, California 94305, United States
| | - An K. Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California 94305, United States
| | - Mindie H. Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California 94305, United States
| | - Shan X. Wang
- Department of Materials Science and Engineering, Stanford University, Stanford, California 94305, United States
- Department of Electrical Engineering, Stanford University, Stanford, California 94305, United States
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7
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Yeo YH, Tseng TC, Hosaka T, Cunningham C, Fung JYY, Ho HJ, Kwak MS, Trinh HN, Ungtrakul T, Yu ML, Kobayashi M, Le AK, Henry L, Li J, Zhang J, Sriprayoon T, Jeong D, Tanwandee T, Gane E, Cheung RC, Wu CY, Lok AS, Lee HS, Suzuki F, Yuen MF, Kao JH, Yang HI, Nguyen MH. Incidence, Factors, and Patient-Level Data for Spontaneous HBsAg Seroclearance: A Cohort Study of 11,264 Patients. Clin Transl Gastroenterol 2020; 11:e00196. [PMID: 33094953 PMCID: PMC7494149 DOI: 10.14309/ctg.0000000000000196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/12/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Spontaneous hepatitis B surface antigen (HBsAg) seroclearance, the functional cure of hepatitis B infection, occurs rarely. Prior original studies are limited by insufficient sample size and/or follow-up, and recent meta-analyses are limited by inclusion of only study-level data and lack of adjustment for confounders to investigate HBsAg seroclearance rates in most relevant subgroups. Using a cohort with detailed individual patient data, we estimated spontaneous HBsAg seroclearance rates through patient and virologic characteristics. METHODS We analyzed 11,264 untreated patients with chronic hepatitis B with serial HBsAg data from 4 North American and 8 Asian Pacific centers, with 1,393 patients with HBsAg seroclearance (≥2 undetectable HBsAg ≥6 months apart) during 106,192 person-years. The annual seroclearance rate with detailed categorization by infection phase, further stratified by hepatitis B e antigen (HBeAg) status, sex, age, and quantitative HBsAg (qHBsAg), was performed. RESULTS The annual seroclearance rate was 1.31% (95% confidence interval: 1.25-1.38) and over 7% in immune inactive patients aged ≥55 years and with qHBsAg <100 IU/mL. The 5-, 10-, 15-, and 20-year cumulative rates were 4.74%, 10.72%, 18.80%, and 24.79%, respectively. On multivariable analysis, male (adjusted hazard ratio [aHR] = 1.66), older age (41-55 years: aHR = 1.16; >55 years: aHR = 1.21), negative HBeAg (aHR = 6.34), and genotype C (aHR = 1.82) predicted higher seroclearance rates, as did lower hepatitis B virus DNA and lower qHBsAg (P < 0.05 for all), and inactive carrier state. DISCUSSION The spontaneous annual HBsAg seroclearance rate was 1.31%, but varied from close to zero to about 5% among most chronic hepatitis B subgroups, with older, male, HBeAg-negative, and genotype C patients with lower alanine aminotransferase and hepatitis B virus DNA, and qHBsAg independently associated with higher rates (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A367).
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Affiliation(s)
- Yee Hui Yeo
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Tai-Chung Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tetsuya Hosaka
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Chris Cunningham
- Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand
- The Hepatitis Foundation of New Zealand, Whakatane, New Zealand
| | | | - Hsiu J. Ho
- Division of Translational Research, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Min-Sun Kwak
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Huy N. Trinh
- San Jose Gastroenterology, San Jose, California, USA
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Ming-Lung Yu
- Hepatobiliary Section, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Liver Research, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mariko Kobayashi
- Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan
| | - An K. Le
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Linda Henry
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Jiayi Li
- Palo Alto Medical Foundation, Mountain View Division, Palo Alto, California, USA
| | - Jian Zhang
- Chinese Hospital, San Francisco, California, USA
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Tassanee Sriprayoon
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Donghak Jeong
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
| | - Tawesak Tanwandee
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ramsey C. Cheung
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Chun-Ying Wu
- Division of Translational Research, Taipei Veterans General Hospital, Taipei City, Taiwan
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Anna S. Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Hyo-Suk Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | - Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mindie H. Nguyen
