Liver international: official journal of the International Association for the Study of the Liver (Liver Int )

Publisher: International Association for the Study of the Liver, Blackwell Publishing

Description

The general aim of Liver International is to promote all aspects of the science of hepatology from basic research to applied clinical studies. It is an international Journal providing a forum for the publication of high quality original research in hepatology. It provides an essential resource for all professionals concerned with normal and abnormal structure and function in the liver and its constituent cells and is intended for clinicians and basic scientists involved in the multi-disciplinary field of hepatology. It includes studies of pathobiology from experimental models and human material. Liver International welcomes articles from all fields of hepatology, which may be published as original articles, rapid communications, reviews, and letters to the Editor. Case reports will be accepted if the clinical problem is studied in detail and of sufficient interest in a wider context. Papers are normally evaluated by a peer review process involving at least two independent reviewers. Within the scope of the Journal, articles will be accepted on the basis of scientific quality, originality and up-to-date relevance.

Impact factor 4.41

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    Impact factor
  • 5-year impact
    3.54
  • Cited half-life
    3.70
  • Immediacy index
    1.35
  • Eigenfactor
    0.02
  • Article influence
    1.04
  • Website
    Liver International website
  • Other titles
    Liver international (Online)
  • ISSN
    1478-3231
  • OCLC
    52034063
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

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    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • Thomas Sersté, Hassane Njimi, Delphine Degré, Pierre Deltenre, Jonas Schreiber, Antonia Lepida, Eric Trépo, Thierry Gustot, Christophe Moreno
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    ABSTRACT: The beneficial effect of nonselective beta-blockers (NSBB) has recently been questioned in patients with end stage cirrhosis. We analyzed the impact of NSBB on outcomes in severe alcoholic hepatitis (AH). This study was based on a prospective database of patients with severe, biopsy-proven AH. Patients admitted from July, 2006 to July, 2014 were retrospectively studied. Patients were divided into 2 groups (with and without NSBB) and assessed for the occurrence of Acute Kidney Injury (AKI) and transplant-free mortality during a 168-day follow-up period. One hundred thirty-nine patients were included, the mean Maddrey score was 71±34 and 86 patients (61.9%) developed AKI. Forty-eight patients (34.5%) received NSBB. The overall 168-day transplant-free mortality was 50.5% (95%CI, 41.3-60.0%). The overall 168-day cumulative incidence of AKI was 61.9% (95%CI, 53.2-69.4%). When compared, patients with NSBB had a lower heart rate (65±13 versus 92±12, p˂0.0001) and a lower mean arterial pressure (MAP, 78±3 versus 87±5, p˂0.0001). Patients with NSBB had comparable MELD scores, Maddrey scores, and medical histories. The 168-day transplant-free mortality was 56.8% (95%CI, 41.3-69.7%) in patients with NSBB and 46.7% (95%CI, 35.0-57.6%) without NSBB (p=0.25). The 168-day cumulative incidence of AKI was 89.6% (95%CI, 74.9-95.9%) with NSBB compared to 50.4% (95%CI: 39.0-60.7) for no NSBB (p=0.0001). The independent factors predicting AKI were a higher MELD score and the presence of NSBB. The use of NSBB in patients with severe AH is independently associated with a higher cumulative incidence of AKI. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
  • Martine Lapalus, Cédric Laouenan, Ana Carolina Ferreira Netto Cardoso, Emilie Estrabaud, Roberto Carvalho-Filho, Qian Zhang, Olivier Lada, Kevin Appourchaux, Feryel Mouri, Nathalie Boyer, Pierre Bedossa, Tarik Asselah, Michelle Martinot-Peignoux, Patrick Marcellin
