1
|
Wong GLH, Chan HLY, Tse YK, Yuen PC, Wong VWS. Machine learning in predicting hepatocellular carcinoma in patients with chronic viral hepatitis in Hong Kong: abridged secondary publication. Hong Kong Med J 2023; 29 Suppl 1:14-17. [PMID: 36919212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Affiliation(s)
- G L H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y K Tse
- Department of Computer Science, Hong Kong Baptist University, Hong Kong SAR, China
| | - P C Yuen
- Department of Computer Science, Hong Kong Baptist University, Hong Kong SAR, China
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Chan HLY, Wong GLH, Wong VWS, Wong MCS, Chan CYK, Singh S. Questionnaire survey on knowledge, attitudes, and behaviour towards viral hepatitis among the Hong Kong public. Hong Kong Med J 2021; 28:45-53. [PMID: 34294603 DOI: 10.12809/hkmj219463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION We aimed to identify gaps in knowledge, attitudes, and behaviours towards viral hepatitis among the Hong Kong public and provide insights to optimise local efforts towards achieving the World Health Organization's viral hepatitis elimination target. METHODS A descriptive, cross-sectional, self-reported web-based questionnaire was administered to 500 individuals (aged ≥18 years) in Hong Kong. Questionnaire items explored the awareness and perceptions of viral hepatitis-related liver disease(s) and associated risk factors in English or traditional Chinese. RESULTS The majority (>80%) were aware that chronic hepatitis B and/or C could increase the risks of developing liver cirrhosis, cancer, and/or failure. Only 55.8% had attended health screenings in the past 2 years, and 67.6% were unaware of their family's history of liver diseases. Misperceptions surrounding the knowledge and transmission risks of viral hepatitis strongly hint at the presence of social stigmatisation within the community. Many misperceived viral hepatitis as airborne or hereditary, and social behaviours (casual contact or dining with an infected person) as a transmission route. Furthermore, 62.4% were aware of hepatitis B vaccination, whereas 19.0% knew that hepatitis C cannot be prevented by vaccination. About 70% of respondents who were aware of mother-to-child transmission were willing to seek medical consultation in the event of pregnancy. Gaps in knowledge as well as the likelihood of seeking screening were observed across all age-groups and education levels. CONCLUSIONS Comprehensive hepatitis education strategies should be developed to address gaps in knowledge among the Hong Kong public towards viral hepatitis, especially misperceptions relevant to social stigmatisation and the importance of preventive measures, including vaccination and screening, when exposed to risk factors.
Collapse
Affiliation(s)
- H L Y Chan
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,Department of Internal Medicine, Union Hospital, Hong Kong
| | - G L H Wong
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - V W S Wong
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - M C S Wong
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.,JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | | | | |
Collapse
|
3
|
Chan HLY, Messinger D, Papatheodoridis GV, Cornberg M, Xie Q, Piratvisuth T, Ren H, Kennedy PT, Thompson A, Caputo A, Bakalos G, Pavlovic V, Lampertico P. A baseline tool for predicting response to peginterferon alfa-2a in HBeAg-positive patients with chronic hepatitis B. Aliment Pharmacol Ther 2018; 48:547-555. [PMID: 29956827 DOI: 10.1111/apt.14862] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 11/24/2017] [Revised: 12/21/2017] [Accepted: 06/06/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Peginterferon induces off-treatment responses in approximately one-third of patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B. AIM To develop an easy-to-use baseline prediction score to identify hepatitis B virus (HBV) genotype B-/C-infected HBeAg-positive Asian patients likely to respond to peginterferon alfa-2a. METHODS Generalised additive models, multiple logistic regression (MLR) analysis and internal validation methods were applied to data from 647 HBeAg-positive patients from China, Hong Kong and Taiwan to develop a scoring system to predict response 24 weeks after completing a 48-week course of peginterferon alfa-2a. RESULTS Five baseline factors (age, sex, alanine aminotransferase ratio, hepatitis B surface antigen (HBsAg) level and HBV DNA level) were retained in the final MLR for HBeAg seroconversion and used to develop a scoring system from 0 to 7. Among patients with scores of 0-1, 2-3, 4 or ≥5, HBeAg seroconversion was achieved in 6.4% (6/94), 23.0% (61/265), 36.4% (67/184) and 54.8% (57/104), respectively, and a combined response (HBeAg seroconversion plus HBV DNA <2000 IU/mL) in 5.3% (5/94), 12.8% (34/265), 25.0% (46/184) and 36.5% (38/104), respectively. Among patients with scores of 0-1, 2-3, 4 or ≥5, 57.0% (53/93), 12.3% (31/253), 3.4% (6/178) and 1.0% (1/100) had HBsAg ≥20 000 IU/mL at treatment Week 12; only 3/91 (3.3%) with HBsAg ≥20 000 IU/mL experienced a combined response at 24 weeks post-treatment (negative predictive value = 97% [88/91]). CONCLUSION A pre-treatment scoring system using readily available baseline characteristics identifies HBeAg-positive Asian patients likely to experience sustained HBeAg seroconversion after treatment with peginterferon alfa-2a.
Collapse
|
4
|
Chuang WL, Jia J, Chan HLY, Han KH, Tanwandee T, Tan D, Chen X, Gane E, Piratvisuth T, Chen L, Xie Q, Sung JJY, Messinger D, Wat C, Bakalos G, Liaw YF. Responses are durable for up to 5 years after completion of peginterferon alfa-2a treatment in hepatitis B e antigen-positive patients. Aliment Pharmacol Ther 2018. [PMID: 29520872 DOI: 10.1111/apt.14595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND In the large randomised NEPTUNE study, peginterferon alfa-2a 180 μg/wk for 48 weeks produced higher hepatitis B e antigen (HBeAg) seroconversion rates 24 weeks post-treatment (36%) than a lower dose (90 μg/wk) and/or shorter duration (24 weeks) (range 14%-26%). AIM To determine seroconversion rates 5 years after completion of treatment in NEPTUNE. METHODS HBeAg-positive patients who completed 24 weeks' follow-up in NEPTUNE (with peginterferon alfa-2a 90 μg/wk × 24 weeks [group 1]; 180 μg/wk × 24 weeks [2]; 90 μg/wk × 48 weeks [3] or 180 μg/wk × 48 weeks [4]) were followed up. RESULTS Three hundred and eighty three of the 544 patients in the original study were enrolled in the long-term follow-up study. Many patients (196 overall; more in groups 1-3 than 4) received nucleos(t)ide analogues or immunomodulators during follow-up, and more patients had missing data at year 5 in groups 2 and 4 (48 weeks, 50/112) than in groups 1 and 3 (24 weeks, 23/103), which confounds the planned per-protocol analysis. HBeAg seroconversion rates in groups 1, 2, 3 and 4 at year 5 were 47.5%, 50.7%, 52.2% and 67.1%, respectively, (odds ratio for group 4 versus 1-3: 2.02; 95% CI 1.21, 3.38), using multiple imputation methods for missing measurements. CONCLUSION Seroconversion rates are durable for up to 5 years after completion of peginterferon alfa-2a therapy and, consistent with NEPTUNE, the results suggest that the licensed regimen (180 μg × 48 weeks) is more efficacious for HBeAg-positive patients than a lower dose and/or shorter treatment duration.
Collapse
|
5
|
Younossi ZM, Chan HLY, Dan YY, Lee MH, Lim YS, Kruger E, Tan SC. Impact of ledipasvir/sofosbuvir on the work productivity of genotype 1 chronic hepatitis C patients in Asia. J Viral Hepat 2018; 25:228-235. [PMID: 29053909 DOI: 10.1111/jvh.12808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/31/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022]
Abstract
Chronic, untreated hepatitis C virus (HCV) infection is associated with a poor clinical prognosis and a detrimental impact on patients' lives, including on work productivity. To estimate the value of productivity losses due to genotype 1 (GT1) HCV infection in Hong Kong, Singapore, South Korea and Taiwan and to estimate the potential productivity gains associated with treating patients with ledipasvir/sofosbuvir (LDV/SOF) therapy, an economic model was developed with a time horizon of 1 year. Hepatitis C virus patients entered the model at 12 weeks post-treatment, having achieved or not achieved sustained virological response (SVR). Absenteeism and presenteeism rates were taken from a pooled analysis of data from the ION 1-3 studies. These rates were converted into hours of lost productivity, multiplied by the average wage and applied to the total employed, adult GT1 population in each country. Results were compared assuming no treatment, and assuming all patients were treated with LDV/SOF. Total productivity losses due to untreated HCV were: $11.3 million, $17.1 m, $146.0 m and $349.1 m in Hong Kong, Singapore, South Korea and Taiwan. LDV/SOF treatment resulted in economic gains of $4.5 m, $6.8 m, $58.7 m and $138 m, respectively. These gains were due to reduced presenteeism. The results were sensitive to changes in the prevalence of HCV and the average wage. In conclusion, productivity losses due to untreated HCV infection represent a substantial economic burden. By instituting universal HCV treatment with LDV/SOF (or other therapies with high SVR rates), productivity gains can be achieved.
