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Khattak A, Vongsavath T, Haque L, Narwan A, Gish RG. The Forgotten Virus, Hepatitis D: A Review of Epidemiology, Diagnosis, and Current Treatment Strategies. J Clin Exp Hepatol 2024; 14:101395. [PMID: 38617106 PMCID: PMC11015125 DOI: 10.1016/j.jceh.2024.101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/05/2024] [Indexed: 04/16/2024] Open
Abstract
Hepatitis D virus (HDV) is an RNA subvirus that infects patients with co-existing hepatitis B virus (HBV) infections. HDV burden is estimated to be approximately 15-20 million people worldwide. Despite HDV severity, screening for HDV remains inadequate. HDV screening would benefit from a revamped approach that automatically reflexes testing when individuals are diagnosed with HBV if HBsAg-positive, to total anti-HDV, and then to quantitative HDV-RNA polymerase chain reaction (PCR) rather than only testing those at high risk sequentially. There are no current treatments in the United States that are Food and Drug Administration (FDA)-approved for the treatment of HDV; however, bulevirtide (BLV) is approved in the European Union conditionally and is under review with the United States FDA. Current treatment strategies in many countries are centered on the use of pegylated-interferon-alfa-2a (PEG-IFNa-2a). There are other therapies in development globally that have shown promise, including BLV, pegylated-interferon-lambda (PEG-IFN-lambda), and lonafarnib (LNF). LNF has shown substantial response in the LOWR trials. BLV is a well-tolerated drug, but it is not finite therapy and has shown significant on-treatment responses in the MYR clinical trials, and the FDA cited concerns with the manufacturing and patient preparation of the drug that have delayed approval. The PDUFA date for BLV in the United States is mid-2024. Current studies with both BLV and LNF are limited in providing sustained virological response (SVR); future trials will need to demonstrate more substantial SVR with possible triple combination trials as options.
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Affiliation(s)
- Adam Khattak
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Tahne Vongsavath
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Lubaba Haque
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Amrit Narwan
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Robert G. Gish
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
- Hepatitis B Foundation, Doylestown, PA, USA
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Lonardo A, Bril F, Caldwell SH, Eslam M, Fan JG, Gish RG, Gronbaek H, Sanal MG, Stefan N, Suzuki A, Targher G, Tilg H, Yu ML, Zheng MH, George J. Researchers call for more flexible editorial conduct rather than abruptly adopting only the new MASLD nomenclature. J Hepatol 2024; 80:e192-e194. [PMID: 38336589 DOI: 10.1016/j.jhep.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/12/2024]
Affiliation(s)
| | - Fernando Bril
- University of Alabama at Birmingham (UAB), Birmingham, AL, United States
| | | | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia
| | - Jian-Gao Fan
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Robert G Gish
- Loma Linda University, Loma Linda, CA, United States; University of Nevada, Reno and Las Vegas, NV, United States; Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, United States; Hepatitis B Foundation, Doylestown, PA, United States
| | - Henning Gronbaek
- Aarhus University Hospital and Clinical Institute, Department of Hepatology & Gastroenterology, Aarhus University, Denmark
| | | | - Norbert Stefan
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University of Tübingen, Tübingen, Germany
| | - Ayako Suzuki
- Gastroenterology, Duke University, Durham, NC, United States
| | - Giovanni Targher
- Department of Medicine, University of Verona, Verona, Italy; Metabolic Diseases Research Unit, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Ming-Lung Yu
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital; College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, NSW, Australia
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Gish RG, Jacobson IM, Lim JK, Waters-Banker C, Kaushik A, Kim C, Cyhaniuk A, Wong RJ. Prevalence and characteristics of hepatitis delta virus infection in patients with hepatitis B in the United States: An analysis of the All-Payer Claims Database. Hepatology 2024; 79:1117-1128. [PMID: 37976395 PMCID: PMC11020024 DOI: 10.1097/hep.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND AIMS HDV leads to the most severe form of viral hepatitis; however, the prevalence of HDV is not well understood. Using real-world data from the All-Payer Claims Database, this study estimates the prevalence of HBV/HDV infection among the chronic HBV population and describes patient/clinical characteristics for adults with HBV/HDV infection in the United States. APPROACH AND RESULTS Adults (≥18 years) with ≥1 inpatient claim or ≥2 outpatient claims for HDV infection or HBV in the All-Payer Claims Database from January 1, 2014, to December 31, 2020, were identified. HDV prevalence was calculated as the proportion of patients with HBV/HDV infection among total patients with HBV infection. Patient characteristics, socioeconomic status, advanced liver complications (eg, cirrhosis, HCC), and comorbidities were assessed. A total of 6719 patients were diagnosed with HBV/HDV among 144,975 with HBV and 12 months of continuous data, for a prevalence of 4.6%. At diagnosis, 31.7% of patients with HBV/HDV had advanced liver complications, including compensated cirrhosis (16.3%) and decompensated cirrhosis (10.4%). Diabetes (50.5%), hypertension (49.8%), and HIV infection (30.9%) were the top 3 comorbidities. CONCLUSIONS In a large database capturing approximately 80% of the US-insured population, HBV/HDV infection prevalence was 4.6% among adults infected with HBV. Patients infected with HDV had high rates of baseline liver complications and other comorbidities at the time of diagnosis, suggesting potentially delayed diagnosis and/or treatment. Earlier identification of HBV/HDV infection among the population with HBV may provide opportunities to improve linkage to care and treatment, thereby reducing the risk of liver-related morbidity and mortality.
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Affiliation(s)
- Robert G. Gish
- The University of Nevada, Reno School of Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, Nevada, USA
- UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, Hepatitis B Foundation, La Jolla, California, USA
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Loma Linda University, San Bernardino County, California, USA
| | | | - Joseph K. Lim
- Section of Digestive Diseases and Yale Liver Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | - Chong Kim
- Gilead Sciences Inc., Foster City, California, USA
| | | | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine and Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
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Gish RG, Wong RJ, Di Tanna GL, Kaushik A, Kim C, Smith NJ, Kennedy PT. Association of hepatitis delta virus with liver morbidity and mortality: A systematic literature review and meta-analysis. Hepatology 2024; 79:1129-1140. [PMID: 37870278 PMCID: PMC11019996 DOI: 10.1097/hep.0000000000000642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS Studies have suggested that patients with chronic hepatitis B, either co- or superinfected, have more aggressive liver disease progression than those with the HDV. This systematic literature review and meta-analysis examined whether HDV RNA status is associated with increased risk of advanced liver disease events in patients who are HBsAg and HDV antibody positive. APPROACH AND RESULTS A total of 12 publications were included. Relative rates of progression to advanced liver disease event for HDV RNA+/detectable versus HDV RNA-/undetectable were extracted for analysis. Reported OR and HRs with 95% CI were pooled using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. The presence of HDV RNA+ was associated with an increased risk of any advanced liver disease event [random effect (95% CI): risk ratio: 1.48 (0.93, 2.33); HR: 2.62 (1.55, 4.44)]. When compared to the patients with HDV RNA- status, HDV RNA+ was associated with a significantly higher risk of progressing to compensated cirrhosis [risk ratio: 1.74 (1.24, 2.45)] decompensated cirrhosis [HR: 3.82 (1.60, 9.10)], HCC [HR: 2.97 (1.87, 4.70)], liver transplantation [HR: 7.07 (1.61, 30.99)], and liver-related mortality [HR: 3.78 (2.18, 6.56)]. CONCLUSIONS The patients with HDV RNA+ status have a significantly greater risk of liver disease progression than the patients who are HDV RNA-. These findings highlight the need for improved HDV screening and linkage to treatment to reduce the risk of liver-related morbidity and mortality.
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Affiliation(s)
- Robert G. Gish
- University of Nevada, Reno School of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, California, USA
| | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland
| | - Ankita Kaushik
- Gilead Sciences Inc., Global Value and Access, Foster City, California, USA
| | - Chong Kim
- Gilead Sciences Inc., Global Value and Access, Foster City, California, USA
| | | | - Patrick T.F. Kennedy
- Barts Liver Centre, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Chen J, Tu T, Cohen C, Wang S, Hsu YC, Gish RG. Letter to the Editor: Halting antiviral therapy in patients with cirrhosis and chronic hepatitis B: A dangerous game? Hepatology 2024; 79:E132-E133. [PMID: 38150019 DOI: 10.1097/hep.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Jacki Chen
- Taiwan Hepatitis Information & Care Association, Kaohsiung, Taiwan
- Department of Pharmacology, Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, USA
| | - Thomas Tu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
| | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Su Wang
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Center for Asian Health, Cooperman Barnabas Medical Center, RWJBarnabas-Rutgers Medical Group, Livingston, New Jersey, USA
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
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Jones DE, Beuers U, Bonder A, Carbone M, Culver E, Dyson J, Gish RG, Hansen BE, Hirschfield G, Jones R, Kowdley K, Kremer AE, Lindor K, Mayo M, Mells G, Neuberger J, Prince M, Swain M, Tanaka A, Thorburn D, Trauner M, Trivedi P, Weltman M, Yeoman A, Levy C. Primary biliary cholangitis drug evaluation and regulatory approval: Where do we go from here? Hepatology 2024:01515467-990000000-00814. [PMID: 38506926 DOI: 10.1097/hep.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease. The management landscape was transformed 20 years ago with the advent of Ursodeoxycholic Acid (UDCA). Up to 40% of patients do not, however, respond adequately to UDCA and therefore still remain at risk of disease progression to cirrhosis. The introduction of Obeticholic acid (OCA) as second-line therapy for patients failing UDCA has improved outcomes for PBC patients. There remains, however, a need for better treatments for higher risk patients. The greatest threat facing our efforts to improve treatment in PBC is, paradoxically, the regulatory approval model providing conditional marketing authorisation for new drugs based on biochemical markers on the condition that long-term, randomized placebo-controlled outcomes trials are performed to confirm efficacy. As demonstrated by the COBALT confirmatory study with OCA, it is difficult to retain patients in the required follow-on confirmatory placebo-controlled PBC outcomes trials when a licensed drug is commercially available. New PBC therapies in development such as the PPAR agonists, face even greater challenges in demonstrating outcomes benefit through randomized placebo-controlled studies once following conditional marketing authorisation, as there will be even more treatment options available. A recently published EMA Reflection Paper provides some guidance on the regulatory pathway to full approval but fails to recognise the importance of Real-World Data in providing evidence of outcomes benefit in rare diseases. Here we explore the impact of the EMA reflection paper on PBC therapy and offer pragmatic solutions for generating evidence of long-term outcomes through Real World data collection.
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Affiliation(s)
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Academisch Medisch Centrum Universiteit van Amsterdam, Netherlands
| | - Alan Bonder
- Division of Gastreonterology, Beth Israel Deaconess Medical Centre, Boston, MA, USA
| | - Marco Carbone
- Division of Gastroenterology and Centre for Autoimmune Liver Disease, University of Milano-Bicocca, Milan, Italy and Liver Unit, ASST Grande Ospedale, Metropolitano Niguarda, Milan, Italy
| | - Emma Culver
- John Radcliffe Hospital, Oxford, UK and University of Oxford, UK
| | - Jessica Dyson
- Liver Unit, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | - Robert G Gish
- Hepatitis B Foundation, San Diego, California, USA and Division of Gastroenterology and Hepatology, Stanford Medicine, Stanford, USA
| | - Bettina E Hansen
- Department of Epidemiology & Biostatistics, Erasmus MC, Rotterdam, Netherlands and University of Toronto, Toronto, Canada and Toronto Center for Liver Disease & Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Canada
| | - Rebecca Jones
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
| | - Kris Kowdley
- Liver Institute Northwest, Elson S. Floyd College of Medicine, Washington State University, USA and Velocity Clinical Research, Seattle, USA
| | - Andreas E Kremer
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Keith Lindor
- College of Health Solutions, Arizona State University, USA
| | - Marlyn Mayo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Texas, USA
| | - George Mells
- The Cambridge Liver Unit, Addenbrooke's Hospital, Cambridge, UK
| | - James Neuberger
- Liver and Hepato-Pancreato-Biliary Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin Prince
- Central Manchester University Hospitals NHS Foundation Trust, Department of Gastroenterology (Manchester Royal Infirmary), Manchester, UK
| | - Mark Swain
- University of Calgary, Calgary, Alberta, Canada
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Japan
| | | | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Medicine III Medical University of Vienna, Austria
| | - Palak Trivedi
- National Institute for Health and Care Research, Birmingham Biomedical Research Centre, Birmingham, UK and Liver Unit, University Hospitals Birmingham, UK
| | - Martin Weltman
- Gastroenterology and Hepatology, Nepean Hospital, New South Wales, Australia
| | - Andrew Yeoman
- Aneurin Bevan University Health Board, Gwent Liver unit, Newport, Wales, UK
| | - Cynthia Levy
- Division of Digestive Health and Liver Diseases and Schiff Center for Liver Diseases, Miami, USA
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Toumi M, Wallace J, Cohen C, Marshall C, Kitchen H, Macey J, Pegram H, Slagle AF, Gish RG, Ning Q, Yatsuhashi H, Cornberg M, Brunetto M, van Bömmel F, Xie Q, Lee D, Habuka N, Sbarigia U, Beumont-Mauviel M, Keever AV, Takahashi Y, Lu Y, Liu A, Chen Q, Ito T, Radunz O, Puggina A, Hilgard G, Chan EKH, Wang S. Experience and impact of stigma in people with chronic hepatitis B: a qualitative study in Asia, Europe, and the United States. BMC Public Health 2024; 24:611. [PMID: 38408941 PMCID: PMC10895774 DOI: 10.1186/s12889-023-17263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/19/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND People with chronic hepatitis B (CHB) commonly experience social and self-stigma. This study sought to understand the impacts of CHB-related stigma and a functional cure on stigma. METHODS Adults with CHB with a wide range of age and education were recruited from 5 countries and participated in 90-minute qualitative, semi-structured interviews to explore concepts related to CHB-associated stigma and its impact. Participants answered open-ended concept-elicitation questions regarding their experience of social and self-stigma, and the potential impact of reduced CHB-related stigma. RESULTS Sixty-three participants aged 25 to 71 years (15 from the United States and 12 each from China, Germany, Italy, and Japan) reported emotional, lifestyle, and social impacts of living with CHB, including prejudice, marginalization, and negative relationship and work experiences. Self-stigma led to low self-esteem, concealment of CHB status, and social withdrawal. Most participants stated a functional cure for hepatitis B would reduce self-stigma. CONCLUSIONS CHB-related social and self-stigma are widely prevalent and affect many aspects of life. A functional cure for hepatitis B may reduce social and self-stigma and substantially improve the health-related quality of life of people with CHB. Incorporating stigma into guidelines along with infectivity considerations may broaden the patient groups who should receive treatment.