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    ABSTRACT: Assessing fibrosis is essential in patients with chronic hepatitis B (CHB). The objective was to investigate the relationship between fibrosis, host and viral factors to identify non-invasive markers of significant fibrosis in a large cohort of unselected, well-characterized, treatment-naïve CHB patients. Three hundred and seventy-seven HBsAg positive patients (97 HBeAg-positive and 280 HBeAg-negative, genotypes A to E) who had liver biopsy were consecutively included. Host and viral factors (ALT, HBsAg and HBV-DNA levels, HBV genotype and precore (PC) / basal core promoter (BCP) variants) were determined on the day of the biopsy. Fibrosis stage was assessed using METAVIR score. 38% of the patients had significant fibrosis (METAVIR F≥2). On univariate analysis, the stages of fibrosis F≥2 were associated with older age (P<0.0001), male gender (P=0.01), higher ALT and HBV-DNA levels (P<0.0001 and P=0.0003, respectively), the presence of BCP (P<0.0001) and BCP/PC variants (P<0.0001). On multivariate analysis, age (P<0.0001), the presence of HBV variants (P<.0001), HBV-DNA level (P=0.0006) and ALT level (P=0.02) were independently associated with significant fibrosis. The diagnostic accuracy of the combination (age, ALT, HBV-DNA, HBV variants) in predicting fibrosis F≥2 was evidenced by a c-index of 0.76 [CI 95% 0.71-0.81]. We identified strong independent risk factors (age, ALT, HBV-DNA, HBV variants) predicting significant fibrosis (F≥2) independently of HBeAg status in patients with CHB. Patients with BCP variants have a higher risk of severe liver disease. The detection of these mutants may help to predict significant fibrosis (F≥2). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
  • Tzu-Yue Shiu, Hsin-Hung Huang, Hsuan-Hwai Lin, Yu-Lueng Shih, Heng-Cheng Chu, Wei-Kuo Chang, Tsai-Yuan Hsieh
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    ABSTRACT: Gilbert's syndrome causes pharmacological variation in drug glucuronidation and unexpected toxicity from therapeutic agents. The two common genotypes of Gilbert's syndrome are a dinucleotide polymorphism (TA)7 in TATA-Box as well as the 211G>A mutation in the coding exon 1, particularly in Asians, of human UGT1A1 gene. In this study, we aimed to establish an effective method to detect the 211G>A mutation. The coding exon 1 sequence of human UGT1A1 gene was analyzed by Vector NTI software. The 211G>A mutation in the coding exon 1 of UGT1A1 gene was determined by restriction fragment length polymorphism (RFLP) method. Serum total bilirubin level was measured as well. A newly identified BsmBI site was located in the coding exon 1 of UGT1A1 gene. The 211G>A mutation in the coding exon 1 of UGT1A1 gene was determined by DNA RFLP. Furthermore, we reported our present work on genetic analysis of mutations of UGT1A1 gene, and the correlation of UGT1A1 mutations with serum total bilirubin levels in Taiwanese population. The results showed that 15 subjects carried 211G>A mutation in 23 subjects related with Gilbert's syndrome. The homozygous 211G>A mutant as well as simultaneously heterozygous mutants both in TATA-Box and 211G>A significantly increased the risk of Gilbert's syndrome similar to subjects carrying homozygous TATA-Box mutant. BsmBI RFLP is an effective method to detect 211G>A mutation in the coding exon 1 of UGT1A1 gene. The common 211G>A mutation is one of the causes of Gilbert's syndrome in Taiwanese population. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: This issue of Liver International has published an article by Dyson et al, which presents data implicating the sympathetic nervous system as a potentially significant contributor and pathogenetic factor for fatigue [1]. Given the prevalence and importance of this line of research, we propose to discuss some general aspects of fatigue, its taxonomy and place the findings reported by Dyson et al in this context. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
  • Arnulf Ferlitsch, Simona Bota, Rafael Paternostro, Thomas Reiberger, Mattias Mandorfer, Birgit Heinisch, Petra Salzl, Remy Schwarzer, Wolfgang Sieghart, Markus Peck-Radosavljevic, Monika Ferlitsch