- Department of Medicine, Stanford University Medical Center, Palo Alto, California, USA
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Li J, Le AK, Chaung KT, Henry L, Hoang JK, Cheung R, Nguyen MH. Fatty liver is not independently associated with the rates of complete response to oral antiviral therapy in chronic hepatitis B patients. Liver Int 2020; 40:1052-1061. [PMID: 32086988 DOI: 10.1111/liv.14415] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis B (CHB) are common liver diseases. Concurrent NAFLD may affect antiviral treatment outcomes in CHB patients. The aim of this study is to investigate the impact of NAFLD on complete viral suppression ([CVS], HBV DNA <20-100 IU/mL) and/or biochemical response ([BR], ALT of ≤25 U/L for females; 35 U/L for males) in CHB patients who received oral antiviral therapy. METHODS A retrospective study of 555 treated CHB patients (187 NAFLD; 368 non-NAFLD) from 2000 to 2016 at a USA medical centre. NAFLD was diagnosed by imaging and/or histology after ruling out secondary causes of hepatic steatosis. RESULTS The majority of patients were male (60.7%), Asian (87.56%) and HBeAg-negative (66.7%). NAFLD patients compared to non-NAFLD were more likely HBeAg negative (74.3% vs 62.8%, P = .02), hypertensive (33.2% vs 22.8%, P = .009) and male (67.4% vs 57.3%, P = .02) with a higher mean BMI (25.4 ± 4.3 vs 23.8 ± 4.0 kg/m2 , P < .001). Both cohorts achieved similar rates of CVS (86% vs 88%) and BR (38% vs 41%) during the follow-up of up to 60 months (P > .05), but NAFLD had higher cumulative rates of CVS + BR, compared with non-NAFLD patients (32.5% vs 22.8%, P = .03). In multivariate analyses, NAFLD was not independently associated with CVS and/or BR outcomes. Receipt of entecavir or tenofovir (vs older therapies) and lower baseline HBV DNA or higher ALT were positively associated with achieving CVS or BR. CONCLUSION Concomitant NAFLD had no impact on the long-term rates of CVS and/or BR in treated CHB patients.
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Affiliation(s)
- Jie Li
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China.,Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Kevin T Chaung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Joseph K Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.,Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
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Nguyen VH, Le AK, Trinh HN, Chung M, Johnson T, Wong C, Wong C, Zhang J, Li J, Levitt BS, Nguyen HA, Nguyen KK, Henry L, Cheung R, Nguyen MH. Poor Adherence to Guidelines for Treatment of Chronic Hepatitis B Virus Infection at Primary Care and Referral Practices. Clin Gastroenterol Hepatol 2019; 17:957-967.e7. [PMID: 30326298 DOI: 10.1016/j.cgh.2018.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/07/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The American Association for the Study of Liver Diseases (AASLD) guidelines for treatment of chronic hepatitis B virus (HBV) infection have changed with time. We assessed rates of treatment evaluation and initiation in patients with chronic HBV infection from different practice settings in the past 14 years. METHODS Treatment-naive patients with chronic HBV infection were recruited from different practice settings in California from January 2002 through December 2016. The study population comprised 4130 consecutive, treatment-naive patients with chronic HBV infection seen by community primary care physicians (n = 616), community gastroenterologists (n = 2251), or university hepatologists (n = 1263). Treatment eligibility was assessed using data from the first 6 months after initial presentation based on AASLD criteria adjusted for changes over time. RESULTS Within the first 6 months of care, the proportions of patients evaluated by all 3 relevant tests (measurements of alanine aminotransferase, hepatitis B virus e antigen, and HBV DNA levels) were as follows: 36.69% in community primary care, 59.80% in gastroenterologist care, and 79.97% in hepatology care (P < .0001 among the 3 groups). Higher proportions of patients were eligible for treatment in specialty practices: 12.76% in community primary care, 24.96% in gastroenterologist care, and 29.43% in hepatology care (P < .0001). Among treatment-eligible patients, there was no significant difference in the proportions of patients who began antiviral therapy between those receiving treatment from a gastroenterologist (55.65%) vs a hepatologist (57.90%; P = .56). Of 243 evaluable patients receiving community primary care, only 31 were eligible for treatment and only 12 of these (38.71%) received treatment. CONCLUSIONS In an analysis of patients receiving care for chronic HBV infection, we found the proportions evaluated and receiving treatment to be suboptimal, according to AASLD criteria, in all practice settings. However, rates of evaluation and treatment were lowest for patients receiving community primary care.
