Hope-For-HepB Top10 April 2008

A revisit of prophylactic lamivudine for chemotherapy-associated hepatitis B reactivation in non-Hodgkin's lymphoma: a randomized trial.

Hsu C, Hsiung CA, Su IJ, Hwang WS, Wang MC, Lin SF, Lin TH, Hsiao HH, Young JH, Chang MC, Liao YM, Li CC, Wu HB, Tien HF, Chao TY, Liu TW, Cheng AL, Chen PJ.

Hepatology. 2008;47(3):844-53.

Rating & Commentary
** Randomized trial of prophylactic or therapeutic lamivudine therapy in HBV carriers with non-Hodgkin's lymphoma (NHL) showing that fewer reactivations with severe hepatic inflammation occurred in prophylactic therapy group (0% vs. 36%, p<0.001).

Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study.

Duberg AS, Törner A, Daviðsdóttir L, Aleman S, Blaxhult A, Svensson A, Hultcrantz R, Bäck E, Ekdahl K.

J Viral Hepat. 2008 Apr 4; Epub ahead of print.

Rating & Commentary
* Large community-based study in 9,517 people with chronic HBV infection, 34,235 people with HCV infection and 1,601 with chronic HBV-HCV co-infection, showing an increased all-cause standardized mortality ratio (SMR) with a great excess mortality from liver disease in all cohorts (SMR 21.7, 35.5 and 46.2, respectively).

Italian blood donors with anti-HBc and occult hepatitis B virus infection.

Manzini P, Girotto M, Borsotti R, Giachino O, Guaschino R, Lanteri M, Testa D, Ghiazza P, Vacchini M, Danielle F, Pizzi A, Valpreda C, Castagno F, Curti F, Magistroni P, Abate ML, Smedile A, Rizzetto M.

Haematologica. 2007;92(12):1664-70.

Rating & Commentary
* Large study in 6,313 blood donors showing that the prevalence of HBsAg-negative, anti-HBc positive subjects was 4.85% (288 blood donors). Occult hepatitis B, as defined by detectable HBV DNA, was present in 4.86% of the 288 anti-HBc positive blood donors.

Persistence of occult hepatitis B after removal of the hepatitis B virus-infected liver.

Ciesek S, Helfritz FA, Lehmann U, Becker T, Strassburg CP, Neipp M, Ciner A, Fytili P, Tillmann HL, Manns MP, Wedemeyer H.

J Infect Dis. 2008;197(3):355-60.

Rating & Commentary
* Study in 25 consecutive, randomly selected liver transplant recipients who tested positive for anti-HBc and negative for HBsAg at the time of transplantation, and in 101 anti-HBc-positive / HBsAg-negative patients showing that a long-term extrahepatic HBV reservoir exists, resulting in reactivation of disease after transplantation.

Detection of HBV core promoter and precore mutations helps distinguish flares of chronic hepatitis from acute hepatitis B.

Kusumoto K, Yatsuhashi H, Nakao R, Hamada R, Fukuda M, Tamada Y, Taura N, Komori A, Daikoku M, Hamasaki K, Nakao K, Ishibashi H, Miyakawa Y, Eguchi K.

J Gastroenterol Hepatol. 2008;23(5):790-3.

Rating & Commentary
* Small study showing that mutations in the core promoter (A1762T/G1764A) and precore region (G1896A) were more frequent in patients with acute exacerbation of chronic hepatitis (n=36) than acute hepatitis (n=36; 81% vs. 19%; P < 0.0001 and 58% vs. 6%; P < 0.0001, respectively). These mutations may thus be useful in distinguishing acute exacerbation of chronic from acute HBV infection.

Combination therapy of thymosin alpha-1 and lamivudine for HBeAg positive chronic hepatitis B: A prospective randomized, comparative pilot study.

Lee HW, Lee JI, Um SH, Ahn SH, Chang HY, Park YK, Hong SP, Moon YM, Han KH.

J Gastroenterol Hepatol. 2008;23(5):729-35.

Rating & Commentary
* Pilot study in 67 chronic hepatitis B patients showing that thymosin alpha-1 and lamivudine for 24 weeks, followed by continuous lamivudine therapy did not result in an increase virological and biochemical response as compared to the lamivudine monotherapy.

Adefovir and lamivudine in combination compared with adefovir monotherapy in HBeAg-negative adults with chronic hepatitis B virus infection and clinical or virologic resistance to lamivudine: A retrospective, multicenter, nonrandomized, open-label study.

Pellicelli AM, Barbaro G, Francavilla R, Romano M, Barbarini G, Mazzoni E, Mecenate F, Paffetti A, Barlattani A, Struglia C, Villani R, Nauri L, Nosotti L, Armignacco O, Ferri F, Camporiondo MP, Soccorsi F.

Clin Ther. 2008;30(2):317-23.

Rating & Commentary
* Study in lamivudine-resistant HBeAg negative patients confirming that the rate of antiviral resistance to adefovir was significantly lower in patients receiving adefovir and lamivudine combination therapy than in those receiving adefovir monotherapy (3% vs. 18%).

Surveillance for acute viral hepatitis--United States, 2006.

Wasley A, Grytdal S, Gallagher K; Centers for Disease Control and Prevention (CDC).

MMWR Surveill Summ. 2008;57(2):1-24.

Rating & Commentary
* Population-based study in the US showing that the incidence of hepatitis A and B dramatically declined between 1995 and 2006 (by 90% and 81%, respectively). The incidence of hepatitis C declined through the 1990s, but plateaued since 2003. The greatest reduction was achieved with universal vaccination of children.

Changes in liver histology as a "surrogate" end point of antiviral therapy for chronic HBV can predict progression to liver complications.

Hui CK, Leung N, Shek WH, Zhang HY, Luk JM, Poon RT, Lo CM, Fan ST, Lau GK.

J Clin Gastroenterol. 2008;42(5):533-538

Rating & Commentary
* Detailed study in 89 HBV infected patients treated with interferon confirming that a 2-point increase in modified histological activity index (HAI) score after antiviral therapy is associated with increased progression to liver complications (relative risk 5.564).

Changing paradigm in the management of hepatocellular carcinoma improves the survival benefit of early detection by screening.

Chan AC, Poon RT, Ng KK, Lo CM, Fan ST, Wong J.

Ann Surg. 2008;247(4):666-73.

Rating & Commentary
* Large study in 1,366 patients with hepatocellular carcinoma (HCC) and underlying HBV or HCV infection confirming that long-term survival was significant better in patients who underwent HCC screening due to increased chance of curative treatment with the advent of liver transplantation and radiofrequency ablation (RFA).