1
|
Hirode G, Hansen BE, Chen CH, Su TH, Wong G, Seto WK, Van Hees S, Papatheodoridi M, Brakenhoff SM, Lens S, Choi HSJ, Chien RN, Feld JJ, Forns X, Sonneveld MJ, Papatheodoridis GV, Vanwolleghem T, Yuen MF, Chan HLY, Kao JH, Hsu YC, Cornberg M, Jeng WJ, Janssen HLA. Erratum: Incidence of Hepatic Decompensation After Nucleos(t)ide Analog Withdrawal: Results From a Large, International, Multiethnic Cohort of Patients With Chronic Hepatitis B (RETRACT-B Study). Am J Gastroenterol 2024:00000434-990000000-01058. [PMID: 38457250 DOI: 10.14309/ajg.0000000000002718] [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] [Indexed: 03/10/2024]
Affiliation(s)
- Grishma Hirode
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- The Toronto Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada
| | - Bettina E Hansen
- Department of Epidemiology, Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Tung-Hung Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Grace Wong
- Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wai-Kay Seto
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, SAR, China
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Sylvia M Brakenhoff
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sabela Lens
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Hannah S J Choi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- The Toronto Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada
| | - Xavier Forns
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Man-Fung Yuen
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, SAR, China
| | - Henry L Y Chan
- The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Chun Hsu
- E-DaHospital/I-Shou University, Kaohsiung, Taiwan
| | - Markus Cornberg
- Department of Gastroenterology, Hepatolology and Endocrinology, Hannover Medical School, Germany; Centre for Individualized Infection Medicine (CiiM), Hannover, Germany
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
2
|
Van Hees S, Desmet S, VanOverbeke L, Mertens G, Verbeke L, Goegebuer T, Lemmens A. A first case of Chimaeribacter species catheter-related bloodstream infection. Acta Clin Belg 2023; 78:521-523. [PMID: 37589240 DOI: 10.1080/17843286.2023.2246227] [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] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
We present a case of a 80-year-old patient with a catheter-related bloodstream infection caused by Chimaeribacter species. The Chimaeribacter genus represents a novel genus within the Yersiniaceae family. To the best of our knowledge, as of today, nothing is known about the pathogenicity of Chimaeribacter species, nor about the appropriate antimicrobial management. In the present case, we demonstrate, for the first time, a potential clinical relevance of the Chimaeribacter species. Antimicrobial susceptibility data are presented.
Collapse
Affiliation(s)
- Stijn Van Hees
- Department of Clinical Microbiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Clinical Biology, University Hospital Ghent, Ghent, Belgium
- Department of Translational Research in Inflammation and Immunology, Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Stefanie Desmet
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lode VanOverbeke
- Department of Gastroenterology and Hepatology, AZ Sint-Maarten, Mechelen, Belgium
| | - Geertrui Mertens
- Department of Gastroenterology and Hepatology, AZ Sint-Maarten, Mechelen, Belgium
| | - Len Verbeke
- Department of Translational Research in Inflammation and Immunology, Laboratory for Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, AZ Sint-Maarten, Mechelen, Belgium
| | - Truus Goegebuer
- Department of Clinical Microbiology, AZ Sint-Maarten, Mechelen, Belgium
| | - Ann Lemmens
- Department of Clinical Microbiology, AZ Sint-Maarten, Mechelen, Belgium
| |
Collapse
|
3
|
