Natural history and prognostic factors for chronic hepatitis B

Istituto di Medicina Clinica, Clinica Medica 2, Università di Padova, Italy.
Gut (Impact Factor: 14.66). 04/1991; 32(3):294-8. DOI: 10.1136/gut.32.3.294
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One hundred and five hepatitis B surface antigen (HBsAg) positive patients presenting with chronic persistent hepatitis (n = 46) or chronic active hepatitis without cirrhosis (n = 59) were followed longitudinally for one to 16 years (mean 5.5 years) and underwent follow up biopsy. During a mean histological follow up of 3.7 years, active cirrhosis developed in 21 (20%) patients one to 13 years after entry to the study with a calculated annual incidence of 5.9%. The probability of evolution to cirrhosis was significantly higher in patients with chronic active hepatitis and bridging hepatic necrosis than in those with moderate chronic active hepatitis or chronic persistent hepatitis (p less than 0.0001). Cox multiple regression analysis showed that the following three variables independently implied poor prognosis: older age, presence of bridging hepatic necrosis, and persistence of hepatitis B virus DNA in serum (p less than 0.0001). These findings indicate that patients with severe chronic active hepatitis and persistent hepatitis B virus replication are at very high risk of rapid progression to cirrhosis.

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Available from: Patrizia Pontisso, Sep 29, 2015
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    • "The cumulative probability of subjects with chronic hepatitis B developing cirrhosis is 15- 20% at the end of 5 years (Fattovich et al., 1991; Liaw et al., 1988). The cumulative incidence of HCC in subjects with chronic hepatitis B without cirrhosis is 1-3% and in subjects with compensated cirrhosis is 10-17% at the end of 5 years (Fattovich et al., 2008). "
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    ABSTRACT: Entecavir is one of the therapeutic options currently available for the management of chronic hepatitis B. In this study, we aimed to analyse the virological response and antiviral resistance mutations in chronic hepatitis B subjects experiencing entecavir therapy from the Indian subcontinent. A total of 45 chronic hepatitis B subjects were studied at baseline and were followed up on entecavir treatment. Among these subjects, 25 (56%) were HBeAg-positive at baseline. Virological response was measured by hepatitis B virus (HBV) DNA levels. HBV reverse transcriptase (rt) domains were sequenced for the identification of resistance mutations. Three-Dimensional (3D) model of HBV polymerase/rt protein, docking and molecular dynamics simulation (MDS) studies were performed for characterization of antiviral resistance mutations. At the median treatment duration of 6 (IQR 6-11) months, 38 (84%) showed virological response. Subjects who showed anti-HBe response demonstrated significant association with virological response (p=0.034). On sequence analysis, none of the subjects were identified with signature entecavir resistance mutations. However, one subject was exclusively detected with rtV173L mutation. Molecular modeling, docking and MDS studies revealed that the rtV173L mutation cannot confer resistance to entecavir independently. Our findings also showed that the prevailing HBV genotypes, subgenotypes and subtypes in this population does not influence treatment outcome to entecavir therapy. In conclusion, entecavir is a potent drug in terms of viral DNA suppression. In addition, none of the subjects developed antiviral resistance mutations to entecavir. Therefore entecavir is a suitable drug of choice in the management of chronic HBV.
    Antiviral Research 02/2013; DOI:10.1016/j.antiviral.2013.02.012 · 3.94 Impact Factor
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    • "In this group the risk is higher with advancing age, in men and in those with a family history of hepatocellular carcinoma. Women are at lower risk but the risk is increased in women above the age of 50 years old [7, 8]. Chronic hepatitis B patients with liver cirrhosis have an annual risk of hepatocellular carcinoma of 3–8%. "
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    ABSTRACT: Hepatocellular carcinoma is one of the most serious complications of chronic liver disease and is the third most lethal cancer worldwide. Symptoms emerge very late in the course of its natural history with an attendant poor outcome. Screening is of paramount importance in a successful strategy to treat hepatocellular carcinoma. A successful screening program rests the availability of an at-risk population, reliable diagnostics tests that are able to diagnose a condition at a stage where effective, and relatively simple and acceptable treatments are available. In hepatocellular carcinoma, all patients with liver cirrhosis or chronic hepatitis B virus infection are at risk. Six monthly ultrasound and alpha-foetoprotein determination form the backbone of the screening program. Newer modalities and tests show promise but have not supplanted the standard tests.
    10/2011; 2011:363151. DOI:10.4061/2011/363151
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    • "Up to 40% patients with chronic hepatitis B virus infection develop serious complications during their lifetime. Up to 12% of patients with HBV cirrhosis die of liver failure, and up to 10% perish from liver cancer [3] [4]. The prognosis for patients with decompensated HBV cirrhosis is poor, with a 5-year survival of only 14% compared with 84% in patients with compensated HBV cirrhosis [3]. "
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    ABSTRACT: Chronic hepatitis B infection progresses from an asymptomatic persistently infected state to chronic hepatitis, cirrhosis, decompensated liver disease, and/or hepatocellular carcinoma. About 3% of patients with chronic hepatitis develop cirrhosis yearly, and about 5% of individuals with hepatitis B cirrhosis become decompensated annually. The outcome for patients with decompensated cirrhosis is bleak. Lamivudine, the first oral antiviral agent available for hepatitis B treatment is safe and effective and can improve or stabilize liver disease in patients with advanced cirrhosis and viraemia. Viral resistance restricts its prolonged use. Entecavir and tenofovir are newer agents with excellent resistance profile to date. These and some other antiviral agents are being investigated for optimal use in this rather challenging patient group.
    06/2011; 2011(1):918017. DOI:10.4061/2011/918017
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