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    ABSTRACT: Despite the important clinical value of hepatic venous pressure gradient (HVPG) and its increasing use, no specific balloon occlusion catheters have been designed to cannulate liver veins. The aim of the study was to evaluate the clinical applicability of a novel balloon(NC) occlusion catheter specifically designed for for HVPG measurement. Comparison of a new CE-certified 7 french balloon occlusion catheter with a 150° angled tip and radiopaque markers, (NC, Pejcl Medizintechnik, Austria) to a commonly used straight balloon catheter (SC, Boston Scientific, USA). Successful liver vein cannulaton rate, need for extra equipment, and total fluoroscopy time were recorded. Experts (>200) and novices (<20) in HVPG measurements were evaluated separately. 566 HVPG measurements performed by 11 investigators (5 experts and 6 novices) were analzyed. Overall, HVPG could be successfully measured in 98.7% of cases. The rate of successful liver vein cannulation at first attempt was significantly higher among experts when compared to novices (87.3%vs.67.3%,p<0.001). Moreover, the rate of successful liver vein cannulation without need for any additional equipment was higher when using the NC, both among experts (NC:91.9%vs.SC:80.6%,p=0.03) and novices (NC:73.3%vs.SC:50.7%,p=0.001). The mean fluoroscopy time needed to cannulate the hepatic vein was significantly shorter in experts as compared to novices (2.37(0.10-26)vs.5.2(0.6-30.2)minutes,p<0.0001), but not significantly different between catheters. Both novices and experts achieve higher liver vein cannulation rates using the new specifically designed catheter. The use of the novel catheter might increase rates of successful liver vein cannulation and reduce the need for additional equipment, especially in novices. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Background & aimsNon-selective beta-blockers (NSBB) are used in patients with cirrhosis and oesophageal varices. Experimental data suggest that NSBB inhibit angiogenesis and reduce bacterial translocation, which may prevent hepatocellular carcinoma (HCC). We therefore assessed the effect of NSBB on HCC by performing a systematic review with meta-analyses of randomised trials.Methods Electronic and manual searches were combined. Authors were contacted for unpublished data. Included trials assessed NSBB for patients with cirrhosis; the control group could receive any other intervention than NSBB. Fixed and random effects meta-analyses were performed with I2 as a measure of heterogeneity. Subgroup, sensitivity, regression, and sequential analyses were performed to evaluate heterogeneity, bias and the robustness of the results after adjusting for multiple testing.ResultsTwenty-three randomised trials on 2618 patients with cirrhosis were included, of which 12 reported HCC incidence and 23 reported HCC mortality. The mean duration of follow up was 26 months (range 8-82). In total, 47 of 694 patients randomized to NSBB developed HCC versus 65 of 697 controls (risk difference -0.026; 95% confidence interval -0.052 to -0.001; number needed to treat 38 patients). There was no heterogeneity (I2 = 7%) or evidence of small-study effects (Eggers P = 0.402). The result was not confirmed in sequential analysis, which suggested that 3719 patients were needed to achieve the required information size. NSBB did not reduce HCC related mortality (RD -0.011; 95% CI -0.040 to 0.017).ConclusionsNSBB may prevent HCC in patients with cirrhosis..This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Background and AimsWe investigated the association between significant liver fibrosis, determined by AST-to-platelet ratio index (APRI), and all-cause mortality among HIV-infected patients prescribed antiretroviral therapy (ART) in ZambiaMethods Among HIV-infected adults who initiated ART, we categorized baseline APRI scores according to established thresholds for significant hepatic fibrosis (APRI ≥1.5) and cirrhosis (APRI ≥2.0). Using multivariable logistic regression we identified risk factors for elevated APRI including demographic characteristics, body mass index (BMI), HIV clinical and immunologic status, and tuberculosis. In the subset tested for hepatitis B surface antigen (HBsAg), we investigated the association of hepatitis B virus co-infection with APRI score. Using Kaplan-Meier analysis and Cox proportional hazards regression we determined the association of elevated APRI with death during ART.ResultsAmong 20,308 adults in the analysis cohort, 1,027 (5.1%) had significant liver fibrosis at ART initiation including 616 (3.0%) with cirrhosis. Risk factors for significant fibrosis or cirrhosis included male sex, BMI <18, WHO clinical stage 3 or 4, CD4+ count <200 cells/mm3, and tuberculosis. Among the 237 (1.2%) who were tested, HBsAg-positive patients had four times the odds (adjusted odds ratio, 4.15; 95% CI, 1.71-10.04) of significant fibrosis compared HBsAg-negatives. Both significant fibrosis (adjusted hazard ratio 1.41, 95% CI, 1.21-1.64) and cirrhosis (adjusted hazard ratio 1.57, 95% CI, 1.31-1.89) were associated with increased all-cause mortality.Conclusion Liver fibrosis may be a risk factor for mortality during ART among HIV-infected individuals in Africa. APRI is an inexpensive and potentially useful test for liver fibrosis in resource-constrained settings.