Collapse
Affiliation(s)
- Z M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - H L Y Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Y Y Dan
- University Medicine Cluster, National University Hospital, Singapore City, Singapore
| | - M H Lee
- National Yang-Ming University, Taipei, Taiwan
| | - Y-S Lim
- Department of Gastroenterology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - E Kruger
- IMS Health, Singapore City, Singapore
| | - S C Tan
- IMS Health, Singapore City, Singapore
| |
Collapse
|
6
|
Maaroufi A, Vince A, Himatt SM, Mohamed R, Fung J, Opare-Sem O, Workneh A, Njouom R, Al Ghazzawi I, Abdulla M, Kaliaskarova KS, Owusu-Ofori S, Abdelmageed MK, Adda D, Akin O, Al Baqali A, Al Dweik N, Al Ejji K, Al Kaabi S, Al Naamani K, Al Qamish J, Al Sadadi M, Al Salman J, AlBadri M, Al-Busafi SA, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Bane A, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Cardenas I, Chan HLY, Chen CJ, Chen DS, Chen PJ, Chien RN, Chuang WL, Cuellar D, Derbala M, Elbardiny AA, Estes C, Farag E, Gamkrelidze I, Garcia V, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Hamoudi W, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Layden J, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Malu AO, Mateva L, Mitova R, Morović M, Murphy K, Mustapha B, Nde H, Nersesov A, Ngige E, Njoya O, Nonković D, Obekpa S, Oguche S, Okolo EE, Omede O, Omuemu C, Ondoa P, Phillips RO, Prokopenko YN, Razavi H, Razavi-Shearer D, Redae B, Reic T, Rinke de Wit T, Rios C, Robbins S, Roberts LR, Sanad SJ, Schmelzer JD, Sharma M, Simonova M, Su TH, Sultan K, Tan SS, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Wani HU, Wong VWS, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Razavi-Shearer K. Historical epidemiology of hepatitis C virus in select countries-volume 4. J Viral Hepat 2017; 24 Suppl 2:8-24. [PMID: 29105285 DOI: 10.1111/jvh.12762] [Citation(s) in RCA: 26] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Abstract
Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.
Collapse
Affiliation(s)
- A Maaroufi
- National Institute of Health Administration, Rabat, Morocco
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | | | | | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahrain
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | | | - D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- National Institute of Health Administration, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, SAR, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, SAR, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, County of Dalmatia, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR, China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, SAR, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantology, Astana, Kazakhstan
| | - M Youbi
- National Institute of Health Administration, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | | |
Collapse
|
7
|
Chan HLY, Chen CJ, Omede O, Al Qamish J, Al Naamani K, Bane A, Tan SS, Simonova M, Cardenas I, Derbala M, Akin O, Phillips RO, Abdelmageed MK, Abdulla M, Adda D, Al Baqali A, Al Dweik N, Al Ejji K, Al Ghazzawi I, Al Kaabi S, Al Sadadi M, Al Salman J, AlBadri M, Al-Busafi SA, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Chen DS, Chen PJ, Chien RN, Chuang WL, Cuellar D, Elbardiny AA, Estes C, Farag E, Fung J, Gamkrelidze I, Garcia V, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Hamoudi W, Himatt SM, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kaliaskarova KS, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Layden J, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Maaroufi A, Malu AO, Mateva L, Mitova R, Mohamed R, Morović M, Murphy K, Mustapha B, Nersesov A, Ngige E, Njouom R, Njoya O, Nonković D, Obekpa S, Oguche S, Okolo EE, Omuemu C, Ondoa P, Opare-Sem O, Owusu-Ofori S, Prokopenko YN, Razavi H, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reic T, Rinke de Wit T, Rios C, Robbins S, Roberts LR, Sanad SJ, Schmelzer JD, Sharma M, Su TH, Sultan K, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Vince A, Wani HU, Wong VWS, Workneh A, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Nde H. The present and future disease burden of hepatitis C virus infections with today's treatment paradigm: Volume 4. J Viral Hepat 2017; 24 Suppl 2:25-43. [PMID: 29105283 DOI: 10.1111/jvh.12760] [Citation(s) in RCA: 17] [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: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022]
Abstract
Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.
Collapse
Affiliation(s)
- H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | | | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahsrain
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, SAR, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China
| | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, SAR, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A Maaroufi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, County of Dalmatia, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR, China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, SAR, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantology, Astana, Kazakhstan
| | - M Youbi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| |
Collapse
|
8
|
Chen DS, Hamoudi W, Mustapha B, Layden J, Nersesov A, Reic T, Garcia V, Rios C, Mateva L, Njoya O, Al-Busafi SA, Abdelmageed MK, Abdulla M, Adda D, Akin O, Al Baqali A, Al Dweik N, Al Ejji K, Al Ghazzawi I, Al Kaabi S, Al Naamani K, Al Qamish J, Al Sadadi M, Al Salman J, AlBadri M, Al-Romaihi HE, Ampofo W, Antonov K, Anyaike C, Arome F, Bane A, Blach S, Borodo MM, Brandon SM, Bright B, Butt MT, Cardenas I, Chan HLY, Chen CJ, Chen PJ, Chien RN, Chuang WL, Cuellar D, Derbala M, Elbardiny AA, Estes C, Farag E, Fung J, Gamkrelidze I, Genov J, Ghandour Z, Ghuloom M, Gomez B, Gunter J, Habeeb J, Hajelssedig O, Himatt SM, Hrstic I, Hu CC, Huang CF, Hui YT, Jahis R, Jelev D, John AK, Kaliaskarova KS, Kamel Y, Kao JH, Khamis J, Khattabi H, Khoudri I, Konysbekova A, Kotzev I, Lai MS, Lao WC, Lee MH, Lesi O, Li M, Lo A, Loo CK, Lukšić B, Maaroufi A, Malu AO, Mitova R, Mohamed R, Morović M, Murphy K, Nde H, Ngige E, Njouom R, Nonković D, Obekpa S, Oguche S, Okolo EE, Omede O, Omuemu C, Ondoa P, Opare-Sem O, Owusu-Ofori S, Phillips RO, Prokopenko YN, Razavi H, Razavi-Shearer D, Razavi-Shearer K, Redae B, Rinke de Wit T, Robbins S, Roberts LR, Sanad SJ, Sharma M, Simonova M, Su TH, Sultan K, Tan SS, Tchernev K, Tsang OTY, Tsang S, Tzeuton C, Ugoeze S, Uzochukwu B, Vi R, Vince A, Wani HU, Wong VWS, Workneh A, Yacoub R, Yesmembetov KI, Youbi M, Yuen MF, Schmelzer JD. Strategies to manage hepatitis C virus infection disease burden-Volume 4. J Viral Hepat 2017; 24 Suppl 2:44-63. [PMID: 29105286 DOI: 10.1111/jvh.12759] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 01/03/2023]
Abstract
The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 17 countries in Africa, Asia, Europe, Latin America and the Middle East, and interventions for achieving the Global Health Sector Strategy on viral hepatitis targets-"WHO Targets" (65% reduction in HCV-related deaths, 90% reduction in new infections and 90% of infections diagnosed by 2030) were considered. Scaling up treatment and diagnosis rates over time would be required to achieve these targets in all but one country, even with the introduction of high SVR therapies. The scenarios developed to achieve the WHO Targets in all countries studied assumed the implementation of national policies to prevent new infections and to diagnose current infections through screening.