Hirode G, Hansen BE, Chen CH, Su TH, Wong G, Seto WK, Van Hees S, Papatheodoridi M, Brakenhoff SM, Lens S, Choi HSJ, Chien RN, Feld JJ, Forns X, Sonneveld MJ, Papatheodoridis GV, Vanwolleghem T, Yuen MF, Chan HLY, Kao JH, Hsu YC, Cornberg M, Jeng WJ, Janssen HLA. Incidence of Hepatic Decompensation After Nucleos(t)ide Analog Withdrawal: Results From a Large, International, Multiethnic Cohort of Patients With Chronic Hepatitis B (RETRACT-B Study). Am J Gastroenterol 2023; 118:1601-1608. [PMID: 36719174 DOI: 10.14309/ajg.0000000000002203] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/09/2022] [Accepted: 12/27/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Despite improvements in the management of chronic hepatitis B (CHB), risk of cirrhosis and hepatocellular carcinoma remains. While hepatitis B surface antigen loss is the optimal end point, safe discontinuation of nucleos(t)ide analog (NA) therapy is controversial because of the possibility of severe or fatal reactivation flares. METHODS This is a multicenter cohort study of virally suppressed, end-of-therapy (EOT) hepatitis B e antigen (HBeAg)-negative CHB patients who stopped NA therapy (n = 1,557). Survival analysis techniques were used to analyze off-therapy rates of hepatic decompensation and differences by patient characteristics. We also examined a subgroup of noncirrhotic patients with consolidation therapy of ≥12 months before cessation (n = 1,289). Hepatic decompensation was considered related to therapy cessation if diagnosed off therapy or within 6 months of starting retreatment. RESULTS Among the total cohort (11.8% diagnosed with cirrhosis, 84.2% start-of-therapy HBeAg-negative), 20 developed hepatic decompensation after NA cessation; 10 events were among the subgroup. The cumulative incidence of hepatic decompensation at 60 months off therapy among the total cohort and subgroup was 1.8% and 1.1%, respectively. The hepatic decompensation rate was higher among patients with cirrhosis (hazard ratio [HR] 5.08, P < 0.001) and start-of-therapy HBeAg-positive patients (HR 5.23, P < 0.001). This association between start-of-therapy HBeAg status and hepatic decompensation remained significant even among the subgroup (HR 10.5, P < 0.001). DISCUSSION Patients with cirrhosis and start-of-therapy HBeAg-positive patients should be carefully assessed before stopping NAs to prevent hepatic decompensation. Frequent monitoring of viral and host kinetics after cessation is crucial to determine patient outcome.
Collapse
Affiliation(s)
- Grishma Hirode
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- The Toronto Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada
| | - Bettina E Hansen
- Department of Epidemiology, Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Tung-Hung Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Grace Wong
- Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Wai-Kay Seto
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, SAR, China
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Sylvia M Brakenhoff
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sabela Lens
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Hannah S J Choi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- The Toronto Viral Hepatitis Care Network (VIRCAN), Toronto, Ontario, Canada
| | - Xavier Forns
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Man-Fung Yuen
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, SAR, China
| | - Henry L Y Chan
- The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Chun Hsu
- E-DaHospital/I-Shou University, Kaohsiung, Taiwan
| | - Markus Cornberg
- Department of Gastroenterology, Hepatolology and Endocrinology, Hannover Medical School, Germany; Centre for Individualized Infection Medicine (CiiM), Hannover, Germany
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
4
|
Van Hees S, Winnock F, Meuleman P. Persistent platelet sattelitism despite normal platelet counts. Hematol Transfus Cell Ther 2023; 45:414-415. [PMID: 36414516 PMCID: PMC10499573 DOI: 10.1016/j.htct.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/04/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stijn Van Hees
- Laboratory for clinical biology, Algemeen Stedelijk Ziekenhuis Aalst, Aalst, Belgium; Laboratory for clinical biology, Ghent University Hospital, Ghent, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium.
