Hope-For-HepB Top10 November 2008

Hepatitis B immunisation in travellers: poor risk perception and inadequate protection.

Zuckerman JN, Hoet B.

Travel Med Infect Dis. 2008;6(5):315-20.

Rating & Commentary
** Large European interview study among 4151 travelers to endemic countries showing that only 15% recalled receiving specific HBV vaccination. In addition, patients visiting a health care professional were not informed about risk factors for HBV transmission. However, one in four patients were at increased risk of HBV transmission during the travel.

Serum HBsAg changes in HBeAg positive chronic hepatitis B patients with continuous viral load reductions during treatment with adefovir or peg-interferon-alpha-2a.

Chen J, Wang Z, Guo Y, Peng J, Sun J, Ahmed CS, Zhou Y, Hou J.

Antiviral Res. 2008 Oct 20; Epub ahead of print.

Rating & Commentary
* Detailed study in 54 HBeAg positive chronic hepatitis B patients receiving adfovir or peginterferon showing that HBsAg level were significantly decreased during the first 12 weeks of therapy (median change –397.0 IU/ml vs. –555.4 IU/ml, p=0.005) but without further decline beyond week 12 in either group. Three different patterns of HBsAg changes were observed: biphasic, assurgent and wavy, offering insights into the possible mechanisms of HBsAg loss.

A randomized trial of combination hepatitis B therapy in HIV/HBV coinfected antiretroviral naïve individuals in Thailand.

Matthews GV, Avihingsanon A, Lewin SR, Amin J, Rerknimitr R, Petcharapirat P, Marks P, Sasadeusz J, Cooper DA, Bowden S, Locarnini S, Ruxrungtham K, Dore GJ.

Hepatology. 2008;48(4):1062-9.

Rating & Commentary
* Small study in 36 HBV-HIV coinfected patients suggesting that tenofovir is superior to lamivudine, with higher rates of undetectable HBV DNA after 48 weeks of therapy. The combination of the two drugs was comparable to monotherapy of tenofovir.

Liver stiffness measurement in combination with noninvasive markers for the improved diagnosis of B-viral liver cirrhosis.

Kim SU, Ahn SH, Park JY, Kang W, Kim DY, Park YN, Chon CY, Han KH.

J Clin Gastroenterol. 2008 Nov 3; Epub ahead of print.

Rating & Commentary
* Detailed study in 130 naïve chronic hepatitis B patients showing that combining liver stiffness measurement with non-invasive markers for fibrosis (AST/ALT ratio, age-platelet index and AST-platelet ratio index) accurately predicted liver cirrhosis (AUC up to 0.87). Liver biopsy could have potentially been avoided in 31.5% by applying this method.

Seroepidemiology of hepatitis B in Greek children 6 years after the implementation of universal vaccination.

Papaevangelou V, Hadjichristodoulou C, Cassimos DC, Pantelaki K, Tzivaras A, Hatzimichael A, Theodoridou M.

Infection. 2008;36(2):135-9.

Rating & Commentary
* Study showing that the prevalence of past HBV infection was significantly lower among children born after than before implementation of universal vaccination (2.9% vs. 5.5%, RR = 1.9, 95% CI 1.03-3.5). The prevalence of past HBV infection had however significantly decreased only among non-immigrant children.

Fibrosis progression rates between chronic hepatitis B and C patients with elevated alanine aminotransferase levels.

Fujiwara A, Sakaguchi K, Fujioka S, Iwasaki Y, Senoh T, Nishimura M, Terao M, Shiratori Y.

J Gastroenterol. 2008;43(6):484-91.

Rating & Commentary
* Retrospective paired-biopsy study in 49 HBV and 21 HCV infected, untreated patients with elevated ALT levels, showing a mean fibrosis progression rate of 0.21 fibrosis units (FU) per year in HBV and 0.13 FU/year in HCV.  The ALT level was an independent variable correlating with fibrosis progression, with an increased rate in patients with a median ALT level of 70 IU/l or more.

Large (>or=2 cm) non-hypervascular nodules depicted on MRI in the cirrhotic liver: fate and implications.

Yu JS, Chung JJ, Kim JH, Kim KW.

Clin Radiol. 2008;63(10):1121-30.

Rating & Commentary
* Small study in 21 cirrhotic patients showing that large (at least 2 cm) non-hypervascular nodules were often associated with malignant disease, particularly in hepatitis B patients (78%).

Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: A systematic review and meta-analysis.

Lehman EM, Wilson ML.

Int J Cancer. 2009;124(3):690-7

Rating & Commentary
* Systematic review showing a weighted mean prevalence for HBV and HCV of 6.7% and 13.9% among healthy populations, and 24.9% and 78.5% among HCC cases in Egypt. Among HCC cases, HBV significantly decreased over time (p=0.001) while HCV did not, suggesting a shift in the relative influences of these viruses in HCC etiology.

Durability of antiviral response in HBeAg-positive chronic hepatitis B patients who maintained virologic response for one year after lamivudine discontinuation.

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

Dig Dis Sci. 2008 Oct 31; Epub ahead of print.

Rating & Commentary
* Small study confirming that durability of response after discontinuation of lamivudine is limited, even in patients who sustained their response at 12 months post-treatment.

Liver stiffness in the hepatitis B virus carrier: A non-invasive marker of liver disease influenced by the pattern of transaminases.

Oliveri F, Coco B, Ciccorossi P, Colombatto P, Romagnoli V, Cherubini B, Bonino F, Brunetto MR.

World J Gastroenterol. 2008;14(40):6154-62.

Rating & Commentary
* Large study in 297 chronic hepatitis B patients showing that necroinflammation, ALT levels and HBV DNA levels significantly influence liver stiffness measurements in addition to fibrosis stage.