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Affiliation(s)
- Mondher Toumi
- Aix-Marseille University, Jardin du Pharo, 58 bd Charles Livon, Marseille, 13284 Cedex 07, France.
- Department of Public Health, Aix-Marseille University, 27 Boulevard Jean Moulin, Marseille, 13385, France.
| | - Jack Wallace
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Rd, Doylestown, PA, 18902, USA
| | - Chris Marshall
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Helen Kitchen
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Jake Macey
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Hannah Pegram
- Clarivate (formerly DRG Abacus), 70 St Mary Axe, London, EC3A 8BE, UK
| | - Ashley F Slagle
- Aspen Consulting, LLC, 625 S Lincoln Ave #101, Steamboat Springs, CO, 80487, USA
| | - Robert G Gish
- Hepatitis B Foundation, 3805 Old Easton Rd, Doylestown, PA, 18902, USA
| | - Qin Ning
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, China
| | - Hiroshi Yatsuhashi
- National Hospital Organization (NHO) Nagasaki Medical Center, 2-1001-1, Kubara, Omura, Nagasaki, 856-8562, Japan
- Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki City, 852-8520, Japan
| | - Markus Cornberg
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maurizia Brunetto
- University Hospital of Pisa, Lungarno Pacinotti 43, Pisa, 56126, Italy
| | - Florian van Bömmel
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Qing Xie
- Shanghai Jiao Tong University School of Medicine, Ruijin Hospital, 227 South Chongqing Road, Shanghai, 20025, China
| | - Dee Lee
- Inno Community Development Organisation, Room 208, Dengzheng Business Center, #57, Dengzhengnan Rd, Yuexiu District, Guangzhou, Guangdong, China
| | - Noriyuki Habuka
- Janssen Pharmaceutical K.K, 3-5-2 Nishi-kanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Urbano Sbarigia
- Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse, B-2340, Belgium
| | - Maria Beumont-Mauviel
- Janssen Research & Development, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA
| | | | - Yasushi Takahashi
- Janssen Pharmaceutical K.K, 3-5-2 Nishi-kanda, Chiyoda-ku, Tokyo, 101-0065, Japan
| | - Yiwei Lu
- Janssen China, 14F, Tower 3, China Central Place, No.77, Jian Guo Road, Chaoyang District, Beijing, 100025, China
| | - Ao Liu
- Janssen China, 14F, Tower 3, China Central Place, No.77, Jian Guo Road, Chaoyang District, Beijing, 100025, China
| | - Qiaoqiao Chen
- Janssen China, 14F, Tower 3, China Central Place, No.77, Jian Guo Road, Chaoyang District, Beijing, 100025, China
| | - Tetsuro Ito
- Janssen Health Economics & Market Access (EMEA), 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG, UK
| | - Olaf Radunz
- Janssen Germany, Johnson-u.-Johnson-Platz 1, 41470, Neuss, Nordrhein-Westfalen, Germany
| | - Anna Puggina
- Janssen Italy, Via Michelangelo Buonarroti, 23, Cologno Monzese, 20093, Italy
| | - Gudrun Hilgard
- Janssen Germany, Johnson-u.-Johnson-Platz 1, 41470, Neuss, Nordrhein-Westfalen, Germany
| | - Eric K H Chan
- Janssen Global Services, LLC, 1000 US 202, Raritan, NJ, 08869, USA.
| | - Su Wang
- Hepatitis B Foundation, 3805 Old Easton Rd, Doylestown, PA, 18902, USA
- Cooperman Barnabas Medical Center, 222 Columbia Turnpike, Florham Park, NJ, 07932, USA
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Lee R, Alukal JJ, Gish RG. The BIG question: Can we stop the use of HBIG? Liver Transpl 2024:01445473-990000000-00320. [PMID: 38289265 DOI: 10.1097/lvt.0000000000000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Regis Lee
- Department of Medicine, Riverside Community Hospital, Riverside, California, USA
| | - Joseph J Alukal
- Department of Medicine, Riverside Community Hospital, Riverside, California, USA
- Department of Medicine, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- School of Medicine, Reno, Reno, Nevada, USA
- Department of Medicine, Las Vegas, Las Vegas, Nevada, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
- Loma Linda University Transplant Institute, Loma Linda, California, USA
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Freeland C, Sreepathi V, Hass RW, Fenkel JM, Torgersen J, Rothstein K, Cohen C, Gish RG. The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample. J Virus Erad 2023; 9:100358. [PMID: 38174110 PMCID: PMC10761777 DOI: 10.1016/j.jve.2023.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Within the United States (US), 2.4 million individuals are living with chronic hepatitis B, but less than 20% are diagnosed. Isolated anti-hepatitis B core (iAHBc) antibodies indicate serology in an individual that is positive for anti-HBc antibodies, while negative for surface antigen (HBsAg) and surface antibodies (anti-HBs). A result of iAHBc could indicate a chronic occult bloodstream infection, necessitating further testing. This study assesses the prevalence and risk factors associated with anti-HBc and iAHBc within community high-risk screening in Greater Philadelphia. Participants (n = 177) were screened for HBsAg, anti-HBs, and anti-HBc during community screening events in 2022. Chi-square tables and Firth logistic regression were used to describe the data and to assess the odds of iAHBc. The findings indicate that there was an iAHBc prevalence of 7.3% (n = 13) within our study. The odds of anti-HBc were increased for immigrants from the Western Pacific (4.5%) and Africa (11.9%). Individuals born in Africa had 7.93 greater odds for iAHBc than those born in the Americas, and these odds are multiplied by 1.01 for every 1-year increase in age. Our data show a high burden of iAHBc within high-risk and often hard-to-reach communities. Triple panel screening should be incorporated into all HBV screening programs, in accordance with current Centers for Disease Control and Prevention (CDC) universal screening recommendations, to ensure a comprehensive picture of the disease burden and reduce the risk of missing people with occult hepatitis B and those at risk for viral reactivation or liver complications.
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Affiliation(s)
| | - Vivek Sreepathi
- Thomas Jefferson University, College of Population Health Science, Philadelphia, PA, USA
| | - Richard W. Hass
- Thomas Jefferson University, College of Population Health Science, Philadelphia, PA, USA
| | - Jonathan M. Fenkel
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Jessie Torgersen
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kenneth Rothstein
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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10
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Gish RG. The "B and D" Times, They Are A-Changin'. Clin Liver Dis 2023; 27:xiii-xiv. [PMID: 37778783 DOI: 10.1016/j.cld.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Robert G Gish
- Medical Director, Hepatitis B Foundation, Doylestown, PA, USA; Adjunct Professor of Medicine, University of Nevada, Reno, Reno, NV, USA; Adjunct Professor of Medicine, University of Nevada, Las Vegas, Las Vegas, NV, USA; Adjunct Professor of Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA; Clinical Professor, Loma Linda University, Loma Linda, CA, USA; Robert G. Gish Consultants, LLC, 6022 La Jolla Mesa Drive, San Diego, CA 92037, USA.
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11
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Roma K, Dossaji Z, Haque L, Laeeq T, Gish RG, Brosgart C. Test All for Hepatitis B Virus: Link to Care and Treatment if Quantitative DNA Positive, Vaccinate if Susceptible. Clin Liver Dis 2023; 27:997-1022. [PMID: 37778782 DOI: 10.1016/j.cld.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Hepatitis B infection affects approximately 262 million people worldwide and is responsible for 900,000 deaths annually. This article reviews the major factors limiting HBV elimination, which includes limited linkage to care and complicated HBV testing and treatment guidelines. The article then provides solutions to these pressing issues.
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Affiliation(s)
- Katerina Roma
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, 1701 West Charleston Boulevard - Suite 230, Las Vegas, NV 89102, USA.
| | - Zahra Dossaji
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, 1701 West Charleston Boulevard - Suite 230, Las Vegas, NV 89102, USA
| | - Lubaba Haque
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, 1701 West Charleston Boulevard - Suite 230, Las Vegas, NV 89102, USA
| | - Tooba Laeeq
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, 1701 West Charleston Boulevard - Suite 230, Las Vegas, NV 89102, USA
| | | | - Carol Brosgart
- Medicine, Biostatistics, and Epidemiology, University of California San Francisco, San Francisco, CA, USA
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12
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Yang Z, Cheung RC, Chitnis AS, Zhang W, Gish RG, Wong RJ. On-treatment risks of cirrhosis and hepatocellular carcinoma among a large cohort of predominantly non-Asian patients with non-cirrhotic chronic hepatitis B. JHEP Rep 2023; 5:100852. [PMID: 37701335 PMCID: PMC10494462 DOI: 10.1016/j.jhepr.2023.100852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 09/14/2023] Open
Abstract
Background & Aims The vast majority of studies evaluating differences in on-treatment risks of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) have been conducted in Asia. Data on the course of CHB on antiviral therapy among predominantly non-Asian populations is less well described. We aimed to evaluate overall risks of cirrhosis and HCC and the influence of baseline factors on this risk among a predominantly non-Asian cohort of patients with CHB in the US. Methods Using longitudinal data from the national Veterans Affairs database, we evaluated the incidence of cirrhosis or HCC among adults with non-cirrhotic CHB on continuous antiviral therapy. Cumulative incidence functions and adjusted Cox proportional hazards models employed competing risks methods and evaluated overall risk and predictors of developing cirrhosis or HCC while on treatment. Results Among 2,496 patients with non-cirrhotic CHB (39.1% African American, 38.4% non-Hispanic White, 18.8% Asian, mean age 58.0 ± 13.4 years), the overall incidences of cirrhosis and HCC were 3.99 per 100 person-years (95% CI 3.66-4.35) and 0.43 per 100 person-years (95% CI 0.33-0.54), respectively. The highest incidences of cirrhosis and HCC were observed in non-Hispanic White patients (5.74 and 0.52 per 100 person-years, respectively), which were significantly higher than in Asian patients (1.93 and 0.17 per 100 person-years, respectively, p <0.0001). On multivariate regression, only baseline FIB-4 score was consistently associated with long-term risk of cirrhosis or HCC. Conclusions Using a longitudinal cohort of predominantly non-Asian Veterans with non-cirrhotic CHB on antiviral therapy (an understudied population), we provide important epidemiological data to describe long-term risks of cirrhosis and HCC. Impact and implications In one of the largest studies to date of a predominantly non-Asian cohort of patients with non-cirrhotic chronic hepatitis B, we provide important epidemiological data describing the long-term risks of cirrhosis and hepatocellular carcinoma among patients on antiviral therapies. Among this understudied population, the overall incidence of cirrhosis was 3.99 per 100-person-years (95% CI 3.66-4.35) and of HCC was 0.43 per 100-person-years (95% CI 0.33-0.54). These data also emphasize the importance of continued monitoring and HCC surveillance among CHB patients who are maintained on antiviral therapies.
