Future prevention and treatment of chronic hepatitis B infection

Vaccination for hepatitis B virus (HBV) infection and treatment for chronic hepatitis B, while effective for primary prevention and control of the disease, still have their limitations. Global coverage of HBV immunization needs improvement. Several patient populations are noted to have suboptimal seroprotective rates after HBV vaccination. There are currently several potential new vaccines undergoing animal and human studies, most notably vaccines containing immunostimulatory DNA sequences. Long-term nucleoside analogue therapy is necessary in achieving permanent virologic suppression. Potential new treatments explore new mechanisms of action, including the inhibition of hepatitis B surface antigen release, targeting antifibrotic mechanism, and immunomodulation through novel interferons and therapeutic vaccines. The clinical application of potential new vaccines and therapies would enhance the prevention of HBV infection and treatment of chronic hepatitis B. © 2012 by Lippincott Williams & Wilkins.postprin

New high-definition narrow band imaging versus conventional high-definition white light colonoscopy for detection of colorectal adenomas: a randomised controlled trial with tandem colonoscopy

This journal suppl. entitled: 19th Medical Research Conference; Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong KongPoster PresentationINTRODUCTION: Adenoma detection is important in colonoscopy as polypectomy has been shown to reduce the subsequent incidence and mortality of colorectal cancer. Narrow band imaging (NBI), an image-enhanced imaging system of the endoscopy, is developed to improve the diagnostic performance of the endoscopy. We tested whether the new generation of NBI colonoscopy would improve detection of colorectal adenoma when compared with high-definition white light (HD-WL) in a randomised tandem colonoscopy study ...postprin

Tenofovir disoproxil fumarate for the treatment of chronic hepatitis B monoinfection

Introduction: Resistance in nucleoside/nucleotide analog (NA) therapy has always been a challenge in the management of chronic hepatitis B (CHB). Clinical studies: Initially developed for the treatment of HIV infection, early in vitro and clinical observational studies had shown tenofovir disoproxil fumarate (TDF) to be also active against CHB. Recent data from various multicenter phase 3 and 4 clinical trials have confirmed TDF being able to achieve a high viral suppression in both NA-naive and -experienced CHB patients. There are also emerging data on the efficacy of TDF in decompensated CHB. Although there are in vitro studies identifying certain mutation loci associated with a reduced susceptibility to TDF, there have so far been no reports of virologic resistance to TDF in clinical studies. TDF has a favorable safety profile, although more long-term data would be needed. Conclusions: TDF has the makings of an 'ideal' first-line drug for the treatment of CHB. © 2011 Asian Pacific Association for the Study of the Liver.postprin

Evaluating the sterility of disposable wall oxygen humidifiers, during and between use on patients.

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Prevalence of past or current Hepatitis B infection and factors for non-vaccination in Chinese patients with inflammatory bowel diseases

The Conference program's website is located at http://jsibd.jp/1staocc/program.htmlPoster Oral: PO-46Information on the prevalence and natural history of chronic hepatitis B (HBV) among Asian IBD patients are scarce. Moreover, the prevalence of HBV vaccination coverage in Asian IBD patients remains unknown. AIM: We determined the prevalence and clinical course of current and past HBV infection among Chinese IBD patients. We also determined the proportion of Chinese IBD patients without protective antibody against HBV and factors associated with non-vaccination. METHODS: All patients attending our IBD Clinic had blood tests for viral hepatitis B markers. The prevalence of current and past infection with HBV, and effective HBV vaccination were determined. We also identified for risk factors associated with non-vaccination. RESULTS: A total of 267 Chinese IBD (166 ulcerative colitis and 101 Crohn’s disease) patients were studied. The mean follow up was 10.5 years. Current HBV infection was detected in 6.7% patients whereas 28.5% had evidence of past HBV infection. One hundred and two (38.2%) patients had no detectable anti-HBs antibodies. Multivariate analysis found that young age of diagnosis (OR 1.021; 95% CI 1.00 – 1.04) and the use of thiopurines (OR 0.51; 95%CI 0.29 – 0.91) were associated with absence of anti-HBs. Deranged liver function was detected in 27 (10.1%) IBD patients including three (16.7%) HBsAg-positive patients. The corresponding proportion of patients with liver derangement was 7.9% in patients with past HBV infection, 8.9% in HBsAg-negative patients without anti-HBs and 11.2% in patients with effective HBV vaccination (P = 0.71). CONCLUSION: Current and past infection with HBV was detected in about one-third of Chinese IBD patients. Approximately 40% of IBD patients lacked protective antibody against HBV. The use of thiopurines and young age of diagnosis was associated with non-vaccination among Chinese IBD patients. A more intensive HBV vaccination program with regular monitoring of anti-HBs may be needed in this group of patients.published_or_final_versio

