scholarly journals Development and Validation of a Novel Model to Predict Liver Histopathology in Patients with Chronic Hepatitis B

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Hongying Guo ◽  
Beidi Zhu ◽  
Shu Li ◽  
Jing Li ◽  
Zhiqing Shen ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Antiviral Therapy ◽  
Chronic Hepatitis B ◽  
Validation Cohort ◽  
Antiviral Treatment ◽  
Roc Curves ◽  
Training Cohort ◽  
Liver Histopathology ◽  
Novel Model

It is still vague for chronic hepatitis B (CHB) patients with normal or mildly increasing alanine aminotransferase (ALT) level to undergo antiviral treatment or not. The purpose of our study was to establish a noninvasive model based on routine blood test to predict liver histopathology for antiviral therapy. This retrospective study enrolled 258 CHB patients with liver biopsy from the First Hospital of Quanzhou (training cohort, n=126) and Huashan Hospital (validation cohort, n=132). Histologic grading of necroinflammation (G) and liver fibrosis (S) was performed according to the Scheuer scoring system. A novel model, ATPI, including aspartate aminotransferase (AST), total bilirubin (TBil), and platelets (PLT), was developed in training cohort. The area under ROC curves (AUC) of ATPI for predicting antiviral therapy indication was 0.83 in training cohort and was 0.88 in the validation cohort, respectively. Similarly, ATPI also displayed the highest AUC in predicting antiviral therapy indication in CHB patients with normal or mildly increasing ALT level. In conclusion, ATPI is a novel independent model to predict liver histopathology for antiviral therapy in CHB patients with normal and mildly increased ALT levels.

scholarly journals A Simple-to-use Tool for Predicting Response to Peginterferon in HBV DNA Suppressed Chronic Hepatitis B Patients

2021 ◽  
Author(s):  
Peipei Ren ◽  
Hu Li ◽  
Yan Huang ◽  
Jiayuan Jiang ◽  
Simin Guo ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Scoring System ◽  
Validation Cohort ◽  
Operating Characteristics ◽  
Hbsag Level ◽  
Training Cohort ◽  
Hbsag Loss ◽  
End Of Treatment

Abstract Background: Rational administration of peginterferon can remarkably reduce serum HBsAg level and improve the rate of HBsAg loss. Considering the high cost and low tolerability of peginterferon, we aimed to develop a simple-to-use scoring system at early stage of treatment to predict low HBsAg level or HBsAg loss at the end of treatment in virological suppressed chronic hepatitis B (CHB) patients.Methods: Non-cirrhotic CHB patients with NA (nucleoside/nucleotide analogues)-induced virological suppression initiated peginterferon treatment by either add-on or switch-to strategy for 48 weeks were enrolled from January 2012 to June 2017 in two tertiary centers. The retrospective design enrolled 320 subjects, including 189 patients in the training cohort and 131 patients in the validation cohort.Results: By logistic regression, a simple-to-use scoring system integrating baseline HBsAg level < 1000 IU/mL, HBsAg decline > 0.5 log at week 12 and ALT flare at week 12 was developed in the training cohort and high performance for predicting HBsAg < 100 IU/mL, HBsAg < 10 IU/mL and HBsAg loss at the end of 48-week treatment. The area under receiver operating characteristics curve was 0.84, 0.80 and 0.76 in the training cohort and 0.88, 0.87 and 0.84 in the validation cohort, respectively.Conclusions: Our simple-to-use scoring system can guide clinicians to decide whether to continue peginterferon treatment in CHB patients in order to achieve low HBsAg levels or HBsAg loss at the end of treatment, which might greatly improve the opportunity to reach a functional cure in these patients and lead more cost-effective treatment decision.

scholarly journals SELECTING THE MANAGEMENT OF PATIENTS WITH CHRONIC HEPATITIS B AFTER THE COMPLETION OF THE LONG-TERM ANTIVIRAL THERAPY

