Hope-For-Hep B Top10 August 2008

Treatment recommendations for chronic hepatitis B: An evaluation of current guidelines based on a natural history study in the United States.

Tong MJ, Hsien C, Hsu L, Sun HE, Blatt LM.

Hepatology. 2008 Jun 19; Epub ahead of print.

Rating & Commentary
**  Retrospective study in 369 HBsAg positive patients showing that only 20-70% of patients developing HCC or dying from liver-related deaths were considered for antiviral therapy according to current guidelines. Adding serum albumin, platelet count and ideally core promoter mutants to these criteria would increase the proportion of these patients identified for treatment to 89-100%.

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

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

J Viral Hepat. 2008;15(7):538-50. Epub 2008 Apr 4.

Rating & Commentary
** Large community-based study in Sweden showing increased all-cause standardized mortality ratios for hepatitis B virus (HBV) (2.3), hepatitis C virus (HCV) (5.8) and HBV/HCV coinfected patients (8.5), with a great excess liver-related mortality in all three cohorts (21.7, 35.5 and 46.2 respectively).

Long-term follow-up of lamivudine treatment in patients with severe acute exacerbation of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B.

Wong VW, Wong GL, Tsang SW, Hui AY, Chim AM, Yiu KK, Chan HY, Chan FK, Sung JJ, Chan HL.

Antivir Ther. 2008;13(4):571-9.

Rating & Commentary
* Detailed study in 76 HBV infected patients showing that patients with severe acute exacerbation had higher HBeAg seroconversion rates (78% versus 52%; P=0.02) and lower risk of virological breakthrough compared to HBV infected controls during lamivudine treatment. However, 33% developed resistance and virological breakthrough by year 5.

Treatment of patients with chronic hepatitis B who have failed previous antiviral treatment with pegylated interferon alpha2a (40 kda; PEGASYS).

Chan HL, Wong VW, Chim AM, Wong GL, Chan HY, Sung JJ.

Antivir Ther. 2008;13(4):555-62.

Rating & Commentary
* Small study in 40 hepatitis B virus (HBV) infected patients who did not respond to nucleot(s)ide analogue therapy. After 48 weeks peginterferon treatment, virological response was achieved in 55% and undetectable HBV DNA in 40% of patients, confirming the efficacy of peginterferon in previous non-responders.

Chronic cirrhotic hepatitis B patients with a high incidence of hepatic decompensation after viral breakthrough with lamivudine-resistant mutants and during rescue treatment.

Joo MK, Yeon JE, Kim JH, Jung YK, Lee SJ, Kim JH, Yim HJ, Byun KS, Park JJ, Kim JS, Bak YT.

Scand J Gastroenterol. 2008 Jul 29:1-8; Epub ahead of print.

Rating & Commentary
* Study in 205 chronic hepatitis B virus infected patients with viral breakthrough during lamivudine therapy showing that hepatic decompensation occurred significantly more often in patients with liver cirrhosis than in those with chronic hepatitis (23% vs. 4%, p=0.001), while hepatitis flares occurred equally in both patient groups (32% vs. 31%).

Meta-analysis: Treatment of hepatitis B infection reduces risk of hepatocellular carcinoma.

Sung JJ, Tsoi KK, Wong VW, Li KC, Chan HL.

Aliment Pharmacol Ther. 2008 Jul 24; Epub ahead of print.

Rating & Commentary
* Meta-analysis of 12 studies including 2,742 chronic hepatitis B patients showing that the risk of developing hepatocellular carcinoma was reduced by 34% and 78% in patients treated with interferon (IFN) or nucleos(t)ide analogues (NA) compared to untreated controls. While IFN benefited patients with cirrhosis, NA benefited patients with no cirrhosis and HBeAg positive chronic hepatitis B.

Changing aetiology of liver dysfunction in the new generation of a hepatitis B and C-endemic area: cross-sectional studies on adolescents born in the first 10 years after universal hepatitis B vaccination.

Kao JT, Wang JH, Hung CH, Hu TH, Lee CM, Hung SF, Lu SN.

Liver Int. 2008 Jul 23; Epub ahead of print.

Rating & Commentary
* Study reporting on 5 cross-sectional screenings including 1788 students born from 1984 to 1993 showing that in place of viral hepatitis, obesity is becoming the major etiology of abnormal liver function among the young generation in a previously hepatitis-endemic area.

Efficacy of serologic marker screening in identifying hepatitis B virus infection in organ, tissue, and cell donors.

Challine D, Chevaliez S, Pawlotsky JM.

Gastroenterology. 2008 Jul 17; Epub ahead of print.

Rating & Commentary
* Large study in 11,155 consecutive organ, tissue, and cell donors showing that the prevalence of HBV DNA with no HBV serologic markers or isolated anti-HBs antibodies was 0.07%, suggesting that the analytic sensitivity of HBV assays to detect HBsAg mutants should be improved.

Virion half-life in chronic hepatitis B infection is strongly correlated with levels of viremia.

Dandri M, Murray JM, Lutgehetmann M, Volz T, Lohse AW, Petersen J.

Hepatology. 2008 Aug 11; Epub ahead of print.

Rating & Commentary
* Study in 80 untreated chronic hepatitis B patients showing a very fast virion half-life (median 46 and 2.5 minutes in HBeAg-positive and HBeAg-negative individuals, respectively). In addition, both host defense mechanisms and levels of circulating virions affected the kinetics of HBV decay assessed in the serum of chronic carriers.

Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B.

Chan HL, Wong GL, Choi PC, Chan AW, Chim AM, Yiu KK, Chan FK, Sung JJ, Wong VW.

J Viral Hepat. 2008 Jul 28; Epub ahead of print.

Rating & Commentary
* Study in 161 chronic hepatitis B patients confirming that transient elastography is a reasonable noninvasive tool to substitute liver biopsy. Since the diagnostic performance of transient elastography was ALT dependent, cutoff values and algorithms were derived for normal and elevated ALT levels.