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Background & AimA common non-synonymous polymorphism, E167K, in transmembrane 6 superfamily member 2 (TM6SF2) gene has been recently associated with an increased hepatic triglyceride content, dyslipidemia and liver fibrosis in NAFLD patients. We investigated possible associations between the TM6SF2 variants and liver lesions in chronic hepatitis C.Patients and Methods148 consecutive patients with biopsy proven anti-HCV/HCV-RNA-positive chronic hepatitis, naive for antiviral therapy, were genotyped for TM6SF2 E167K and PNAPL3 I148M variants.ResultsThe score of liver steatosis was higher in the 18 patients with TM6SF2 E167K variant (mean 1.9+1.3) than in the 130 homozygotes for TM6SF2 167E allele (1.1+1.1, p=0.02), and the prevalence of a steatosis score>3 was 33.3% vs. 12.3%, respectively (p=0.02). No difference in necroinflammatory or fibrosis scores was found between the two groups. A general linear model identified as independent predictors of steatosis TM6SF2 E167K and PNAPL3 M148M variants and waist circumference (p=0.0376, p=0.0069 and p=0.0273, respectively).Conclusions This is the first demonstration that TM6SF2 E167K variant is an independent predictor of liver steatosis in chronic hepatitis C.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Background & AimsThe study aimed to evaluate the tissue expression of molecules involved in intracellular signaling pathways as predictors of response to sorafenib in advanced hepatocellular carcinoma (HCC).Methods We considered 77 patients enrolled into three prospective trials of sorafenib treatment for whom pre-treatment tumour tissue was available. The tissue expression of β-catenin, glutamine synthetase (GS), phosphorylated extracellular signal regulated kinase (pERK), phosphorylated v-akt murine thymoma viral oncogene homolog (pAKT) and vascular endothelial growth factor receptor-2 (VEGFR-2) was analysed by immunostaining. Stains were scored semi-quantitatively and compared with a reference group of 56 untreated HCCs.ResultsOverall, the expression of antigens was comparable between treated and untreated patients. Shorter progression-free survival (PFS) and overall survival (OS) were associated with increased pERK staining (≥ 2+ scores) (PFS: 75th percentile 4.4 vs 8.4 months; P = 0.01; OS: 75th percentile 7.0 vs 15.0 months; P = 0.005) and VEGFR-2 staining (≥ 2+ scores) (PFS: 75th percentile 3.8 vs 7.0 months; P = 0.039; OS: 75th percentile 6.3 vs 15.0 months; P = 0.004). At multivariate analysis, both pERK and VEGFR-2 staining maintained an independent effect on OS (HR 2.09; 95% CI, 1.13-3.86, P = 0.019 and HR 2.28; 95% CI, 1.13-4.61, P = 0.021, respectively). No effect was observed for the other tested biomarkers.Conclusions Elevated tissue expression of pERK and VEGFR-2 was predictive of poor outcome in advanced HCC treated with sorafenib.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Background and aimIn the past three decades, there have been major advances in the procedure and candidate selection for liver transplantation. The aim of this study was to assess the changes in outcomes of liver transplantations in the Unites States.Methods This observational study uses the Scientific Registry of Transplant Recipients (SRTR) that includes all liver transplants from 1987-2013 (N=108,707 adults).ResultsFour study cycles were introduced: 1987-1993, 1994-2000, 2001-2006, 2007-2013. The length of inpatient stay for receiving liver transplant substantially shortened (42 to 20 days), and so did the rate of acute post-transplant rejections (33% to 4%). The use of high risk donors and donors with chronic diseases increased significantly. Of transplant outcomes, despite recently reported unfavorable changes in clinico-demographic profile of liver transplant recipients (older age, substantial increases