2018 ◽  
Vol 10 (3) ◽  
pp. 108-114
Author(s):  
E. V. Esaulenko ◽  
K. A. Zakharov ◽  
I. S. Alikian ◽  
A. A. Sukhoruk ◽  
T. A. Stasishkis ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Viral Load ◽  
Hepatitis B ◽  
Antiviral Therapy ◽  
Chronic Hepatitis B ◽  
Clinical Laboratory ◽  
Antiviral Treatment ◽  
Treatment Discontinuation ◽  
Clinical Relapse ◽  
Negative Chronic Hepatitis

Study aims: The study purpose was to analyze the results of the clinical and laboratory monitoring of HBeAg-negative chronic hepatitis B patients after discontinuation of longterm nucleosides analogues antiviral therapy in order to determine further management.Materials and methods: A retrospective-prospective investigation was performed in 106 patients with diagnosis of HBeAg-negative chronic hepatitis B during the course of antiviral therapy using nucleosides analogues. Average treatment duration was 190,1±77,7 weeks. The therapy was discontinued for 29 patients in the period of time from two to five years of the treatment, they were followed up from 6 months to 6 years. The activity of aminotransferases, the levels of HBV DNA were evaluated, the liver elastometry was performed during the patients monitoring. The relapse of disease after the treatment discontinuation was considered when the viral load exceeded 2.0x103 IU / ml and/or alanine aminotransferase levels were above the reference values.Results: The viral load varied from 4,0х102 IU/ml to 2,87 х 107 IU/ml at 86,2% cases after the 6 months of discontinuation of the treatment. However median levels of viral load were not higher than 2,5 х 103 IU/ml at different timepoints of observation. The VL was higher than 2,0 х 103 IU/ml in 62,1% patients and it matched to relapse criterion. Clinical relapse was not revealed in 13,8% cases at observational period from 6 months to 2 years. The second course of antiviral therapy was not required for 37,9% patients, at the same time it was necessary to consider it for the rest ones.Conclusion: Regular medical checkups with periodical clinical, laboratory and instrumental examinations after antiviral treatment discontinuation are required for timely detection of relapse and decision regarding the next course of antiviral therapy. 

Development and Validation of a Risk Score for Liver Cirrhosis Prediction in Untreated and Treated Chronic Hepatitis B

2020 ◽  
Vol 223 (1) ◽  
pp. 139-146
Author(s):  
An K Le ◽  
Hwai-I Yang ◽  
Ming-Lun Yeh ◽  
Mingjuan Jin ◽  
Huy N Trinh ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Antiviral Therapy ◽  
Chronic Hepatitis B ◽  
Risk Score ◽  
Antiviral Treatment ◽  
External Validation ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Derivation Cohort

Abstract Background Chronic hepatitis B (CHB) can progress to cirrhosis, but there are limited noninvasive tools available to estimate cirrhosis risk, including in patients receiving antiviral therapy. This study developed and validated a simple model to assess risk in CHB patients. Methods The derivation cohort included 3000 CHB patients from 6 centers in the United States, with 52.60% receiving antiviral therapy. External validation was performed for 4552 CHB individuals from similar cohorts in Taiwan, with 21.27% receiving therapy. Cox proportional hazards regression analyses were used to screen predictors and develop the risk score for cirrhosis. Areas under receiver operating characteristic curves (AUROCs) were calculated for predictive value. Results Sex, age, diabetes, antiviral treatment status/duration, hepatitis B e-antigen, and baseline alanine aminotransferase/aspartate aminotransferase levels were significantly associated with increased cirrhosis risk. A 13-point risk score was developed based on these predictors. The AUROCs for predicting cirrhosis risk were 0.82 at 3 years, 0.85 at 5 years, and 0.89 at 10 years in the derivation cohort, and 0.82, 0.79, and 0.77 in the validation cohort, respectively. Conclusions We developed and validated a simple cirrhosis prediction model with an independent external cohort that can be applied to both treatment-naive and treatment-experienced CHB patients in diverse settings and locations.