Collapse
Affiliation(s)
- D S Chen
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - W Hamoudi
- Department of Gastroenterology & Hepatology, Al Bashir Hospital, Amman, Jordan.,Jordan Ministry of Health, Amman, Jordan
| | | | - J Layden
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL, USA
| | - A Nersesov
- National Research Institute of Cardiology and Internal Diseases, Almaty, Kazakhstan
| | - T Reic
- European Liver Patients Association, Sint-Truiden, Belgium
| | - V Garcia
- Ministry of Public Health, Santo Domingo, Dominican Republic
| | - C Rios
- Department of Health Promotion and Disease Prevention, Ministry of Health and Social Protection, Bogota, Colombia
| | - L Mateva
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - O Njoya
- Research Laboratory on Viral Hepatitis & Health Communication, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - S A Al-Busafi
- Division of Gastroenterology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - M Abdulla
- Salmaniya Medical Complex, Manama, Bahrain
| | - D Adda
- Civil Society Network on Hepatitis, Abuja, Nigeria.,Chagro-Care Trust (CCT), Jalingo, Nigeria
| | - O Akin
- Federal Ministry of Health, Abuja, Nigeria
| | - A Al Baqali
- Al Kindi Specialised Hospital, Manama, Bahrain
| | - N Al Dweik
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Ejji
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Al Ghazzawi
- GI and Hepatology Department, Jordan Royal Medical Services, Amman, Jordan
| | - S Al Kaabi
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K Al Naamani
- Division of Gastroenterology and Hepatology, Department of Medicine, Armed Forces Hospital, Muscat, Oman
| | - J Al Qamish
- Gastroenterolgy Clinic, IBN Al-Nafees Hospital, Manama, Bahrain
| | | | | | - M AlBadri
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - W Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - K Antonov
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - C Anyaike
- Federal Ministry of Health, Abuja, Nigeria
| | - F Arome
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria
| | - A Bane
- Gastroenterology and Hepatology, Addis Ababa University Medical School, Addis Ababa, Ethiopia.,Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia
| | - S Blach
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - M M Borodo
- Aminu Kano Teaching Hospital, Kano, Nigeria.,Bayero University, Kano, Nigeria
| | - S M Brandon
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - B Bright
- LiveWell Initiative (LWI), Lagos, Nigeria
| | - M T Butt
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - I Cardenas
- Communicable Diseases Division, Ministry of Health and Social Protection, Bogota, Colombia
| | - H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | | | - P J Chen
- National Taiwan University, Taipei, Taiwan
| | - R N Chien
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - W L Chuang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - D Cuellar
- Department of Epidemiology and Demography, Ministry of Health and Social Protection, Bogota, Colombia
| | - M Derbala
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - C Estes
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Farag
- Ministry of Public Health Qatar, Doha, Qatar
| | - J Fung
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - I Gamkrelidze
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Genov
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - Z Ghandour
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Ghuloom
- Salmaniya Medical Complex, Manama, Bahrain
| | - B Gomez
- Pan American Health Organization, Washington, DC, USA
| | - J Gunter
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - J Habeeb
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Hajelssedig
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S M Himatt
- Ministry of Public Health Qatar, Doha, Qatar
| | - I Hrstic
- General Hospital Pula, Pula, Croatia
| | - C C Hu
- Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - C F Huang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Y T Hui
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - R Jahis
- Disease Control Division, Ministry of Health, Putrajaya, Malaysia
| | - D Jelev
- University Hospital "St. Ivan Rilski", Sofia, Bulgaria
| | - A K John
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K S Kaliaskarova
- Ministry of Healthcare and Social Development of the Republic of Kazakhstan, Astana, Kazakhstan.,Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - Y Kamel
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Miniya University, Minya, Egypt
| | - J H Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - J Khamis
- Salmaniya Medical Complex, Manama, Bahrain
| | - H Khattabi
- Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - I Khoudri
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A Konysbekova
- Republican Diagnostic Center, Astana, Kazakhstan.,University Medical Center, Astana, Kazakhstan
| | - I Kotzev
- University Hospital "St. Marina", Varna, Bulgaria
| | - M S Lai
- Department of Medicine, North District Hospital, Hong Kong, China
| | - W C Lao
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - M H Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - O Lesi
- University of Lagos, Lagos, Nigeria.,Lagos University Teaching Hospital, Lagos, Nigeria
| | - M Li
- Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China
| | - A Lo
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - C K Loo
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - B Lukšić
- Clinical Department of Infectious Diseases, Split University Hospital and Split University Medical School, Split, Croatia
| | - A Maaroufi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - A O Malu
- Benue State University Teaching Hospital, Makurdi, Nigeria
| | - R Mitova
- University Hospital "Queen Joanna", Sofia, Bulgaria
| | - R Mohamed
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - M Morović
- Department of Infectious Diseases, Zadar General Hospital, Zadar, Croatia
| | - K Murphy
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - H Nde
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - E Ngige
- Federal Ministry of Health, Abuja, Nigeria
| | - R Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - D Nonković
- Department of Epidemiology, Institute of Public Health, Split, Croatia
| | - S Obekpa
- Advocacy for the Prevention of Hepatitis in Nigeria, Jos, Nigeria.,Benue State University Teaching Hospital, Makurdi, Nigeria
| | - S Oguche
- Department of Pediatrics, University of Jos, Jos, Nigeria.,Department of Medicine, University of Jos, Jos, Nigeria.,Jos University Teaching Hospital, Jos, Nigeria
| | - E E Okolo
- Beacon Youth Initiative, Lafia, Nigeria
| | - O Omede
- Federal Ministry of Health, Abuja, Nigeria
| | - C Omuemu
- University of Benin, Benin City, Nigeria
| | - P Ondoa
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,African Society of Laboratory Medicine, Addis Ababa, Ethiopia
| | - O Opare-Sem
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - R O Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Y N Prokopenko
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan
| | - H Razavi
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | | | | | - B Redae
- Ethiopian Gastroenterological Association, Addis Ababa, Ethiopia.,St. Paul's Hospital Millennium College, Addis Ababa, Ethiopia
| | - T Rinke de Wit
- PharmAccess Foundation, Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - S Robbins
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| | - L R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S J Sanad
- BDF Hospital, Royal Medical Services, Riffa, Bahrain
| | - M Sharma
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - M Simonova
- Clinic of Gastroenterology, Military Medical Academy, Sofia, Bulgaria
| | - T H Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - K Sultan
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - S S Tan
- Department of Hepatology, Selayang Hospital, Selangor, Malaysia
| | | | - O T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital Authority, Hong Kong, SAR China
| | - S Tsang
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - C Tzeuton
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - S Ugoeze
- Federal Medical Centre, Jalingo, Nigeria
| | - B Uzochukwu
- Institute of Public Health, University of Nigeria, Nsukka, Nigeria
| | - R Vi
- Republican Coordination Center for Hepatology and Gastroenterology, Astana, Kazakhstan.,International HepatoTransplant Group, Astana, Kazakhstan
| | - A Vince
- Medical School University of Zagreb, University Hospital of Infectious Diseases Zagreb, Zagreb, Croatia
| | - H U Wani
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - A Workneh
- Non-Communicable Diseases Programme, World Health Organization, Addis Ababa, Ethiopia.,Federal Ministry of Health, Addis Ababa, Ethiopia
| | - R Yacoub
- Division of Gastroenterology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - K I Yesmembetov
- National Scientific Center of Oncology and Transplantation, Astana, Kazakhstan
| | - M Youbi
- Department of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - M F Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - J D Schmelzer
- Center for Disease Analysis (CDA), Lafayette, CO, USA
| |
Collapse
|
9
|
Marcellin P, Ahn SH, Chuang WL, Hui AJ, Tabak F, Mehta R, Petersen J, Lee CM, Ma X, Caruntu FA, Tak WY, Elkhashab M, Lin L, Wu G, Martins EB, Charuworn P, Yee LJ, Lim SG, Foster GR, Fung S, Morano L, Samuel D, Agarwal K, Idilman R, Strasser SI, Buti M, Gaeta GB, Papatheodoridis G, Flisiak R, Chan HLY. Predictors of response to tenofovir disoproxil fumarate plus peginterferon alfa-2a combination therapy for chronic hepatitis B. Aliment Pharmacol Ther 2016; 44:957-966. [PMID: 27629859 DOI: 10.1111/apt.13779] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 05/27/2016] [Revised: 06/17/2016] [Accepted: 08/04/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND In patients with chronic hepatitis B, tenofovir disoproxil fumarate (TDF) plus pegylated interferon (PEG-IFN) for 48-weeks results in higher rates of hepatitis B surface antigen (HBsAg) loss than either monotherapy. AIM To identify baseline and on-treatment factors associated with HBsAg loss at Week 72 and provide a model for predicting HBsAg loss in patients receiving combination therapy for 48 weeks. METHODS A secondary analysis of data from an open-label study where patients were randomised to TDF (300 mg/day, oral) plus PEG-IFN (PI, 180 μg/week, subcutaneous) for 48 weeks (TDF/PI-48w); TDF plus PEG-IFN for 16 weeks, TDF for 32 weeks (TDF/PI-16w+TDF-32w); TDF for 120 weeks (TDF-120w) or PEG-IFN for 48 weeks (PI-48w). Logistic regression methods were used to identify models that best predicted HBsAg loss at Week 72. RESULTS Rates of HBsAg loss at Week 72 were significantly higher in the TDF/PI-48w group (6.5%) than in the TDF/PI-16w+TDF-32w (0.5%), TDF-120w (0%) and PI-48w (2.2%) groups (P = 0.09). The only baseline factor associated with response was genotype A. HBsAg decline at Week 12 or 24 of treatment was associated with HBsAg loss at Week 72 (P < 0.001). HBsAg decline >3.5 log10 IU/mL at Week 24 in the TDF/PI-48w group resulted in a positive predictive value of 85% and a negative predictive value of 99% for HBsAg loss at Week 72. CONCLUSIONS HBsAg decline at Week 24 of TDF plus PEG-IFN combination therapy may identify patients who, after completing 48 weeks of treatment, have a better chance of achieving HBsAg loss at Week 72.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - L Lin
- Gilead Sciences, Inc., Foster City, CA, USA
| | - G Wu
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | - L J Yee
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Lampertico P, Chan HLY, Janssen HLA, Strasser SI, Schindler R, Berg T. Review article: long-term safety of nucleoside and nucleotide analogues in HBV-monoinfected patients. Aliment Pharmacol Ther 2016; 44:16-34. [PMID: 27198929 DOI: 10.1111/apt.13659] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 12/18/2015] [Revised: 01/15/2016] [Accepted: 04/21/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nucleos(t)ide analogues (NUCs) for chronic hepatitis B treatment achieve high rates of viral suppression and are generally well tolerated. Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are the currently preferred first-line agents. The safety of these agents in clinical practice is particularly relevant since long-term treatment is usually required. AIM To summarise and critically discuss recent real-world evidence on the safety of treatment with ETV or TDF in hepatitis B virus (HBV)-monoinfected patients. METHODS PubMed and conference proceedings up to 15th June 2015 were searched using the terms ((((Hepatitis_B) OR HBV) AND ((tenofovir) OR entecavir)) AND (((lactic_acidosis) OR bone) OR renal)). RESULTS In selected populations included in registration studies, both ETV and TDF were well tolerated with no clinically significant renal toxicity or lactic acidosis. Growing 'real-world' clinical experience with these agents includes some reports of ETV-associated lactic acidosis and TDF-associated renal impairment; however, evidence from cohort studies appears to be conflicting. In the case of ETV-related lactic acidosis, a small number of cases have been reported, all in patients with decompensated cirrhosis. The degree of association between TDF treatment and changes in markers of renal function varies between studies: discrepancies may result from the use of different definitions and cut-offs for reporting renal toxicities, and differences in patient populations. CONCLUSIONS Pre-treatment and on-treatment monitoring of eGFR and phosphorus, with prompt appropriate dose adjustment or treatment switch can minimise the impact of NUC renal toxicity. Standardisation of measures of renal impairment and identification of early molecular markers remain an unmet need.