| | - Frederic Winnock
- Laboratory for clinical biology, Algemeen Stedelijk Ziekenhuis Aalst, Aalst, Belgium
| | - Paul Meuleman
- Laboratory for clinical biology, Algemeen Stedelijk Ziekenhuis Aalst, Aalst, Belgium
| |
Collapse
|
5
|
Choi HSJ, Hirode G, Chen CH, Su TH, Seto WK, Van Hees S, Papatheodoridi M, Lens S, Wong GLH, Brakenhoff SM, Chien RN, Feld JJ, Sonneveld MJ, Chan HLY, Forns X, Papatheodoridis GV, Vanwolleghem T, Yuen MF, Hsu YC, Kao JH, Cornberg M, Hansen BE, Jeng WJ, Janssen HLA. Differential Relapse Patterns After Discontinuation of Entecavir vs Tenofovir Disoproxil Fumarate in Chronic Hepatitis B. Clin Gastroenterol Hepatol 2022; 21:1513-1522.e4. [PMID: 35863683 DOI: 10.1016/j.cgh.2022.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/09/2022] [Revised: 06/27/2022] [Accepted: 07/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) differentially affect relapse and outcomes following treatment discontinuation across different patient subpopulations remains unclear. We aimed to compare rates of off-therapy hepatitis B surface antigen (HBsAg) loss, virological and clinical relapse, and retreatment between chronic hepatitis B (CHB) patients who discontinued TDF or ETV therapy. METHODS This study included 1402 virally suppressed CHB patients who stopped either ETV (n = 981) or TDF (n = 421) therapy between 2001 and 2020 from 13 participating centers across North America, Europe, and Asia. All patients were hepatitis B e antigen-negative at treatment discontinuation. Inverse probability of treatment weighting was used to balance the treatment groups. Outcomes were analyzed using survival methods. RESULTS During a median off-treatment follow-up of 18 months, HBsAg loss occurred in 96 (6.8%) patients overall. Compared with ETV, TDF was associated with a higher rate of HBsAg loss (P = .03); however, the association was no longer significant after statistical adjustment (P = .61). Virological relapse occurred earlier among TDF-treated patients (P < .01); nonetheless, rates became comparable after the first year off therapy (P = .49). TDF was significantly associated with a higher clinical relapse rate than ETV throughout follow-up (P < .01). The development of a virological or clinical relapse did not affect the rate of HBsAg loss. Retreatment rates were not significantly different between the treatment groups. CONCLUSIONS TDF and ETV have differential relapse patterns but are associated with similar rates of HBsAg loss and retreatment following discontinuation. Finite therapy can be considered for CHB patients on either TDF or ETV therapy.
Collapse
Affiliation(s)
- Hannah S J Choi
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada
| | - Grishma Hirode
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Viral Hepatitis Care Network, University Health Network, Toronto, Ontario, Canada
| | - Chien-Hung Chen
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wai-Kay Seto
- Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margarita Papatheodoridi
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Sabela Lens
- Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Grace L H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Sylvia M Brakenhoff
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Linkou, Taiwan
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Viral Hepatitis Care Network, University Health Network, Toronto, Ontario, Canada
| | - Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Henry L Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Xavier Forns
- Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Man-Fung Yuen
- Department of Medicine, School of Clinical Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Centre for Individualized Infection Medicine, Helmholtz Centre for Infection Research and Hannover Medical School, Hannover, Germany
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Linkou, Taiwan
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, Ontario, Canada; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | | |
Collapse
|
6
|
Hirode G, Choi HSJ, Chen CH, Su TH, Seto WK, Van Hees S, Papatheodoridi M, Lens S, Wong G, Brakenhoff SM, Chien RN, Feld J, Sonneveld MJ, Chan HLY, Forns X, Papatheodoridis GV, Vanwolleghem T, Yuen MF, Hsu YC, Kao JH, Cornberg M, Hansen BE, Jeng WJ, Janssen HLA. Off-Therapy Response After Nucleos(t)ide Analogue Withdrawal in Patients With Chronic Hepatitis B: An International, Multicenter, Multiethnic Cohort (RETRACT-B Study). Gastroenterology 2022; 162:757-771.e4. [PMID: 34762906 DOI: 10.1053/j.gastro.2021.11.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [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: 04/20/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Functional cure, defined based on hepatitis B surface antigen (HBsAg) loss, is rare during nucleos(t)ide analogue (NA) therapy and guidelines on finite NA therapy have not been well established. We aim to analyze off-therapy outcomes after NA cessation in a large, international, multicenter, multiethnic cohort of patients with chronic hepatitis B (CHB). METHODS This cohort study included patients with virally suppressed CHB who were hepatitis B e antigen (HBeAg)-negative and stopped NA therapy. Primary outcome was HBsAg loss after NA cessation, and secondary outcomes included virologic, biochemical, and clinical relapse, alanine aminotransferase flare, retreatment, and liver-related events after NA cessation. RESULTS Among 1552 patients with CHB, cumulative probability of HBsAg loss was 3.2% at 12 months and 13.0% at 48 months of follow-up. HBsAg loss was higher among Whites (vs Asians: subdistribution hazard ratio, 6.8; 95% confidence interval, 2.7-16.8; P < .001) and among patients with HBsAg levels <100 IU/mL at end of therapy (vs ≥100 IU/mL: subdistribution hazard ratio, 22.5; 95% confidence interval, 13.1-38.7; P < .001). At 48 months of follow-up, Whites with HBsAg levels <1000 IU/mL and Asians with HBsAg levels <100 IU/mL at end of therapy had a high predicted probability of HBsAg loss (>30%). Incidence rate of hepatic decompensation and hepatocellular carcinoma was 0.48 per 1000 person-years and 0.29 per 1000 person-years, respectively. Death occurred in 7/19 decompensated patients and 2/14 patients with hepatocellular carcinoma. CONCLUSIONS The best candidates for NA withdrawal are virally suppressed, HBeAg- negative, noncirrhotic patients with CHB with low HBsAg levels, particularly Whites with <1000 IU/mL and Asians with <100 IU/mL. However, strict surveillance is recommended to prevent deterioration.