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Affiliation(s)
- Zeyuan Yang
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Ramsey C. Cheung
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amit S. Chitnis
- Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, CA, USA
| | - Wei Zhang
- Division of Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Robert J. Wong
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, USA
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13
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Gish RG. Delta Hepatitis in the United States: Epidemiology, Testing, and Linkage to Care. Gastroenterol Hepatol (N Y) 2023; 19:603-605. [PMID: 38404959 PMCID: PMC10882855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Robert G Gish
- Medical Director, Hepatitis B Foundation Clinical Professor, Loma Linda University Loma Linda, California
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14
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Razavi HA, Buti M, Terrault NA, Zeuzem S, Yurdaydin C, Tanaka J, Aghemo A, Akarca US, Al Masri NM, Alalwan AM, Aleman S, Alghamdi AS, Alghamdi S, Al-Hamoudi WK, Aljumah AA, Altraif IH, Asselah T, Ben-Ari Z, Berg T, Biondi MJ, Blach S, Braga WSM, Brandão-Mello CE, Brunetto MR, Cabezas J, Cheinquer H, Chen PJ, Cheon ME, Chuang WL, Coffin CS, Coppola N, Craxi A, Crespo J, De Ledinghen V, Duberg AS, Etzion O, Ferraz MLG, Ferreira PRA, Forns X, Foster GR, Gaeta GB, Gamkrelidze I, García-Samaniego J, Gheorghe LS, Gholam PM, Gish RG, Glenn J, Hercun J, Hsu YC, Hu CC, Huang JF, Janjua N, Jia J, Kåberg M, Kaita KDE, Kamal H, Kao JH, Kondili LA, Lagging M, Lázaro P, Lazarus JV, Lee MH, Lim YS, Marotta PJ, Navas MC, Naveira MCM, Orrego M, Osiowy C, Pan CQ, Pessoa MG, Raimondo G, Ramji A, Razavi-Shearer DM, Razavi-Shearer K, Ríos-Hincapié CY, Rodríguez M, Rosenberg WMC, Roulot DM, Ryder SD, Safadi R, Sanai FM, Santantonio TA, Sarrazin C, Shouval D, Tacke F, Tergast TL, Villalobos-Salcedo JM, Voeller AS, Yang HI, Yu ML, Zuckerman E. Hepatitis D double reflex testing of all hepatitis B carriers in low-HBV- and high-HBV/HDV-prevalence countries. J Hepatol 2023; 79:576-580. [PMID: 37030400 DOI: 10.1016/j.jhep.2023.02.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/19/2023] [Accepted: 02/24/2023] [Indexed: 04/10/2023]
Abstract
Hepatitis D virus (HDV) infection occurs as a coinfection with hepatitis B and increases the risk of hepatocellular carcinoma, decompensated cirrhosis, and mortality compared to hepatitis B virus (HBV) monoinfection. Reliable estimates of the prevalence of HDV infection and disease burden are essential to formulate strategies to find coinfected individuals more effectively and efficiently. The global prevalence of HBV infections was estimated to be 262,240,000 in 2021. Only 1,994,000 of the HBV infections were newly diagnosed in 2021, with more than half of the new diagnoses made in China. Our initial estimates indicated a much lower prevalence of HDV antibody (anti-HDV) and HDV RNA positivity than previously reported in published studies. Accurate estimates of HDV prevalence are needed. The most effective method to generate estimates of the prevalence of anti-HDV and HDV RNA positivity and to find undiagnosed individuals at the national level is to implement double reflex testing. This requires anti-HDV testing of all hepatitis B surface antigen-positive individuals and HDV RNA testing of all anti-HDV-positive individuals. This strategy is manageable for healthcare systems since the number of newly diagnosed HBV cases is low. At the global level, a comprehensive HDV screening strategy would require only 1,994,000 HDV antibody tests and less than 89,000 HDV PCR tests. Double reflex testing is the preferred strategy in countries with a low prevalence of HBV and those with a high prevalence of both HBV and HDV. For example, in the European Union and North America only 35,000 and 22,000 cases, respectively, will require anti-HDV testing annually.
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Affiliation(s)
- Homie A Razavi
- Center for Disease Analysis Foundation, Lafayette, United States.
| | - Maria Buti
- Liver Unit, Hospital Universitari Vall d Hebron and CIBEREHD del Insituto Carlos III. Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Norah A Terrault
- Keck Medicine of University of Southern California, Los Angeles, United States
| | - Stefan Zeuzem
- Department of Medicine, University Hospital, Frankfurt, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Junko Tanaka
- Epidemiology, Infectious Disease Control and Prevention, Hiroshima University, Hiroshima, Japan
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Ulus S Akarca
- Department of Gastroenterology, Ege University, Medical School, Izmir, Turkey
| | - Nasser M Al Masri
- Department of Gastroenterology & Hepatology, Prince Sultan Medical Military City (PSMMC), Riyadh, Saudi Arabia
| | - Abduljaleel M Alalwan
- Department of Hepatobiliary Science and Liver Transplantation King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Soo Aleman
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Abdullah S Alghamdi
- Gastroenterology Unit/Medical Department, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Saad Alghamdi
- Liver & Small Bowel Health Centre Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Abdulrahman A Aljumah
- Department of Clinical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Ibrahim H Altraif
- Hepatology Division - Hepatobiliary Sciences and Organ Transplant Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Tarik Asselah
- Hepatology Department, University of Paris-Cité, Hôpital Beaujon, AP-HP, INSERM UMR1149, Paris, France
| | - Ziv Ben-Ari
- Liver Diseases Center, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Mia J Biondi
- School of Nursing, York University, Toronto, Canada
| | - Sarah Blach
- Epidemiology, Center for Disease Analysis Foundation, Lafayette, United States
| | - Wornei S M Braga
- Virology Department, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Carlos E Brandão-Mello
- Internal Medicine & Gastroenterology, University of Rio de Janeiro, Rio de Janeiro, Brazil; Clinica de Doenças do Fígado, Rio de Janeiro, Brazil
| | - Maurizia R Brunetto
- Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Integrated Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
| | - Joaquin Cabezas
- Gastroenterology and Hepatology Department, Marques de Valdecilla University Hospital, Santander, Spain; Clinical and Translational Research in Digestive Diseases, IDIVAL, Santander, Spain
| | - Hugo Cheinquer
- Department of Gastroenterology and Hepatology, Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Pei-Jer Chen
- Hepatitis Research Center, National Taiwan University, Taipei, Taiwan
| | - Myeong-Eun Cheon
- Division of HIV/AIDS Prevention and Control, Korea Disease Control and Prevention Agency, Osong, Republic of Korea
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Carla S Coffin
- Medicine / Microbiology and Infectious Diseases Department, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nicola Coppola
- Mental Health and Public Medicine, University of Campania, Naples, Italy
| | - Antonio Craxi
- PROMISE, School of Medicine, University of Palermo, Palermo, Italy
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain; School of Medicine, University of Cantabria, Santander, Spain
| | - Victor De Ledinghen
- Service d'hepatologie et de Transplantation Hepatique, CHU, Bordeaux, France
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ohad Etzion
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beersheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel
| | | | - Paulo R A Ferreira
- Division of Infectious Disease, Federal University of Sāo Paulo, Sāo Paulo, Brazil
| | - Xavier Forns
- Liver Unit, Hospital Clínic. IDIBAPS and CIBEREHD. University of Barcelona., Barcelona, Spain
| | - Graham R Foster
- Blizard Institute, Barts Liver Centre, Queen Mary University London, London, United Kingdom
| | | | | | - Javier García-Samaniego
- Liver Unit, Hospital Universitario La Paz, CIBERehd/IdiPAZ. Universidad Autónoma de Madrid, Madrid, Spain
| | - Liliana S Gheorghe
- Department of Gastroenterology & Hepatology, Carol Davila University of Medicine & Pharmacy, Bucharest, Romania; Department of Gastroenterology & Hepatology, Fundeni Clinical Institute, Bucharest, Romania
| | - Pierre M Gholam
- Medicine, Case Western Reserve University School of Medicine, Cleveland, United States
| | | | - Jeffrey Glenn
- Medicine and Microbiology & Immunology, Stanford University, Palo Alto, United States
| | - Julian Hercun
- Liver Unit, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Yao-Chun Hsu
- Department of Medical Research, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Ching-Chih Hu
- Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jee-Fu Huang
- Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China, Mainland
| | - Martin Kåberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kelly D E Kaita
- Internal Medicine, Section of Hepatology, University of Manitoba, Winnipeg, Canada
| | - Habiba Kamal
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Jia-Horng Kao
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Loreta A Kondili
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Martin Lagging
- Department of Infectious Diseases / Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Pablo Lázaro
- Independent Health Services Researcher, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Young-Suk Lim
- Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Paul J Marotta
- Department of Medicine, Western University, London, Canada
| | - Maria-Cristina Navas
- Grupo de Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Mauricio Orrego
- Gastroenterología y Hepatología, Clínica Las Americas AUNA, Medellín, Colombia; Hepatology Department, Clinica Las Vegas Quiron, Medellin, Colombia
| | - Carla Osiowy
- Viral Hepatitis and Bloodborne Pathogens Department, National Microbiology Lab, Public Health Agency of Canada, Winnipeg, Canada
| | - Calvin Q Pan
- Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, NYU Grossman School of Medicine, New York, United States
| | - Mário G Pessoa
- Division of Gastroenterology and Hepatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Giovanni Raimondo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alnoor Ramji
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Cielo Y Ríos-Hincapié
- Dirección de Promoción y Prevención, Ministerio de Salud y Protección Social, Bogotá, Colombia
| | - Manuel Rodríguez
- Liver Unit. Division of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - William M C Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, UCL, London, United Kingdom
| | - Dominique M Roulot
- APHP, Hopital Avicenne, Unité d'Hépatologie, Université Sorbonne Paris Nord, Bobigny, France
| | - Stephen D Ryder
- Hepatology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rifaat Safadi
- The Liver Institute, Hadassah Medical Organization, Jerusalem, Israel
| | - Faisal M Sanai
- Gastroenterology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Teresa A Santantonio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Christoph Sarrazin
- Medizinische Klinik 2, St. Josefs-Hospital, Wiesbaden, Germany; Medizinische Klinik 1, Goethe-University, Frankfurt Am Main, Germany
| | - Daniel Shouval
- The Liver Institute, Hadassah Medical Organization, Jerusalem, Israel
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tammo L Tergast
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Alexis S Voeller
- Center for Disease Analysis Foundation, Lafayette, United States
| | - Hwai-I Yang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan
| | - Ming-Lung Yu
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan; Hepatobiliary Section, Department of Internal Medicine, and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Eli Zuckerman
- Liver Unit, Carmel Medical Center, Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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15
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Glynn M, Cohen C, Gish RG, Andrews R, Trang A, Zovich B, Hall W, Clary R, Joseph B, Scott L, Scott R, Jackson T, Ntiri-Reid B, Southworth A, Dieterich D, Sepe T. Advancing research, awareness, screening, and linkage to care to eliminate HDV in the U.S. Hepatol Commun 2023; 7:e00168. [PMID: 37347227 DOI: 10.1097/hc9.0000000000000168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/30/2023] [Indexed: 06/23/2023] Open
Abstract
HDV, which coinfects individuals living with HBV, is the most aggressive form of viral hepatitis. Compared with hepatitis B monoinfection, hepatitis delta is associated with more rapid progression to cirrhosis and an increased risk of liver cancer and death. Despite being a major contributor to hepatitis B-associated liver disease, hepatitis delta remains largely unknown to the general public, health care providers, and at-risk communities. Given the widespread lack of awareness and underdiagnosis of hepatitis delta in the US, the American Liver Foundation (ALF) and the Hepatitis B Foundation (HBF) convened a virtual Hepatitis Delta Roundtable Meeting on April 21 and 22, 2022. The Roundtable Panel included persons living with hepatitis delta, caregivers, liver disease specialists, primary care providers, state and federal public health professionals, and community-based organizations. The Panel identified several major challenges surrounding hepatitis delta, including a lack of awareness of hepatitis delta among the public and health care providers; complex risk-based testing protocols; a lack of accurate prevalence data; limited data on linkage to care; and inadequate communications among stakeholders. Potential strategies to address these challenges include improving and expanding education for different audiences; advocating for simplified protocols for hepatitis B screening with hepatitis delta reflex testing; expanding surveillance for hepatitis delta; requiring automated reporting and national notification; improving data sharing for research; and enhancing communications around hepatitis delta. The recent CDC recommendations for universal adult screening and vaccination against hepatitis B and the anticipated availability of new therapies for hepatitis delta present a unique opportunity to focus attention on this dangerous virus. The Roundtable Panel calls for urgent action to make significant progress in addressing hepatitis delta among individuals living with hepatitis B.
