Association between hepatitis B and metabolic syndrome:Current state of the art

Chronic hepatitis B(CHB)is a global health issue that increases the risk of liver cirrhosis and hepatocellular carcinoma in infected patients.Metabolic syndrome(Met S)is a disease endemic mostly to the developed countries.It is associated with high cardiovascular mortality and morbidity,diabetes mellitus as well as cancer.In this manuscript,we systematically review the published data on the relationship between Met S and CHB infection.Multiple studies have described highly variable correlations between CHB on one hand and Met S,non-alcoholic fatty liver disease and dyslipidemia on the other.No association between CHB and diabetes mellitus or atherosclerosis has been described as of now.The presence of Met S in patients infected with hepatitis B virus increases the risk of fibrosis,cirrhosis and hepatocellular carcinoma.Appropriate lifestyle,but also pharmacological interventions are needed to prevent the development of these complications.

Pleiotropic effects of statins in the diseases of the liver

Statins are a class of molecules that inhibit HMG Co A reductase. They are usually prescribed as a lipid lowering medication. However, there is accumulating evidence that statins have multiple secondary effects both related and unrelated to their lipid-lowering effect. This narrative review of the literature aims to provide the reader with information from clinical studies related to the effect of statin and statins' potential use in patients with liver diseases. In patients with advanced liver disease due to any etiology, statins exhibit an antifibrotic effect possibly through the prevention of hepatic sinusoidal microthrombosis. Two randomized controlled trials confirmed that statins decrease hepatic vein pressure gradient in patients with portal hypertension and improve the survival of patients after variceal bleeding. Lower rates of infections were observed in patients with cirrhosis who received statin treatment. Statins decrease the risk of hepatocellular carcinoma(HCC) in patients with advanced liver disease in general but particularly in patients with chronic hepatitis B and C. Statins in patients with chronic hepatitis C likely increase the virological response to the treatment with pegylated interferon and ribavirin and have the potential to decrease the rate of fibrosis. Finally, data from randomized controlled trials also confirmed that the addition of statin prolongs the survival of patients with advanced HCC even more than sorafenib. Statins are a very promising group of drugs especially in patients with liver disease, where therapeutic options can often be limited. Some indications, such as the prevention of re-bleeding from esophageal varices and the palliative treatment of HCC have been proven through randomized controlled trials, while additional indications still need to be confirmed through prospective studies.

R0 Liver Resection should be a First-line Treatment for Selected Patients with Intermediate Hepatocellular Cancer

Introduction Hepatocellular cancer(HCC)is the sixth most common malignancy worldwide and the second most common cause of mortality among all malignancies.Most HCCs occur in cirrhotic livers,but an increasing proportion of cases occur in livers without cirrhosis,particularly in Hepatitis B virus infection or in nonalcoholic fatty liver disease patients.^(1) Liver resection(LR)is the treatment of choice in most noncirrhotic patients,therefore most discussion is related to patients with cirrhosis.Overall survival(OS)depends on the stage at the time of diagnosis.Barcelona Clinic Liver Cancer(BCLC)staging is the currently preferred staging system for HCC in Europe and North America^(2) Only a small proportion of patients with HCC are diagnosed at a very early or early stage(BCLC 0-A)when curative treatment,including LR,is generally recommended.