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Affiliation(s)
- Vy H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; University of California, Berkeley, California
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Huy N Trinh
- San Jose Gastroenterology, San Jose, California
| | - Mimi Chung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Princeton University, Princeton, New Jersey
| | - Tiffani Johnson
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; University of California, Berkeley, California
| | | | | | - Jian Zhang
- Chinese Hospital, San Francisco, California
| | - Jiayi Li
- Gastroenterology, Palo Alto Medical Foundation, Mountain View, California
| | | | | | | | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; VA Palo Alto Health Care System, Palo Alto, California
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California.
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10
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Trinh S, Le AK, Chang ET, Hoang J, Jeong D, Chung M, Lee MH, Wang U, Henry L, Cheung R, Nguyen MH. Changes in Renal Function in Patients With Chronic HBV Infection Treated With Tenofovir Disoproxil Fumarate vs Entecavir. Clin Gastroenterol Hepatol 2019; 17:948-956.e1. [PMID: 30130625 DOI: 10.1016/j.cgh.2018.08.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/12/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is unclear whether drugs used to treat chronic hepatitis B virus (HBV) infection cause significant renal impairment. We compare adjusted mean estimated glomerular filtration rates (eGFR; mL/min/1.73 m2) of patients with chronic HBV infection treated with tenofovir disoproxil fumarate (TDF) vs patients treated with entecavir. METHODS We performed a retrospective study of patients with chronic HBV infections treated with TDF (n = 239) or entecavir (n = 171), from 2000 through 2016, followed for a mean time of 43-46 months. Levels of serum creatinine were measured ≥12 months while patients received treatment. Patients did not have prior exposure to adefovir or HCV, HDV, or HIV co-infection. We performed propensity score matching (PSM) for age, sex, presence of hypertension, diabetes mellitus, baseline eGFR, cirrhosis, and follow-up duration. We performed multivariate generalized linear modeling, adjusting for cirrhosis, diabetes, and hypertension, to estimate adjusted mean eGFR for matched and unmatched cohorts. Cox regression was used to identify predictors of renal impairment. RESULTS eGFRs were ≥60, after PSM, in 116 patients given entecavir and in 116 patients given TDF; eGFRs were <60 in 32 patients given entecavir and 26 patients given TDF. Multivariate generalized linear modeling of the unmatched overall and <60 eGFR cohorts revealed significantly lower adjusted mean eGFRs in patients given TDF (all P < .001). However, in the eGFR ≥60 PSM cohort, the adjusted mean eGFR was similar between patients receiving either treatment. In Cox regression analysis, TDF was not associated with mild or moderate renal impairment compared with entecavir. CONCLUSION In a retrospective study of patients with chronic HBV infections treated with TDF vs entecavir, we found that TDF was not associated with higher risk of worsening renal function during short- or intermediate-term follow-up periods, among patients without significant renal impairment. Additional studies, with longer follow-up periods, are needed because treatment for chronic HBV infection is generally long term or life-long. For patients with baseline renal impairment, significant renal decline was among patients given TDF compared to patients given entecavir.
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Affiliation(s)
- Sam Trinh
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
| | - Ellen T Chang
- Stanford Cancer Institute, Stanford, California; Center for Health Sciences, Exponent, Inc, Menlo Park, California
| | - Joseph Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
| | - Donghak Jeong
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
| | - Mimi Chung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California; Princeton University, Princeton, New Jersey
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Uerica Wang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
| | - Linda Henry
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California; Division of Gastroenterology, Palo Alto Veterans Administration Healthcare System, Palo Alto, California
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California.