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Affiliation(s)
- Megan Glynn
- American Liver Foundation, Programs, Toledo, Ohio
| | | | | | | | - Amy Trang
- Hepatitis B Initiative of Washington DC, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | - Thomas Sepe
- Clinical Professor of Medicine, University Gastroenterology
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16
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Wong RJ, Kaufman HW, Niles JK, Kapoor H, Gish RG. Simplifying Treatment Criteria in Chronic Hepatitis B: Reducing Barriers to Elimination. Clin Infect Dis 2023; 76:e791-e800. [PMID: 35594550 DOI: 10.1093/cid/ciac385] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early, sustained hepatitis B virus (HBV) DNA suppression reduces long-term risks of hepatocellular carcinoma. Chronic hepatitis B (CHB) treatment criteria are complex. Simplifying criteria will improve timely linkage to therapy. We evaluated treatment eligibility patterns among US patients with CHB and propose stepwise simplification of CHB treatment criteria. METHODS Using 2016-2020 Quest Diagnostics data, we evaluated treatment eligibility among patients with CHB (2 positive HBV tests [HBV surface antigen, HBV e antigen, or HBV DNA] ≥6 months apart) using American Association for the Study of Liver Disease (AASLD), European Association for Study of the Liver (EASL), Asian Pacific Association for Study of the Liver (APASL), and Asian American Treatment Algorithm (AATA) criteria. RESULTS Among 84 916 patients with CHB, 6.7%, 6.2%, 5.8%, and 16.4% met AASLD, EASL, APASL, and AATA criteria, respectively. Among treatment-ineligible patients with CHB, proportion with significant fibrosis (aspartate aminotransferase platelet ratio index >0.5) were 10.4%, 10.4%, 10.8%, and 7.7% based on AASLD, EASL, APASL, and AATA, respectively. In the proposed treatment simplification, the proportion of patients with CHB eligible for therapy increased from 10.3% for step 1 (HBV DNA >20 000 IU/mL, elevated alanine aminotransferase [ALT] level) to 14.1% for step 2 (HBV >2000 IU/mL, elevated ALT level), 33.5% for step 3 (HBV DNA >2000 IU/mL, any ALT level), and 87.2% for step 4 (detectable HBV DNA, any ALT level). CONCLUSIONS A large proportion of patients with CHB not meeting established treatment criteria have significant fibrosis. Simplifying criteria to treat all patients with detectable HBV DNA will reduce complexity and heterogeneity in assessing treatment eligibility, improving treatment rates and progress toward HBV elimination.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | | | - Hema Kapoor
- Quest Diagnostics, Secaucus, New Jersey, USA
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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Abstract
Hepatitis B virus (HBV) and hepatitis D virus are leading causes of morbidity and mortality worldwide. Despite the availability of HBV vaccinations that are 98% to 100% effective, an estimated 820,000 annual deaths were attributed to HBV in 2019, mainly related to the sequelae of cirrhosis and hepatocellular carcinoma. Because disease prevalence is concentrated outside of the United States, it is overlooked, but with expanded vaccination recommendations provided by the Centers for Disease Control and Prevention and recommended screening, as well as heightened awareness by health care providers, we can work toward the eradication of this preventable disease.
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Affiliation(s)
- Ann Robinson
- California Pacific Medical Center, 1101 Van Ness Avenue, San Francisco, CA 94109, USA
| | - Robert Wong
- Gastroenterology and Hepatology, Stanford University, 3801 Miranda Avenue, GI-111, Palo Alto, CA 94304, USA
| | - Robert G Gish
- University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences; University of Nevada, Reno School of Medicine.
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18
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Lam D, Wong RJ, Tessier A, Zapata Y, Saldana E, Gish RG. Barriers to Hepatitis C Virus Care and How Federally Qualified Health Centers Can Improve Patient Access to Treatment. Gastroenterology Res 2022; 15:343-352. [PMID: 36660471 PMCID: PMC9822664 DOI: 10.14740/gr1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Background Despite the availability of direct-acting antiviral agents (DAAs) for hepatitis C virus (HCV) treatment, disparities in HCV care and treatment persist for underserved populations due to demographic-based and insurance-based barriers. We aim to examine the effect of barriers on HCV treatment access for a federally qualified health center (FQHC) population. Methods We retrospectively evaluated medical records of adults diagnosed with chronic HCV at an FQHC clinic from 2016 to 2020 with follow-up through 2021. Univariate and bivariate analyses were used to describe the patient population and significant associations between predictors of linkage to HCV care and treatment access. Adjusted multivariate logistic regression analyses were used to identify predictors of starting HCV treatment. Results Of 279 total patients with chronic HCV, 162 patients started treatment (58%), 138 patients (50%) completed treatment, and 99 patients (35%) achieved sustained virological response (SVR). Of the total patients, 145 (52%) were seen by their primary care physician (PCP) for their HCV care and treatment, and 134 (48%) were seen by a provider that specializes in management and treatment of HCV (HCV provider). Patients seen by an HCV provider in addition to their PCP were more likely to have had their prior authorization requests for HCV treatment denied by their insurance providers than patients seen only by their PCP for HCV care (30% vs. 14%, P = 0.001). We believe that this discrepancy stems from two issues. One, prior authorizations are reviewed by insurance providers who are not specially trained in HCV management, so the verbiage used perplexes these reviewers, possibly causing them to issue denials. Two, insurance providers often require HCV genotype testing for DAA medication eligibility, and HCV providers order genotype tests for patients only when HCV treatments have failed to cure patients, so this requirement becomes another barrier to DAA medications. Patients who spoke a non-English language, lived in the USA for less than 10 years, and showed inability to pay for treatment had received treatment despite these characteristics being common barriers to HCV treatment. On multivariate regression, factors independently associated with patients starting treatment included prior denial for DAA medication (odds ratio (OR), 8.88; 95% confidence interval (CI), 3.22 - 24.6; P < 0.001) and being seen by an HCV provider (OR, 24.8; 95% CI, 11.7 - 52.5; P < 0.001). However, the most significant barrier to HCV treatment access for the FQHC population was eligibility restrictions from insurance providers. Conclusions Demographic-based barriers (e.g., age, race, and income) often impede HCV care and treatment, but insurance-based barriers are the greatest challenge currently that affects treatment outcomes in our study population. Removing these restrictions would, in our opinion, help to increase treatment levels to underserved populations.
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Affiliation(s)
- David Lam
- Family Practice Department, La Maestra Community Health Centers, San Diego, CA, USA
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine and Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Adla Tessier
- Family Practice Department, La Maestra Community Health Centers, San Diego, CA, USA
| | - Yenice Zapata
- Family Practice Department, La Maestra Community Health Centers, San Diego, CA, USA
| | - Elsie Saldana
- Family Practice Department, La Maestra Community Health Centers, San Diego, CA, USA
| | - Robert G. Gish
- Family Practice Department, La Maestra Community Health Centers, San Diego, CA, USA,Robert G. Gish Consultants, LLC, San Diego, CA, USA,La Maestra Community Health Centers, San Diego, CA, USA,Corresponding Author: Robert G. Gish, Robert G. Gish Consultants, LLC, San Diego, CA 92037, USA.
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19
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Yuen MF, Locarnini S, Lim TH, Strasser SI, Sievert W, Cheng W, Thompson AJ, Given BD, Schluep T, Hamilton J, Biermer M, Kalmeijer R, Beumont M, Lenz O, De Ridder F, Cloherty G, Ka-Ho Wong D, Schwabe C, Jackson K, Lai CL, Gish RG, Gane E. Combination treatments including the small-interfering RNA JNJ-3989 induce rapid and sometimes prolonged viral responses in patients with CHB. J Hepatol 2022; 77:1287-1298. [PMID: 35870702 DOI: 10.1016/j.jhep.2022.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS RNA interference therapy has been shown to reduce hepatitis B surface antigen (HBsAg) levels in preclinical models, which could confer functional cure in patients with chronic hepatitis B. This phase IIa trial (ClinicalTrials.gov Identifier: NCT03365947) assessed the safety and efficacy of the small-interfering RNA JNJ-73763989 (JNJ-3989) plus a nucleos(t)ide analogue (NA), with/without the capsid assembly modulator JNJ-56136379 (JNJ-6379) in patients with chronic hepatitis B. METHODS Treatment-naïve and NA-suppressed patients received 3 subcutaneous JNJ-3989 doses every week (QW; 100, 200, or 300 mg), 2 weeks (Q2W; 100 mg) or 4 weeks (Q4W; 25, 50, 100, 200, 300, or 400 mg), or JNJ-3989 Q4W (200 mg) plus oral JNJ-6379 250 mg daily for 12 weeks. Patients received NAs throughout. RESULTS Eighty-four patients were recruited. All treatments were well tolerated, with all 5 serious adverse events considered unrelated to study drugs. JNJ-3989 100 to 400 mg Q4W resulted in HBsAg reductions ≥1 log10 IU/ml from baseline in 39/40 (97.5%) patients at the nadir. All patients receiving the triple combination (n = 12) had HBsAg reductions ≥1 log10 IU/ml from baseline at the nadir. HBsAg reductions were similar for HBeAg-positive (n = 21) and HBeAg-negative (n = 47) patients in all JNJ-3989 Q4W treatment arms, including the triple combination (n = 68). Smaller HBsAg reductions were seen with 25 mg (n = 8) and 50 mg (n = 8) than with 100 to 400 mg (n = 40). Shorter dosing intervals (QW [n = 12] and Q2W [n = 4]) did not improve response vs. Q4W dosing. HBsAg reductions ≥1 log10 IU/ml from baseline persisted in 38% of patients 336 days after the last JNJ-3989 dose. CONCLUSIONS JNJ-3989 plus an NA, with/without JNJ-6379, was well tolerated and resulted in HBsAg reductions up to 336 days after the last JNJ-3989 Q4W dose. CLINICAL TRIAL NUMBER NCT03365947. LAY SUMMARY Hepatitis B virus affects people's livers and produces particles called hepatitis B surface antigen (HBsAg) that damage a person's liver and can help the virus infect a person for a long time, known as chronic hepatitis B (CHB). In this study, a new treatment called JNJ-3989 was assessed (in combination with normal treatment known as nucleos(t)ide analogues), for its safety and effectiveness in reducing the number of HBsAg particles in people with CHB. The results of this study showed that treatment with JNJ-3989 could be safe for people with CHB, lowered their HBsAg levels, and kept HBsAg levels lowered for 336 days in 38% of patients after receiving their last dose of JNJ-3989.
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Affiliation(s)
- Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory, Victoria, Australia
| | - Tien Huey Lim
- Department of Gastroenterology, Middlemore Hospital, Auckland, New Zealand
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - William Sievert
- Department of Gastroenterology, Monash Health and Monash University, Melbourne, Australia
| | - Wendy Cheng
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia; Linear Clinical Research, Perth, Australia
| | - Alex J Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | | | | | | | | | | | | | | | | | | | - Danny Ka-Ho Wong
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Victoria, Australia
| | - Ching Lung Lai
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Edward Gane
- Auckland Clinical Studies, Auckland, New Zealand
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20
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Pham TN, Le DH, Dao DV, Phan LT, Pham TT, Nguyen TB, Mize GW, Gish RG, Lee WM, Trang A, Le AN, Chen M, Phan HT, Nguyen BT, Tang HK, Dao DY. Establishing baseline framework for hepatitis B virus micro-elimination in Ho Chi Minh City, Vietnam – A community-based seroprevalence study. The Lancet Regional Health - Western Pacific 2022; 30:100620. [DOI: 10.1016/j.lanwpc.2022.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/21/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022]
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21
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Kim TV, Le DH, Dao DV, Pham TND, Mize GW, Phan LT, Nguyen DX, Ngo TTD, Gish RG, Lee WM, Trang A, Le AN, Chen M, Phan HT, Nguyen BT, Tang HK, Dao DY. Demonstration of a population-based HCV serosurvey in Ho Chi Minh City, Viet Nam: Establishing baseline prevalence of and continuum of care for HCV micro-elimination by 2030. Lancet Reg Health West Pac 2022; 27:100524. [PMID: 35846980 PMCID: PMC9283666 DOI: 10.1016/j.lanwpc.2022.100524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND A baseline of hepatitis C virus (HCV) burden and other HCV epidemiological profiles is necessary for HCV micro-elimination in Ho Chi Minh City (HCMC), Viet Nam. This study aimed to determine HCV exposure and prevalence of HCV viremia as well as the proportion of HCV testing and treatment uptake among participants. METHODS From 2019 to 2020, the probability proportionate to size sampling method was deployed to representatively invite approximately 20,000 adults (18 or older) throughout HCMC to free screening and linkage to care for HCV. FINDINGS In HCMC, the weighted prevalence of anti-HCV was 1·3% (95% CI, 1·1%-1·6%). Individuals born from 1945 to 1964 had the anti-HCV prevalence of 3·6% (95% CI, 3·0%-4·2%) and represented 40·4% of all HCV cases. There were wide variations in anti-HCV prevalence in HCMC, including variations between districts, risk factors, and socioeconomic statuses. A baseline HCV continuum of care for the city demonstrated that only 28·5% (85/298, 95%CI 23·4-33·7%) of persons with anti-HCV (+) were aware of their HCV status, with 77.6% (66/85, 95%CI 68·8-86·5%) diagnosing HCV incidentally, 82·7% (62/75, 95%CI 74·1-91·2%) initiating anti-HCV therapy, and 53.6% (30/56, 95%CI 40·5-66·6%) achieving HCV cures. INTERPRETATION There remains a considerable disease burden of HCV in HCMC of which a significant proportion was in the age group born between 1945 to 1964. Additionally, there were significant gaps in HCV awareness, screening, and access to care in the community in Viet Nam. Thus, future interventions must have pragmatic targets, be tailored to the local needs, and emphasise screening. FUNDING This work was supported by investigator-sponsored research grants from Gilead Sciences Inc. (Grant No: IN-US-987-5382); Roche Diagnostic International Ltd. (Grant No. SUB-000196); and in-kind donations from Abbott Diagnostic Viet Nam; Hepatitis B Foundation; Medic Medical Center, Viet Nam; Johns Hopkins University School of Medicine's Center of Excellence for Liver Disease in Viet Nam; and the Board of Directors, Viet Nam Viral Hepatitis Alliance (V-VHA).
