Antiviral treatment standards for hepatitis B:An urgent need for expansion

The present letter to the editor is related to the review with the title“Past,present,and future of long-term treatment for hepatitis B virus.”Chronic hepatitis B(CHB)represents an important and pressing public health concern.Timely identification and effective antiviral therapy hold the potential to reduce liver-related mortality attributable to chronic infection with hepatitis B virus(HBV)substantially.However,the current global treatment rates for CHB remain conspicuously low,with the excessively stringent treatment criteria advocated by national CHB guidelines being a contributing factor to these low rates.Nevertheless,recent strides in comprehending this malady and the emergence of novel antiviral agents prompt the imperative re-evaluation of treatment standards to extend the sphere of potential beneficiaries.An impending need arises for a novel paradigm for the classification of patients with CHB,the expansion of antiviral treatment eligibility for HBV-infected individuals,and even the streamlining of the diagnostic process for CHB to amplify cost-effectiveness and augment survival prospects.

Influence of nonalcoholic fatty liver disease on response to antiviral treatment in patients with chronic hepatitis B:A meta-analysis

BACKGROUND Although hepatitis B virus infection is the leading cause of chronic liver injury globally,nonalcoholic fatty liver disease(NAFLD)is gradually gaining attention as another major chronic liver disease.The number of patients having chronic hepatitis B(CHB)with concomitant hepatic steatosis has increased.AIM To analyze the effect of NAFLD on the response to antiviral treatment in patients with CHB.METHODS Relevant English studies were systematically searched across PubMed,EMBASE,Web of Science,and Cochrane Library until October 2023.Studies in which the treatment outcomes were compared between patients with CHB only and those with CHB and hepatic steatosis were included.RESULTS Of the 2502 retrieved studies,11 articles were finally included.Biochemical response until 48 wk(OR=0.87,95%CI:0.50–1.53,P=0.000)and 96 wk(OR=0.35,95%CI:0.24–0.53,P=0.24)and virological response until 96 wk(OR=0.80,95%CI:0.43–1.49,P=0.097)were lower in patients with hepatic steatosis than in patients with CHB alone.CONCLUSION Hepatic steatosis lowers the biochemical response to antiviral treatment in patients with CHB.

Influence of weight management on the prognosis of steatohepatitis in chronic hepatitis B patients during antiviral treatment

Background:Although concomitant nonalcoholic steatohepatitis(NASH)is common in chronic hepatitis B(CHB),the impact of viral factors on NASH and the outcome of CHB patients concomitant with NASH remain unclear.We aimed to investigate the outcomes of NASH in CHB patients receiving antiviral treatment.Methods:In the post-hoc analysis of a multicenter trial,na?ve CHB patients receiving 72-week entecavir treatment were enrolled.We evaluated the biochemical,viral and histopathological responses of these patients.The histopathological features of NASH were also evaluated,using paired liver biopsies at baseline and week 72.Results:A total of 1000 CHB patients were finally enrolled for analysis,with 18.2%of whom fulfilling the criteria of NASH.A total of 727 patients completed entecavir antiviral treatment and received the second biopsy.Serum HBe Ag loss,HBe Ag seroconversion and HBV-DNA undetectable rates were similar between patients with or without NASH(P>0.05).Among patients with NASH,the hepatic steatosis,ballooning,lobular inflammation scores and fibrosis stages all improved during follow-up(all P<0.001),46%(63/136)achieved NASH resolution.Patients with baseline body mass index(BMI)≥23 kg/m2(Asian criteria)[odds ratio(OR):0.414;95%confidence interval(95%CI):0.190-0.899;P=0.012]and weight gain(OR:0.187;95%CI:0.050-0.693;P=0.026)were less likely to have NASH resolution.Among patients without NASH at baseline,22(3.7%)developed NASH.Baseline BMI≥23 kg/m2(OR:12.506;95%CI:2.813-55.606;P=0.001)and weight gain(OR:5.126;95%CI:1.674-15.694;P=0.005)were predictors of incident NASH.Conclusions:Lower BMI and weight reduction but not virologic factors determine NASH resolution in CHB.The value of weight management in CHB patients during antiviral treatment deserves further evaluation.