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11
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Wei MT, Le AK, Chang MS, Hsu H, Nguyen P, Zhang JQ, Wong C, Wong C, Cheung R, Nguyen MH. Antiviral therapy and the development of osteopenia/osteoporosis among Asians with chronic hepatitis B. J Med Virol 2019; 91:1288-1294. [PMID: 30776311 DOI: 10.1002/jmv.25433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Recent studies have suggested a potential increase in the incidence of osteoporosis for patients receiving tenofovir disoproxil fumarate (TDF), but this issue remains controversial. METHODS The retrospective cohort study of 1224 Asian chronic hepatitis B (CHB) patients greater than 18 years without baseline osteopenia/osteoporosis seen at four US centers from 2008 to 2016. Patients were categorized into three groups-treatment-naive patients who initiated therapy with TDF (1) or entecavir (ETV) (2), or untreated patients (3). Patients were followed until the development of osteopenia/osteoporosis or end of the study. RESULTS Of the 1224 study patients, 276 were treated with TDF, 335 with ETV, and 613 were untreated. The prevalence of cirrhosis was lower for untreated patients (2.6% vs 16.3% for TDF and 17.6% for ETV; P < 0.001). The 8-year cumulative incidence rate of osteopenia/osteoporosis was 13.17% for TDF, 15.09% for ETV, and 10.17% for untreated patients, with no statistically significant difference among the three groups ( P = 0.218). On multivariate Cox regression controlling for demographics, osteoporosis risk factors, albumin, and hepatitis B virus (HBV) DNA levels, neither TDF (adjusted hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.34 and 1.59) nor ETV (adjusted HR = 0.98; 95% CI: 0.51 and 1.90) were associated with increased osteopenia/osteoporosis risk compared with untreated patients. CONCLUSIONS Our retrospective study suggests that there is no significant increase in the incidence of osteopenia/osteoporosis for patients with CHB treated with TDF or ETV during a median follow-up of about 4 to 5 years. However, further study with longer follow-up is needed as an anti-HBV therapy, which is often lifelong or long-term and the development of osteopenia/osteoporosis can be a slow process.
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Affiliation(s)
- Mike T Wei
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - An K Le
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Matthew S Chang
- Department of Gastroenterology, Kaiser Permanente, Northern California, Santa Clara, California
| | - Holden Hsu
- Department of Medical Research, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pauline Nguyen
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | | | - Chris Wong
- C. Wong Clinic, San Francisco, California
| | | | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mindie H Nguyen
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
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12
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Chen VL, Yeh ML, Le AK, Jun M, Saeed WK, Yang JD, Huang CF, Lee HY, Tsai PC, Lee MH, Giama N, Kim NG, Nguyen PP, Dang H, Ali HA, Zhang N, Huang JF, Dai CY, Chuang WL, Roberts LR, Jun DW, Lim YS, Yu ML, Nguyen MH. Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience. Aliment Pharmacol Ther 2018; 48:44-54. [PMID: 29797518 DOI: 10.1111/apt.14801] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/02/2018] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) worldwide. It remains incompletely understood in the real world how anti-viral therapy affects survival after HCC diagnosis. METHODS This was an international multicentre cohort study of 2518 HBV-related HCC cases diagnosed between 2000 and 2015. Cox proportional hazards models were utilised to estimate hazard ratios (HR) with 95% (CI) for anti-viral therapy and cirrhosis on patients' risk of death. RESULTS Approximately, 48% of patients received anti-viral therapy at any time, but only 17% were on therapy at HCC diagnosis (38% at US centres, 11% at Asian centres). Anti-viral therapy would have been indicated for >60% of the patients not on anti-viral therapy based on American criteria. Patients with cirrhosis had lower 5-year survival (34% vs 46%; P < 0.001) while patients receiving anti-viral therapy had increased 5-year survival compared to untreated patients (42% vs 25% with cirrhosis and 58% vs 36% without cirrhosis; P < 0.001 for both). Similar findings were seen for other patient subgroups by cancer stages and cancer treatment types. Anti-viral therapy was associated with a decrease in risk of death, whether started before or after HCC diagnosis (adjusted HR 0.62 and 0.79, respectively; P < 0.001). CONCLUSIONS Anti-viral therapy improved overall survival in patients with HBV-related HCC across cancer stages and treatment types but was underutilised at both US and Asia centres. Expanded use of anti-viral therapy in HBV-related HCC and better linkage-to-care for HBV patients are needed.
