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Sasaki-Tanaka R, Kanda T, Yokoo T, Abe H, Hayashi K, Sakamaki A, Kamimura H, Terai S. Hepatitis A and E Viruses Are Important Agents of Acute Severe Hepatitis in Asia: A Narrative Review. Pathogens 2025; 14:454. [PMID: 40430774 PMCID: PMC12114595 DOI: 10.3390/pathogens14050454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 04/25/2025] [Accepted: 05/03/2025] [Indexed: 05/29/2025] Open
Abstract
Acute-on-chronic liver failure (ACLF) and acute liver failure (ALF) are severe hepatitis that occur in patients with and without chronic liver diseases and/or cirrhosis, respectively, and both often result in death. Hepatitis A virus (HAV) and hepatitis E virus (HEV) infection can cause these severe conditions. We reviewed the role of HAV and HEV, which infect humans through the fecal-oral route, in ALF and ACLF in Asian countries. This narrative review was the derived from a traditional non-systematic review. Hepatitis A should be recognized as one of the sexually transmitted infections, especially among men who have sex with men. HAV genotype IIIA infection seems to present a more severe clinical manifestation. Acute HEV-1 infection is associated with ALF in pregnant women in India. HEV-4, rather than HEV-3, was found in severe hepatitis in Japan. HEV also plays a role as a cause of acute insult and/or chronic liver disease in immunocompromised patients with ACLF. Further studies are needed for the development of vaccines and antivirals against HAV and HEV infections. Despite the limitations of the recording of cases and the extent of specific vaccinations, multidisciplinary cooperation, involving hepatologists, virologists, experts in public health, etc., may improve the treatment of HAV and HEV infection.
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Affiliation(s)
- Reina Sasaki-Tanaka
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
| | - Tatsuo Kanda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
- Division of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Uonuma Kikan Hospital, Minami-Uonuma, Niigata 949-7302, Japan
| | - Takeshi Yokoo
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
| | - Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
| | - Akira Sakamaki
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
| | - Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8520, Japan; (R.S.-T.); (T.Y.); (H.A.); (K.H.); (A.S.); (H.K.); (S.T.)
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Kao YT, Liu YC, Cheng YT, Wen YW, Hsieh YC, Hsu CE, Su CW, Tai JCH, Chen YC, Jeng WJ, Lin CY, Chien RN, Tai DI, Sheen IS. Hepatocellular Carcinoma Incidences and Risk Factors in Hepatitis C Patients: Interferon versus Direct-Acting Agents. Viruses 2024; 16:1485. [PMID: 39339961 PMCID: PMC11440110 DOI: 10.3390/v16091485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/13/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) remains a significant concern for patients with chronic hepatitis C (HCV), even after achieving a sustained virological response (SVR) with direct-acting antivirals (DAAs) or interferon (IFN)-based therapies. This study compared the risk of HCC in patients with HCV who achieved SVR through the DAA versus IFN regimens. METHODS A retrospective analysis was conducted on 4806 HCV patients, without coinfection nor prior HCC history, treated at the Chang Gung Memorial Hospital, Taiwan (DAA: 2825, IFN: 1981). Kaplan-Meier and Cox regression analyses with propensity score matching (PSM) were used to adjust for baseline differences. RESULTS DAA-treated patients exhibited a higher incidence of HCC than IFN-treated patients before and after PSM (after PSM: annual: 1% vs. 0.5%; 6-year: 6% vs. 3%, p = 0.01). Both DAA and IFN patients had a decreased HCC incidence during follow-up (>3 vs. <3 years from the end of treatment: DAA: 1.43% vs. 1.00% per year; IFN: 0.47% vs. 0.36% per year, both p < 0.05). HCC incidence was higher in the first three years post-SVR in DAA-treated ACLD patients and then decreased (3.26% vs. 1.39% per year, p < 0.01). In contrast, HCC incidence remained constant in the non-ACLD and IFN-treated groups. Multivariate Cox regression identified age ≥ 60, male sex, BMI, AFP ≥ 6 ng/mL, FIB-4, and ACLD status as independent risk factors for HCC, but antiviral regimens were not an independent factor for HCC. CONCLUSION DAA treatment significantly affects HCC risk primarily within three years post-treatment, especially in younger HCV patients with ACLD. HCC incidence was reduced after three years in ACLD patients treated by DAA, but continued surveillance was still necessary. However, patients under 60 without advanced liver disease may require less intensive follow-up.
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Affiliation(s)
- Yu-Ting Kao
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yen-Chun Liu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ya-Ting Cheng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Wen Wen
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yi-Chung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Er Hsu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chung-Wei Su
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jennifer Chia-Hung Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yi-Cheng Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Dar-In Tai
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan; (Y.-T.K.); (Y.-C.L.); (Y.-T.C.); (Y.-C.H.); (C.-E.H.); (C.-W.S.); (J.C.-H.T.); (Y.-C.C.); (C.-Y.L.); (R.-N.C.); (D.-I.T.); (I.-S.S.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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