Hope-For-HepB Top10 October 2008

Metabolic syndrome increases the risk of liver cirrhosis in chronic hepatitis B.

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

Gut. 2008 Oct 2; Epub ahead of print.

Rating & Commentary
** Large study in 1,466 chronic hepatitis B patients showing that histologic liver cirrhosis and cirrhosis on transient elastography was more common among patients who had metabolic syndrome (38% and 24%) versus those who did not (11% and 11%, P<0.001). Metabolic syndrome was an independent factor associated with cirrhosis in these chronic hepatitis B virus infected patients.

Experience of German Red Cross blood donor services with nucleic acid testing: results of screening more than 30 million blood donations for human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus.

Hourfar MK, Jork C, Schottstedt V, Weber-Schehl M, Brixner V, Busch MP, Geusendam G, Gubbe K, Mahnhardt C, Mayr-Wohlfart U, Pichl L, Roth WK, Schmidt M, Seifried E, Wright DJ; German Red Cross NAT Study Group.

Transfusion. 2008;48(8):1558-66.

Rating & Commentary
** Very large study in over 30 million blood donation samples showing that the risk of a blood recipient becoming infected with hepatitis C virus (HCV; 1 in 10.88 million), human immunodeficiency virus (HIV-1; 1 in 4.3 million) or hepatitis B virus (HBV; 1 in 360,000) has reached an extremely low level. Introduction of individual donation testing for HCV and HIV-1 would have a marginal effect on interception of window period donation.

A cost-effectiveness analysis of currently approved treatments for HBeAg-positive chronic hepatitis B.

Spackman DE, Veenstra DL.

Pharmacoeconomics. 2008;26(11):937-49.

Rating & Commentary
* Cost-utility analysis using a Markov model showing that entecavir (18.70 QALYs) and pegylated interferon (18.64 QALYs) provided the largest treatment benefits in patients with HBeAg positive chronic hepatitis B. Initiation of treatments with a favourable combination of seroconversion, viral suppression and resistance profile appear to offer the greatest clinical and economic value.

Is there a meaningful serum hepatitis B virus DNA cutoff level for therapeutic decisions in hepatitis B e antigen-negative chronic hepatitis B virus infection?

Papatheodoridis GV, Manesis EK, Manolakopoulos S, Elefsiniotis IS, Goulis J, Giannousis J, Bilalis A, Kafiri G, Tzourmakliotis D, Archimandritis AJ.

Hepatology. 2008 Jul 10; Epub ahead of print.

Rating & Commentary
* Large study in 434 HBeAg negative chronic hepatitis B patients confirming that all inactive carriers had HBV DNA <20,000 IU/mL. Patients with persistently or transiently increased ALT and HBV DNA >/=20,000 IU/mL almost always required therapeutic intervention. A liver biopsy should be considered in patients with elevated ALT levels, also if HBV DNA is <2,000 IU/mL.

A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2008 Update.

Keeffe EB, Dieterich DT, Han SH, Jacobson IM, Martin P, Schiff ER, Tobias H.

Clin Gastroenterol Hepatol. 2008 Aug 23; Epub ahead of print.

Rating & Commentary
* Updated treatment algorithm for chronic hepatitis B by an American expert panel stating that entecavir, peginterferon alfa-2a and tenofovir are preferred as first-line therapies.

Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review.

Yang J, Zeng XM, Men YL, Zhao LS.

Virol J. 2008 Aug 28;5:100.

Rating & Commentary
* Systematic review including four randomized trials involving 789 people showing that elective caesarean section was associated with a lower risk of mother to child transmission that vaginal delivery (10.5% vs. 28.0%, p<0.001) in a setting without antiviral therapy.

Prevalence and risk factors of hepatic steatosis and its impact on liver injury in Chinese patients with chronic hepatitis B infection.

Shi JP, Fan JG, Wu R, Gao XQ, Zhang L, Wang H, Farrell GC.

J Gastroenterol Hepatol. 2008;23(9):1419-25.

Rating & Commentary
* Large study in 1915 Chinese chronic hepatitis B patients showing that steatosis was present in 15% of males and 8% of female patients (p<0.001). Multivariate analysis showed that steatosis was independently associated with body mass index, serum triglyceride, apolipoprotein B, uric acid, and fasting blood glucose, not with viral factors.

Clinical, biochemical, immunological and virological profiles of, and differential diagnosis between, patients with acute hepatitis B and chronic hepatitis B with acute flare.

Han Y, Tang Q, Zhu W, Zhang X, You L.

J Gastroenterol Hepatol. 2008 Sep 24; Epub ahead of print.

Rating & Commentary
* Detailed retrospective study showing that there are significant differences with respect to clinical, biochemical, immunological and virological aspects between acute self-limiting hepatitis B and chronic hepatitis B with an acute flare. IgM anti-HBc and HBV-DNA were most effective and most practicable in distinguishing between the two.

Practical efficacy of sorafenib monotherapy for advanced hepatocellular carcinoma patients in a Hepatitis B virus-endemic area.

Shim JH, Park JW, Choi JI, Park BJ, Kim CM.

J Cancer Res Clin Oncol. 2008 Oct 10; Epub ahead of print.

Rating & Commentary
* Retrospective study in 57 consecutive patients with unresectable or metastatic hepatocellular carcinoma (HCC) showing that disease control could be achieved in 40.4% of patients with sorafenib (400 mg). The most common adverse events were hand-foot syndrome (8.8%), diarrhea (7.0%), and skin rash (7.0%).

Hepatitis B immunisation in persons not previously exposed to hepatitis B or with unknown exposure status.

Mathew JL, El Dib R, Mathew PJ, Boxall EH, Brok J.

Cochrane Database Syst Rev. 2008;(3):CD006481.

Rating & Commentary
* Systematic review of persons not previously exposed to hepatitis B infection showing that based on data of available participants from 12 eligible trials HBV vaccination reduced the risk of developing HBsAg (RR 0.12, 95% CI 0.03 to 0.44) and anti-HBc positivity (RR 0.36, 95% CI 0.17 to 0.76).