Collapse
Affiliation(s)
- Grishma Hirode
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada
| | - Hannah S J Choi
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | - Tung-Hung Su
- National Taiwan University Hospital, Taipei, Taiwan
| | - Wai-Kay Seto
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Sabela Lens
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Grace Wong
- The Chinese University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Sylvia M Brakenhoff
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Linkou, Taiwan
| | - Jordan Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada
| | - Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Henry L Y Chan
- The Chinese University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Xavier Forns
- Hospital Clinic Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | | | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
| | - Man-Fung Yuen
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, Special administrative regions of China
| | - Yao-Chun Hsu
- E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | | | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany Centre for Individualized Infection Medicine, Hannover, Germany
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Linkou, Taiwan
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; The Toronto Viral Hepatitis Care Network, Toronto, Canada.
| |
Collapse
|
7
|
Furquim d'Almeida A, Ho E, Van Hees S, Vanwolleghem T. Clinical management of chronic hepatitis B: A concise overview. United European Gastroenterol J 2021; 10:115-123. [PMID: 34846093 PMCID: PMC8830276 DOI: 10.1002/ueg2.12176] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
Worldwide, over 250 million people are chronically infected with the hepatitis B virus (HBV). Infected patients have an up to 100-fold increased risk for liver-related complications, including cirrhosis, hepatic decompensation and hepatocellular carcinoma. Nonetheless, the majority of the infections remains asymptomatic, stressing the importance of HBV screening and linkage to care. Excellent clinical outcomes are seen during nucleos(t)ide analogue (NA) therapy, which often is continued indefinitively due to a lack of functional cure. Increasing evidence suggests that NA discontinuation following long-term treatment induced viral suppression in patients without a functional cure may be a favourable option. Reliable biomarkers are, however, urgently needed to select the patients that would benefit from NA withdrawal. In addition, renewed and novel approaches to improve screening and linkage to care are other fundamental factors in the optimisation of the clinical management of chronic hepatitis B.
Collapse
Affiliation(s)
- Arno Furquim d'Almeida
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.,Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Erwin Ho
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.,Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.,Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.,Viral Hepatitis Research Group, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
8
|
Wuyts L, Janssens A, Vonghia L, Michielsen P, Raskin J, Driessen A, Van Hees S, Francque S, Vanwolleghem T. Nivolumab and anti-HCV activity, a case report. Acta Clin Belg 2021; 76:392-396. [PMID: 32182200 DOI: 10.1080/17843286.2020.1741897] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Exhaustion of antigen-specific T-cells in order to escape immune destruction is frequently seen in chronic viral infection and different types of cancer. Blockade of overexpressed negative co-stimulatory pathways, a process known as immune checkpoint modulation, is a promising novel therapy that could improve the treatment of liver diseases with features of T cell exhaustion. We present a case of a 54-year-old hepatitis C virus (HCV) positive patient with an acute flare of hepatitis during nivolumab treatment for a stage IV lung carcinoma, an anti-programmed death-1 (PD-1) immunotherapy. Retrospective testing of HCV RNA documented infection more than 6 months ago. Nivolumab treatment was associated with an alanine aminotransferase (ALT) flare reaching a peak value of 663 U/L, along with bilirubin levels of 0.74 mg/dL and no signs of coagulopathy. The assumption of a nivolumab-associated autoimmune hepatitis led to the interruption of the immune checkpoint inhibitor treatment. However, a subsequent 1-log decrease of HCV RNA load was noticed, which raised the possibility of an immune reconstitution against the HCV-infected hepatocytes with cell lysis. Liver biopsy specimen demonstrated no evidence for autoimmune liver disease or fibrosis. Clinical evolution was favorable and serum transaminases returned to normal levels and HCV RNA load increased to baseline values following nivolumab cessation. The current case suggests an anti-HCV activity of anti-PD-1 treatment in the setting of concomitant HCV viremia and lung carcinoma.