Serum Vitamin D Levels in Chronic Hepatitis B Patients Before and During Treatment

2019 ◽  
Vol 19 ◽  
Author(s):  
Amal Ahmed Mohamed ◽  
Sabry Abdo ◽  
Ebada Said ◽  
Waleed El Agawy ◽  
Peter Awad ◽  
...  
Keyword(s):  
Vitamin D ◽  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Antiviral Therapy ◽  
Chronic Hepatitis B ◽  
Antiviral Treatment ◽  
Serum Vitamin ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
The Impact

Background & Aims: Hepatitis B is a potentially life-threatening liver infection and it is a major global health problem. Over the past decade, numerous studies have reported that patients with CLD, especially HCV-positive and HBV-positive patients, have decreased 25(OH) D levels. The current study was designed to assess the serum levels of vitamin D [25(OH) D3] in chronic hepatitis B patients, before and during treatment with antiviral therapy. Methods: It was a prospective study in which 80 subjects were enrolled between December 2017 and June 2018. A total of 50 treatment-naïve chronic HBV patients and 30 healthy subjects were recruited. The studied cases received treatment in the form of Lamivudine 100 mg tablet, once daily. Full routine laboratory investigations, HBV DNA measurement by real time PCR; once before initiation of antiviral treatment and again at least 6 months later, serum vitamin D level [25(OH)D3; assessed twice, once before initiation of antiviral treatment and again at least 6 months later; were done for all the patients enrolled in the study. Results: The studied cases showed a significantly low mean serum Vitamin D level when assessed before treatment (21.6 ± 5.8 ng/ml), compared to the level after 6 ms of treatment (31.1 ± 7.3 ng/ml) that was comparable to that of the control group (33.4 ± 5 ng/ml). Conclusion: The present study highlights the impact of antiviral therapy on vitamin D deficiency in CHB patients, where an effective therapy improves vitamin D levels. Meanwhile it is recommended to study the impact of vitamin D replacement and correction on the disease progression or regression.

scholarly journals Clinical features of chronic B hepatitis in children depending on treatment response

2020 ◽  
Vol 4 (11) ◽  
pp. 682-686
Author(s):  
O.V. Churbakovа ◽  
◽  
V.G. Akimkin ◽  
D.V. Pechkurov ◽  
◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Liver Fibrosis ◽  
Hepatitis B ◽  
Antiviral Therapy ◽  
Treatment Response ◽  
Chronic Hepatitis B ◽  
Clinical Features ◽  
Sustained Virologic Response ◽  
Antiviral Treatment ◽  
Virologic Response

Background: chronic hepatitis is a common infection in all age groups. The optimization of therapeutic approaches is an important medical social and national economic issue. Aim: to describe the clinical and laboratory features of chronic hepatitis B (CHB) in children depending on the efficacy of antiviral therapy. Patients and Methods: 31 children aged 3–17 years with НBeAg-negative CHB who were treated in the Children’s Infectious Department of N.A. Semashko Samara City Clinical Hospital No. 2 and then monitored in a children’s hepatological center were enrolled. These children received no prior antiviral treatment. T he efficacy of antivirals and CHB outcomes over a 6-year perio d were evaluated. Results: the changes in clinical and biochemical parameters in children with CHB depending on treatment response were analyzed. All children were prescribed with antiviral therapy according to Diagnosis and Treatment Protocol for Hepatitis B and C (2010). In 14 (45.2%) children who received antiviral therapy, sustained virologic response was achieved after 48 weeks. In these children, no cases of liver fibrosis were reported over a 6-year period. Meanwhile, in the group without sustained virologic response after antiviral therapy (n=17), 1 patient was diagnosed with liver fibrosis stage 1 and 2 patients were diagnosed with Child class A cirrhosis. Conclusion: despite countrywide HBV vaccination, the incidence of CHB is still high thus requiring the development of novel diagnostic and therapeutic strategies. KEYWORDS: chronic hepatitis B, children, differential therapy, viral host response, prognosis. FOR CITATION: Churbakovа O.V., Akimkin V.G., Pechkurov D.V. Clinical features of chronic B hepatitis in children depending on treatment response. Russian Medical Inquiry. 2020;4(11):682–686. DOI: 10.32364/2587-6821-2020-4-11-682-686.

