Problems with the variants or quasi-species of the Hepatitis B virus (HBV) in treatment

The HBV genome has a very high mutation rate, which is why it is considered a highly variable virus, being able to produce different variants or quasi-species in the same host, differentiated by small mutations that favor the oncogenic potential of the virus, in addition to attenuating the immunogenicity and antigenicity. There are a large number of epidemiological findings and studies that suggest a relationship between genotypes and pre-core / core variants of the hepatitis B virus with the clinical course of infection and the response to different antiviral treatments.

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The role of prophylactic antibiotics in hepatitis B virus-related acute-on-chronic liver failure patients at risk of bacterial infection: a retrospective study

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00830-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Xiao-Qin Liu ◽

Xue-Yun Zhang ◽

Yue Ying ◽

Jian-Ming Zheng ◽

Jian Sun ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Clinical Course ◽

Prophylactic Antibiotics ◽

Third Generation ◽

Chronic Liver Failure ◽

Free Survival ◽

B Virus ◽

Third Generation Cephalosporins

Abstract Background Acute-on-chronic liver failure (ACLF) is characterized by an excessive systemic inflammatory response and organ failure and has high mortality. Bacterial infections (BIs) worsen the clinical course of ACLF and carry a poor prognosis in ACLF patients. The efficacy of third-generation cephalosporins has been challenged in recent years. The aim of this study was to characterize the difference between ACLF patients with and without BIs and to provide a reference for medical intervention. Methods A total of 140 patients with hepatitis B virus-related ACLF (HBV-ACLF) hospitalized at the Department of Infectious Diseases, Huashan Hospital, Fudan University (Shanghai, China) between May 2013 and January 2020 were enrolled. Mann-Whitney U test was used to compare the baseline characteristics of HBV-ACLF patients with and without BIs. Univariate and multivariate analyses were performed to find predictors of BIs. The characteristics of BIs and the role of prophylactic antibiotics were profiled. Results A total of 97 episodes of BIs occurred in patients during the course of HBV-ACLF. Patients with and without BIs differed in clinical characteristics. The incidence of BIs showed a positive correlation with the ACLF grade (P = 0.003) and the clinical course (P = 0.003). The 90-day transplant-free survival of patients with BIs was lower than those without BIs (P < 0.0001). Patients administered prophylactic antibiotics showed a lower incidence of BIs and had a higher transplant-free survival probability than those who did not (P = 0.046). No statistical differences in antibiotic efficacy between third-generation and other antibiotics were observed (P = 0.108). Conclusions BIs affected the clinical course and prognosis of patients with HBV-ACLF. Prophylactic antibiotics were of potential clinical importance in the prevention of BIs and improving the clinical course and prognosis in HBV-ACLF patients. Third-generation cephalosporins were qualified for use in antibiotic prophylaxis.

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G‐to‐A Hypermutation in Hepatitis B Virus (HBV) and Clinical Course of Patients with Chronic HBV Infection

The Journal of Infectious Diseases ◽

10.1086/598951 ◽

2009 ◽

Vol 199 (11) ◽

pp. 1599-1607 ◽

Cited By ~ 16

Author(s):

Chiemi Noguchi ◽

Michio Imamura ◽

Masataka Tsuge ◽

Nobuhiko Hiraga ◽

Nami Mori ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Clinical Course ◽

Hbv Infection ◽

Chronic Hbv Infection ◽

B Virus ◽

Chronic Hbv

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Risk stratification and clinical course of hepatitis B virus reactivation in rheumatoid arthritis patients with resolved infection: final report of a multicenter prospective observational study at Japanese Red Cross Hospital

Arthritis Research & Therapy ◽

10.1186/s13075-019-2053-1 ◽

2019 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Wataru Fukuda ◽

Tadamasa Hanyu ◽

Masaki Katayama ◽

Shinichi Mizuki ◽

Akitomo Okada ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Risk Stratification ◽

Scoring System ◽

Clinical Course ◽

Hbv Dna ◽

Hbv Reactivation ◽

B Virus

Abstract Background The prophylaxis for hepatitis B virus (HBV) reactivation assumes that hepatic injury after reactivation is often rapidly progressive and can evoke fulminant hepatitis. The incidence and prognosis of reactivation in patients with rheumatoid arthritis (RA) may be different from those receiving organ transplantation and cancer chemotherapy. This study aimed to investigate the incidence, risk factors, and clinical course of HBV reactivation and develop a scoring system for risk stratification in RA patients with resolved infection. Methods HBV DNA was measured using real-time polymerase chain reaction, and patient data were collected for 4 years in RA patients with resolved HBV infection who were treated with steroids or synthetic or biologic immunosuppressive drugs. Results Among 1127 patients, HBV DNA was detected in 57 patients (1.65/100 person-years); none of the reactivated patients exhibited worsening of hepatic function. Multivariate logistical analysis revealed that age > 70 years and HB core antibody (HBcAb) positivity alone were independent risk factors for HBV reactivation. HBV DNA ≥ 2.1 log copies/mL was observed in 15 patients (0.43/100 person-years); seven patients were treated with nucleic acid analogs (NAAs), whereas the remaining eight were observed without treatment. Among reactivated cases, 15 cases changed to HBV DNA-negative status spontaneously, whereas 24 cases remained HBV DNA positive < 2.1 log copies/mL during the observation period. We designed the following scoring system: HBV reactivation risk score = 1 × (age > 70 years) + 2 × (HBcAb positivity alone) + 1 × (treatment other than methotrexate monotherapy). This revealed that patients with the highest score had an odds ratio of 13.01 for HBV reactivation, compared to those with the lowest score. Conclusions Rapid progression and poor outcomes after HBV reactivation were not frequent in RA patients with resolved infection. Our new risk scoring system might be useful for screening and optimization of prophylactic treatment by distinguishing patients with significantly lower reactivation risk.

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