Liver-related effects of chronic hepatitis C antiviral treatment

More than five years ago,the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral(DAA)drugs.They proved highly efficient in curing patients with chronic hepatitis C(CHC),including patients with cirrhosis.The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis,but the exact cause of the expected benefit was unclear.Further,little was known about how the underlying liver disease would be affected during and after viral clearance.In this review,we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects,such as macrophage activation,and the time-dependent effects of therapy,with specific emphasis on inflammation,structural liver changes,and liver function,as these factors are all related to morbidity and mortality in CHC patients.It seems clear that antiviral therapy,especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis.There seems to be a timedependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions.These improvements lead to favorable effects on liver function,followed by an improvement in cognitive dysfunction and portal hypertension.Overall,the data provide knowledge on the several beneficial effects of DAA therapy on liverrelated parameters in CHC patients suggesting short-and long-term improvements in the underlying disease with the promise of an improved longterm prognosis.

Tumor characteristics of hepatocellular carcinoma after direct-acting antiviral treatment for hepatitis C: Comparative analysis with antiviral therapy-naive patients

BACKGROUND Insufficient and contradictory data are available about the relation between directacting antivirals(DAAs)and hepatocellular carcinoma(HCC)development in patients with hepatitis C virus(HCV).AIM To analyze differences in basic clinical,radiological,and laboratory characteristics in addition to tumor behavior upon HCC diagnosis between patients with and without a previous history of DAAs exposure.METHODS This multicenter case-control study included 497 patients with chronic HCVrelated HCC,allocated into one of two groups according to their history of antiviral treatment for their HCV.RESULTS Group I included 151 HCC patients with a history of DAAs,while 346 patients who had never been treated with DAAs were assigned to group II.A significant difference was observed between both groups regarding basic assessment scores(Child,MELD,and BCLC),which tended to have more advanced liver disease and HCC stage upon diagnosis in group I.However,serum albumin was significantly affected,and serumα-fetoprotein was significantly higher in group II(P<0.001).In addition,group I showed significant HCC multicentricity than group II,while the incidence of portal vein thrombosis was significantly higher in group I(P<0.001).CONCLUSION The basic clinical scores and laboratory characteristics of HCC patients are advanced in patients who are naïve to DAAs treatment;however,HCC behavior is more aggressive in DAA-treated patients.

Traditional Chinese medicine in antiviral treatment

The Novel Coronavirus(COVID-19),which broke out in Wuhan,China in December 2019,attracted worldwide attention.With a long incubation period and strong infectiousness,COVID-19 poses a great threat to the life and health worldwide with high incidence,high pathogenicity and low sensitivity to antibiotics.At present,there are less kinds of antiviral drugs,including rimantadine hydiochloride,acyclovir,interferon,zidovudine,ribavirin,etc.,which maybe lead to severe adverse reactions of the nervous system,hematopoietic system,liver and kidney system,as well as side effects such as nausea,vomiting,upper abdominal discomfort and diarrhea.Meanwhile,the development of antiviral drugs requires huge investment and time,the development of effective antiviral drugs and vaccine lags far behind the rapidly developed disease.Traditional Chinese medicine has played an important role against the infection,especially in the fight against severe acute respiratory syndrome,H1N1 influenza,H7N9 flu virus,middle east respiratory syndrome and Ebola virus infection.In this paper,the classification,mechanism,existing problems and the prospect of traditional Chinese medicine in antiviral treatment has been summarized in order to provide certain reference for the research and prescription screening of traditional Chinese medicine anti-COVID-19 drugs.

Chinese Consensus on Antiviral Treatment of Chronic Hepatits B Patients with Nucleos(t)ide Analogues

Antiviral treatment is the main method for chronic hepatitis B(CHB).After antiviral treatment,some patients may obtain satisfactory therapeutic effect,but some patients still show primary non-response,suboptimal response,even resistance to nucleos(t)ide analogues or relapse,which are becoming the key problems and confusing the clinical staffs.Thus,in January 2013,editorial department of Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition),Chinese Journal of Liver Diseases(Electronic Edition)

Effectiveness of potential antiviral treatments in COVID-19 transmission control:a modelling study

Background:Novel coronavirus disease 2019(COVID-19)causes an immense disease burden.Although public health countermeasures effectively controlled the epidemic in China,non-pharmaceutical interventions can neither be maintained indefinitely nor conveniently implemented globally.Vaccination is mainly used to prevent COVID-19,and most current antiviral treatment evaluations focus on clinical efficacy.Therefore,we conducted population-based simulations to assess antiviral treatment effectiveness among different age groups based on its clinical efficacy.