Collapse
Affiliation(s)
- Laura Wuyts
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Annelies Janssens
- Department of Thoracic Oncology, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Luisa Vonghia
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), Antwerp, Belgium
- Translational Sciences in Inflammation and Immunology (TWI2N), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Peter Michielsen
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Jo Raskin
- Department of Thoracic Oncology, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Ann Driessen
- Department of Pathology, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), Antwerp, Belgium
- Translational Sciences in Inflammation and Immunology (TWI2N), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), Antwerp, Belgium
- Translational Sciences in Inflammation and Immunology (TWI2N), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital (UZA), Antwerp, Belgium
- Translational Sciences in Inflammation and Immunology (TWI2N), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| |
Collapse
|
9
|
Siewe Fodjo JN, Faria de Moura Villela E, Van Hees S, Vanholder P, Reyntiens P, Colebunders R. Follow-Up Survey of the Impact of COVID-19 on People Living with HIV during the Second Semester of the Pandemic. Int J Environ Res Public Health 2021; 18:4635. [PMID: 33925506 PMCID: PMC8123847 DOI: 10.3390/ijerph18094635] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
COVID-19 affects persons living with HIV (PLWH) both directly (via morbidity/mortality) and indirectly (via disruption of HIV care). From July-November 2020, an online survey was conducted to investigate the psychosocial well-being of PLWH and changes in HIV care during the second semester of the COVID-19 outbreak. Data were collected on the socio-demographic characteristics of PLWH, their psychosocial well-being, impact of COVID-19 preventive measures on their daily routines and HIV follow-up. Of the 247 responses analyzed (mean age: 44.5 ± 13.2 years; 73.7% male), 67 (27.1%) and 69 (27.9%) respondents screened positive for anxiety (GAD-2 score ≥ 3) and depression (PHQ-2 score ≥ 3), respectively. HIV care had returned to pre-COVID-19 state for 48.6% PLWH, and 108 (43.7%) had no HIV follow-up during the past month. Over three quarters (76.1%) of respondents expressed willingness to receive the COVID-19 vaccine. Compared to previous findings in April 2020, substance use increased from 58.6% to 67.2% (p < 0.001). Our findings suggest that the well-being and medical follow-up of PLWH are still affected after almost a year into the COVID-19 outbreak. Remote HIV follow-up (telemedicine) with psychosocial support should be envisaged in the medium to long-term. Given that most PLWH accept COVID-19 vaccination, they may be prioritized for this intervention.
Collapse
Affiliation(s)
| | - Edlaine Faria de Moura Villela
- Disease Control Coordination, State Health Department, São Paulo 01246000, Brazil
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia 74605050, Brazil;
| | - Stijn Van Hees
- Global Health Institute, University of Antwerp, 2610 Wilrijk, Belgium; (S.V.H.); (R.C.)
| | | | - Patrick Reyntiens
- Sensoa, Flemish Expertise Centre for Sexual Health, 2060 Antwerp, Belgium;
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2610 Wilrijk, Belgium; (S.V.H.); (R.C.)
| |
Collapse
|
10
|
Ditekemena JD, Mavoko HM, Obimpeh M, Van Hees S, Siewe Fodjo JN, Nkamba DM, Tshefu A, Van Damme W, Muyembe JJ, Colebunders R. Adherence to COVID-19 Prevention Measures in the Democratic Republic of the Congo, Results of Two Consecutive Online Surveys. Int J Environ Res Public Health 2021; 18:ijerph18052525. [PMID: 33806286 PMCID: PMC7967309 DOI: 10.3390/ijerph18052525] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 01/12/2023]
Abstract
Adherence to preventive measures is essential to reduce the risk of COVID-19 transmission. Two online surveys were conducted in the Democratic Republic of the Congo (DRC) from 23 April to 8 June 2020, and from August 24th to September 8th, respectively. A total of 3268 (round 1) and 4160 (round 2) participants were included. In both surveys, there was a moderate level of adherence to regular handwashing (85% and 77%, respectively), wearing of facemasks (41.4% and 69%, respectively), and respecting physical distancing (58% and 43.4%, respectively). The second survey found that, working in private (OR = 2.31, CI: 1.66-3.22; p < 0.001) and public organizations (OR = 1.61, CI: 1.04-2.49; p = 0.032) and being a healthcare worker (OR = 2.19, CI: 1.57-3.05; p < 0.001) significantly increased the odds for better adherence. However, a unit increase in age (OR = 0.99, CI: 0.98-0.99; p < 0.026), having attained lower education levels (OR = 0.60, CI: 0.46-0.78; p < 0.001), living in a room (OR = 0.36, CI: 0.15-0.89; p = 0.027), living in a studio (OR = 0.26, CI: 0.11-0.61; p = 0.002) and apartment (OR = 0.29, CI: 0.10-0.82; p = 0.019) significantly decreased the odds for better adherence. We recommend a multi-sectorial approach to monitor and respond to the pandemic threat. While physical distancing may be difficult in Africa, it should be possible to increase the use of facemasks.