in all major comorbidities), the proportion of patients discharged alive increased from 78.2% to 91.8%. On the other hand, post-discharge 1-, 3- and 5-year mortality varied between 6.7% and 8.0%, 15.2% to 17.2% and 22.5% to 24.5%, respectively, and no consistent trend was found. Despite this, the rates of graft failure decreased: an approximately 2-fold decrease in 1 year graft loss, and a 1.6-fold decrease in 5 year graft loss were observed.Conclusion Despite all improvements in liver transplant technique and patient management, the changes in post-transplant outcomes vary. While inpatient mortality, graft losses and post-transplant infection rates improved substantially, post-discharge mortality remains stable due to increasing losses to competing risks in patients with non-liver comorbidities.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Objective To compare the management of chronic hepatitis B (CHB) and its evolution over time in currently-followed HIV-positive and HIV-negative patients.Methods709 consecutive patients with past or present positive HBs antigenemia seen in October 2012 in 19 French participating centers were included. The data were retrospectively collected from the first visit onwards through standardized questionnaires.ResultsCHB was less often assessed in the 299 HIV-positive patients, who were older, more likely to be male, excessive alcohol drinkers and HBe antigen-, HCV- and HDV-positive. They were also followed for a longer time (11.3+/-8.8 vs. 8.6+/-6.9 years, p<10-3) and were more frequently treated for HBV (95.3% vs. 56.8%, p<10-3). HBV was undetectable at the last visit in 80.8% of HIV-positive vs. 55.1% of HIV-negative patients (p<10-3).In multivariate analyses, undetectable HBV was significantly associated with older age, lower baseline HBV DNA, longer HBV therapy and no previous lamivudine monotherapy, but not with HIV.Cirrhosis was associated with age, male gender, Asian origin, alcoholism, HCV, HDV but not with HIV infection. Hepatocellular carcinoma, less frequently observed in HIV-positive patients (0.7% vs 4.7%, p=0.002), was positively associated with age, male gender, cirrhosis, and negatively associated with HIV infection (OR 0.15, 95%CI 0.03-0.67, p=0.01).Conclusions Though the assessment of CHB still has to be improved in HIV-positive patients, the negative impact of HIV on the virological, histological and clinical evolution of CHB seems to be disappearing, probably because of the immunovirological impact of HAART and the more frequent and longer use of HBV therapy.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Background & AimsAdvanced liver fibrosis is associated with recurrence after curative resection of hepatocellular carcinoma (HCC). This study aimed to investigate whether noninvasive fibrosis indices could predict intrahepatic recurrence and death after curative resection of HCC.Methods Patients who underwent curative resection for hepatitis B virus (HBV)-related HCC between 2006 and 2010 at a single tertiary hospital were included. This study analyzed the association of noninvasive fibrosis indices with recurrence and overall survivalResultsA total of 303 patients were included. During a median follow-up period of 56.0 (inter-quartile range, 42.0–70.0) months, 151 (49.8%) patients experienced HCC recurrence and 54 (17.8%) died. Based on multivariate analysis, Forns index (hazard ratio [HR], 1.238; 95% confidence interval [CI], 1.097-1.398; P=0.001) was independently associated with tumor recurrence after adjustment for anti-HBe positivity, histological cirrhosis, tumor size, and number. Patients with Forns index <6.9 had a significantly longer recurrence-free survival rate than patients with Forns index ≥6.9 (P<0.001 by log rank test). Forns index (HR, 1.246; 95% CI, 1.034-1.501; P=0.02) could also predict overall survival after adjustment for tumor size and number. Forns index detected cirrhosis with an AUROC of 0.700 (95% CI, 0.641-0.758). Aspartate aminotransferase-to-platelet ratio index, cirrhosis discriminant score, FIB-4 index, P2/MS, and Lok index detected cirrhosis comparably to Forns index, but were not associated with tumor recurrence or deathConclusions Our data suggest that Forns index could be a useful predictor of recurrence and overall survival after curative resection of HBV-related HCC.