Hepatology International

This study aimed to evaluate the efficacy and safety of entecavir, lamivudine and telbivudine for treating patients with HBV-ACLF and to validate the Tongji prognostic predictor model (TPPM) in these patients. In this retrospective study, we enrolled 283 patients with HBV-ACLF (100 treated with entecavir, 98 treated with lamivudine and 85 treated with telbivudine). There were no significant differences in baseline clinical and virological characteristics among patients treated with entecavir, telbivudine or lamivudine. There were no significant differences in the 4- and 12-week survival rates of entecavir-, telbivudine- and lamivudine-treated patients (79.00, 81.18 and 86.73 %, respectively, at 4 weeks; 67.00, 65.88 and 73.47 %, respectively, at 12 weeks). Patients in all three groups achieved an improvement in the model for end-stage liver disease (MELD) score. Using the Hosmer-Lemeshow test, the validation of the TPPM score for HBV-ACLF demonstrated a good degree of fit with disease prognosis. Based on this unique group of patients, the TPPM score with an AUC of 0.787 was superior to the MELD score, which had an AUC of 0.736 in the prediction of 12-week mortality. The TPPM had an AUC of 0.733, and the MELD score had an AUC of 0.672 in the prediction of 4-week mortality. Using a cutoff value of 0.22 for 12-week mortality prediction by the TPPM, the positive predictive value was 49.66 %, with a negative predictive value of 89.55 %. Treatment with nucleoside analogs including entecavir, lamivudine and telbivudine prevented disease progression and increased the survival of patients with HBV-ACLF. Validation of the established TPPM scoring system in this study confirmed its superior predictive value for HBV-ACLF patients when compared with the MELD system.

Hepatitis B virus is a member of the Hepadnaviridae family and responsible for causing acute and chronic hepatitis in humans. The current estimates of people chronically infected with the virus are put at 250 million worldwide. Immune-mediated liver damage in these individuals may lead to the development of cirrhosis and hepatocellular carcinoma later in life. This review deals with our current understanding of the virology, molecular biology, life cycle and cell-to-cell spread of this very important pathogen, all of which are considered essential for current and future approaches to antiviral treatment.

Chronic hepatitis C is an important health issue worldwide. The current standard therapy is based on a combination of pegylated-interferon (pegIFN) and ribavirin (RBV), but this treatment leads to only ~50% sustained virological response (SVR) in patients with HCV genotype 1 and high viral loads, who were mostly null-responders or relapsers. Among HCV genotypes other than HCV genotype 1, especially HCV genotype 4 patients show only 40–70% SVR by this treatment. Although new drugs also depend on the combination of pegIFN and RBV, it appears that these drugs improve not only rapid virological response (RVR) but also early virological response, leading to SVR in these patients. In the near future, we predict higher SVR rates in chronic hepatitis C patients treated with these new drugs.

To address the relationship between hepatitis B virus (HBV) endemicity and HBV-related liver diseases in Mexico. Research literature reporting on HBsAg and antibody to hepatitis B core antigen (anti-HBc) prevalence in Mexican study groups were searched in NLM Gateway, PubMed, IMBIOMED, and others. Weighted mean prevalence (WMP) was calculated from the results of each study group. A total of 50 studies were analyzed. Three nationwide surveys revealed an HBsAg seroprevalence of less than 0.3%. Horizontal transmission of HBV infection occurred mainly by sexual activity and exposure to both contaminated surgical equipment and body fluids. High-risk groups exposed to these factors included healthcare workers, pregnant women, female sex workers, hemodialysis patients, and emergency department attendees with an HBsAg WMP ranging from 1.05% (95% confidence interval [CI], 0.68–1.43) to 14.3% (95% CI, 9.5–19.1). A higher prevalence of anti-HBc in adults than those younger than 20 years was associated with the main risk factors. Anti-HBc WMP ranged from 3.13% (95% CI, 3.01–3.24) in blood donors to 27.7% (95% CI, 21.6–33.9) in hemodialysis patients. A heterogeneous distribution of HBV infection was detected, mainly in native Mexican groups with a high anti-HBc WMP of 42.0% (95% CI, 39.5–44.3) but with a low HBsAg WMP of 2.9% (95% CI 2.08–3.75). Estimations of the Mexican population growth rate and main risk factors suggest that HBsAg seroprevalence has remained steady since 1974. A low HBsAg prevalence is related to the low incidence of HBV-related liver cirrhosis and hepatocellular carcinoma (HCC) previously reported in Mexico.

Tính hiệu quả của entecavir (ETV) và tenofovir disoproxil fumarate (TDF) trong điều trị các kết cục liên quan đến gan ở bệnh nhân viêm gan B mãn tính mất bù (CHB) vẫn chưa được làm rõ. Một nghiên cứu đoàn hệ kéo dài 8 năm với 736 bệnh nhân CHB mất bù đã được thực hiện, trong đó 65 bệnh nhân được điều trị bằng TDF đã được khớp với 260 bệnh nhân được điều trị bằng ETV dựa vào tuổi, giới và điểm số mô hình bệnh gan giai đoạn cuối (MELD) theo phương pháp ghép cặp dựa trên điểm số thiên lệch. Trong số 736 bệnh nhân, 574 (78%) là nam giới, với độ tuổi trung bình là 54.3 năm, 438 (59.5%) mắc xơ gan, 147 (20%) dương tính với HBeAg, và 84 (11.6%) cùng 652 (88.4%) được điều trị bằng TDF và ETV, tương ứng. Những bệnh nhân được điều trị bằng ETV (652 người) có tuổi cao hơn, có điểm số MELD nền tảng cao hơn và tỷ lệ bệnh não gan cao hơn, nhưng có mức ALT thấp hơn so với 84 bệnh nhân được điều trị bằng TDF. Không có sự khác biệt có ý nghĩa thống kê nào được ghi nhận trong tỷ lệ tử vong liên quan đến gan hoặc ghép gan (1 tháng, 18.45 so với 14.01%, p = 0.368; 8 năm, 39.74 so với 34.24%, p = 0.298), và phát triển ung thư biểu mô tế bào gan (5 năm, 7.21 so với 13.17%, p = 0.994; 8 năm, 11.60 so với 13.17%, p = 0.857) giữa 260 bệnh nhân ETV và 65 bệnh nhân TDF đã được ghép cặp. Điểm số MELD nền tảng (tỷ lệ nguy cơ phân bố phụ thuộc (sHR): 1.063; khoảng tin cậy 95% (CI) của sHR: 1.016–1.112) và bệnh não gan (sHR: 5.127; 95% CI sHR: 3.032–8.669) có mối liên hệ độc lập với tỷ lệ tử vong liên quan đến gan hoặc ghép gan ở các bệnh nhân đã được ghép cặp. ETV và TDF có hiệu quả tương đương trong các kết cục liên quan đến gan ngắn hạn và dài hạn ở bệnh nhân CHB mất bù, và dự trữ gan nền tảng có liên quan đến các kết quả này.