Lamivudine treatment enabling right hepatectomy for hepatocellular carcinoma in decompensated cirrhosis

Benefits of nucleos(t)ide analog treatments for hepatitis B virus-related cirrhosis

Chronic hepatitis B infection induces progressive liver disease. Before nucleos(t)ide analogs (NUCs) became established as a safe and effective treatment for hepatitis B, it was difficult to suppress the activity of the hepatitis B virus (HBV). Currently, many patients with hepatitis or cirrhosis associated with HBV are treated with NUCs for an extended period of time, and the effects, benefits, and limitations of these treatments have been apparent. This article reviews HBV-related cirrhosis, its natural course and survival, histological improvement after NUC treatments, treatment effects for decompensated cirrhosis, the incidence of hepatocellular carcinoma (HCC) after NUC treatments, and the efficacy of NUC treatments before and after the treatment of patients for HBV-related HCC. Of particular interest are the histological improvements, including regression of fibrosis, that have been achieved with NUC treatments. Liver function of patients with decompensated cirrhosis has significantly improved regardless of the type of NUC applied, and treatment with NUCs has reduced the incidence of HCC in cirrhotic patients. However, cirrhosis remains the strongest risk factor for HCC occurrence following NUC treatments, and the long-term cumulative incidence of HCC after NUC treatments remains high. When recurrence does occur, it is important to reconsider the treatment modality according to the degree of improved liver function that was achieved.

Clinical effects of different antiviral treatments for chronic hepatitis B

AIM: To compare the clinical effects of different antiviral treatments for chronic hepatitis B (CHB).

METHODS: A total of 266 patients with chronic CHB were included. They all underwent optimized treatment, including 97 patients treated with telbivudine tablets, 92 with entecavir tablets, and 77 with adefovir dipivoxil tablets. The undectable rates of HBV DNA at 12, 24 and 108 wk, the recovery rate of alanine aminotransferase (ALT), the disappearance rate of hepatitis B e antigen (HBeAg), and the conversion rate of HBeAg were compared. The Child-Pugh stage prior treatment and at 108 wk posttreatment as well as adverse reactions were also compared.

RESULTS: The undectable rates of HBV DNA at 12 and 24 wk and the recovery rate of ALT in the telbivudine group and entecavir group were significantly higher than those in the adefovir dipivoxil group (60.82%, 57.61% vs 35.06%; 73.20%, 73.91% vs 45.45%; 50.52%, 51.09% vs 31.17%; 59.79%, 61.96% vs 40.26%; P < 0.05). There was no significant difference in the unpredictable rate of HBV DNA at 108 wk and the recovery rate of ALT in the three groups. The disappearance rate of HBeAg at 108 wk and the conversion rate of HBeAg in the telbivudine group were significantly higher than those in the adefovir dipivoxil group (39.18% vs 20.78%, 28.87% vs 9.09%, P < 0.05). The proportions of Child-Pugh stage A at 108 wk posttreatment for the three groups were significantly higher than those prior treatment (57.73% vs 28.87%, 51.09% vs 21.74%, 54.55% vs 24.68%, P < 0.05), and there was no significant difference for the three groups in the proportions of Child-Pugh stage A at 108 wk posttreatment (57.73% vs 51.09% vs 54.55%, P > 0.05).

CONCLUSION: Telbivudine can improve liver function, reduce HBV DNA copies, improve the conversion rate of HBeAg, and reduce the score of Child-Pugh, representing a preferred treatment for patients with CHB.

Antiviral therapy for hepatitis B virus-associated hepatocellular carcinoma

Hepatitis B virus (HBV) is the main cause of hepatocellular carcinoma (HCC) in China. High HBV load is an important factor affecting the development and prognosis of primary HCC. Since surgery, local therapy and other treatments have the potential to reactivate HBV, antiviral therapy is considered the most fundamental treatment for HCC. Combination therapy with above treatment and antiviral therapy can significantly reduce the copies of HBV DNA, decrease tumor recurrence and metastasis, and extend survival time in patients with middle or advanced stage HCC.

Detection of primary YMDD mutations in HBV-related hepatocellular carcinoma using hybridization-fluorescence polarization

Lamivudine is used for the treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). However, HBV-related HCC patients with mutations in the tyrosine-methionine-aspartate-aspartate (YMDD) motif have no response to lamivudine therapy. The detection of YMDD mutations in HBV-related HCC patients may help guide the treatment of HCC. In this study, a simple, sensitive, reliable and cost-effective hybridization-fluorescence polarization assay for the detection of YMDD mutations in HCC was developed. A pair of general primers within the highly conserved region of the HBV polymerase gene was used in an asymmetric PCR. Three probes specific for the corresponding YMDD mutations labeled with different fluorescent reporters hybridized to their target amplicons, and hybridization was indicated by higher fluorescence polarization. The hybridization-fluorescence polarization assay was capable of detecting YMDD mutations at a limit of detection of 10 copies per reaction, and the assay was able to detect minor populations of viruses with primary YMDD mutations as low as 10%. The rates of primary YMDD mutations and the correlation between YMDD mutations and HBV genotypes in 251 HBV-related HCC patients were investigated using the hybridization-fluorescence polarization assay.