Collapse
Affiliation(s)
- P Lampertico
- Division of Gastroenterology and Hepatology, "A.M. and A. Migliavacca" Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - H L Y Chan
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - H L A Janssen
- Toronto Centre for Liver Diseases, University Health Network, Toronto, ON, Canada
| | - S I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - R Schindler
- Department of Nephrology and Intensive Care, Campus Virchow, Charité - Universitätsmedizin, Berlin, Germany
| | - T Berg
- Section Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
11
|
Lai CL, Wong VWS, Yuen MF, Yang JC, Knox SJ, Mo H, Han LL, Brainard DM, Chan HLY. Sofosbuvir plus ribavirin for the treatment of patients with chronic genotype 1 or 6 hepatitis C virus infection in Hong Kong. Aliment Pharmacol Ther 2016; 43:96-101. [PMID: 26503414 DOI: 10.1111/apt.13429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 08/06/2015] [Revised: 09/08/2015] [Accepted: 09/25/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Hong Kong, most patients with hepatitis C virus (HCV) have either genotype 6a or 1b infection. AIM To evaluate the efficacy and safety of sofosbuvir with ribavirin in treatment-naïve patients in Hong Kong with HCV genotype 1 or 6. METHODS In an open-label study, patients were randomised to sofosbuvir 400 mg once daily plus ribavirin 1000-1200 divided twice daily for 12 (n = 10), 16 (n = 11) or 24 (n = 10) weeks. The primary endpoint was the percentage of patients with HCV RNA < LLOQ (lower limit of quantification, 25 IU/mL) 12 weeks after cessation of therapy (SVR12). RESULTS All 31 patients (20 HCV genotype 1 and 11 genotype 6) had HCV RNA < LLOQ by Week 4 of treatment and at their last on-treatment visit. SVR12 rates were high in all treatment groups: 100% (10/10) for 12 weeks, 100% (11/11) for 16 weeks and 90% (9/10) for 24 weeks of therapy. The only patient who did not reach SVR12 had genotype 1 HCV and relapsed at post-treatment Week 4. Sofosbuvir with ribavirin was generally well tolerated. The most common adverse events were malaise (13%) and upper respiratory tract infection (13%), followed by anaemia (10%). No patients experienced serious adverse events. One patient discontinued treatment at Week 16 because of an adverse event. The event, upper respiratory tract infection, was not considered treatment related by the investigator. This subject achieved SVR12. CONCLUSIONS The all-oral regimen sofosbuvir plus ribavirin is effective in treatment-naïve patients in Hong Kong with genotype 1 or 6 HCV. TRIAL REGISTRATION NUMBER NCT02021643.
Collapse
Affiliation(s)
- C L Lai
- Queen Mary Hospital, Hong Kong, China
| | - V W-S Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - M F Yuen
- Queen Mary Hospital, Hong Kong, China
| | - J C Yang
- Gilead Sciences Inc., Foster City, CA, USA
| | - S J Knox
- Gilead Sciences Inc., Foster City, CA, USA
| | - H Mo
- Gilead Sciences Inc., Foster City, CA, USA
| | - L L Han
- Gilead Sciences Inc., Foster City, CA, USA
| | | | - H L Y Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
12
|
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: 1661] [Impact Index Per Article: 207.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
Lao TTH, Leung TY, Chan HLY, Wong VWS. Effect of pregnancy on the activity and infectivity of hepatitis B virus in women with chronic hepatitis B infection. Hong Kong Med J 2015; 21 Suppl 7:S4-S7. [PMID: 26908264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- T T H Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong
| | - T Y Leung
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong
| | - H L Y Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - V W S Wong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| |
Collapse
|
14
|
Ding CM, Sung JJY, Chan HLY, Luan J. Viral mutant discovery in hepatitis B virus quasi-species in patients undergoing long-term lamivudine treatment. Hong Kong Med J 2015; 21 Suppl 4:31-34. [PMID: 26157101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- C M Ding
- Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong
| | | | | | | |
Collapse
|
15
|
Poon TCW, Chan HLY, Leung HWC, Lo A, Lau RHY, Hui AY, Sung JJY. Liver cirrhosis-specific glycoforms of serum proteins in chronic hepatitis B infection: identification by lectin affinity chromatography and quantitative proteomic profiling. Hong Kong Med J 2015; 21 Suppl 4:22-26. [PMID: 26157099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- T C W Poon
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | | | | | | | | | | | | |
Collapse
|
16
|
Chong CCN, Wong VWS, Lai PBS, Chan HLY. Letter: pre- and post-operative anti-viral therapy is important for patients with hepatitis B virus-related hepatocellular carcinoma - authors' reply. Aliment Pharmacol Ther 2015; 41:790. [PMID: 25781043 DOI: 10.1111/apt.13108] [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)
- C C N Chong
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | |
Collapse
|
17
|
Chong CCN, Wong GLH, Wong VWS, Ip PCT, Cheung YS, Wong J, Lee KF, Lai PBS, Chan HLY. Antiviral therapy improves post-hepatectomy survival in patients with hepatitis B virus-related hepatocellular carcinoma: a prospective-retrospective study. Aliment Pharmacol Ther 2015; 41:199-208. [PMID: 25413146 DOI: 10.1111/apt.13034] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 08/20/2014] [Revised: 09/15/2014] [Accepted: 11/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effect of antiviral therapy on the post-hepatectomy long-term survival in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains uncertain. AIM To evaluate the effect of antiviral therapy on post-hepatectomy survival and recurrence in patients with HBV-related HCC. METHODS This was a prospective-retrospective study of a total of 404 patients who underwent hepatectomy for HBV-related HCC in a tertiary academic hospital. Data on patient and tumour characteristics, tumour recurrence, treatment for recurrence and survival were compared between antiviral and no antiviral groups. RESULTS Patient's and tumour characteristics were comparable between the two groups, except a higher proportion of patients with cirrhosis in the antiviral group. With a mean follow-up time of 52.4 months, antiviral group had a better 5-year overall survival (66.7% vs. 56.0%, P = 0.001) while there was no significant difference in the 5-year disease-free survival (44.7% vs. 38.1%, P = 0.166). Use of antiviral therapy was associated with better liver function reserve at the time of recurrence and a greater proportion of patients could receive curative treatment for recurrence (38.5% vs. 24.3%, P = 0.041). There was no significant different in the hazard ratios of patients who started antiviral therapy before or after operation (P = 0.054). CONCLUSIONS Use of antiviral therapy improves the long-term post-hepatectomy survival in patients with HBV-related HCC. With a better liver function reserve at the time of recurrence, a greater proportion of patients in antiviral group could receive curative treatment for recurrence.