Collapse
Affiliation(s)
- John D. Ditekemena
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Democratic Republic of the Congo; (D.M.N.); (A.T.)
- Correspondence:
| | - Hypolite M. Mavoko
- Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Democratic Republic of the Congo;
| | - Michael Obimpeh
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium; (M.O.); (S.V.H.); (J.N.S.F.); (R.C.)
| | - Stijn Van Hees
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium; (M.O.); (S.V.H.); (J.N.S.F.); (R.C.)
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium; (M.O.); (S.V.H.); (J.N.S.F.); (R.C.)
| | - Dalau M. Nkamba
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Democratic Republic of the Congo; (D.M.N.); (A.T.)
- Pôle d’Épidémiologie et Biostatistique, Université Catholique de Louvain (UCLouvain), Institut de Recherche Expérimentale et Clinique (IREC), 1348 Brussels, Belgium
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Democratic Republic of the Congo; (D.M.N.); (A.T.)
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, 2600 Antwerp, Belgium;
| | - Jean Jacques Muyembe
- Institut National de Recherche Biomédicale and Faculty of Medicine, University of Kinshasa, Kinshasa 834, Democratic Republic of the Congo;
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium; (M.O.); (S.V.H.); (J.N.S.F.); (R.C.)
| |
Collapse
|
11
|
Millevert C, Van Hees S, Siewe Fodjo JN, Wijtvliet V, Faria de Moura Villela E, Rosso B, Gil-Nagel A, Weckhuysen S, Colebunders R. Impact of COVID-19 on the lives and psychosocial well-being of persons with epilepsy during the third trimester of the pandemic: Results from an international, online survey. Epilepsy Behav 2021; 116:107800. [PMID: 33571838 PMCID: PMC8803628 DOI: 10.1016/j.yebeh.2021.107800] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of the coronavirus disease 2019 (COVID-19) measures on the lives and psychosocial well-being of persons with epilepsy (PWE) during the third trimester of the COVID-19 pandemic. METHODS A structured questionnaire investigating different aspects of the lives and psychosocial well-being of PWE during the COVID-19 pandemic was developed. Persons with epilepsy were invited via social media to anonymously respond to a secure web-based online questionnaire (www.icpcovid.com). Responses were collected between July 26th and December 3rd, 2020. Hospital anxiety and depression scales (HADS) were used to screen respondents for depression (HADS-D) and anxiety (HADS-A). RESULTS Responses of 407 PWE were included in the analysis; 304 (74.7%) respondents were female and 245 (60.2%) living in Europe, 157 (38.6%) in South America, and 5 (1.2%) in Canada. Seventy-six (18.7%) reported a decrease of income during the COVID-19 lockdown, and 122 (30.0%) experienced difficulties in obtaining anti-seizure medication (ASM), mostly (72/122, 59.0%) due to unavailability. Seizure frequency increased in 122 (30.0%); 295 (72.5%) screened positive for anxiety, and 159 (39.1%) for depression. Hundred eighty-eight (46.2%) reported reluctance to seek medical care; 27.3% believed that epilepsy was associated with an increased risk of COVID-19 disease. Forty-six (74.2%) of 62 PWE who were followed up by telephone or video consult were satisfied with this consult. Fifty-five respondents, most (89.1%) of whom were from Europe, had also participated in a previous survey during the early months of the pandemic. In this subgroup, although there was no difference in prevalence of a positive screening for depression or anxiety, mean scores on HADS-A and HADS-D increased from 6.65 ± 3.99 to 7.27 ± 4.01 (p = 0.418), and from 5.84 ± 4.43 to 6.60 ± 4.45 (p = 0.371), respectively. CONCLUSIONS The COVID-19 pandemic continues to impact the psychosocial and somatic well-being of PWE. To minimize this impact, ensuring uninterrupted access to ASM is essential. Teleconsultations are valid alternatives for continued follow-up, but should include attention to psychosocial well-being. Persons with epilepsy should be more actively informed that epilepsy is not a risk factor for developing (more severe) COVID-19 disease.
