Hope-For-HepB Top10 February 2010
Chen YC, Chu CM, Liaw YF.
Hepatology. 2010;51(2):435-44.
Rating & Commentary
*** In 508 patients with spontaneous HBeAg seroconversion the impact of the age of HBeAg seroconversion on prognosis was investigated. The 15-year cumulative incidences of cirrhosis and HCC were 4 and 2% for seroconversion before the age of 30, and 43% and 8% for seroconversion after the age of 40.
Simonetti J, Bulkow L, McMahon BJ, Homan C, Snowball M, Negus S, Williams J, Livingston SE.
Hepatology. 2009 Nov 30. [Epub ahead of print]
Rating & Commentary
** In a prospective population-based cohort study in 1,271 Alaska native persons with chronic HBV infection followed for an average of 19.6 years, HBsAg loss occurred in 158 persons for a rate of HBsAg clearance of 0.7%/year. In these 158 subjects the incidence of HCC was 4-fold lower than in those who remained HBsAg positive, but still six patients, two with cirrhosis and four without, developed HCC a mean of 7.3 years after HBsAg clearance. This study suggests that periodic HCC screening should continue after HBsAg loss.
Reijnders JG, Deterding K, Petersen J, Zoulim F, Santantonio T, Buti M, van Bömmel F, Hansen BE, Wedemeyer H, Janssen HL; for the VIRGIL Surveillance Study Group.
J Hepatol. 2010 Feb 4. [Epub ahead of print]
Rating & Commentary
* This prospective, multicenter, European cohort study investigating 161 chronic hepatitis B patients (34% nucleos(t)ide analogue-experienced) treated with entecavir monotherapy confirmed its efficacy in nucleos(t)ide analogue-naïve patients. The antiviral efficacy of entecavir was not influenced by prior treatment with adefovir or presence of adefovir-resistance. Entecavir is an option in lamivudine-experienced patients in case lamivudine-resistance never developed; however, entecavir should not be used in patients with previous lamivudine-resistance.
Institute of Medicine recommendations for the prevention and control of hepatitis B and C.
Mitchell AE, Colvin HM, Palmer Beasley R.
Hepatology. 2010 Feb 22. [Epub ahead of print]
Rating & Commentary
** Important statement on measurements to reduce new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis in a low-endemic Western country. It makes specific recommendations in four areas: improved surveillance for HBV and HCV; improved knowledge and awareness among healthcare and social-service providers and the public, especially at-risk people; improved HBV vaccine coverage; and improved viral hepatitis services and access to those services.
Lok AS.
Hepatology. 2009 Dec 9. [Epub ahead of print]
Rating & Commentary
** Important editorial on the indications of starting antiviral therapy in HBV patients with mildy elevated ALT levels. It is stated that, until data supporting a benefit of antiviral therapy for clinical outcomes become available, initiating every chronic hepatitis B patient with mildly elevated ALT levels is not warranted. Some of these patients will turn out to have mild liver disease on biopsy, and others, notably young HBeAg-positive patients, may undergo spontaneous HBeAg seroconversion and enter into remission (at least temporarily) during the next few years.
Chen EQ, Wang LC, Lei J, Xu L, Tang H.
Virol J. 2009;6:163.
Rating & Commentary
* Meta-analysis of studies that evaluate the efficacy of rescue therapy with ADV plus LAM compared to ADV monotherapy in LAM-resistant CHB patients. The combination was found to be superior in inhibiting HBV replication and preventing ADV resistance to ADV alone, but an effect on liver damage was not yet evident in these 442 patients.
Schwimmer JB, Dunn W, Norman GJ, Pardee PE, Middleton MS, Kerkar N, Sirlin CB.
Gastroenterology. 2010 Jan 8. [Epub ahead of print]
Rating & Commentary
** Important large observational study using data from children's hospitals, the national health and nutrition examination survey (NHANES, 1999-2006), overweight children with and without non-alcoholic fatty liver disease (NAFLD), and children with chronic Hepatitis B virus (HBV) or Hepatitis C virus (HCV) infections. The median upper limit of ALT at children's hospitals was 53 U/L (range, 30-90), yet the 95th percentile levels for ALT in healthy weight, metabolically normal, liver disease-free, NHANES pediatric participants were 25.8 U/L (boys) and 22.1 U/L (girls). This study indicates that the upper limit of ALT used in children's hospitals varies widely and is set too high to reliably detect chronic liver disease.
Soriano V, Mocroft A, Peters L, Rockstroh J, Antunes F, Kirkby N, de Wit S, Monforte AD, Flisiak R, Lundgren J; on behalf of EuroSIDA.
J Antimicrob Chemother. 2010 Jan 5. [Epub ahead of print]
Rating & Commentary
* This study was done on all HIV-positive patients living in Europe and Argentina recruited in EuroSIDA (1994-2006) that were tested for serum HBV surface antigen (HBsAg). HIV positive patients with chronic hepatitis B frequently showed HBV viraemia, despite antiretroviral drugs including lamivudine.
Chen CH, Lee CM, Tung WC, Wang JH, Hung CH, Hu TH, Wang JC, Lu SN, Changchien CS.
J Hepatol. 2010 Feb 2. [Epub ahead of print]
Rating & Commentary
* Studying the evolution of full-length hepatitis B virus (HBV) sequences in 11 chronic hepatitis B (CHB) patients with sequential lamivudine (LAM) and adefovir (ADV) resistance revealed that changes of nucleotide or amino acid sequences occurred commonly in addition to the known LAM- and ADV-resistant mutations.
Weber NK, Forman LM, Trotter JF.
Dig Dis Sci. 2010;55(2):505-9.
Rating & Commentary
* Cohort study confirming earlier reports that HBIg discontinuation with maintenance oral anti-viral monotherapy is safe and effective for HBV liver transplant recipients in preventing recurrence. However, larger and better-designed studies are needed to confirm these observations.