Collapse
Affiliation(s)
- C C N Chong
- Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Chan HLY, Wong VWS, Wong GLH, Choi PCL. Non-invasive algorithm for detecting advanced liver fibrosis in chronic hepatitis B patients. Hong Kong Med J 2014; 20 Suppl 6:31. [PMID: 25482969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - V W S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - G L H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - P C L Choi
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong
| |
Collapse
|
19
|
Li MS, Lau TCK, Chan HLY, Tsui SKW. Functional significance of hepatitis B virus subgenotype Cs genomic markers. Hong Kong Med J 2014; 20 Suppl 6:28-30. [PMID: 25482968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- M S Li
- School of Biomedical Sciences, The Chinese University of Hong Kong
| | - T C K Lau
- Department of Biology and Chemistry, The City University of Hong Kong
| | - H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - S K W Tsui
- School of Biomedical Sciences, & Hong Kong Bioinformatics Centre, & Centre for Microbial Genomics and Proteomics, The Chinese University of Hong Kong
| |
Collapse
|
20
|
Lam KLY, Hui AJ, Chan HLY. Commentary: how long does one need to fast before a Fibroscan examination? Aliment Pharmacol Ther 2014; 39:540-1. [PMID: 24494839 DOI: 10.1111/apt.12598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 12/10/2013] [Indexed: 12/14/2022]
Affiliation(s)
- K L Y Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; Institute of Digestive Disease and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
| | | | | |
Collapse
|
21
|
Wang Y, Thongsawat S, Gane EJ, Liaw YF, Jia J, Hou J, Chan HLY, Papatheodoridis G, Wan M, Niu J, Bao W, Trylesinski A, Naoumov NV. Efficacy and safety of continuous 4-year telbivudine treatment in patients with chronic hepatitis B. J Viral Hepat 2013; 20:e37-46. [PMID: 23490388 PMCID: PMC3618368 DOI: 10.1111/jvh.12025] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [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: 06/01/2012] [Accepted: 10/01/2012] [Indexed: 12/16/2022]
Abstract
In the phase-III GLOBE/015 studies, telbivudine demonstrated superior efficacy vs lamivudine during 2-year treatment in HBeAg-positive and HBeAg-negative chronic hepatitis B (CHB). After completion, 847 patients had an option to continue telbivudine treatment for further 2 years. A total of 596 (70%) of telbivudine-treated patients, who were serum HBV DNA positive or negative and without genotypic resistance to telbivudine at the end of the GLOBE/015 trials, were enrolled into a further 2-year extension study. A group of 502 patients completed 4 years of continuous telbivudine treatment and were included in the telbivudine per-protocol population. Amongst 293 HBeAg-positive patients, 76.2% had undetectable serum HBV DNA and 86.0% had normal serum ALT at the end of 4 years. Notably, the cumulative rate of HBeAg seroconversion was 53.2%. Amongst 209 HBeAg-negative patients, 86.4% had undetectable HBV DNA and 89.6% had normal serum ALT. In patients who had discontinued telbivudine treatment due to HBeAg seroconversion, the HBeAg response was durable in 82% of patients (median 111 weeks of off-treatment follow-up). The cumulative 4-year resistance rate was 10.6% for HBeAg-positive and 10.0% for HBeAg-negative patients. Most adverse events were mild or moderate in severity and transient. Renal function measured by estimated glomerular filtration rate (eGFR) increased by 14.9 mL/min/1.73 m(2) (16.6%) from baseline to 4 years (P < 0.0001). In conclusion, in HBeAg-positive and HBeAg-negative CHB patients without resistance after 2 years, two additional years of telbivudine treatment continued to provide effective viral suppression with a favourable safety profile. Moreover, telbivudine achieved 53% of HBeAg seroconversion in HBeAg-positive patients.
Collapse
Affiliation(s)
- Y Wang
- Institute of Infectious Diseases, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - S Thongsawat
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityChiang Mai, Thailand
| | - E J Gane
- New Zealand Liver Unit, Auckland City HospitalAuckland, New Zealand
| | - Y-F Liaw
- Liver Research Unit, Chang Gung Memorial Hospital & UniversityTaipei, Taiwan
| | - J Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical UniversityBeijing, China
| | - J Hou
- Hepatology Unit and Department of Infectious Diseases, Nanfang HospitalGuangzhou, China
| | - H L Y Chan
- Medicine and Therapeutics, Chinese University of Hong KongHong Kong, China
| | - G Papatheodoridis
- Academic Department of Medicine, Hippokration General HospitalAthens, Greece
| | - M Wan
- Department of Infectious Diseases, ChangHai Hospital of the Second Military Medical UniversityShanghai, China
| | - J Niu
- Department of Hepatology, First hospital of Jilin UniversityJilin, China
| | - W Bao
- Novartis Pharma CorporationEast Hanover, NJ, USA
| | | | | |
Collapse
|
22
|
Chan HLY, Chen YC, Gane EJ, Sarin SK, Suh DJ, Piratvisuth T, Prabhakar B, Hwang SG, Choudhuri G, Safadi R, Tanwandee T, Chutaputti A, Yurdaydin C, Bao W, Avila C, Trylesinski A. Randomized clinical trial: efficacy and safety of telbivudine and lamivudine in treatment-naïve patients with HBV-related decompensated cirrhosis. J Viral Hepat 2012; 19:732-43. [PMID: 22967105 DOI: 10.1111/j.1365-2893.2012.01600.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [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] [Indexed: 12/15/2022]
Abstract
Patients with decompensated cirrhosis owing to chronic hepatitis B viral (HBV) infection have a high morbidity/mortality rate, and the treatment remains a challenge. We studied the safety and efficacy of telbivudine and lamivudine in such patients. This noninferiority, double-blind trial randomized 232 treatment-naive patients with decompensated HBV (1:1) in 80 academic hospitals to receive once-daily telbivudine 600 mg or lamivudine 100 mg for 104 weeks. Primary composite endpoint was proportion of patients with HBV DNA <10 000 copies/mL, normal alanine aminotransferase (ALT) and Child-Turcotte-Pugh score improvement/stabilization at week 52. Response rates using a post hoc modified endpoint (HBV DNA <300 copies/mL [57 IU/mL] and ALT normalization) in intent-to-treat analysis (missing = failure) were 56.3%vs 38.0% after 76 weeks (P = 0.018) and 45.6%vs 32.9% after 104 weeks (P = 0.093) for telbivudine vs lamivudine. Telbivudine treatment was an independent predictive factor for HBV DNA <300 copies/mL and ALT normalization (P = 0.037). Response rates with protocol-defined composite endpoint in intent-to-treat analysis (M = F) were 56.2 vs 54.0% (noninferiority not achieved) and 39.1%vs 36.4% (noninferiority achieved) in telbivudine and lamivudine groups at 52 and 104 weeks. Telbivudine treatment was associated with a significant improvement in glomerular filtration rate compared to lamivudine treatment and was also associated with a trend for improvement in survival (87%vs 79%). No cases of lactic acidosis were reported. Telbivudine compared to lamivudine was associated with a higher rate of patients with both viral suppression and ALT normalization, a trend towards a higher rate of survival and significant improvement in glomerular filtration.
Collapse
Affiliation(s)
- H L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Liaw YF, Jia JD, Chan HLY, Han KH, Tanwandee T, Chuang WL, Tan DM, Chen XY, Gane E, Piratvisuth T, Chen L, Xie Q, Sung JJY, Wat C, Bernaards C, Cui Y, Marcellin P. Shorter durations and lower doses of peginterferon alfa-2a are associated with inferior hepatitis B e antigen seroconversion rates in hepatitis B virus genotypes B or C. Hepatology 2011; 54:1591-9. [PMID: 22045673 DOI: 10.1002/hep.24555] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [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] [Indexed: 12/12/2022]
Abstract
UNLABELLED As there is currently a lack of consensus on the most appropriate dose and duration of peginterferon alfa-2a (PEG-IFNα-2a) therapy in hepatitis B e antigen (HBeAg)-positive patients, the efficacy and safety of either 24 or 48 weeks' duration and 90 μg/week or 180 μg/week doses were compared. HBeAg-positive patients (n = 544; 34% genotype B, 51% genotype C) were randomized to receive PEG-IFNα-2a (2 × 2 factorial design) for 24 or 48 weeks and at 90 μg/week or 180 μg/week and included in the per-protocol population. The primary efficacy endpoint of the noninferiority study was HBeAg seroconversion 6 months posttreatment. The prespecified odds ratio (OR) noninferiority margin was 1.88 with a one-sided significance level of 0.025. The highest rates of HBeAg seroconversion 6 months posttreatment were in the 180/48 arm (36.2% versus 14.1%-25.8% in the other arms). When the dose and duration arms were pooled, the OR for noninferiority of 24 weeks versus 48 weeks was 2.17 (95% confidence interval [CI] 1.43, 3.31; P = 0.749) and for 90 μg versus 180 μg was 1.79 (95% CI 1.18, 2.72; P = 0.410). As the upper limit of the 95% CI of the ORs were >1.88, 24 weeks were inferior to 48 weeks and 90 μg/week was inferior to 180 μg/week. The highest rates of response in the 180/48 arm were achieved by patients with HBsAg <1,500 IU/mL at Week 12 (58%) or Week 24 (57%), whereas patients with HBsAg >20,000 IU/mL did not respond. Adverse events were typical of those associated with PEG-IFNα-2a. CONCLUSION Compared with lower doses and shorter durations, the licensed PEG-IFNα-2a treatment regimen (180 μg/48 weeks) was the most efficacious and beneficial for HBeAg-positive patients predominantly infected with hepatitis B virus genotypes B or C.