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Affiliation(s)
- Thanh V. Kim
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Duc H. Le
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | | | - Trang Ngoc Doan Pham
- Vietnam Viral Hepatitis Alliance, Reston, VA, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Gary W. Mize
- Vietnam Viral Hepatitis Alliance, Reston, VA, USA
| | | | - Dan X. Nguyen
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | | | | | - William M. Lee
- Vietnam Viral Hepatitis Alliance, Reston, VA, USA
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Amy Trang
- Vietnam Viral Hepatitis Alliance, Reston, VA, USA
| | - Anh N. Le
- Vietnam Viral Hepatitis Alliance, Reston, VA, USA
| | - Moon Chen
- University of California at Davis, Davis, CA, USA
| | - Hai T. Phan
- Medic Medical Center, Ho Chi Minh City, Viet Nam
| | - Binh T. Nguyen
- Ho Chi Minh City Department of Health, Ho Chi Minh City, Viet Nam
| | - Hong K. Tang
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | - Doan Y Dao
- Vietnam Viral Hepatitis Alliance, Reston, VA, USA
- Center of Excellence for Liver Disease in Viet Nam, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Veracruz N, Gish RG, Cheung R, Chitnis AS, Wong RJ. Global trends and the impact of chronic hepatitis B and C on disability-adjusted life years. Liver Int 2022; 42:2145-2153. [PMID: 35753064 DOI: 10.1111/liv.15347] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/12/2022] [Accepted: 06/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Advances in hepatitis B virus (HBV) and hepatitis C virus (HCV) therapies have improved morbidity and mortality, but global disparities in viral hepatitis outcomes remain. We evaluate global trends in the impact of HBV and HCV on disability-adjusted life years (DALYs). METHODS Using data from the 2010-2019 Global Burden of Diseases Study (GBD), overall all-cause DALYs for patients with acute HBV or HCV, HBV- or HCV-related cirrhosis, and HBV- or HCV-related hepatocellular carcinoma (HCC) was calculated as the sum of years of life lost because of premature death and years lived with disability. DALYs were presented as age-standardized rates per 100 000 population stratified by age and sex. RESULTS From 2010 to 2019, the overall global impact of HBV on DALYs per 100 000 decreased from 27.6 to 20.9 for acute HBV and 168.6 to 129.8 for HBV-related cirrhosis but remained stable for HBV-related HCC. The impact of HCV on DALYs per 100 000 decreased from 5.23 to 3.3 for acute HCV, 159.2 to 146.2 for HCV-related cirrhosis, and 37.5 to 34.9 for HCV-related HCC. We observed significant differences in the impact of HBV and HCV on DALYs when stratified by world regions. CONCLUSION Decreases in HBV and HCV DALYs from 2010 to 2019 were observed. Disparities in DALY improvements across world regions suggest unequal access to viral hepatitis care and treatment. Achieving goals of viral hepatitis elimination will require enhanced prevention efforts and funding for high-burden regions and regions that have not had substantial reductions in DALYs because of HBV and HCV.
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Affiliation(s)
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Amit S Chitnis
- Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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23
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Lin N, Lin Y, Xu J, Liu D, Li D, Meng H, Gallant MA, Kubota N, Roy D, Li JS, Gorospe EC, Sherman M, Gish RG, Abou-Alfa GK, Nguyen MH, Taggart DJ, Van Etten RA, Hoshida Y, Li W. A multi-analyte cell-free DNA-based blood test for early detection of hepatocellular carcinoma. Hepatol Commun 2022; 6:1753-1763. [PMID: 35244350 PMCID: PMC9234637 DOI: 10.1002/hep4.1918] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022] Open
Abstract
The limited performance of guideline-recommended abdominal ultrasound and serum alpha-fetoprotein (AFP) highlights the urgent, unmet need for new biomarkers for more accurate detection of early hepatocellular carcinoma (HCC). To this end, we have conducted a prospective clinical validation study to evaluate the performance of the HelioLiver Test, a multi-analyte blood test combining cell-free DNA methylation patterns, clinical variables, and protein tumor markers. A blinded, multicenter validation study was performed with 247 subjects, including 122 subjects with HCC and 125 control subjects with chronic liver disease. The performance of the HelioLiver Test was compared with AFP and the GALAD score as established HCC surveillance blood tests. The performance of the HelioLiver Test (area under the receiver operating characteristic curve [AUROC] = 0.944) was superior to both AFP (AUROC = 0.851; p < 0.0001) and GALAD (AUROC = 0.899; p < 0.0001). Using a prespecified diagnostic algorithm, the HelioLiver Test showed sensitivities of 85% (95% confidence interval [CI], 78%-90%) for HCC of any stage and 76% (95% CI, 60%-87%) for early stage (American Joint Committee on Cancer [AJCC] I and II) HCC. In contrast, AFP (≥20 ng/mL) alone and the GALAD score (≥-0.63) showed lower sensitivities of 62% (95% CI, 54%-70%) and 75% (95% CI, 67%-82%) for HCC overall, and 57% (95% CI, 40%-71%) and 65% (95% CI, 49%-79%) for early stage (AJCC I and II) HCC, respectively. The specificities of the HelioLiver Test (91%; 95% CI, 85%-95%), AFP (97%; 95% CI, 92%-99%), and the GALAD score (94%; 95% CI, 88%-97%) were similar for control subjects. The HelioLiver Test showed superior performance for HCC detection compared to with both AFP and the GALAD score and warrants further evaluation in HCC surveillance settings.
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Affiliation(s)
- Nan Lin
- The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | - Yongping Lin
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | | | - Dan Liu
- Laboratory for Advanced Medicine, Inc.BeijingChina
| | - Diange Li
- Guangzhou Youze Biological Pharmaceutical Technology Company LtdGuangzhouGuangdong ProvinceChina
| | - Hongyu Meng
- The Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
| | | | - Naoto Kubota
- Department of Internal MedicineSimmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Jason S Li
- Division of Computational BiomedicineDepartment of Biological ChemistrySchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
| | | | | | | | | | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology and Department of Epidemiology and Population HealthStanford University Medical CenterStanfordCaliforniaUSA
| | | | - Richard A Van Etten
- Department of MedicineChao Family Comprehensive Cancer CenterUniversity of CaliforniaIrvineCaliforniaUSA
| | - Yujin Hoshida
- Department of Internal MedicineSimmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Wei Li
- Division of Computational BiomedicineDepartment of Biological ChemistrySchool of MedicineUniversity of CaliforniaIrvineCaliforniaUSA
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24
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Kivlighn S, Schuur E, Gish RG, Cryer D. Letter to the editor: Beneath the surface of the pandemic: Persons with alcohol-associated liver disease need our attention. Hepatology 2022; 76:E7-E8. [PMID: 35202492 DOI: 10.1002/hep.32422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 12/08/2022]
Affiliation(s)
| | | | - Robert G Gish
- Robert G. Gish Consultants, LLC, San Diego, California, USA
| | - Donna Cryer
- Global Liver Institute, Washington, District of Columbia, USA
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25
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Veracruz N, Gish RG, Cheung R, Chitnis AS, Wong RJ. Global incidence and mortality of hepatitis B and hepatitis C acute infections, cirrhosis and hepatocellular carcinoma from 2010 to 2019. J Viral Hepat 2022; 29:352-365. [PMID: 35274406 DOI: 10.1111/jvh.13663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/15/2022] [Indexed: 12/21/2022]
Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) contribute to significant healthcare burden globally. We aim to provide an updated and comprehensive analysis of global trends in the incidence and mortality of HBV and HCV related acute infections, cirrhosis and hepatocellular carcinoma (HCC). Estimates of annual cause-specific disease incidence and mortality for HBV and HCV were analysed using the 2010-2019 Global Burden of Diseases, Injuries and Risk Factors Study database. Three distinct disease states were evaluated: acute infections, cirrhosis and HCC. Age-standardized disease incidence and mortality were presented per 100,000 population and stratified by age, sex, year and 21 world regions. From 2010 to 2019, overall incidence of acute HBV declined by 19.3% (95% CI 4.1-32.0, p < .05) and HBV cirrhosis declined by 15.0% (95% CI 9.8-20.7, p < .05). Incidence of HCV cirrhosis increased by 5.6% (95% CI 0.3-10.2, p < .05) and HCV HCC remained stable. Incidence of acute HCV declined until 2015, after which it began increasing. From 2010 to 2019, overall mortality for HBV cirrhosis and HCV cirrhosis declined, whereas mortality for acute infections and HCC remained stable. Major differences in HBV and HCV incidence and mortality trends were observed when stratified by world regions. In conclusion, while our analyses of global trends in HBV and HCV incidence and mortality demonstrate encouraging trends, disparities in disease epidemiology were observed across world regions. These observations will identify regions and populations where greater focus and resources are needed to continue progressing towards viral hepatitis elimination.
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Affiliation(s)
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Amit S Chitnis
- Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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26
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Méndez-Sánchez N, Bugianesi E, Gish RG, Lammert F, Tilg H, Nguyen MH, Sarin SK, Fabrellas N, Zelber-Sagi S, Fan JG, Shiha G, Targher G, Zheng MH, Chan WK, Vinker S, Kawaguchi T, Castera L, Yilmaz Y, Korenjak M, Spearman CW, Ungan M, Palmer M, El-Shabrawi M, Gruss HJ, Dufour JF, Dhawan A, Wedemeyer H, George J, Valenti L, Fouad Y, Romero-Gomez M, Eslam M. Global multi-stakeholder endorsement of the MAFLD definition. Lancet Gastroenterol Hepatol 2022; 7:388-390. [PMID: 35248211 DOI: 10.1016/s2468-1253(22)00062-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Nahum Méndez-Sánchez
- National Autonomous University of Mexico, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic Foundation, Mexico City, Mexico
| | - Elisabetta Bugianesi
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Robert G Gish
- Liver Transplant Clinic, Loma Linda University, Loma Linda, CA, USA
| | - Frank Lammert
- Department of Medicine II, Hannover Medical School, Hannover, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology and Hepatology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gamal Shiha
- European Liver Patients' Association, Brussels, Belgium; World Hepatitis Alliance, London, UK; African Liver Patient Association, Cairo, Egypt; Association of Liver Patients Care, Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Egyptian Liver Research Institute and Hospital, Sherbin, Egypt
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shlomo Vinker
- World Organization of Family Doctors Europe, Ljublijana, Slovenia; European General Practice Research Network, Maastricht, Netherlands; Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Association of Family Physicians, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine and Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
| | - Marko Korenjak
- European Liver Patients' Association, Brussels, Belgium; Association SLOVENIA HEP, Maribor, Slovenia
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mehmet Ungan
- World Organization of Family Doctors Europe, Ljublijana, Slovenia; European General Practice Research Network, Maastricht, Netherlands; Department of Family Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Melissa Palmer
- Gannex-Ascletis Pharma, Beijing, China; Liver Consulting, New York, NY, USA
| | - Mortada El-Shabrawi
- Paediatric Hepatology Unit, Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt; The International Society of Tropical Paediatrics, Cairo, Egypt
| | | | - Jean-François Dufour
- Swiss NASH Foundation, Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, University of Milan, Milan, Italy
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt; The Egyptian MAFLD Research Group, Cairo, Egypt
| | - Manuel Romero-Gomez
- UCM Digestive Diseases, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla (HVR/CSIC/US), CIBER Hepatic and Digestive Diseases, University of Seville, Seville, Spain
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.
