Hope-For-HepB Top10 May 2008

Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT.

Kumar M, Sarin SK, Hissar S, Pande C, Sakhuja P, Sharma BC, Chauhan R, Bose S.

Gastroenterology. 2008;134(5):1376-84.

Rating & Commentary
** Large study in 189 chronic hepatitis B patients with persistently normal ALT levels (PNALT) and 1198 with persistently or intermittently elevated ALT levels (PIEALT) showing that about one-fifth of PNALT patients with HBV DNA 105 copies/ml had significant fibrosis or necroinflammation on liver biopsy, stressing the need for liver biopsy in such patients.

Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta-analysis.

Katz LH, Fraser A, Gafter-Gvili A, Leibovici L, Tur-Kaspa R.

J Viral Hepat. 2008;15(2):89-102.

Rating & Commentary
** Meta-analysis of 21 studies investigating the effect of prophylactic lamivudine therapy in HBsAg positive patients undergoing immunosuppressive therapy showing that lamivudine therapy significantly reduced clinical reactivation (odds ratio 0.09 [0.05-0.15]) and all-cause mortality (odds ratio 0.36 [0.23-0.56]).

What can be revealed by extending the sensitivity of HBsAg detection to below the present limit?

Togashi H, Hashimoto C, Yokozawa J, Suzuki A, Sugahara K, Saito T, Yamaguchi I, Badawi H, Kainuma N, Aoyama M, Ohya H, Akatsuka T, Tanaka Y, Mizokami M, Kawata S.

J Hepatol. 2008 Apr 22; Epub ahead of print.

Rating & Commentary
* Large study in 210 healthy volunteers and 368 patients with non-HBV chronic liver disease with undetectable HBsAg by standard methods showing that in about 3% of healthy volunteers and 9% of liver disease patients HBsAg was detectable by the more sensitive radical immunoassay. HBV DNA was detected by PCR assay in about 2% of HBsAg negative patients with chronic liver disease.

Prevalence of fibrosis and cirrhosis in chronic hepatitis B: Implications for treatment and management.

Fung J, Lai CL, But D, Wong D, Cheung TK, Yuen MF.

Am J Gastroenterol. 2008 Apr 16; Epub ahead of print.

Rating & Commentary
* Large study using transient elastography in 1315 Asian chronic hepatitis B patients showing that the prevalence of severe fibrosis increased with increasing age to 81% in those aged >65 years. In addition to age, male sex and higher ALT levels were associated with severe fibrosis. The prevalence of cirrhosis was lower in patients who received antiviral therapy compared to treatment-naïve patients.

Safety, efficacy, and pharmacokinetics of adefovir dipivoxil in children and adolescents (age 2 to <18 years) with chronic hepatitis B.

Jonas MM, Kelly D, Pollack H, Mizerski J, Sorbel J, Frederick D, Mondou E, Rousseau F, Sokal E.

Hepatology. 2008;47(6):1863-71.

Rating & Commentary
* Large study in 173 children with HBeAg positive chronic hepatitis B showing that adefovir resulted in higher rates of combined response (HBV DNA <1,000 copies/ml and ALT normal) compared to placebo in patients aged 12-17 years (23% vs. 0%, p=0.007), but not in those aged 2-11 years despite adequate exposure to the drug.

Low risk of adefovir resistance in lamivudine-resistant chronic hepatitis B patients treated with adefovir plus lamivudine combination therapy: Two-year follow-up.

Yatsuji H, Suzuki F, Sezaki H, Akuta N, Suzuki Y, Kawamura Y, Hosaka T, Kobayashi M, Saitoh S, Arase Y, Ikeda K, Watahiki S, Iwasaki S, Kobayashi M, Kumada H.

J Hepatol. 2008;48(6):923-31.

Rating & Commentary
* Study in 132 lamivudine-resistant chronic hepatitis B patients showing that combination therapy of adefovir and lamivudine results in undetectable HBV DNA in 81% of patients after 2 years and confirming a low risk of resistance of 4% after 2 years.

Comparing the safety, tolerability and quality of life in patients with chronic hepatitis B vs chronic hepatitis C treated with peginterferon alpha-2a.

Marcellin P, Lau GK, Zeuzem S, Heathcote EJ, Pockros PJ, Reddy KR, Piratvisuth T, Farci P, Chow WC, Jia JD, Paik W, Wintfeld N, Pluck N.

Liver Int. 2008;28(4):477-85.

Rating & Commentary
* Pooled data of hepatitis B virus (HBV, n=448) and hepatitis C virus (HCV, n=791) infected patients receiving peginterferon alpha-2a monotherapy for 48 weeks confirming that the frequency of (serious) adverse events, treatment withdrawals and depression-related events was lower in HBV than HCV infected patients.

Prevalence, aetiology and associated co-morbidities of elevated aminotransferases in a German cohort of orthopaedic surgery patients.

Lobstein S, Kaiser T, Liebert U, Wojan M, Leichtle A, Mössner J, Wiegand J, Tillmann HL.

Z Gastroenterol. 2008;46(5):415-20.

Rating & Commentary
* Large study in 960 orthopaedic surgery patients, of whom 300 had elevated ALT and/or AST levels, showing that patients with elevated aminotransferases significantly more often had hypertension, chronic ischaemic heart disease, hyperlipidaemia and hyperuricaemia as compared to controls without elevated aminotransferases.

Family physicians' knowledge and screening of chronic hepatitis and liver cancer.

Ferrante JM, Winston DG, Chen PH, de la Torre AN.

Fam Med. 2008;40(5):345-51.

Rating & Commentary
* Cross-sectional survey among 217 family physicians in the United States showing that family physicians have insufficient knowledge about screening and counseling for chronic hepatitis and hepatocellular carcinoma.

Systematic review: the effect of preventive lamivudine on hepatitis B reactivation during chemotherapy.

Loomba R, Rowley A, Wesley R, Liang TJ, Hoofnagle JH, Pucino F, Csako G.

Ann Intern Med. 2008;148(7):519-28.

Rating & Commentary
* Systematic review of 14 studies including 275 patients undergoing chemotherapy receiving preventive lamivudine and 475 controls showing that preventive treatment with lamivudine may reduce the risk of HBV reactivation and its associated morbidity and mortality.