Levels of HBV DNA and not HBsAg are associated with biochemical flares after HBeAg seroconversion

BACKGROUND: The role of HBsAg levels in predicting subsequent flares in chronic hepatitis B patients after HBeAg seroconversion is not known METHODS: Serum HBsAg and HBV DNA levels were determined in 224 CHB patients at 6-12 months after spontaneous HBeAg seroconversion. Serum HBV DNA levels were performed using Cobas Taqman assay. HBsAg titers were determined using Roche Elecsys HBsAg II ...postprin

Effect of nucleos(t)ide analogues therapy on HBsAg, intrahepatic HBV DNA and covalently closed circular DNA levels

BACKGROUND: We aimed to study 1) the effects of 1-year nucleos(t)ide analogue (NA) therapy on HBsAg and covalently closed circular DNA (cccDNA) levels; and 2) the possible use of HBsAg reduction as a marker for cccDNA reduction. METHODS: We recruited 124 NA-treated patients with ...postprin

Continuous entecavir for treatment-naïve Chinese chronic hepatitis B in the real world setting: the six-year results

This journal suppl. entitled: 2014 DDW AbstractBACKGROUND: There is a paucity of data on uninterrupted entecavir for treatment-naive chronic hepatitis B (CHB) beyond 5 years. METHODS: Treatment-naive Chinese CHB patients were treated continuously with entecavir 0.5mg daily in the real world setting for up to 6 years. The cumulative rates of hepatitis B e antigen (HBeAg) seroconversion, alanine aminotransferase (ALT) normalization, DNA undetectability, virologic breakthrough (>1 log HBV DNA increase from the nadir) and genotypic resistance to entecavir were determined. HBV DNA levels were measured by Roche Taqman real time PCR assay (lower limit of detection: 20 IU/mL). Resistance profile was determined by line probe assay (LiPA, Innogenetics NV, Gent, Belgium) for patients ...postprin

A new model using routinely available clinical parameters to predict significant liver fibrosis in chronic hepatitis B

Objective: We developed a predictive model for significant fibrosis in chronic hepatitis B (CHB) based on routinely available clinical parameters. Methods: 237 treatment-naïve CHB patients [58.4% hepatitis B e antigen (HBeAg)-positive] who had undergone liver biopsy were randomly divided into two cohorts: training group (n = 108) and validation group (n = 129). Liver histology was assessed for fibrosis. All common demographics, viral serology, viral load and liver biochemistry were analyzed. Results: Based on 12 available clinical parameters (age, sex, HBeAg status, HBV DNA, platelet, albumin, bilirubin, ALT, AST, ALP, GGT and AFP), a model to predict significant liver fibrosis (Ishak fibrosis score ≥3) was derived using the five best parameters (age, ALP, AST, AFP and platelet). Using the formula log(index+1) = 0.025+0.0031(age)+0.1483 log(ALP)+0.004 log(AST)+0.0908 log(AFP+1)-0.028 log(platelet), the PAPAS (Platelet/Age/Phosphatase/AFP/AST) index predicts significant fibrosis with an area under the receiving operating characteristics (AUROC) curve of 0.776 [0.797 for patients with ALT <2×upper limit of normal (ULN)] The negative predictive value to exclude significant fibrosis was 88.4%. This predictive power is superior to other non-invasive models using common parameters, including the AST/platelet/GGT/AFP (APGA) index, AST/platelet ratio index (APRI), and the FIB-4 index (AUROC of 0.757, 0.708 and 0.723 respectively). Using the PAPAS index, 67.5% of liver biopsies for patients being considered for treatment with ALT <2×ULN could be avoided. Conclusion: The PAPAS index can predict and exclude significant fibrosis, and may reduce the need for liver biopsy in CHB patients. © 2011 Seto et al.published_or_final_versio

Atherosclerosis in patients with rheumatoid arthritis

Both Rheumatoid Arthritis (RA) and atherosclerosis are complex polygenic diseases. Previous studies have demonstrated that patients with RA are associated with up to 60% increased risk of cardiovascular disease related death. Nonetheless, the increased cardiovascular morbidity and mortality in patients with RA cannot be entirely explained by traditional risk factors, and likely to be multifactorial. The present article reviews the data supporting the association of RA with cardiovascular risk factors, possible mechanism for developing atherosclerosis and evaluates the potential strategies that may prevent premature atherosclerosis in these patients.published_or_final_versio