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Affiliation(s)
- V L Chen
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI, USA.,Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - M-L Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - A K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - M Jun
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - W K Saeed
- Division of Gastroenterology, Hanyang University Medical Center, Seoul, Korea
| | - J D Yang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - C-F Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H Y Lee
- Division of Gastroenterology, Hanyang University Medical Center, Seoul, Korea
| | - P-C Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M-H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - N Giama
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - N G Kim
- Stanford University School of Medicine, Stanford, CA, USA
| | - P P Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - H Dang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
| | - H A Ali
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - N Zhang
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - J-F Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C-Y Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - W-L Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - L R Roberts
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - D W Jun
- Division of Gastroenterology, Hanyang University Medical Center, Seoul, Korea
| | - Y-S Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M-L Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA
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13
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Gilman AJ, Le AK, Zhao C, Hoang J, Yasukawa LA, Weber SC, Vierling JM, Nguyen MH. Autoantibodies in chronic hepatitis C virus infection: impact on clinical outcomes and extrahepatic manifestations. BMJ Open Gastroenterol 2018; 5:e000203. [PMID: 29755758 PMCID: PMC5942460 DOI: 10.1136/bmjgast-2018-000203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 12/16/2022] Open
Abstract
Goals To examine the role that autoantibodies (auto-abs) play in chronic hepatitis C virus (HCV) regarding demographics, presence of extrahepatic manifestations and long-term outcomes in a large US cohort. Background Auto-abs have been reported to be prevalent in patients with chronic HCV infection, but data on the natural history of these patients are limited. Study The study included 1556 consecutive patients with HCV without concurrent HIV and/or HBV who had testing for antinuclear antibody (ANA), antimitochondrial antibody (AMA), antismooth muscle antibody (ASMA) and/or antiliver kidney microsomal antibody (LKM). Primary outcomes included development of cirrhosis, hepatic decompensations, hepatocellular carcinoma (HCC), mortality and/or sustained virological response (SVR) to antiviral therapy. Results A total of 388 patients tested positive for any auto-ab (ANA 21.8%, ASMA 13.3%, AMA 2.2% and LKM 1.2%). Patients who tested positive versus negative were more likely to be women (29.3% vs 20.9%, p<0.001) and less likely to achieve SVR with most treated patients receiving interferon-based therapies (37.2% vs 47.1%, p=0.031). There was no difference between groups for baseline laboratory data, disease state or rate of extrahepatic manifestations (42.8% vs 45.0%, p=0.44). Kaplan-Meier analysis revealed no statistically significant difference between groups for the 10-year development of cirrhosis, hepatic decompensations, HCC nor survival. Furthermore, auto-ab positivity was only found to be a predictor for a lower rate of SVR on multivariate analysis (adjusted OR=1.61, 95 % CI 1.00 to 2.58, p=0.048). Conclusions In our cohort, auto-ab positivity was common, especially in women, and predicted a lower rate of SVR but otherwise had no impact on the natural history of chronic HCV or presence of extrahepatic manifestations.
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Affiliation(s)
- Andrew J Gilman
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
| | - Changqing Zhao
- Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, ShangHai, China
| | - Joseph Hoang
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
| | - Lee A Yasukawa
- Center for Clinical Informatics, Stanford University, Stanford, California, USA
| | - Susan C Weber
- Center for Clinical Informatics, Stanford University, Stanford, California, USA
| | - John M Vierling
- Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA
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Le AK, Garcia G, Nguyen MH. Editorial: hepatitis C virus (HCV) disease progression - HCV cure and the elimination of the "ethnic slope". Authors' reply. Aliment Pharmacol Ther 2017; 46:1012-1013. [PMID: 29052853 DOI: 10.1111/apt.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- A K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, US
| | - G Garcia
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, US
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, US
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15
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Le AK, Zhao C, Hoang JK, Tran SA, Chang CY, Jin M, Nguyen NH, Yasukawa LA, Zhang JQ, Weber SC, Garcia G, Nguyen MH. Ethnic disparities in progression to advanced liver disease and overall survival in patients with chronic hepatitis C: impact of a sustained virological response. Aliment Pharmacol Ther 2017; 46:605-616. [PMID: 28766727 DOI: 10.1111/apt.14241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/04/2017] [Accepted: 07/08/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C (CHC) can lead to cirrhosis and hepatocellular carcinoma (HCC). A sustained virological response (SVR) is associated with improved outcomes, however, its impact on different ethnic groups is unknown. AIM To evaluate ethnic differences in the natural history of CHC and the impact of SVR. METHODS We conducted a cohort study of 8039 consecutive adult CHC patients seen at two medical centres in California between January 1997 and June 2016. Individual chart review confirmed CHC diagnosis. RESULTS Asian and Hispanic but not African American patients had significantly higher cirrhosis and HCC incidence than Caucasians. On multivariate analysis, Hispanic ethnicity was independently associated with increased cirrhosis (adjusted HR 1.37, CI, confidence interval 1.10-1.71, P=.006) and HCC risk (adjusted HR 1.47, CI 1.13-1.92, P=.004) compared to Caucasian. Asian ethnicity had a significant association with cirrhosis (adjusted HR 1.28, CI 1.02-1.61, P=.034) and HCC risk (adjusted HR 1.29, CI 0.94-1.77, P=.025). In patients who achieved SVR, Hispanic ethnicity was no longer independently associated with cirrhosis (adjusted HR 1.76, CI 0.66-4.71, P=.26) or HCC (adjusted HR 1.05, CI 0.27-4.08, P=.94); nor was Asian ethnicity (adjusted HR 0.62, CI 0.21-1.82, P=.38 for cirrhosis; 2.01, CI 0.63-6.36, P=.24 for HCC). Similar findings were observed with overall survival among the ethnicities by SVR status. CONCLUSION Hispanic and Asian ethnicity was independently associated with increased cirrhosis and HCC risk. Achieving an SVR eliminates the ethnic disparity in liver disease progression and overall survival between Hispanic and Asian vs Caucasian CHC patients.