Prolonged SARS-CoV-2 Viral Shedding in Patients with COVID-19 was Associated with Delayed Initiation of Arbidol Treatment and Consulting Doctor Later: A Retrospective Cohort Study

Objective:To study data about SARS-CoV-2 virus shedding and clarify the risk factors for prolonged virus shedding.Methods:Data were retrospectively collected from adults hospitalized with laboratory-confirmed coronavirus disease-19(COVID-19)in Wuhan Union Hospital.We compared clinical features among patients with prolonged(a positive SARS-CoV-2 RNA on day 23 after illness onset)and short virus shedding and evaluated risk factors associated with prolonged virus shedding by multivariate regression analysis.Results:Among 238 patients,the median age was 55.5 years,57.1%were female,92.9%(221/238)were administered with arbidol,58.4%(139/238)were given arbidol in combination with interferon.The median duration of SARS-CoV-2 virus shedding was 23 days(IQR,17.8-30 days)with a longest one of 51 days.The patients with prolonged virus shedding had higher value of D-dimer(P=0.002),IL-6(P<0.001),CRP(P=0.005)and more lobes lung lesion(P=0.014)on admission,as well as older age(P=0.017)and more patients with hypertension(P=0.044)than in those the virus shedding less than 23 days.Multivariate regression analysis revealed that prolonged viral shedding was significantly associated with initiation arbidol≥8 days after symptom onset[OR:2.447,95%CI(1.351-4.431)],≥3 days from onset of symptoms to first medical visitation[OR:1.880,95%CI(1.035-3.416)],illness onset before Jan.31,2020[OR:3.289,95%CI(1.474-7.337)].Arbidol in combination with interferon was also significantly associated with shorter virus shedding[OR:0.363,95%CI(0.191-0.690)].Conclusion:Duration of SARS-CoV-2 virus shedding was long.Early initiation of arbidol and arbidol in combination with interferon as well as consulting doctor timely after illness onset were helpful for SARS-CoV-2 clearance.

Chronic hepatitis B in pregnant women: Current trends and approaches

Chronic hepatitis B(CHB)is a significant public health problem worldwide.The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women.The prevalence of hepatitis B virus(HBV)infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area.All women have to be screened for hepatitis B surface antigen(HBsAg)during pregnancy.Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen,HBV viral load,alanine aminotransferase level,and HBsAg level.The management of pregnancy depends on the phase of the HBV infection,which has to be determined before pregnancy.In women of childbearing age with CHB,antiviral therapy can pursue two main goals:Treatment of active CHB,and vertical transmission prevention.During pregnancy,tenofovir is the drug of choice in both cases.A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB.In such cases,there are no contraindications to breastfeeding.

Genotype 3-hepatitis C virus’last line of defense

Chronic infection with hepatitis C virus(HCV)is one of the leading causes of liver disease globally,affecting approximately 71 million people.The majority of them are infected with genotype(GT)1 but infections with GT3 are second in frequency.For many years,GT3 was considered to be less pathogenic compared to other GTs in the HCV family due to its favorable response to interferon(IFN)-based regimen.However,the growing evidence of a higher rate of steatosis,more rapid progression of liver fibrosis,and lower efficacy of antiviral treatment compared to infection with other HCV GTs has changed this conviction.This review presents the specifics of the course of GT3 infection and the development of therapeutic options for GT3-infected patients in the era of direct-acting antivirals(DAA).The way from a standard of care therapy with pegylated IFNalpha(pegIFNα)and ribavirin(RBV)through a triple combination of pegIFNα+RBV and DAA to the highly potent IFN-free pangenotypic DAA regimens is discussed along with some treatment options which appeared to be dead ends.Although the implementation of highly effective pangenotypic regimens is the most recent stage of revolution in the treatment of GT3 infection,there is still room for improvement,especially in patients with liver cirrhosis and those who fail to respond to DAA therapies,particularly those containing inhibitors of HCV nonstructural protein 5A.

Direct acting antiviral-induced dynamic reduction of serum a fetoprotein in hepatitis C patients without hepatocellular carcinoma