scholarly journals Outcomes of Cessation of Antiviral Therapy in Chronic Hepatitis B: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Pınar Ergen ◽  
Burcu Işık ◽  
Ferhat Arslan ◽  
Fatma Yılmaz Karadağ ◽  
Özlem Aydın ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Cohort Study ◽  
Hepatitis B ◽  
Antiviral Therapy ◽  
Chronic Hepatitis B ◽  
Viral Suppression ◽  
Antiviral Treatment ◽  
Hbeag Seroconversion ◽  
Adverse Outcomes ◽  
Clinical Relapse

Objective: Data on the efficacy and duration of nucleos(t)ide analogue (NUC) therapies to prevent the development of cirrhosis and hepatocellular carcinoma in chronic hepatitis B (CHB) patients are scarce and heterogeneous. This study aimed to summarize the clinical and laboratory results of the patients with CHB infection who discontinued oral antiviral therapy. Methods: A single-centered cohort study was conducted with CHB infection. NUCs were discontinued in patients who were under viral suppression for at least two years with undetectable HBV DNA levels for 18 months. Risk factors for clinical relapse (CR) were evaluated. Results: A total of 77 patients were recruited. HBeAg status showed that 9.4% of the patients underwent HBeAg seroconversion with NUCs. HBeAg reversion was noted in four (31%) of these patients. Severe hepatitis, which resolved after antiviral therapy was restored, was reported in two out of 77 patients (4%). None of the patients with CR had clinical or biological signs of hepatic decompensation or died during the study period. Conclusions: We found no benefits of the discontinuation of antiviral therapy after viral suppression in patients with initially severe fibrotic HBV infection. In patients with mild to moderate fibrosis, cessation of antiviral treatment is not associated with adverse outcomes

scholarly journals A noninvasive model to predict liver histology for antiviral therapy decision in chronic hepatitis B with alanine aminotransferase < 2 upper limit of normal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shanshan Chen ◽  
Haijun Huang ◽  
Wei Huang
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Liver Biopsy ◽  
Antiviral Therapy ◽  
Alanine Aminotransferase ◽  
Antiviral Treatment ◽  
Training Group ◽  
Liver Histology ◽  
Validation Group ◽  
Upper Limit

Abstract Background At present, most assessments of liver fibrosis staging mainly focus on non-invasive diagnostic methods. This study aims to construct a noninvasive model to predict liver histology for antiviral therapy in chronic hepatitis B (CHB) with alanine aminotransferase (ALT) < 2 times upper limit of normal (ULN). Methods We retrospectively analyzed 577 patients with CHB who received liver biopsy and whose ALT was less than 2 ULN. Then they were randomly divided into a training group and a validation group. Through logistic regression analysis, a novel predictive model was constructed in the training group to predict significant changes in liver histology [necro-inflammatory activity grade (G) ≥ 2 or fibrosis stage (S) ≥ 2] and then validated in the validation group. Results If liver biopsy showed moderate or severe inflammation or significant fibrosis, antiviral treatment was recommended. Aspartate aminotransferase (AST), anti-hepatitis B virus core antibody (anti-HBC) and glutamine transpeptidase (GGT) were identified as independent predictors for antiviral therapy, with area under the ROC curve (AUROC) of 0.649, 0.647 and 0.616, respectively. Our novel model index, which combined AST, anti- HBC and GGT with AUROC of 0.700 and 0.742 in training set and validation set. Conclusions This study established a noninvasive model to predict liver histology for antiviral treatment decision in patients with CHB with ALT < 2 ULN, which can reduce the clinical needs of liver biopsy.

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