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Jagarlamudi N, Reyes M, Fung S, Wong F. The Use of Tenofovir Disoproxil Fumarate in the Management of eAg-Negative Chronic Hepatitis B Infection. J Clin Med 2024; 13:1864. [PMID: 38610629 PMCID: PMC11012673 DOI: 10.3390/jcm13071864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Background/Objectives: Currently, there are insufficient data to recommend the treatment of patients with hepatitis B e antigen (HBeAg)-negative chronic infection who have normal ALT and low HBV DNA, since the prognosis is generally regarded as favorable. The aim of this pilot study was to determine whether the use of tenofovir disoproxil fumarate (TDF) 300 mg/day for 3 years was able to achieve functional cure (HBsAg loss) and HBsAg seroconversion in HBeAb-positive individuals. Methods: Fifty patients not on antiviral therapy (40% men, mean age 48.9 ± 10.9 years, 84% Asians) with minimal fibrosis were enrolled. Results: TDF reduced HBV DNA significantly to undetectable levels after 6 months. Overall, 48.3% of inactive carriers (baseline HBV DNA < 2000 IU/mL) remained HBV DNA negative 6 months after treatment withdrawal, which was significantly higher than the 5.6% in those who were not inactive carriers (baseline HBV DNA ≥ 2000 IU/mL) (p = 0.003). The HBsAg levels did not drop throughout the study period with no difference between inactive carriers versus those who were not. Five inactive carriers achieved functional cure, but none of these were amongst those who were not inactive carriers. No renal dysfunction or ALT flare on treatment withdrawal was observed. Conclusions: TDF could potentially be used to induce functional cure in patients who are inactive carriers with normal ALT, low HBV DNA and without advanced fibrosis.
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Affiliation(s)
| | | | | | - Florence Wong
- Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G2C4, Canada (M.R.); (S.F.)
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Wong F, Reddy KR, Tandon P, Lai JC, Jagarlamudi N, Weir V, Kok B, Kalainy S, Srisengfa YT, Albhaisi S, Reuter B, Acharya C, Shaw J, Thacker LR, Bajaj JS. The Prediction of In-Hospital Mortality in Decompensated Cirrhosis with Acute-on-Chronic Liver Failure. Liver Transpl 2022; 28:560-570. [PMID: 34564944 DOI: 10.1002/lt.26311] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/05/2021] [Accepted: 09/20/2021] [Indexed: 01/05/2023]
Abstract
Acute-on-chronic liver failure (ACLF) is a condition in cirrhosis associated with organ failure (OF) and high short-term mortality. Both the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) and North American Consortium for the Study of End-Stage Liver Disease (NACSELD) ACLF definitions have been shown to predict ACLF prognosis. The aim of this study was to compare the ability of the EASL-CLIF versus NACSELD systems over baseline clinical and laboratory parameters in the prediction of in-hospital mortality in admitted patients with decompensated cirrhosis. Five NACSELD centers prospectively collected data to calculate EASL-CLIF and NACSELD-ACLF scores for admitted patients with cirrhosis who were followed for the development of OF, hospital course, and survival. Both the number of OFs and the ACLF grade or presence were used to determine the impact of NACSELD versus EASL-CLIF definitions of ACLF above baseline parameters on in-hospital mortality. A total of 1031 patients with decompensated cirrhosis (age, 57 ± 11 years; male, 66%; Child-Pugh-Turcotte score, 10 ± 2; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) were enrolled. Renal failure prevalence (28% versus 9%, P < 0.001) was more common using the EASL-CLIF versus NACSELD definition, but the prevalence rates for brain, circulatory, and respiratory failures were similar. Baseline parameters including age, white cell count on admission, and MELD score reasonably predicted in-hospital mortality (area under the curve, 0.76). The addition of number of OFs according to either system did not improve the predictive power of the baseline parameters for in-hospital mortality, but the presence of NACSELD-ACLF did. However, neither system was better than baseline parameters in the prediction of 30- or 90-day outcomes. The presence of NACSELD-ACLF is equally effective as the EASL-CLIF ACLF grade, and better than baseline parameters in the prediction of in-hospital mortality in patients with cirrhosis, but not superior in the prediction of longer-term 30- or 90-day outcomes.
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Affiliation(s)
- Florence Wong
- Department of Medicine, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - K Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Puneeta Tandon
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jennifer C Lai
- Department of Medicine, University of California, San Francisco, CA
| | - Nishita Jagarlamudi
- Department of Medicine, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Vanessa Weir
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Beverley Kok
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sylvia Kalainy
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Somaya Albhaisi
- Department of Medicine, Virginia Commonwealth University, Richmond, VA.,Department of Medicine, McGuire VA Medical Center, Richmond, VA
| | - Bradley Reuter
- Department of Medicine, Virginia Commonwealth University, Richmond, VA.,Department of Medicine, McGuire VA Medical Center, Richmond, VA
| | - Chathur Acharya
- Department of Medicine, Virginia Commonwealth University, Richmond, VA.,Department of Medicine, McGuire VA Medical Center, Richmond, VA
| | - Jawaid Shaw
- Department of Medicine, Virginia Commonwealth University, Richmond, VA.,Department of Medicine, McGuire VA Medical Center, Richmond, VA
| | - Leroy R Thacker
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Jasmohan S Bajaj
- Department of Medicine, Virginia Commonwealth University, Richmond, VA.,Department of Medicine, McGuire VA Medical Center, Richmond, VA
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Dong V, Gosselin M, Jagarlamudi N, Kok B, Swain MG, Bajaj JS, Abraldes JG, Marquez V, Todd Stravitz R, Montano-Loza AJ, Merli M, Wong P, Brisebois A, Tandon P, Wendon J, Nyberg SL, Carrier FM, Lucey MR, Wong F, Feld JJ, Karvellas CJ, Rose CF, Bissonnette J. Proceedings from the 2018 Canadian Association for the Study of the Liver Single Topic Conference—Decompensated cirrhosis: from clinic to transplant. CanLivJ 2019; 2:137-170. [DOI: 10.3138/canlivj.2019-0011] [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] [Received: 05/09/2019] [Accepted: 05/20/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Victor Dong
- Joint senior authors
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Maxime Gosselin
- Joint senior authors
- Hôpital de Verdun, Montréal, Québec, Canada
| | - Nishita Jagarlamudi
- Joint senior authors
- Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Beverley Kok
- Joint senior authors
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Mark G Swain
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - Juan G Abraldes
- Cirrhosis Care Clinic, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Vladimir Marquez
- Division of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - R Todd Stravitz
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Aldo J Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Phil Wong
- Division of Gastroenterology and Hepatology, McGill University, Montréal, Québec, Canada
| | - Amanda Brisebois
- Division of General Internal Medicine, Department of Medicine and Division of Palliative Care, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - Julia Wendon
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom
| | - Scott L Nyberg
- Division of Transplantation Surgery, Mayo Clinic, Rochester, New York, USA
| | - François M Carrier
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Michael R Lucey
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Florence Wong
- Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
| | - Constantine J Karvellas
- Joint first authors
- Department of Critical Care Medicine and Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Christopher F Rose
- Joint first authors
- Hepato-Neuro Laboratory, CRCHUM, Université de Montréal, Montréal, Québec, Canada
| | - Julien Bissonnette
- Joint first authors
- Service d’hépatologie, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
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