Collapse
Affiliation(s)
- Y-F Liaw
- Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Sun J, Hou JL, Xie Q, Li XH, Zhang JM, Wang YM, Wang H, Lai JY, Chen SJ, Jia JD, Sheng JF, Chan HLY, Wang JF, Li MKK, Jiang M, Popescu M, Sung JJY. Randomised clinical trial: efficacy of peginterferon alfa-2a in HBeAg positive chronic hepatitis B patients with lamivudine resistance. Aliment Pharmacol Ther 2011; 34:424-31. [PMID: 21692822 DOI: 10.1111/j.1365-2036.2011.04750.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies suggested that a finite course of peginterferon alfa-2a may offer an alternative rescue therapy for patients with lamivudine resistance. However, because of the limitation of study design and small sample size, it is difficult to make definitive conclusion. AIM To explore the role of peginterferon alfa-2a, in the rescue treatment of HBeAg-positive chronic hepatitis B patients with lamivudine resistance. METHODS In this randomised study, chronic hepatitis B patients with lamivudine resistance were treated with peginterferon alfa-2a for 48 weeks (n=155) or adefovir for 72 weeks (n=80). All enrolled patients were treated with lamivudine for the first 12weeks. RESULTS At 6 months posttreatment, 14.6% (18/123) of peginterferon alfa-2a-treated patients achieved HBeAg seroconversion, in contrast to 3.8% (3/80) of adefovir-treated patients after 72 weeks continuous therapy (P=0.01). For peginterferon alfa-2a-treated patients, the rate of HBeAg seroconversion at week 72 was significantly higher in patients who had HBsAg decline >0.5 Log(10) IU/mL from baseline at week 24, compared with patients with HBsAg decline ≤0.5 Log(10) IU/mL from baseline at week 24 (25.5% vs. 7.7%, P=0.01). After 72 weeks continuous adefovir treatment, 22.5% of patients achieved HBV DNA <80 IU/mL, compared with 10.6% in peginterferon alfa-2a-treated patients at 6months off-treatment (P=0.02). CONCLUSIONS Overall, the response to peginterferon alfa-2a among patients with lamivudine resistance was suboptimal. HBeAg seroconversion rate at week 72 by 48 weeks peginterferon alfa-2a treatment was higher than continuous adefovir therapy. Monitoring HBsAg levels can help to predict response to peginterferon alfa-2a.
Collapse
Affiliation(s)
- J Sun
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Bevc S, Hojs R, Ekart R, Gorenjak M, Puklavec L, Nakano C, Hamano T, Fujii N, Matsui I, Obi Y, Okada N, Tsubakihara Y, Rakugi H, Isaka Y, Pisano A, Testa A, Spoto B, Sanguedolce MC, Parlongo RM, Tripepi G, Leonardis D, Mallamaci F, Zoccali C, Papale M, Gigante M, Prattichizzo C, Rocchetti MT, Battaglia M, Gesualdo L, Ranieri E, Legendre C, Babu S, Furman R, Sheerin N, Cohen D, Gaber O, Eitner F, Delmas Y, Loirat C, Greenbaum L, Bedrosian C, Zimmerhackl LB, Gane E, Deray G, Piratvisuth T, Chan HLY, Zeuzem S, Jia J, Ren H, Uddin A, Bosset S, Avila C, Trylesinski A. CKD / Human studies. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Lin LY, Wong VWS, Zhou HJ, Chan HY, Gui HL, Guo SM, Wang H, Huang L, Bao SS, Xie Q, Chan HLY. Relationship between serum hepatitis B virus DNA and surface antigen with covalently closed circular DNA in HBeAg-negative patients. J Med Virol 2010; 82:1494-500. [PMID: 20648602 DOI: 10.1002/jmv.21863] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) is responsible for viral persistence. This study aimed to investigate the serum surrogate markers for cccDNA and to evaluate the intrahepatic viral events associated with disease activity in HBeAg-negative chronic hepatitis B patients. Thirty-three treatment-naïve patients with a negative HBeAg who had a liver biopsy were studied. Active disease was defined as a serum alanine aminotransferase >40 IU/L and a serum HBV DNA >10,000 copies/ml. This study showed significant correlation between serum HBV DNA and both log cccDNA (r = 0.41, P = 0.018) and log total intrahepatic HBV DNA (r = 0.71, P < 0.0001). No significant correlation was observed between serum HBsAg and log cccDNA (P = 0.15) or log total intrahepatic HBV DNA (P = 0.97). Fourteen and 19 patients had inactive and active disease, respectively. The median log cccDNA and log total intrahepatic HBV DNA (copies/10(6) cells) were significantly higher in patients with active disease compared with those with inactive disease (4.11 vs. 3.53, P = 0.03 and 5.46 vs. 4.64, P < 0.001, respectively). The HBV replicative efficiency, defined as the ratio of serum HBV DNA to cccDNA, was approximately 20% higher in patients with active disease. No significant difference was observed in the HBsAg levels and the ratio of serum HBsAg to cccDNA between the two groups. In conclusion, serum HBV DNA, but not HBsAg, reflects the amount of cccDNA and the replication efficiency of HBV in patients with HBeAg-negative chronic hepatitis B.
Collapse
Affiliation(s)
- L Y Lin
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Leung WWM, Ho SC, Chan HLY, Wong V, Yeo W, Mok TSK. Moderate coffee consumption reduces the risk of hepatocellular carcinoma in hepatitis B chronic carriers: a case-control study. J Epidemiol Community Health 2010; 65:556-8. [DOI: 10.1136/jech.2009.104125] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Wong GLH, Wong VWS, Choi PCL, Chan AWH, Chan HLY. Development of a non-invasive algorithm with transient elastography (Fibroscan) and serum test formula for advanced liver fibrosis in chronic hepatitis B. Aliment Pharmacol Ther 2010; 31:1095-103. [PMID: 20180785 DOI: 10.1111/j.1365-2036.2010.04276.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-invasive assessments of liver fibrosis in chronic hepatitis B were well established. AIM To develop a combined algorithm of liver stiffness measurement (LSM) and serum test formula to predict advanced liver fibrosis in chronic hepatitis B. METHODS We reported an alanine aminotransferase (AST)-based LSM algorithm for liver fibrosis in 156 chronic hepatitis B patients, which formed the training cohort to evaluate the performance of APRI (AST-to-platelet-ratio-index), Forns index, FIB-4 and Fibroindex against liver histology. The best combined LSM-serum formula algorithm would be validated in another cohort of 82 chronic hepatitis B patients. RESULTS In the training cohort, LSM has the best performance of diagnosing advanced (> or =F3) fibrosis [area under the receiver operating characteristics curve (AUROC) 0.88, 95% confidence interval (CI) 0.85-0.91], while Forns index has the best performance among the various serum test formulae (AUROC 0.70, 95% CI 0.62-0.78). In the combined algorithm, low LSM or low Forns index could be used to exclude advanced fibrosis as both of them had high sensitivity (>90%). To confirm advanced fibrosis, agreement between high LSM and high Forns index could improve the specificity (from 99% to 100% and from 87% to 98% in the training and validation cohorts respectively). CONCLUSION A combined LSM-Forns algorithm can improve the accuracy to predict advanced liver fibrosis in chronic hepatitis B.