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Fouad Y, Palmer M, Chen M, Regev A, Banerjee R, Myers R, Riccio R, Torstenson R, Younes R, Arora PS, Landgren H, Karsdal MA, Blake M, Shapiro DA, Gruss HJ, Sheikh MY, Attia D, Bollipo S, Smith AD, Freilich B, Gish RG, Schuppan D. Redefinition of Fatty Liver Disease from NAFLD to MAFLD through the Lens of Drug Development and Regulatory Science. J Clin Transl Hepatol 2022; 10:374-382. [PMID: 35528969 PMCID: PMC9039717 DOI: 10.14218/jcth.2021.00408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
Metabolic (dysfunction)-associated fatty liver disease (MAFLD) affects a third of the population and is a leading cause of liver-related death. Since no effective treatments exist, novel approaches to drug development are required. Unfortunately, outdated terminology and definitions of the disease are hampering efforts to develop new drugs and treatments. An international consensus panel has put forth an influential proposal for the disease to be renamed from nonalcoholic fatty liver disease (NAFLD) to MAFLD, including a proposal for how the disease should be diagnosed. As allies with the many stakeholders in MAFLD care-including patients, patients' advocates, clinicians, researchers, nurse and allied health groups, regional societies, and others-we are aware of the negative consequences of the NAFLD term and definition. We share the sense of urgency for change and will act in new ways to achieve our goals. Although there is much work to be done to overcome clinical inertia and reverse worrisome recent trends, the MAFLD initiative provides a firm foundation to build on. It provides a roadmap for moving forward toward more efficient care and affordable, sustainable drug and device innovation in MAFLD care. We hope it will bring promising new opportunities for a brighter future for MAFLD care and improve care and outcomes for patients of one of the globe's largest and costliest public health burdens. From this viewpoint, we have revisited this initiative through the perspectives of drug development and regulatory science.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology, and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
- Correspondence to: Yasser Fouad, Endemic Medicine Department, Minia University, Main Road, Minia 11432, Egypt. Tel: +20-1091318555, Fax: +20-1-114721500, E-mail: ; Detlef Schuppan, Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. Tel: +49-6131-17-7356, Fax: +49-6131-177357, E-mail:
| | - Melissa Palmer
- Gannex/Ascletis Pharma Co Ltd, Beijing, China
- Liver Consulting LLC, New York, NY, USA
| | - Minjun Chen
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Arie Regev
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Rob Myers
- Gilead Sciences Inc, Foster City, CA, USA
| | | | | | - Ramy Younes
- Boehringer Ingelheim International, GmbH, Ingelheim, Germany
| | | | | | | | | | | | | | | | - Dina Attia
- Gastroenterology and Hepatology Department, Beni-Suef University, Beni Suef, Egypt
| | - Steven Bollipo
- Department of Gastroenterology and Endoscopy, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | | | | | - Robert G. Gish
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, CA, USA
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Correspondence to: Yasser Fouad, Endemic Medicine Department, Minia University, Main Road, Minia 11432, Egypt. Tel: +20-1091318555, Fax: +20-1-114721500, E-mail: ; Detlef Schuppan, Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. Tel: +49-6131-17-7356, Fax: +49-6131-177357, E-mail:
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28
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Cohen C, Moraras K, Jackson M, Kamischke M, Gish RG, Brosgart CL, Toy M, Hutton D, Block TM, Wang S, So S. Letter to the editor: Importance of universal screening for chronic hepatitis B infection in adults in the United States. Hepatology 2022; 75:1062-1063. [PMID: 34951931 DOI: 10.1002/hep.32304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Chari Cohen
- Hepatitis B FoundationDoylestownPennsylvaniaUSA
| | | | | | | | | | - Carol L Brosgart
- Department of Medicine, Epidemiology and BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Mehlika Toy
- Asian Liver CenterDepartment of SurgeryStanford University School of MedicinePalo AltoCaliforniaUSA
| | - David Hutton
- Department of Health Management and PolicyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Su Wang
- World Hepatitis AllianceLondonUK.,Saint Barnabas Medical CenterLivingstonNew JerseyUSA
| | - Samuel So
- Asian Liver CenterDepartment of SurgeryStanford University School of MedicinePalo AltoCaliforniaUSA
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29
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Yuen MF, Wong DKH, Schluep T, Lai CL, Ferrari C, Locarnini S, Lo RCL, Gish RG, Hamilton J, Wooddell CI, Mak LY, Given BD. Long-term serological, virological and histological responses to RNA inhibition by ARC-520 in Chinese chronic hepatitis B patients on entecavir treatment. Gut 2022; 71:789-797. [PMID: 33712437 DOI: 10.1136/gutjnl-2020-323445] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We examined the serological, virological (in serum and liver) and histological profiles in chronic hepatitis B virus (HBV) patients during and after completion of multiple dose (MD) ARC-520. DESIGN The present phase 1b study was a multidose, open-label extension cohort of patients that had received single dose ARC-520 in our previous study. Eight patients received 4-9 4 weekly doses of MD ARC-520 and entecavir. Liver biopsies were performed in six patients. Intrahepatic and serum HBV DNA, HBV RNA and viral antigens were measured. RESULTS All patients had 28.9-30.4 months of follow-up after the last MD. All three hepatitis B e antigen (HBeAg)-positive patients had profound reductions in hepatitis B surface antigen (HBsAg), HBeAg, hepatitis B core-related antigen and HBV RNA with two undergoing HBeAg seroconversion. One further achieved HBsAg seroconversion (anti-HBs level of 25.1 IU/L) and the remaining two had HBsAg reductions of -1.7 and -3.5 log IU/mL >30 months after MD. Among the five HBeAg-negative patients, four had modest HBsAg reduction >29 months after completion of MD and one achieved HBsAg seroconversion (anti-HBs level of 152.5 IU/L) and was negative for liver HBsAg staining. Entecavir was successfully stopped in this patient 12 months after HBsAg seroconversion. Temporally related alanine aminotransferase elevations preceded by HBsAg reductions were observed in three patients suggesting immune activation. HBcAg staining was negative in all six biopsied patients. Two patients with <10% HBsAg positive staining of hepatocytes had correspondingly low serum HBsAg levels of 1.5 and 11.5 IU/mL. CONCLUSIONS MD ARC-520 therapy achieved sustained and profound reductions of viral antigens and HBV RNA. HBsAg seroclearance was achievable. TRIAL REGISTRATION NUMBER NCT02065336.
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Affiliation(s)
- Man-Fung Yuen
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Danny Ka-Ho Wong
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Ching-Lung Lai
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Carlo Ferrari
- Unit of Infectious Diseases and Hepatology, University of Parma, Parma, Italy
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Victoria, Australia
| | - Regina Cheuk-Lam Lo
- The University of Hong Kong, Hong Kong, Hong Kong.,Department of Pathology, The University of Hong Kong, Hong Kong, China
| | | | | | | | - Lung Yi Mak
- Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Bruce D Given
- Arrowhead Pharmaceuticals, Pasadena, California, USA
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30
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Fouad Y, Dufour JF, Zheng MH, Bollipo S, Desalegn H, Grønbaek H, Gish RG. The NAFLD-MAFLD debate: Is there a Consensus-on-Consensus methodology? Liver Int 2022; 42:742-748. [PMID: 35182007 DOI: 10.1111/liv.15197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022]
Abstract
Polarizing opinions have recently arisen in hepatology on the name and redefinition of fatty liver disease associated with metabolic dysfunction. In spite of growing and robust evidence of the superior utility of the term metabolic (dysfunction) associated fatty liver disease (MAFLD) definition for clinical and academic practice, controversy abounds. It should therefore come, as no surprise that the most common arguments used in contrarian op-eds is that there are no consensus on any name change. In this context, we suggest that discourse on an accurate understanding of what scientific consensus means, the various methods of achieving consensus, as well as other alternative models for reaching agreement is pivotal for the field. In this opinion piece, we provide an overview of these aspects as it applies to the case of fatty liver disease. We provide evidence that consensus on a change from non-alcoholic fatty liver disease (NAFLD) to MAFLD has already been achieved. We believe that the time has come for redirecting stakeholder focus and energy on capitalizing on the momentum generated by the debate to improve the lives of people at its centre, our patients.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Jean-François Dufour
- Centre des Maladies Digestives, Lausanne, Switzerland.,Swiss NASH Foundation, Bern, Switzerland
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.,The Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | | | - Henning Grønbaek
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
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31
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Gish RG, Asselah T, Squires K, Mayers D. Active site polymerase inhibitor nucleotides (ASPINs): Potential agents for chronic HBV cure regimens. Antivir Chem Chemother 2022; 30:20402066221138705. [PMID: 36423233 PMCID: PMC9703507 DOI: 10.1177/20402066221138705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/06/2022] [Indexed: 10/03/2023] Open
Abstract
Chronic hepatitis B virus (HBV) infection affects 240 to 300 million people worldwide. In the nucleus of infected hepatocytes, the HBV genome is converted to covalently closed circular DNA (cccDNA), which persists and serves as a transcriptional template for viral progeny. Therefore, a long-term cure for chronic HBV infection will require elimination of cccDNA. Although currently available nucleos(t)ide analogues (eg, tenofovir disoproxil fumarate, tenofovir alafenamide, entecavir) effectively control HBV replication, they are seldom curative (functional cure rate ∼10%) and require lifelong treatment for most patients. As such, antiviral agents with novel mechanisms of action are needed. Active site polymerase inhibitor nucleotides (ASPINs) noncompetitively distort the HBV polymerase active site to completely inhibit all polymerase functions, unlike traditional chain-terminating nucleos(t)ide analogues, which only target select polymerase functions and are consumed in the process. Clevudine, a first-generation ASPIN, demonstrated potent and prolonged HBV suppression in phase 2 and 3 clinical studies, but long-term treatment was associated with reversible myopathy in a small number of patients. ATI-2173, a novel next-generation ASPIN, is structurally similar to clevudine but targets the liver and demonstrates potent anti-HBV activity on and off treatment, and may ultimately demonstrate an improved pharmacokinetic and safety profile by significantly reducing systemic clevudine exposure. Thus, ATI-2173 is currently in clinical development as an agent for HBV cure. Here, we review the mechanism of action and preclinical and clinical profiles of clevudine and ATI-2173 to support the role of ASPINs as part of curative regimens for chronic HBV infection.
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Affiliation(s)
- Robert G Gish
- Hepatitis B Foundation, Doylestown, PA, USA
- Robert G. Gish Consultants, LLC, La Jolla, CA, USA
| | - Tarik Asselah
- Université de Paris, Inserm U1149, Centre de Recherche sur l’inflammation, Paris, France
- Department of Hepatology, AP-HP, Hôpital Beaujon, Clichy, France
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32
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Manne V, Ryan J, Wong J, Vengayil G, Basit SA, Gish RG. Hepatitis C Vaccination: Where We Are and Where We Need to Be. Pathogens 2021; 10:pathogens10121619. [PMID: 34959574 PMCID: PMC8705661 DOI: 10.3390/pathogens10121619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
The hepatitis C virus (HCV) is a common cause of chronic liver disease and liver cancer worldwide. Despite advances in curative therapies for HCV, the incidence of new infections is not decreasing at the expected rate to hit the World Health Organization (WHO) target for the elimination of HCV by 2030. In fact, there are still more new cases of infection in the United States and worldwide than are being cured. The reasons for the rise in new cases include poor access to care and the opioid epidemic. The clinical burden of HCV requires a multimodal approach to eradicating the infection. Vaccination would be an excellent tool to prevent incidence of new infections; however, the genetic diversity of HCV and its ability to generate quasispecies within an infected host make creating a broadly reactive vaccine difficult. Multiple vaccine candidates have been identified, but to date, there has not been a target that has led to a broadly reactive vaccine, though several of the candidates are promising. Additionally, the virus is very difficult to culture and testing candidates in humans or chimpanzees is ethically challenging. Despite the multiple barriers to creating a vaccine, vaccination still represents an important tool in the fight against HCV.
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Affiliation(s)
- Vignan Manne
- HCA Healthcare Graduate Medical Education, Las Vegas, NV 89148, USA; (V.M.); (J.W.); (G.V.)
| | - John Ryan
- Comprehensive Digestive Institute of Nevada, Las Vegas, NV 89148, USA; (J.R.); (S.A.B.)
| | - Jonathan Wong
- HCA Healthcare Graduate Medical Education, Las Vegas, NV 89148, USA; (V.M.); (J.W.); (G.V.)
| | - Gayatri Vengayil
- HCA Healthcare Graduate Medical Education, Las Vegas, NV 89148, USA; (V.M.); (J.W.); (G.V.)
| | - Syed Abdul Basit
- Comprehensive Digestive Institute of Nevada, Las Vegas, NV 89148, USA; (J.R.); (S.A.B.)