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: Background Chronic infection with HCV remains a public health problem with approximately 150 million people infected worldwide. HCV intersects with lipid metabolism for replication and entry; and plasma concentrations of apolipoproteins have been identified as predictors for response to therapy. Herein, we conducted a screen of plasma proteins, including all apolipoproteins, to identify correlates of response to therapy using pegylated-interferon/ribavirin (PR) and HCV non-structural protein 3 (NS3) inhibitors (i.e., telaprevir/boceprevir) in treatment-experienced cirrhotic patients from the ANRS CUPIC cohort. METHODS: We analyzed 220 baseline plasma protein concentrations in 189 patients using Luminex technology and correlated results with sustained virological response (SVR). RESULTS: We identified baseline levels of apolipoprotein H (apoH) as a correlate for virological response. Notably, increased plasma concentration of apoH, used in combination with known clinical parameters, established a robust model with improved classification of patients as likely to achieve SVR (AUC=0.77, Se=66%, Sp=72%, NRI=39%). Moreover, we provide mechanistic information that indicates a previously unidentified role for apoH during viral entry. Using a human liver slices HCV infection model, we demonstrate that apoH limits replication.Conclusion These data support testing of new biomarker strategies for the management of cirrhotic HCV patients and expand our understanding of how apoH may intersect with HCV infection.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
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    ABSTRACT: The standard of care (SOC) for the treatment of HCV genotype 2 (HCV-2) was pegylated interferon alpha plus ribavirin (PEG-IFN/RBV) at weight-based doses for a response-guided duration. The launches of sofosbuvir and daclatasvir in 2014 have resulted in new, better tolerated and shorter treatment. The combination of sofosbuvir and RBV for 12 weeks appears to be the new SOC in both European and American guidelines. The cost and therefore the access to this treatment remains a problem in many countries because of major economic constraints. For the few more difficult-to-treat patients, a combination of direct acting antivirals may be suitable and is being studied in ongoing trials. Because of rapidly changing treatment recommendations, the decision to treat HCV-2 patients with currently approved drugs or to wait until a better option is available in the future, must be made according to the stage of fibrosis.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015; 35(s1).
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    ABSTRACT: The end point of liver fibrosis in almost all chronic liver diseases including HBV chronic hepatitis is cirrhosis. Progression to cirrhosis is associated with annular deposition of fibrous tissue and vascular remodeling with a shift from a lobular to nodular organization. Although advanced liver fibrosis was previously thought to be irreversible, today there is compelling evidence that cirrhosis can be reversed if the underlying cause of liver injury is eliminated. Indeed, most clinical trials with antiviral therapy and histological follow-up have shown that fibrosis can regress and that in some cases even cirrhosis can reverse following long-term HBV-DNA suppression, although the return to a fully normal liver is rarely observed and difficult to prove. Nevertheless, a marked percentage of cirrhosis will not reverse even after effective antiviral therapy. Generally cirrhosis is more likely to regress if it is recent, there is effective and long-lasting viral suppression, an internal capacity to regenerate and no vascular thrombosis. HBV treatment in patients with cirrhosis is associated with an improved clinical outcome although there may still be a risk of hepatocellular carcinoma. Nevertheless it has not yet been determined if a favorable outcome depends on histological regression or whether the reversal of cirrhosis is merely a surrogate marker of viral suppression. The significance of the reversal of cirrhosis is still a subject of debate because neither the histological scoring systems nor non-invasive markers to evaluate the reversal of cirrhosis have been validated.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015; 35(s1).