Collapse
Affiliation(s)
- G L H Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | | | | |
Collapse
|
29
|
Wong GLH, Wong VWS, Choi PCL, Chan AWH, Chan HLY. Development of a non-invasive algorithm with transient elastography (Fibroscan) and serum test formula for advanced liver fibrosis in chronic hepatitis B. Aliment Pharmacol Ther 2010. [PMID: 20180785 DOI: 10.1111/j.13652036.2010.04276.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
BACKGROUND Non-invasive assessments of liver fibrosis in chronic hepatitis B were well established. AIM To develop a combined algorithm of liver stiffness measurement (LSM) and serum test formula to predict advanced liver fibrosis in chronic hepatitis B. METHODS We reported an alanine aminotransferase (AST)-based LSM algorithm for liver fibrosis in 156 chronic hepatitis B patients, which formed the training cohort to evaluate the performance of APRI (AST-to-platelet-ratio-index), Forns index, FIB-4 and Fibroindex against liver histology. The best combined LSM-serum formula algorithm would be validated in another cohort of 82 chronic hepatitis B patients. RESULTS In the training cohort, LSM has the best performance of diagnosing advanced (> or =F3) fibrosis [area under the receiver operating characteristics curve (AUROC) 0.88, 95% confidence interval (CI) 0.85-0.91], while Forns index has the best performance among the various serum test formulae (AUROC 0.70, 95% CI 0.62-0.78). In the combined algorithm, low LSM or low Forns index could be used to exclude advanced fibrosis as both of them had high sensitivity (>90%). To confirm advanced fibrosis, agreement between high LSM and high Forns index could improve the specificity (from 99% to 100% and from 87% to 98% in the training and validation cohorts respectively). CONCLUSION A combined LSM-Forns algorithm can improve the accuracy to predict advanced liver fibrosis in chronic hepatitis B.
Collapse
Affiliation(s)
- G L H Wong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | | | | |
Collapse
|
30
|
Leung WK, Chan HLY, Lai RWM, Sung JJY. Establishment of public norovirus genome database in Hong Kong. Hong Kong Med J 2010; 16:4-7. [PMID: 20864738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- W K Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, SAR, China.
| | | | | | | |
Collapse
|
31
|
Poon TCW, Kam RKT, Sung JJY, Wong N, Hui AY, Chan HLY. Serum total glycosylation profiling for non-invasive diagnosis of liver cirrhosis in people with chronic hepatitis B. Hong Kong Med J 2009; 15 Suppl 8:42-44. [PMID: 20393213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Affiliation(s)
- T C W Poon
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China.
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
BACKGROUND Chronic hepatitis B (CHB) infection leads to development of hepatocellular carcinoma (HCC), but the effects of treatment in preventing HCC are not clear. AIM To study the effects of interferon (IFN) or nucleoside/tide analogue (NA) on the risk of developing HCC in CHB patients. METHODS Randomized trials, case-control and cohort studies were retrieved from five electronic databases and international conferences over the past 10 years. Relative risks (RRs) of HCC with or without treatment were studied. RESULTS Twelve studies (n = 2742) enrolling patients treated by IFN vs. control showed that the risk of HCC after treatment was reduced by 34% (RR: 0.66, 95% CI: 0.48-0.89). Benefit is more significant among patients with early cirrhosis than among those without cirrhosis. Five studies (n = 2289) compared patients treated by NA with control. The risk of HCC after treatment was reduced by 78% (RR: 0.22, 95% CI: 0.10-0.50). HBeAg-positive patients showed more significantly reduced HCC risk with treatment. Patients without cirrhosis benefited more from NA than those with cirrhosis. Resistance to NA has obviated the benefit of the treatment. CONCLUSIONS IFN or NA treatment significantly reduces risk of HCC. While IFN benefited patients with cirrhosis, NA benefited patients with no cirrhosis and HBeAg-positive CHB infection.
Collapse
Affiliation(s)
- J J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | | | | | | | | |
Collapse
|
33
|
Wong VWS, Hui AY, Tsang SWC, Chan JLY, Wong GLH, Chan AWH, So WY, Cheng AYS, Tong PCY, Chan FKL, Sung JJY, Chan HLY. Prevalence of undiagnosed diabetes and postchallenge hyperglycaemia in Chinese patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2006; 24:1215-22. [PMID: 17014580 DOI: 10.1111/j.1365-2036.2006.03112.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease is prevalent in affluent countries and is strongly associated with metabolic syndrome. AIM To study the prevalence of undiagnosed diabetes and postchallenge hyperglycaemia in Chinese patients with non-alcoholic fatty liver disease. METHODS 73 consecutive patients with biopsy-proven non-alcoholic fatty liver disease and no history of diabetes underwent comprehensive metabolic screening. Diagnosis of diabetes and impaired glucose regulation was based on the 2006 American Diabetes Association criteria. RESULTS The prevalence of undiagnosed diabetes and impaired glucose tolerance in non-alcoholic fatty liver disease patients was 33% and 29%, respectively. Among patients with 2-h plasma glucose above 7.8 mm, 47% had normal fasting glucose (below 5.6 mm). Impaired glucose tolerance was more common in patients with non-alcoholic steatohepatitis than those with simple hepatic steatosis (P = 0.036), and 2-h plasma glucose correlated with fibrosis stage (Spearman coefficient: 0.25, P = 0.046). In a binary logistic regression analysis, high fasting glucose and low high-density lipoprotein cholesterol were independent factors associated with diabetes. Nevertheless, if oral glucose tolerance test was only performed in non-alcoholic fatty liver disease patients with impaired fasting glucose, 20.8% of diabetes cases would be missed. CONCLUSIONS Isolated postchallenge hyperglycaemia is common among Chinese non-alcoholic fatty liver disease patients without history of diabetes. It is associated with histological severe disease, and cannot be accurately predicted by any fasting glucose cut-off.
Collapse
Affiliation(s)
- V W S Wong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Cheng AYS, Kong APS, Wong VWS, So WY, Chan HLY, Ho CS, Lam CWK, Tam JS, Chow CC, Cockram CS, Chan JCN, Tong PCY. Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients. Diabetologia 2006; 49:1777-84. [PMID: 16736132 DOI: 10.1007/s00125-006-0294-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 03/29/2006] [Indexed: 01/07/2023]
Abstract
AIMS/HYPOTHESIS We examined the association between chronic hepatitis B virus (HBV) infection and clinical outcomes in a consecutive cohort of Chinese patients with type 2 diabetes. SUBJECTS, MATERIALS AND METHODS Between 1995 and 1999, 2,838 type 2 diabetes patients underwent comprehensive assessments and blood screening for hepatitis B surface antigen (HBsAg). The risk of occurrence of cardiovascular events and end-stage renal disease (defined as need for dialysis, doubling of serum creatinine or serum creatinine > or =500 micromol/l) was compared between HBsAg-positive and HBsAg-negative groups. RESULTS At baseline, HBV-infected patients (n=286, 10.1%) were younger (51.0+/-11.5 vs 53.7+/-12.7 years, p=0.004), had earlier onset of diabetes (51.0+/-11.5 vs 53.7+/-12.7 years, p=0.001) and a higher frequency of retinopathy (28 vs 22%, p=0.03) than non-HBV-infected patients. After a median follow-up of 3.5 years (interquartile range: 1.7-5.9 years) and adjustment of age, glycaemic control and other potential confounding factors, HBV-infected patients were more likely to develop end-stage renal disease than non-HBV infected patients (8.7 vs 6.4%) with a hazard ratio of 4.5 (95% CI 1.1-18.6). The difference in the frequency of cardiovascular endpoints was not statistically significant. CONCLUSIONS In Chinese type 2 diabetes patients, chronic HBV infection was associated with increased risk of end-stage renal disease, and this was independent of other potential confounding factors. Early identification of HBV status and close surveillance of renal function are important in patients with type 2 diabetes who are living in areas where HBV is endemic or who are at risk of chronic HBV infection.
Collapse
Affiliation(s)
- A Y S Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Chor SY, Hui AY, To KF, Chan KK, Go YY, Chan HLY, Leung WK, Sung JJY. Anti-proliferative and pro-apoptotic effects of herbal medicine on hepatic stellate cell. J Ethnopharmacol 2005; 100:180-6. [PMID: 15950418 DOI: 10.1016/j.jep.2005.02.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 02/14/2005] [Accepted: 02/19/2005] [Indexed: 05/02/2023]
Abstract
Hepatic stellate cells (HSC) play a central role in hepatic fibrosis and compounds that promote apoptosis in HSC may have anti-fibrotic potentials. Herbal medicine has long been used in chronic liver disease but there is little scientific evidence for their actions. The present study investigated the effects of 14 commonly used herbs on cellular proliferation and apoptosis of a rat hepatic stellate cell line, HSC-T6 and the underlying mechanism of herb-induced apoptosis. HSC-T6 cell were incubated with herbal extracts and their proliferation was assessed by colorimetric assay. Apoptosis was measured and confirmed by flow cytometry, terminal transferase uridyl nick end labeling (TUNEL) assay and morphological features in hematoxylin and eosin staining. Apoptotic pathways involving Fas receptor and Bcl-2 family were investigated by Western blot. Five herbs, namely Angelica sinensis (AS), Carthamus tinctorius (CT), Ligusticum chuanxiong (LC), Salvia miltiorrhiza (SM) and Stephania tetrandra (ST) demonstrated both anti-proliferative and pro-apoptotic activities in HSC-T6. The highest potency was detected in SM and ST with 51.63 and 44.52% of HSC-T6 showing apoptotic changes, respectively. This was associated with upregulation of Fas and Bax and down-regulation of Bcl-xL in HSC. Fas ligand and Bcl2 expressions remained unchanged. The potential anti-fibrotic effect of herbal medicine warrants further evaluation.