| | - Robert G. Gish
- Liver Transplant Clinic, Loma Linda University, Loma Linda, CA 92350, USA
- Correspondence: ; Tel.: +1-866-873-8877
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33
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Wong RJ, Cheung R, Gish RG, Chitnis AS. Prevalence of hepatitis E infection among adults with concurrent chronic liver disease. J Viral Hepat 2021; 28:1643-1655. [PMID: 34415657 DOI: 10.1111/jvh.13597] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/17/2023]
Abstract
While hepatitis E virus (HEV) infection can increase the risk of liver decompensation and death in patients with underlying chronic liver disease (CLD), prevalence of HEV in this cohort is not well reported. Using data from the 2011-2018 National Health and Nutrition Examination Survey, we aim to evaluate seroprevalence of HEV IgG among adults with non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), chronic hepatitis C virus (HCV) and chronic hepatitis B virus (HBV). HEV IgG seroprevalence between groups was evaluated with chi-square testing, and adjusted multivariate logistic regression models evaluated for predictors of seropositivity for HEV IgG. Seroprevalence of HEV IgG was 6.58% in ALD, 8.66% in HCV, 8.81% in NAFLD and 19.86% in HBV. We observed increasing HEV IgG seroprevalence over time in our study period, and in 2015-2018, seroprevalence was highest among the individuals with HCV (10.00%) and HBV (30.30%). Older age and being born outside of the United States were associated with seropositivity for HEV IgG in ALD, NAFLD, HBV, and for HCV, older age and being at or below poverty level were associated with seroprevalence for HEV IgG. In conclusion, we observed a relatively high prevalence of HEV among adults with CLD. These data highlight the need for greater awareness and education about the role of HEV in patients with underlying CLD, improving HEV test diagnostics, and revisiting the discussion about the potential role of HEV vaccines in CLD patients who are at higher risk of decompensation and death from acute HEV infection.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.,Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Amit S Chitnis
- Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California, USA
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34
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George J, Gish RG, Geier A. MAFLD and Cardiovascular Events: What Does the Evidence Show? Clin Gastroenterol Hepatol 2021; 19:2025-2028. [PMID: 33610759 DOI: 10.1016/j.cgh.2021.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California
| | - Andreas Geier
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
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35
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Wong RJ, Brosgart CL, Welch S, Block T, Chen M, Cohen C, Kim WR, Kowdley KV, Lok AS, Tsai N, Ward J, Wong SS, Gish RG. An Updated Assessment of Chronic Hepatitis B Prevalence Among Foreign-Born Persons Living in the United States. Hepatology 2021; 74:607-626. [PMID: 33655536 PMCID: PMC8453838 DOI: 10.1002/hep.31782] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Although prevalence of chronic hepatitis B (CHB) in the USA includes 0.42 million (range, 0.28-0.67) U.S.-born persons, foreign-born (FB) persons contribute a substantially larger number to the burden of CHB in the USA. Over the past decade, patterns of U.S. immigration have changed and many countries have implemented HBV prevention programs. This study aims to estimate the number of FB persons with CHB in the USA by country of origin, updating our 2011 study. APPROACH AND RESULTS We performed systematic searches for articles published in 2009-2019 reporting HBsAg seroprevalence in emigrants and in-country populations of 117 countries. Data meeting inclusion criteria were combined with data from our 2011 study to calculate pooled prevalence estimates for 99 countries using meta-analyses (total 2,800 surveys involving 112 million subjects). Combining country-specific CHB rate estimates with the number of FB in the USA in 2018, by country of origin from the U.S. Census Bureau, we estimate that the number of FB with CHB in the USA in 2018 was 1.47 million (95% CI, 1.21-1.73), substantially higher than previously reported. The weighted average CHB prevalence for all FB in the USA in 2018 was 3.07%. Approximately 59% of FB with CHB in the USA in 2018 emigrated from Asia, 19% from the Americas, and 15% from Africa. Subgroup analyses found that for many countries, CHB rates are higher in males than females and have declined over the past three decades, but no consistent pattern is observed between emigrant and in-country rates. CONCLUSIONS Including FB and U.S.-born persons, the total prevalence of CHB in the USA may be as high as 2.4 million.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA.,Division of Gastroenterology and HepatologyVeterans Affairs Palo Alto Healthcare SystemPalo AltoCA
| | - Carol L Brosgart
- Department of Medicine, Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCA
| | | | - Tim Block
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | | | - Chari Cohen
- Hepatitis B FoundationDoylestownPA.,Baruch S Blumberg InstituteDoylestownPA
| | - W Ray Kim
- Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordCA
| | | | - Anna S Lok
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMI
| | | | - John Ward
- Coalition for Global Hepatitis EliminationTask Force for Global HealthDecaturGA
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36
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Zakalashvili M, Zarkua J, Gish RG, Zhamutashvili M, Sartania V, Weizenegger M, Bartel J, Raabe M, Gvinjilia L, Metreveli S, Barnova M, Abramishvili N, Rtskhiladze I, Metreveli D. Assessment of treatment options for patients with hepatitis C virus recombinant form 2k/1b. Hepatol Res 2021; 51:156-165. [PMID: 33207029 DOI: 10.1111/hepr.13587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022]
Abstract
AIM Hepatitis C virus (HCV) intergenotype recombinant form (RF) 2k/1b has been actively circulating in HCV-infected patients, and the prevalence of this RF virus in the Republic of Georgia is one of the highest reported worldwide. The aim of this study was to define the optimal treatment regimen for patients with RF_2k/1b. METHODS We analyzed the data of 2735 patients who started treatment at the Medical Center Mrcheveli within Georgia's hepatitis C elimination program from May 2015 through December 2019. The patients were treated with sofosbuvir (SOF)-based regimens. For identification of RF_2k/1b variants, refinement of standard (INNO-LiPA) genotyping results for all patient samples assigned the unspecific HCV genotypes (GT) 2a/2c was carried out by sequencing of core and non-structural protein 5B genes. RESULTS Overall, 444 patients, representing 66% of GT2 and 16% of the total samples, were RF_2k/1b. Treatment of patients with RF_2k/1b with SOF/ledipasvir and SOF/velpatasvir was highly effective and viral cure rates did not differ among genotypes treated with the same regimen: RF_2k/1b, 99% (343/346); GT1, 99% (876/885); GT2, 96% (156/162); and GT3, 99% (545/552). A separate comparison analysis of sustained virologic response rate, treated with SOF plus ribavirin, showed significantly higher sustained virologic response (96%) in patients with confirmed GT2 (by sequencing) compared to unspecified GT2 (by INNO-LiPA) (79%) (P < 0.05). CONCLUSION Sofosbuvir-based regimens are highly effective for treatment of RF 2k/1b patients, and with availability of new pan-genotypic direct-acting antivirals, genotyping to identify RF 2k/1b patients might not be necessary.
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Affiliation(s)
- Mamuka Zakalashvili
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Jaba Zarkua
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Maia Zhamutashvili
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Vakhtang Sartania
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | | | - Jan Bartel
- Medical Service Center Dr. Limbach & colleagues, Heidelberg, Germany
| | - Monika Raabe
- Medical Service Center Dr. Limbach & colleagues, Heidelberg, Germany
| | - Lia Gvinjilia
- TEPHINET independent contractor for Georgia Hepatitis C Elimination Program, Atlanta, Georgia, USA
| | - Sophia Metreveli
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Maka Barnova
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Nikoloz Abramishvili
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Irakli Rtskhiladze
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - David Metreveli
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
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Gish RG, Stravitz RT. Correction of Coagulopathy of Liver Disease Prior to Procedures. Gastroenterol Hepatol (N Y) 2021; 17:16-23. [PMID: 34135700 PMCID: PMC8191819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Gish RG, Brothers JM. Current Observations in the Management of Hypo- and Hypercoagulability in Patients With Acute or Chronic Liver Failure. Gastroenterol Hepatol (N Y) 2021; 17:23-26. [PMID: 34135701 PMCID: PMC8191818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Gish RG, Flamm SL. Anticoagulation in Patients With Chronic Liver Disease. Gastroenterol Hepatol (N Y) 2021; 17:10-15. [PMID: 34135699 PMCID: PMC8191816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Gish RG, Regenstein FG. Background and Evaluation of Hypercoagulability. Gastroenterol Hepatol (N Y) 2021; 17:3-10. [PMID: 34135698 PMCID: PMC8191817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Gish RG, Elmofti Y. Editorial: tenofovir alafenamide fumarate-a new silver bullet to prevent mother-to-child transmission of hepatitis B virus. Aliment Pharmacol Ther 2020; 52:1744-1745. [PMID: 33205879 DOI: 10.1111/apt.16090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Robert G Gish
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, CA, USA.,Department of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Yousif Elmofti
- Department of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
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Gish RG. We Are All Africans: A Highly Personal Migratory View of the History of Hepatitis B. Clin Liver Dis (Hoboken) 2020; 16:24-33. [PMID: 33042524 PMCID: PMC7538925 DOI: 10.1002/cld.989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023] Open
Abstract
Watch an interview with the author.
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Affiliation(s)
- Robert G. Gish
- Robert G. Gish Consultants LLCLa JollaCA
- Medical Director, Hepatitis B FoundationDoylestownPA
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Castellanos Fernández MI, Cepeda Mullo ME, la Rosa Hernández D, Vega Sánchez H, González Fabian L, Gish RG, Torres González AL, Dorta Guridi Z. Autoimmune Hepatitis in Cuban Patients: A Retrospective Analysis of Clinical and Histological Profiles, Treatments, and Outcomes. Curr Ther Res Clin Exp 2020; 93:100594. [PMID: 32922567 PMCID: PMC7476064 DOI: 10.1016/j.curtheres.2020.100594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/03/2020] [Indexed: 10/26/2022]
Abstract
BACKGROUND Population-based studies on the clinical course and prognosis of autoimmune hepatitis (AIH) from Caribbean countries are limited. OBJECTIVE The aim of this study was to provide information regarding the clinical and laboratory findings, histological profile, treatments, and outcomes of patients with AIH with long-term follow-up in a tertiary referral center. METHODS A retrospective study was performed at the National Institute of Gastroenterology in Havana, Cuba, by enrolling 82 patients with a well-documented, long-term clinical course of AIH. Clinical and laboratory findings, histological profiles, treatments, and outcomes were analyzed. RESULTS At diagnosis, 73 (89%) patients had AIH type 1, 84.1% were women, and their median age was 46.5 years (range, 17-79 years). The median follow-up period was 84 months (interquartile range, 12-276 months). Clinical onset was mild or subclinical in 72% of patients and asymptomatic in 12.2%. At diagnosis, the Hennes's median score was 6 (range, 3-8). Complications were seen in 44 (53.6%) patients, 42 (51.2%) with liver-related complications and 9 (10.9%) without liver-related complications. Cirrhosis was present at diagnosis in 32 (39%) patients. Cirrhosis was subsequently diagnosed in the other 28 patients who were not cirrhotic at diagnosis, over a median follow-up of 12 (IQR, 2-84) months. During follow-up, 6 patients died (7.3%). Cumulative survival at 5 and 10 years was 98.4% and 89%, respectively. A complete biochemical response was achieved in 79% of patients in a mean (SD) of 11.7 (11.6) months. Side effects due to treatment were reported in 76 (92.7%) patients, and no pretreatment factors were found to predict treatment response. CONCLUSIONS These Cuban patients with AIH had acceptable disease remission rate and a prompt treatment response. Although most patients had advanced-stage liver disease at diagnosis or developed during follow-up, the cumulative survival rate was high when patients were receiving and complying with treatment.
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Affiliation(s)
| | | | | | - Hector Vega Sánchez
- Department of Immunology, National Institute of Gastroenterology, Havana, Cuba
| | | | - Robert G. Gish
- Las Vegas, Nevada Hepatitis B Foundation, University of Nevada, Las Vegas, Las Vegas, Nevada
| | | | - Zaily Dorta Guridi
- Department of Hepatology, National Institute of Gastroenterology, Havana, Cuba
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Gane E, Locarnini S, Lim TH, Strasser S, Sievert W, Cheng W, Thompson A, Given B, Schluep T, Hamilton J, Biermer M, Kalmeijer R, Beumont-Mauviel M, Lenz O, Cloherty G, Wong DKH, Schwabe C, Jackson K, Ferrari C, Lai CL, Gish RG, Yuen MF. Short-term treatment with RNA interference therapy, JNJ-3989, results in sustained hepatitis B surface antigen supression in patients with chronic hepatitis B receiving nucleos(t)ide analogue treatment. J Hepatol 2020. [DOI: 10.1016/s0168-8278(20)30597-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Yuen M, Schiefke I, Yoon J, Ahn SH, Heo J, Kim JH, Lik Yuen Chan H, Yoon KT, Klinker H, Manns M, Petersen J, Schluep T, Hamilton J, Given BD, Ferrari C, Lai C, Locarnini SA, Gish RG. RNA Interference Therapy With ARC-520 Results in Prolonged Hepatitis B Surface Antigen Response in Patients With Chronic Hepatitis B Infection. Hepatology 2020; 72:19-31. [PMID: 31654573 PMCID: PMC7496196 DOI: 10.1002/hep.31008] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS ARC-520, the first an RNA interference (RNAi) therapeutic, was designed to reduce all RNA transcripts derived from covalently closed circular DNA, leading to a reduction in viral antigens and hepatitis B virus (HBV) DNA. APPROACH AND RESULTS We aimed to evaluate the depth of hepatitis B surface antigen (HBsAg) decline in response to multiple doses of ARC-520 compared to placebo (PBO) in two randomized, multicenter studies in nucleoside/nucleotide analogue reverse-transcriptase inhibitor (NUC)-experienced patients with hepatitis B early antigen (HBeAg)-negative (E-neg) or HBeAg-positive (E-pos) disease. A total of 58 E-neg and 32 E-pos patients were enrolled and received four monthly doses of PBO (n = 20 E-neg, 11 E-pos), 1 mg/kg ARC-520 (n = 17 E-neg, 10 E-pos), or 2 mg/kg ARC-520 (n = 21 E-neg, 11 E-pos) concomitantly with NUC. HBsAg change from baseline to 30 days after the last ARC-520 dose were compared to PBO. Both E-neg and E-pos high-dose groups significantly reduced HBsAg compared to PBO, with mean reductions of 0.38 and 0.54 log IU/mL, respectively. HBsAg reductions persisted for approximately 85 days and >85 days after the last dose in E-neg and E-pos patients, respectively. The low-dose groups did not reach statistical significance in either study. E-pos patients showed a dose-dependent reduction in HBeAg from baseline. Mean maximum reduction was 0.23 and 0.69 log Paul Ehrlich IUs/mL in the low-dose and high dose ARC-520 groups respectively. ARC-520 was well tolerated, with only two serious adverse events of pyrexia possibly related to study drug observed. CONCLUSIONS ARC-520 was active in both E-neg and E-pos, NUC-experienced HBV patients; but absolute HBsAg reductions were moderate, possibly due to expression of HBsAg from integrated HBV DNA, indicating the need for RNAi therapeutics that can target viral transcripts regardless of origin.