Collapse
Affiliation(s)
- Charissa Millevert
- Department of Neurology, University Hospital Antwerp, Belgium; VIB-Center for Molecular Neurology, VIB, University of Antwerp, Belgium
| | - Stijn Van Hees
- Global Health Institute, University of Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | - Veerle Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | - Barbara Rosso
- Department of Neurology, Italian Hospital of Buenos Aires, Argentina
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Sarah Weckhuysen
- Department of Neurology, University Hospital Antwerp, Belgium; VIB-Center for Molecular Neurology, VIB, University of Antwerp, Belgium
| | | |
Collapse
|
12
|
Ditekemena JD, Nkamba DM, Mutwadi A, Mavoko HM, Siewe Fodjo JN, Luhata C, Obimpeh M, Van Hees S, Nachega JB, Colebunders R. COVID-19 Vaccine Acceptance in the Democratic Republic of Congo: A Cross-Sectional Survey. Vaccines (Basel) 2021; 9:153. [PMID: 33672938 PMCID: PMC7917589 DOI: 10.3390/vaccines9020153] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
We investigated the level of willingness for COVID-19 vaccination in the Democratic Republic of Congo (DRC). Data were collected between 24 August 2020 and 8 September 2020 through an online survey. A total of 4131 responses were included; mean age of respondents was 35 years (standard deviation: 11.5); 68.4% were females; 71% had elementary or secondary school education. One fourth (24.1%) were convinced that COVID-19 did not exist. Overall, 2310 (55.9%) indicated they were willing to be vaccinated. In a multivariable regression model, belonging to the middle and high-income category (OR = 1.85, CI: 1.46-2.35 and OR = 2.91, CI: 2.15-3.93, respectively), being tested for COVID-19 (OR = 4.71, CI: 3.62-6.12; p < 0.001), COVID-19 community vaccine acceptance (OR = 14.45, CI: 2.91-71.65; p = 0.001) and acknowledging the existence of COVID-19 (OR = 6.04, CI: 4.42-8.23; p < 0.001) were associated with an increased willingness to be vaccinated. Being a healthcare worker was associated with a decreased willingness for vaccination (OR = 0.46, CI: 0.36-0.58; p < 0.001). In conclusion, the current willingness for COVID-19 vaccination among citizens of the DRC is too low to dramatically decrease community transmission. Of great concern is the low intention of immunization among healthcare workers. A large sensitization campaign will be needed to increase COVID-19 vaccine acceptance.
Collapse
Affiliation(s)
- John D. Ditekemena
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo; (D.M.N.); (A.M.); (C.L.)
| | - Dalau M. Nkamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo; (D.M.N.); (A.M.); (C.L.)
- Pôle d’Épidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), 1348 Brussels, Belgium
| | - Armand Mutwadi
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo; (D.M.N.); (A.M.); (C.L.)
| | - Hypolite M. Mavoko
- Department of Tropical Medicine, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo;
| | - Joseph Nelson Siewe Fodjo
- Global Health Institute, University of Antwerp, 2000 Antwerp, Belgium; (J.N.S.F.); (M.O.); (S.V.H.); (R.C.)
| | - Christophe Luhata
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 7948, Democratic Republic of the Congo; (D.M.N.); (A.M.); (C.L.)
| | - Michael Obimpeh
- Global Health Institute, University of Antwerp, 2000 Antwerp, Belgium; (J.N.S.F.); (M.O.); (S.V.H.); (R.C.)
| | - Stijn Van Hees
- Global Health Institute, University of Antwerp, 2000 Antwerp, Belgium; (J.N.S.F.); (M.O.); (S.V.H.); (R.C.)
