An-Luo-Hua-Xian Pill Improves the Regression of Liver Fibrosis in Chronic Hepatitis B Patients Treated with Entecavir

Background and Aims:Chronic hepatitis B(CHB)can cause liver fibrosis and lead to cirrhosis and cancer.As the effectiveness of antiviral therapy to reverse liver fibrosis is limited,We aimed to evaluate the effect of An-Luo-Hua-Xian pill(ALHX)on fibrosis regression in CHB patients treated with entecavir(ETV).Methods:Treatment-naïve patients with CHB were randomly treated with ETV alone or combined with ALHX(ETV+ALHX)between October 1,2013 and December 31,2020.Demographic,laboratory,and liver histology data before and after 78 weeks of treatment were collected.The Ishak fibrosis score(F)was used and fibrosis regression required a decrease in F of≥1 after treatment.Results:A total of 780 patients were enrolled,and 394 with a second liver biopsy after treatment were included in the per-protocol population,132 in ETV group and 262 in ETV+ALHX group.After 78 weeks of treatment,the fibrosis regression rate in the ETV+ALHX group was significantly higher than that of the ETV group at baseline F≥3 patients:124/211(58.8%)vs.45/98(45.9%),p=0.035.The percentage of patients with a decreased liver stiffness measurement(LSM)was higher in the ETV+ALHX group:156/211(73.9%)vs.62/98(63.%),p=0.056.Logistic regression analysis showed that ETV combined with ALHX was associated with fibrosis regression[odds ratio(OR)=1.94,p=0.018],and a family history of hepatocellular carcinoma was on the contrary.(OR=0.41,p=0.031).Conclusions:ETV combined with ALHX increased liver fibrosis regression in CHB patients.

Unsatisfying antiviral therapeutic effect in patients with mother-tochild transmissed chronic hepatitis B virus infection: a prospective multi-center clinical study

Background:Few data are available regarding the progression of liver disease and therapeutic efficacy in chronic hepatitis B(HBV)carriers infected by mother-to-child transmission(MTCT).This study aimed to investigate these two aspects by comparing the adult chronic HBV carriers in MTCT group with those in horizontal transmission group.Methods:The 683 adult chronic HBV patients qualified for liver biopsy including 191 with MTCT and 492 with horizontal transmission entered the multi-center prospective study from October 2013 to May 2016.Biopsy results from 217 patients at baseline and 78 weeks post antiviral therapy were collected.Results:Patients infected by MTCT were more likely to have e antigen positive(68.6%vs.58.2%,x^2=-2.491,P=0.012)than those with horizontal transmission.However,in patients with MTCT,levels of alkaline phosphatase(ALP)(P=0.031),Fibroscan(P=0.013),N-terminal propeptide of Type III procollagen(PIIINP)(P=0.014),and Laminin(LN)(P=0.006)were high,in contrast to the patients with horizontal transmission for whom the levels of albumin(ALB)(P=0.041),matrix metalloproteinase-3(MMP-3)(P=0.001)were high.The 47.2% of patients with MTCT and 36.8%of those with horizontal transmission had significant liver fibrosis(P=0.013).Following antiviral therapy for 78 weeks,21.2%and 38.0%patients with MTCT and horizontal transmission acquired hepatitis B e antigen(HBeAg)clearance,respectively(P=0.043),and the virological response rates were 54.7%and 74.1%in the MTCT and horizontal groups,respectively(P=0.005).MTCT was a risk factor for HBeAg clearance and virological response.Conclusion:Adult patients with MTCT were more prone to severe liver diseases,and the therapeutic efficacy was relatively poor,which underlined the importance of earlier,long-term treatment and interrupting perinatal transmission.