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Affiliation(s)
- Man‐Fung Yuen
- Queen Mary HospitalThe University of Hong KongHong KongChina
| | | | - Jung‐Hwan Yoon
- Seoul National University HospitalSeoulRepublic of Korea
| | - Sang Hoon Ahn
- Yonsei University College of MedicineSeoulRepublic of Korea
| | - Jeong Heo
- Pusan National University and Medical Research InstituteBusanRepublic of Korea
| | - Ju Hyun Kim
- Gachon University Gil HospitalIncheonRepublic of Korea
| | | | - Ki Tae Yoon
- Pusan National University Yangsan HospitalYangsan‐siRepublic of Korea
| | | | | | - Joerg Petersen
- IFI Institute at Asklepios Klinik St. GeorgHamburgGermany
| | | | | | | | - Carlo Ferrari
- Unit of Infectious Diseases and HepatologyUniversity of ParmaParmaItaly
| | - Ching‐Lung Lai
- Queen Mary HospitalThe University of Hong KongHong KongChina
| | | | - Robert G. Gish
- Division of Gastroenterology and HepatologyDepartment of MedicineStanford University Medical CenterStanfordCA
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Sasadeusz J, Grigg A, Hughes PD, Lim SL, Lucas M, McColl G, McLachlan SA, Peters MG, Shackel N, Slavin M, Sundararajan V, Thompson A, Doyle J, Rickard J, De Cruz P, Gish RG, Visvanathan K. Screening and Prophylaxis to Prevent Hepatitis B Reactivation: Patients with Hematological and Solid Tumor Malignancies. Clin Liver Dis 2019; 23:511-519. [PMID: 31266624 DOI: 10.1016/j.cld.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients with malignancies require chemotherapy and other immunosuppressive therapies for treatment. Because of this immunosuppression, in patients who have ever been exposed to hepatitis B it is possible for reactivation to occur. This reactivation can be fatal. Reactivation is particularly likely in patients who receive B cell-active agents such as rituximab. The occurrence of reactivation flares may also delay further chemotherapy, which can negatively affect the outcome of the underlying malignancy. Accordingly, it is important to screen patients for markers of hepatitis B and institute antiviral prophylaxis to prevent reactivation.
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Affiliation(s)
- Joe Sasadeusz
- Peter Doherty Institute for Infection and Immunity, Elizabeth Street, Melbourne, Victoria 3000, Australia; University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
| | - Andrew Grigg
- Olivia Newton John Cancer Research Institute, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Peter D Hughes
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia
| | - Seng Lee Lim
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Michaela Lucas
- University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Geoff McColl
- University of Queensland Oral Health Centre, 288 Herston Road, Queensland 4006, Australia
| | - Sue Anne McLachlan
- St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
| | - Marion G Peters
- University of California, San Francisco, S357 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Nicholas Shackel
- Ingham Institute, 1 Campbell Street, Liverpool, Sydney, North South Wales 2170, Australia
| | - Monica Slavin
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia; Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Vijaya Sundararajan
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia; Department of Public Health, La Trobe University, Plenty Road, Bundoora, Victoria 3086, Australia
| | - Alexander Thompson
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
| | - Joseph Doyle
- The Alfred and Monash University, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - James Rickard
- Olivia Newton John Cancer Research Institute, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Peter De Cruz
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Kumar Visvanathan
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
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Sasadeusz J, Grigg A, Hughes PD, Lee Lim S, Lucas M, McColl G, McLachlan SA, Peters MG, Shackel N, Slavin M, Sundararajan V, Thompson A, Doyle J, Rickard J, De Cruz P, Gish RG, Visvanathan K. Screening and Prophylaxis to Prevent Hepatitis B Reactivation: Transplant Recipients. Clin Liver Dis 2019; 23:493-509. [PMID: 31266623 DOI: 10.1016/j.cld.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Organ transplantation is a lifesaving procedure for many patients. To prevent rejection or graft-versus-host disease, recipients require long-term immunosuppression. In patients who have ever been exposed to hepatitis B, it is possible for reactivation to occur; this includes patients who are anti-hepatitis B core antibody-positive only or both anti-hepatitis B core antibody-positive and hepatitis B surface antibody-positive. The susceptibility to this varies with the nature of the transplant. Hepatitis B can be transmitted from donor to recipient. It is important to assess the hepatitis B status and formulate a strategy to prevent transmission and prevent reactivation.
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Affiliation(s)
- Joe Sasadeusz
- Peter Doherty Institute for Infection and Immunity, Elizabeth Street, Melbourne, Victoria 3000, Australia; University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
| | - Andrew Grigg
- Olivia Newton John Cancer Research Institute, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Peter D Hughes
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia
| | - Seng Lee Lim
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Michaela Lucas
- University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Geoff McColl
- University of Queensland Oral Health Centre, 288 Herston Road, Queensland 4006, Australia
| | - Sue Anne McLachlan
- St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
| | - Marion G Peters
- University of California, San Francisco, S357 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Nicholas Shackel
- Ingham Institute, 1 Campbell Street, Liverpool, Sydney, New South Wales 2170, Australia
| | - Monica Slavin
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia; Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Vijaya Sundararajan
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia; Department of Public Health, La Trobe University, Plenty Road, Bundoora, Victoria 3086, Australia
| | - Alexander Thompson
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
| | - Joseph Doyle
- The Alfred and Monash University, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - James Rickard
- Olivia Newton John Cancer Research Institute, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Peter De Cruz
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Kumar Visvanathan
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
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Sasadeusz J, Grigg A, Hughes PD, Lee Lim S, Lucas M, McColl G, McLachlan SA, Peters MG, Shackel N, Slavin M, Sundararajan V, Thompson A, Doyle J, Rickard J, De Cruz P, Gish RG, Visvanathan K. Screening and Prophylaxis to Prevent Hepatitis B Reactivation: Other Populations and Newer Agents. Clin Liver Dis 2019; 23:521-534. [PMID: 31266625 DOI: 10.1016/j.cld.2019.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Because of the relatively high prevalence of both hepatitis B infection and various forms of autoimmune inflammatory diseases treated with aggressive immunotherapy, reactivation of hepatitis B occurs in a substantial number of patients. The risk of reactivation depends on the degree and duration of immunosuppression. A large number of drug treatments have resulted in reactivation of hepatitis B virus infection and, based on the mechanisms and extent of immunosuppression, recommendations for some of the newer classes of immunosuppressive drugs are provided.
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Affiliation(s)
- Joe Sasadeusz
- Peter Doherty Institute for Infection and Immunity, Elizabeth Street, Melbourne, Victoria 3000, Australia; University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
| | - Andrew Grigg
- Olivia Newton John Cancer Research Institute, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Peter D Hughes
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia
| | - Seng Lee Lim
- National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Michaela Lucas
- University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Geoff McColl
- University of Queensland Oral Health Centre, 288 Herston Road, Queensland 4006, Australia
| | - Sue Anne McLachlan
- St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
| | - Marion G Peters
- University of California, San Francisco, S357 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Nicholas Shackel
- Ingham Institute, 1 Campbell Street, Liverpool, Sydney, North South Wales 2170, Australia
| | - Monica Slavin
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia; Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia
| | - Vijaya Sundararajan
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia; Department of Public Health, La Trobe University, Plenty Road, Bundoora, Victoria 3086, Australia
| | - Alexander Thompson
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
| | - Joseph Doyle
- The Alfred and Monash University, 85 Commercial Road, Melbourne, Victoria 3004, Australia; Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia
| | - James Rickard
- Olivia Newton John Cancer Research Institute, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia
| | - Peter De Cruz
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Kumar Visvanathan
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; St Vincent's Hospital, 41 Victoria Street, Fitzroy, Victoria 3065, Australia
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Abstract
Hepatitis B virus (HBV) infection is a global health burden. The chronicity of this infection leads to complication such as cirrhosis and hepatocellular carcinoma, making it a leading cause of morbidity and mortality worldwide. Chronic infection commonly develops among those who acquire infection during childhood, hence the importance of effective implementation of HBV vaccination policies designed to eradicate chronic HBV. This article provides updated estimates of worldwide HBV disease prevalence and discusses how implementation of vaccination policies has affected HBV epidemiology.
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Affiliation(s)
- Chantal Gomes
- Department of Medicine, Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System, Highland Hospital, Highland Hospital Campus, Highland Care Pavilion 5th Floor, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Robert J Wong
- Department of Medicine, Division of Gastroenterology and Hepatology, Endoscopy Unit, Alameda Health System, Highland Hospital, Highland Hospital Campus, Highland Care Pavilion 5th Floor, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Robert G Gish
- Division of Gastroenterology and Hepatology, Stanford Health Care, 300 Pasteur Drive, Palo Alto, CA 94304, USA
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50
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Pandyarajan V, Gish RG, Alkhouri N, Noureddin M. Screening for Nonalcoholic Fatty Liver Disease in the Primary Care Clinic. Gastroenterol Hepatol (N Y) 2019; 15:357-365. [PMID: 31391806 PMCID: PMC6676352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a spectrum of diseases ranging from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) to advanced fibrosis and cirrhosis as well as liver cancer. Despite the significant morbidity associated with NAFLD, there are no global consensus guidelines to screen for liver fibrosis in patients considered high risk, including patients older than 50 years with type 2 diabetes or metabolic syndrome. Multiple therapies are currently being investigated and may soon receive regulatory approval for use in the clinic. It is suggested that patients at high risk for NAFLD be screened in the outpatient setting. This article aims to supply primary care providers (PCPs) with the knowledge and tools needed to properly evaluate a patient at high risk of developing significant liver disease from NASH. A tripartite algorithm is described to help PCPs identify patients with NAFLD using liver enzymes and abdominal ultrasound, assess the presence of advanced liver fibrosis using clinical prediction rules, and, if appropriate, determine when to refer patients to specialist care.
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Affiliation(s)
- Vijay Pandyarajan
- Dr Pandyarajan is a research fellow in the Division of Digestive and Liver Diseases in the Department of Medicine at the Cedars-Sinai Medical Center in Los Angeles, California. Dr Gish is a consulting professor of medicine in the Division of Gastroenterology and Hepatology in the Department of Medicine at Stanford University Medical Center in Stanford, California. Dr Alkhouri is director of the Metabolic Center at the Texas Liver Institute in San Antonio, Texas, and an associate professor of medicine in the Division of Gastroenterology at the University of Texas Health System in San Antonio, Texas. Dr Noureddin is director of the Cedars-Sinai Fatty Liver Program in the Division of Digestive and Liver Diseases in the Department of Medicine at the Comprehensive Transplant Center of the Cedars-Sinai Medical Center
| | - Robert G Gish
- Dr Pandyarajan is a research fellow in the Division of Digestive and Liver Diseases in the Department of Medicine at the Cedars-Sinai Medical Center in Los Angeles, California. Dr Gish is a consulting professor of medicine in the Division of Gastroenterology and Hepatology in the Department of Medicine at Stanford University Medical Center in Stanford, California. Dr Alkhouri is director of the Metabolic Center at the Texas Liver Institute in San Antonio, Texas, and an associate professor of medicine in the Division of Gastroenterology at the University of Texas Health System in San Antonio, Texas. Dr Noureddin is director of the Cedars-Sinai Fatty Liver Program in the Division of Digestive and Liver Diseases in the Department of Medicine at the Comprehensive Transplant Center of the Cedars-Sinai Medical Center
| | - Naim Alkhouri
- Dr Pandyarajan is a research fellow in the Division of Digestive and Liver Diseases in the Department of Medicine at the Cedars-Sinai Medical Center in Los Angeles, California. Dr Gish is a consulting professor of medicine in the Division of Gastroenterology and Hepatology in the Department of Medicine at Stanford University Medical Center in Stanford, California. Dr Alkhouri is director of the Metabolic Center at the Texas Liver Institute in San Antonio, Texas, and an associate professor of medicine in the Division of Gastroenterology at the University of Texas Health System in San Antonio, Texas. Dr Noureddin is director of the Cedars-Sinai Fatty Liver Program in the Division of Digestive and Liver Diseases in the Department of Medicine at the Comprehensive Transplant Center of the Cedars-Sinai Medical Center
| | - Mazen Noureddin
- Dr Pandyarajan is a research fellow in the Division of Digestive and Liver Diseases in the Department of Medicine at the Cedars-Sinai Medical Center in Los Angeles, California. Dr Gish is a consulting professor of medicine in the Division of Gastroenterology and Hepatology in the Department of Medicine at Stanford University Medical Center in Stanford, California. Dr Alkhouri is director of the Metabolic Center at the Texas Liver Institute in San Antonio, Texas, and an associate professor of medicine in the Division of Gastroenterology at the University of Texas Health System in San Antonio, Texas. Dr Noureddin is director of the Cedars-Sinai Fatty Liver Program in the Division of Digestive and Liver Diseases in the Department of Medicine at the Comprehensive Transplant Center of the Cedars-Sinai Medical Center
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