Direct acting antiviral(DAA)treatments may reduce the elevatedαfetoprotein(AFP),but data on how these treatments affect elevated AFP in patients with chronic hepatitis C(CHC)remain insufficient.In the present study,the frequency of baseline AFP elevations and their related factors,AFP dynamics during and after DAA treatment,and factors associated with AFP reduction was assessed.This retrospective study included 141 patients with CHC without hepatocellular carcinoma who received DAA and achieved sustained virological response.The details are as follows:mean post-treatment follow-up was 99 weeks(12–213);mean age,57.8 years old;52%,males;79%,genotype(GT)1;and 47%,cirrhosis.Pre-treatment AFP elevation(>5.5 ng/mL)was seen in 48.2%patients.On multivariate analysis,baseline AFP>5.5 was associated with the presence of cirrhosis(P=0.001),co-existing non-alcoholic steatohepatitis(NASH)(P=0.035),and GT 1(P=0.029).AFP normalization was seen in 28.2%patients at treatment week 2,in 52%at the end of treatment,and in 73.4%at the end of follow-up.Post-treatment week 24 AFP normalization was associated with the absence of cirrhosis(P=0.003),Child--Pugh score<6(P=0.015),and baseline AFP<10(P=0.015).AFP elevation is common in patients with CHC and independently associated with NASH,cirrhosis,and GT 1.DAA treatment resulted in AFP normalization as early as treatment week 2.Post-treatment week 24 AFP normalization is independently associated with the absence of cirrhosis,Child--Pugh score<6,and baseline AFP<10.

Direct acting antivirals therapy and hepatocellular carcinoma risk in patients with hepatitis C virus

The estimated number of people with active hepatitis C virus infection worldwide is about 70 million.The estimated number of people with active hepatitis C virus infection worldwide is about 70 million.Approximately 30%of infected individuals develop cirrhosis,whilst some develop liver cancer,the fifth most common cancer worldwide.Currently available treatments,high-efficacy antiviral agents mostly short-term(8-12 weeks)and pangenotypic,have efficacy rates of over 96%.Some patients,especially those with cirrhosis,develop primary liver cancer even after effective hepatitis C virus treatment.In order to diagnose hepatocellular carcinoma early,patients at risk should be enrolled in a surveillance program.

Hepatitis B and Hepatitis C Reactivation in the Biologic Era

Hepatitis B (HBV) and hepatitis C (HCV) reactivation may occur after the use of biologic agents. During the last decade, utilization of biologics has changed the fate of many treated for cancer, autoimmune and connective tissue disease, mainte-nance of transplanted organs, and the prevention of graft-versus-host disease among others. HBV reactivation has been reported in up to 50% of HBV carriers undergoing immuno-suppressive therapy, and there is emerging data pointing towards an increased risk for HCV reactivation. If reactivation of HBV and HCV occurs, the spectrum of clinical manifestations can range from asymptomatic hepatitis flares to hepatic decompensation, fulminant hepatic failure, and death. Therefore, identifying patients at risk and early diagnosis are imperative to decrease significant morbidity and mortality. The purpose of this article is to review the pathophysiology of the reactivation of HBV and HCV infection in patients receiving biologic therapies and the approaches used to diagnose, prevent, and treat HBV and HCV reactivation.

HIV screening and retention in care in people who use drugs in Madrid, Spain: a prospective study

Background::The burden of human immunodeficiency virus(HIV)infection in people who use drugs(PWUD)is significant.We aimed to screen HIV infection among PWUD and describe their retention in HIV care.Besides,we also screen for hepatitis C virus(HCV)infection among HIV-seropositive PWUD and describe their linkage to care.Methods::We conducted a prospective study in 529 PWUD who visited the"Ca?ada Real Galiana"(Madrid,Spain).The study period was from June 1,2017,to May 31,2018.HIV diagnosis was performed with a rapid antibody screening test at the point-of-care(POC)and HCV diagnosis with immunoassay and PCR tests on dried blood spot(DBS)in a central laboratory.Positive PWUD were referred to the hospital.We used the Chi-square or Fisher’s exact tests,as appropriate,to compare rates between groups.Results::Thirty-five(6.6%)participants were positive HIV antibodies,but 34 reported previous HIV diagnoses,and 27(76%)had prior antiretroviral therapy.Among patients with a positive HIV antibody test,we also found a higher prevalence of homeless(P<0.001)and injection drug use(PWID)(P<0.001),and more decades of drug use(P=0.002).All participants received HIV test results at the POC.Of the 35 HIV positives,28(80%)were retained in HIV medical care at the end of the HIV screening study(2018),and only 22(62.9%)at the end of 2020.Moreover,12/35(34.3%)were positive for the HCV RNA test.Of the latter,10/12(83.3%)were contacted to deliver the HCV results test(delivery time of 19 days),5/12(41.7%)had an appointment and were attended at the hospital and started HCV therapy,and only 4/12(33.3%)cleared HCV.Conclusions::We found almost no new HIV-infected PWUD,but their cascade of HIV care was low and remains a challenge in this population at risk.The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care.