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    ABSTRACT: The development of direct acting antivirals (DAAs) against the hepatitis C virus (HCV) has revolutionized treatment paradigms for HCV in HIV co-infected subjects. In the era of DAAs, HIV/HCV co-infected patients have the same cure rates of over 90% with interferon (IFN)-free DAA combinations. Therefore, guidelines no longer separate mono- and co-infected subjects. Indications for HCV therapy and DAA drug selection have become the same for all patients. The only special consideration in HIV/HCV co-infected subjects is the need to check for drug–drug interactions between HIV and HCV drugs, especially HIV and HCV protease inhibitors which have a high risk of clinically significant drug interactions. Because of the faster progression of fibrosis and the higher risk of hepatic decompensation in co-infected subjects, even with combination antiretroviral (ART) therapy, the availability of modern HCV treatments needs to be extended and HCV therapy should be discussed in all co-infected patients.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015; 35(s1).
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    ABSTRACT: Chronic hepatitis C virus (HCV) causes chronic liver injury and can lead to cirrhosis and hepatocellular carcinoma (HCC). HCV can also interact with the immune system to cause several HCV related disorders including essential mixed cryoglobulinemia, vasculitis, dermatitis, glomerulonephritis and lymphoma. A strong association between HCV and diabetes mellitus also exists. These extrahepatic features may lead to increased fatigue and a reduced quality of life. It is now possible to cure most patients with chronic HCV using oral antiviral therapy. Many of these HCV-related disorders and symptoms can be cured when HCV is eradicated. However, some patients may have irreversible injury to extrahepatic sites, cirrhosis that cannot resolve, an increased risk for HCC, persistent fatigue and a reduced quality of life, despite achieving sustained virological response.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015; 35(s1).
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    ABSTRACT: HBeAg negative chronic hepatitis B (CHB) is a frequent, progressive and difficult-to-cure phase of CHB. The end-point of therapy is to persistently suppress viral replication to halt progression of liver disease. Two different treatment strategies are currently available: a short-term course of pegylated interferon alpha (PEG-IFN) or long-term therapy with nucleot(s)ide analogues (NA), i.e. entecavir or tenofovir. Young patients with mild-to-moderate stages of liver disease can benefit from a 48-week course of PEG-IFN, while NA may be preferred in patients with more severe liver disease, in older patients, and in those who do not respond, are unwilling or have contraindications to PEG-IFN. Nucleot(s)ide analogues provide persistent viral suppression and biochemical normalization in almost all patients, together with the regression of fibrosis and the prevention of decompensation, but the effect on hepatocellular carcinoma rates is limited. Thus, NAs have become the most popular treatment strategy worldwide but lifelong administration is associated with high cost, unknown safety and adherence issues and an unknown risk of drug-resistance over time as well as limited rates of HBsAg seroclearance. On the other hand, PEG-IFN treatment may achieve a SVR in nearly a quarter of patients ultimately leading to HBsAg loss in almost 30–50%. Interestingly, response rates to PEG-IFN may further increase with more careful patient selection based on age, ALT and HBV DNA levels at baseline and by applying early on-treatment stopping rules based on HBV DNA and HBsAg kinetics. The combination of NA and PEG-IFN is not currently recommended but numerous studies are ongoing.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015; 35(s1).
  • Patrick Borentain, Philippe Colson, Albert Darque, René Gérolami
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    ABSTRACT: We read with interest the article by Donato et al (1) who raised the question of the optimal duration of anti-hepatitis C virus (HCV) treatment with direct-acting agent (DAA) sofosbuvir before liver transplantation (LT), in order to reduce the risk of post-LT HCV recurrence. In the only available study that addressed this issue, a minimal period of 30 days between achievement of HCV RNA undetectability and LT was necessary to achieve post-LT HCV eradication in almost all cases (2). We report here a case of sustained virological response (SVR) post-LT in a patient who received sofosbuvir and ribavirin for only 14 days before LT.This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;
  • Jérôme Guéchot
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    ABSTRACT: While, liver biopsy, despite of its limitations, remains the reference for the staging of liver fibrosis in chronic liver diseases (CLD), the overall need of liver biopsy for clinical decision making is regressing. More non-invasive methods of liver fibrosis assessment including serum markers and liver stiffness measurement by transient elastography are increasingly well validated and contribute to safer and more practical clinical care for patients [1-2].This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 01/2015;