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Affiliation(s)
- A K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - C Zhao
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai, China
| | - J K Hoang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - S A Tran
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Stanford University, Palo Alto, CA, USA
| | - C Y Chang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - M Jin
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Biostatistics, Zhejiang University, Hangzhou, China
| | - N H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - L A Yasukawa
- Center for Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - J Q Zhang
- Chinese Hospital, San Francisco, CA, USA
| | - S C Weber
- Center for Clinical Informatics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - G Garcia
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
| | - M H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
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16
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Chen VL, Le AK, Kim NG, Kim LH, Nguyen NH, Nguyen PP, Zhao C, Nguyen MH. Effects of Cirrhosis on Short-term and Long-term Survival of Patients With Hepatitis B-related Hepatocellular Carcinoma. Clin Gastroenterol Hepatol 2016; 14:887-895.e1. [PMID: 26820401 DOI: 10.1016/j.cgh.2015.12.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/15/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Hepatitis B virus (HBV) is the most common cause of hepatocellular carcinoma (HCC) worldwide. Unlike other liver diseases, HBV can cause HCC in the absence of cirrhosis. We investigated whether features of HCC in patients with HBV infection without cirrhosis and survival times differ from those of patients who develop HCC after cirrhosis. METHODS We performed a retrospective cohort study of 487 consecutive cases of HBV-related HCC who were seen from 2000 through 2014 at a tertiary care center. Laboratory values, imaging results, and treatment information were obtained from subjects' medical records. Symptoms of HCC included weight loss, abdominal pain, or new hepatic decompensation. The primary outcome was overall survival, which was categorized as short-term survival (up to 3 years after the diagnosis of HCC) or long-term survival (3-10 years after diagnosis). RESULTS The mean tumor size at diagnosis was significantly larger in patients without cirrhosis (6.4 ± 4.3 cm) than in patients with cirrhosis (5.0 ± 3.8 cm) (P = .0009). A significantly larger proportion of patients without cirrhosis had symptoms at diagnosis (43.8% vs 35.4% in patients without cirrhosis, P = .09). A significantly higher proportion of patients without cirrhosis survived for the long-term (P = .003), but there was no significant difference between groups in short-term survival (P = .37). Notably, the same proportions of asymptomatic patients with and without cirrhosis survived for the short-term (64.3% vs 64.2%, P = .73), but a lower proportion of asymptomatic patients with cirrhosis survived for the long-term (P = .015). In multivariate Cox regression analysis, cirrhosis was an independent predictor of death in 3-10 years (hazard ratio, 3.76; P = .003) but not in less than 3 years (P = .48). Symptoms at diagnosis predicted death within 3 years (hazard ratio, 1.76; P =.006) but not in 3-10 years (P = .15). CONCLUSIONS Patients with HBV infection and HCC without cirrhosis present with larger tumors, and a larger percentage have symptoms of cancer than patients with cirrhosis. This may indicate that HCC surveillance is less than optimal for patients with HBV infection without cirrhosis. Despite this suboptimal surveillance, patients without cirrhosis have higher long-term survival than those with cirrhosis, especially when asymptomatic at diagnosis.
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Affiliation(s)
- Vincent L Chen
- Department of Medicine, Stanford University Medical Center, Palo Alto, California
| | - An K Le
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Nathan G Kim
- School of Medicine, Stanford University, Stanford, California
| | - Lily H Kim
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; School of Medicine, Stanford University, Stanford, California
| | - Nghia H Nguyen
- Department of Medicine, University of California in San Diego, San Diego, California
| | - Pauline P Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Changqing Zhao
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Cirrhosis, Institute of Liver Disease, Shuguang Hospital, Shanghai University of T.C.M., Shanghai, P.R.C
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California.
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