Collapse
Affiliation(s)
- S Y Chor
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Living related liver transplantation (LRLT) has gained popularity, especially in Asian countries as the primary mode of liver transplantation. LRLT, however, carries the inherent problem of potential donor harm. In view of reports of donor deaths and significant donor morbidity (as high as 67%), we examined donor complication rates in our LRLT program. All sixteen LRLT donors between February 2000 and January 2003 were retrospectively analyzed. The 16 donors (13 men, 3 women) of mean age 30 years (range, 18-49 years) included 5 donations from siblings, 2 from parents, and 9 from offsprings. The portion of liver donated was L hepatectomy (n = 4) R hepatectomy (n = 7), and Modified Extended R hepatectomy (n = 5) with the weight of resected liver being 618.9 g (range, 380-1000). The mean blood loss was 936 mL (range, 400-1900 mL), but only 2 donors required transfusion of banked blood. The mean intensive care unitstay was 1.06 days (range, 1-2 days) and the mean hospital stay was 9.12 days (range, 7-14 days). There was no case of reoperation and no mortality. There was no biliary or vascular complication. Four of 16 (25%) donors had a minor morbidity; 2 of 16 (12.5%) had a morbidity requiring intervention. In conclusion, with meticulous preoperative, intraoperative, and postoperative management, successful LRLT can be performed with minimal donor morbidities.
Collapse
Affiliation(s)
- A R N Rao
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
Severe acute respiratory syndrome (SARS) struck 1755 patients in Hong Kong and developed into a global health crisis. Although the World Health Organization and national health authorities are sparing no effort to contain the disease and to find a cure for the potentially deadly infection, SARS has an impact on our liver transplantation (LTx) program. Before the SARS outbreak, an average of 1 LTx was performed per month in our center. For 6 months since the outbreak, there had been no LTx performed. The intensive care unit had to be dedicated to patients with SARS. Two of the LTx team members were struck by SARS. A survey conducted among LTx recipients and their family members (n = 45) demonstrated symptoms of anxiety and stress in all. Some LTx recipients were treated at the Emergency Department for suspected SARS, which were later confirmed to be false alarms. Many LTx patients were too frightened to come back for follow-up. A new strain of coronavirus was identified as the causative agent. The origin of this virus is uncertain but the probability of zoonoses is being seriously discussed. Not only are immunosuppressed patients exposed to higher risk of infection, but also the waiting list mortality is also expected to increase. The SARS outbreak has demonstrated the vulnerability of an organ transplantation service and reminds us of the fearful possibility of zoonoses in future xeno-transplantation.
Collapse
Affiliation(s)
- A K K Chui
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | | | | | | |
Collapse
|
38
|
Chui AKK, Rao ARN, Island ER, Chan HLY, Leung TWT, Lau WY. Multimodality tumor control and living donor transplantation for unresectable hepatocellular carcinoma. Transplant Proc 2004; 36:2287-8. [PMID: 15561221 DOI: 10.1016/j.transproceed.2004.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Liver transplantation (LT) is an acceptable mode of treatment for selected patients with unresectable hepatocellular carcinoma (HCC). However, due to the scarcity of cadaveric donor organs, it is considered desirable for patients to opt for living donor liver transplantation (LDLT) or, for those not being transplanted soon, to have some form of tumor control therapy. Such an approach in our program is analyzed and reported. At our institution, 42 LTs were performed between October 1999 and April 2003. Of these, 18 recipients (15 men, 3 women) had 27 HCC. The average number and size of HCC was 1.59 (1 to 4) and 2.31 (0.2 to 6.5) cm, respectively. Thirteen (72%) patients were transplanted primarily for the HCC, whereas five (28%) others were incidental HCC cases. Seven patients (5 LRLT, 2 cadaveric LT) were transplanted soon after listing, and thus did not require tumor control therapy. Six patients waited for 11 (6 to 19) months before LT. Three patients underwent microwave coagulation therapy, and one had additional alcohol injections. One patient received the novel PIAF (cisplatin, interferon, adriamycin, and 5-FU) chemotherapy regimen followed by selective internal irradiation (SIR) treatment. One patient received conformal radiation therapy and another received SIR treatment before LT. Besides 2 postoperative deaths, the remaining 16 patients have been well, with a mean follow-up of 20.4 (3.6 to 41.2) months. In conclusion, for patients with unresectable HCC, in areas with poor cadaveric donor rate, living donation should be the first option. If a suitable live donor is not available, aggressive multimodality therapy is recommended while waiting for cadaveric LT.
Collapse
Affiliation(s)
- A K K Chui
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
39
|
Chan HLY, Chui AKK, Chan FKL, Rao ARN, Wong J, Lau WY. Virological and histological outcome of a patient with chronic hepatitis B transplanted with liver from hepatitis C virus-positive donor. Transplant Proc 2003; 35:423-4. [PMID: 12591470 DOI: 10.1016/s0041-1345(02)03882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- H L Y Chan
- Departments of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | | |
Collapse
|
40
|
Chui AKK, Wong J, Rao ARN, Ng SSM, Chan FKL, Chan HLY, Chan CJ, Mi R, Lau WY. High incidence of incidental hepatocellular carcinoma exists among hepatitic explanted livers. Transplant Proc 2003; 35:350-1. [PMID: 12591435 DOI: 10.1016/s0041-1345(02)04010-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A K K Chui
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Chui AKK, Rao ARN, Wong J, Ng SSM, Chan HLY, Chan FKL, Mi R, Lau WY. Liver transplantation for hepatocellular carcinoma in cirrhotic patients-a single-center experience. Transplant Proc 2003; 35:379-80. [PMID: 12591449 DOI: 10.1016/s0041-1345(02)03821-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- A K K Chui
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Chui AKK, Chan CJ, Rao ARN, Wong J, Chan FKL, Chan HLY, Mi R, Ng SSM, Lau WY. Immunosuppression with rapid steriod reduction among predominantly HBV liver transplantation recipients: initial experience. Transplant Proc 2003; 35:419-20. [PMID: 12591468 DOI: 10.1016/s0041-1345(02)03825-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A K K Chui
- Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, SAR, Shatin, Hong Kong, China
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
BACKGROUND Cyclooxygenase-2 may play a role in the development of hepatocellular carcinoma, but the relationship between cyclooxygenase-2 and chronic hepatitis B is unknown. AIM To investigate the expression and cellular localization of cyclooxygenase-2 in chronic hepatitis B patients and the effects of anti-viral therapy. METHODS Using immunohistochemistry, in situ hybridization, Western blot and reverse transcription polymerase chain reaction, protein and messenger RNA expression and cellular localization of cyclooxygenase-2 in 35 chronic hepatitis B patients were assessed. Fourteen histologically normal and non-viral-infected livers were used as controls. The cyclooxygenase-2 immunoreactivities of paired liver biopsies from 12 patients receiving anti-viral therapy were compared. RESULTS Immunohistochemistry and in situ hybridization revealed that cyclooxygenase-2 expression was confined to hepatocytes. Patients with chronic hepatitis B had significantly higher cyclooxygenase-2 expression compared with controls. The cyclooxygenase-2 expression of hepatitis B e antigen-positive and -negative chronic hepatitis B patients was not significantly different, although the necro-inflammatory activity of the latter group was significantly lower. Over-expression of cyclooxygenase-2 in patients with chronic hepatitis B was further confirmed by Western blot and reverse transcription polymerase chain reaction. Twelve hepatitis B e antigen-positive chronic hepatitis B patients received anti-viral therapy: lamivudine in seven and interferon in five. Despite hepatitis B e antigen seroconversion, disappearance of hepatitis B virus DNA in serum, normalization of liver enzymes and a significant reduction in necro-inflammatory activity in all 12 patients, no significant change in cyclooxygenase-2 expression was found. CONCLUSIONS Chronic hepatitis B is associated with elevated cyclooxygenase-2 levels in hepatocytes, and the over-expression of this enzyme does not reflect inflammatory activity. Up-regulation of cyclooxygenase-2 persists after successful anti-viral therapy.
Collapse
Affiliation(s)
- A S L Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, ROC
| | | | | | | | | | | | | |
Collapse
|