Epidemiology and Natural History of Hepatitis B
Hepatitis B virus (HBV) is a common viral pathogen that currently infects an estimated 4 million people worldwide, including 400 million who have chronic infection. Persons with chronic HBV infection are at a lifelong risk of developing hepatocellular carcinoma (HCC) or cirrhosis, or both. Many persons with HBV are unaware that they carry the infection, and, of those who are chronically infected, only a minority receives routine, scheduled follow-up to monitor their disease status. Persons from high-risk populations, especially immigrants from nations where hepatitis B is highly endemic, should be tested for HBV seromarkers and should be vaccinated if they are found to be negative. The natural history of chronic HBV is a dynamic one: patients can fluctuate between periods of active liver inflammation and periods of inactive disease. Disease progression is influenced by various factors, including viral genotype and specific mutations, demographic features, concurrent viral infections, and social and environmental factors. Recent data suggest that antiviral therapy can decrease the risk of liver decompensation and liver-related death and reduce the risk of HCC in selected individuals with active liver disease and severe fibrosis. Persons identified with chronic HBV infection need lifelong, regular monitoring for the development of active liver disease and HCC.
[Show abstract] [Hide abstract] ABSTRACT: Objective . To evaluate the efficacy and safety of Kushenin (KS) combined with nucleoside analogues (NAs) for chronic hepatitis B (CHB). Methods . Randomized controlled trials (RCTs) of KS combined with NAs for CHB were identified through 7 databases. Frequencies of loss of serum HBeAg, HBeAg seroconversion, undetectable serum HBV-DNA, ALT normalization, and adverse events at 48 weeks were abstracted by two reviewers. The Cochrane software was performed to assess the risk of bias in the included trials. Data were analyzed with Review Manager 5.3 software. Results . 18 RCTs involving 1684 subjects with CHB were included in the analysis. KS combined with NAs including lamivudine (LAM), entecavir (ETV), adefovir dipivoxil (ADV), and telbivudine (TLV) showed different degree of improvement in CHB indices. KS combined with NAs increased the frequency of loss of serum HBeAg, HBeAg seroconversion, undetectable HBV-DNA levels, and ALT normalization compared with single agents. It also decreased serum ALT and AST level after one-year treatment. However, KS combined with TLV did not show a significant difference in CHB indices. The side-effects of KS combined with NAs were light and of low frequency. Conclusion . KS combined with NAs improves the efficacy of NAs in CHB.0Comments 0Citations
- "Chronic hepatitis B (CHB) is a global health problem with an estimated 400 billion people worldwide being chronically infected with the virus (HBV) . Chronic infection with HBV can significantly impair the quality of life and life expectancy of patients. "
[Show abstract] [Hide abstract] ABSTRACT: It has been reported that hepatitis B virus (HBV) replication can be suppressed by microRNA-210 (miR-210). However, whether serum miR-210 levels can serve as disease parameters in patients with chronic hepatitis B (CHB) remains unclear. Serum miR-210 levels were quantified in 115 CHB patients and 20 healthy controls by real-time PCR. We found that serum miR-210 levels can discriminate the different groups of CHB patients from healthy control (P<0.05), as well as patients with HBe antigen positive from those with HBe antigen negative (P<0.05). Serum miR-210 levels correlated with HBV DNA and HBs antigen (r= 0.525, P<0.001 and r= 0.348, P<0.001). Notably, inactive carrier patients with high (>3500 IU/mL) or low (<3500 IU/mL) levels of HBs antigen were differentiated by serum miR-210 levels (P<0.05). Moreover, serum miR-210 levels correlated with liver inflammatory activity markers including alanine aminotransferase (ALT) and HAI score. However, there was no correlation of serum miR-210 levels with parameters of liver function including serum albumin, international normalized ratio and bilirubin, as well as the stages of liver fibrosis. Serum miR-210 can be used as an indicator of HBV replication and translation, and a potential marker of necroinflammation in patients with CHB. Copyright © 2015. Published by Elsevier B.V.0Comments 0Citations
- "Chronic infection with the hepatitis B virus (HBV), accounting for 350–400 millions of patients worldwide, is a predominant etiological factor for liver disease in China  . In particular, about 7.8% of China population are HBV carriers (93 million, two-thirds of the world's total number of carriers) . "
[Show abstract] [Hide abstract] ABSTRACT: We investigated hepatic histological changes in a cohort of HBeAg-negative chronic hepatitis B (CHB) patients (n=50) under long-term antiviral treatment in clinical practice. Liver biopsies were obtained at baseline and after prolonged antiviral treatment with lamivudine (42/50), entecavir (6/50), telbivudine (1/50), or tenofovir (1/50). Due to viral resistance to lamivudine a nucleotide analog was added in 17 patients (adefovir n=11; tenofovir n=6). Twenty-two patients had initially received a 12-month course of pegylated interferon-α, followed by nucleos(t)ide analogs. Necroinflammatory activity was graded as 1-minimal (histological activity index [HAI]: 0-3), 2-mild (HAI: 4-8), 3-moderate (HAI: 9-12), or 4-severe (HAI: 13-18); staging was performed according to the METAVIR system. Twenty-seven patients were male and 23 female; mean age was 46.9±10.7 years. Mean interval between biopsies was 72.6±27.8 months. Improvement in activity was observed in 31/42 patients (74%) (mean drop -1.1 grade, SD=1.0), and in histological staging in 24/50 patients (48%) (mean drop -0.56 stage, SD=0.73). Importantly, the repeat biopsies of 5/10 patients with initial stage F4 were classified as F3 (n=3), F2 (n=1) or F1 (n=1). Worsening of staging was observed in only one patient. Development of resistance to lamivudine had no significant effect on stage improvement. Sustained hepatitis B virus suppression with antiviral treatment in HBeAg-negative CHB patients leads to reduction in necroinflammatory activity and improvement in staging, regardless of transient viral breakthrough. Potent antivirals in common clinical use for CHB can even lead to regression of fibrous septa and architectural improvement of cirrhotic livers.0Comments 2Citations
- "Chronic hepatitis B (CHB) infection affects an estimated 400 million people worldwide and continues to be an important cause of morbidity and mortality . CHB often leads to cirrhosis and hepatocellular carcinoma (HCC). "