Changes in the etiology of liver cirrhosis and the corresponding management strategies

We read with interest the article by Xing Wang,which was published in the recent issue of the World Journal of Hepatology 2023;15:1294-1306.This article focuses particularly on the prevalence and trends in the etiology of liver cirrhosis(LC),prognosis for patients suffering from cirrhosis-related complications and hepatocellular carcinoma(HCC),and management strategies.The etiology of cirrhosis varies according to geographical,economic,and population factors.Viral hepatitis is the dominant cause in China.Vaccination and effective treatment have reduced the number of people with viral hepatitis,but the overall number is still large.Patients with viral hepatitis who progress over time to LC and HCC remain an important population to manage.The increased incidence of metabolic syndrome and alcohol consumption is likely to lead to a potential exponential increase in metabolic dysfunction-associated steatotic liver disease(MASLD)-associated LC and alcoholic liver disease in the future.Investigating the evolution of the etiology of LC is important for guiding the direction of future research and policy development.These changing trends indicate a need for greater emphasis on tackling obesity and diabetes,and implementing more effective measures to regulate alcohol consumption in order to reduce the occurrence of MASLD.In an effort to help cope with these changing trends,the authors further proposed countermeasures for healthcare authorities doctors,and patients.

Efficacy and Safety of Tenofovir Disoproxil Treatment for Chronic Hepatitis B Patients with Genotypic Resistance to Other Nucleoside Analogues： A Prospective Study

Background： Tenofovir disoproxil （TDF） is a promising salvage therapy for patients with chronic hepatitis B （CHB） who failed regimens of other nucleoside analogues （NAs）. In this study, we aimed to investigate the clinical efficacy and safety ofTDF monotherapy in Chinese CHB patients with genotypic resistance. Methods： A total of 33 CHB patients who had tailed treatment with other NAs and had genotypic resistance were switched to TDF monotherapy for 48 weeks. Patients＇ demographic data （age, sex, history of hepatitis B virus [HBV] therapy）, laboratory testing results （hepatitis B e antigen [HBeAg] status, HBV DNA levels, alanine aminotransferase [ALT] levels, serum creatinine, urinary protein, genotypic assay）, clinical symptoms, and liver color ultrasound examinations were collected for evaluation at day 0 （baseline） and the 12th, 24th, 36th, and 48th weeks after initiating treatment. Statistical analyses were carried out using rank sum test or rank correlation. Results： With regard to efficacy, the study found that all patients who switched to TDF monotherapy had undetectable HBV DNA levels after 48 weeks. In addition, patients with lower baseline HBV DNA levels realized earlier virological undetectability （r = 0.39, P = 0.030）. AET levels were normal in 30 of 33 patients （91%）. HBeAg negative conversion occurred in 7 of 25 patients （28%）, among whom HBeAg seroconversion （12%） and H BeAg seroclearance （16%） occurred. The time of complete virological response was significantly affected by the number of resistance loci （r = 0.36, P = 0.040）. Concerning safety, the study found that no adverse events were observed during the 48 weeks. Conclusion： TDF monotherapy is an effective and safe salvage treatment for CHB patients who are resistant to other NAs.