| | - Jean B. Nachega
- Department of Epidemiology Infectious Diseases and Microbiology and Center for Global Health, University of Pittsburgh, Pittsburgh, PA 15260, USA;
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town 7505, South Africa
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2000 Antwerp, Belgium; (J.N.S.F.); (M.O.); (S.V.H.); (R.C.)
| |
Collapse
|
13
|
Hotterbeekx A, Lammens M, Onzivua S, Lukande R, Olwa F, Kumar-Singh S, Van Hees S, Idro R, Colebunders R. Neuropathological Changes in Nakalanga Syndrome-A Case Report. Pathogens 2021; 10:pathogens10020116. [PMID: 33498763 PMCID: PMC7912209 DOI: 10.3390/pathogens10020116] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Nakalanga syndrome is a clinical manifestation of onchocerciasis-associated epilepsy characterized by stunting, delayed or absent secondary sexual development and skeletal deformities, and is often accompanied by epileptic seizures. The pathophysiology of Nakalanga syndrome is unknown. Here, we describe the post-mortem findings of a 17-year-old female who died with Nakalanga syndrome in northern Uganda. Macroscopic and histopathological examination of all major organs (liver, lungs, kidney and heart), including the brain and the pituitary gland, was performed. The suspected cause of death was malaria, and all major organs and pituitary gland appeared normal, except the lungs, which were edematous consistent with the malaria. Neuropathological changes include signs of neuro-inflammation (gliosis and activated microglia), which co-localized with tau-reactive neurofibrillary tangles and threads. The pathology was most abundant in the frontal cortex, thalamic and hypothalamic regions, and mesencephalon. The choroid plexus showed psammoma bodies. These findings indicate accelerated aging, probably due to repeated seizures. The neuropathological findings were similar to other persons who died with onchocerciasis-associated epilepsy. Examination of the pituitary gland did not reveal new information concerning the underlying pathophysiological mechanism of Nakalanga syndrome. Therefore, more post-mortem studies should be performed.
Collapse
Affiliation(s)
- An Hotterbeekx
- Global Health Institute, University of Antwerp, 2100 Antwerp, Belgium; (S.V.H.); (R.C.)
- Molecular Pathology Group, Laboratory of Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2100 Antwerp, Belgium;
- Correspondence: ; Tel.: +32-32-65-89-15; Fax: +32-3-265-26-63
| | - Martin Lammens
- Department of Pathology, Antwerp University Hospital, 2100 Antwerp, Belgium;
- Department of Neuropathology, Born-Bunge Institute, University of Antwerp, 2100 Antwerp, Belgium
| | - Sylvester Onzivua
- Department of Pathology, Makerere University Medical School, Kampala P.O. Box 7072, Uganda; (S.O.); (R.L.)
| | - Robert Lukande
- Department of Pathology, Makerere University Medical School, Kampala P.O. Box 7072, Uganda; (S.O.); (R.L.)
| | - Francis Olwa
- Department of Diagnostics, Faculty of Health Sciences, Lira University, Lira P. O. Box 1035, Uganda;
| | - Samir Kumar-Singh
- Molecular Pathology Group, Laboratory of Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, 2100 Antwerp, Belgium;
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2100 Antwerp, Belgium
| | - Stijn Van Hees
- Global Health Institute, University of Antwerp, 2100 Antwerp, Belgium; (S.V.H.); (R.C.)
| | - Richard Idro
- Department of Pediatrics, Makerere University Medical School, Kampala P.O. Box 7072, Uganda;
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2100 Antwerp, Belgium; (S.V.H.); (R.C.)
| |
Collapse
|
14
|
Van Hees S, Cuypers B, Bourgeois S, Groothuismink ZMA, Meysman P, Van der Vlies P, de Knegt R, Vonghia L, Michielsen P, Francque S, Laukens K, Boonstra A, Vanwolleghem T. Sorted B cell transcriptomes point towards actively regulated B cell responses during ongoing chronic hepatitis B infections. Cell Immunol 2021; 362:104283. [PMID: 33548734 DOI: 10.1016/j.cellimm.2021.104283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
The natural course of chronic hepatitis B virus (HBV) infections follows distinct clinical disease phases, characterized by fluctuating levels of serum HBV DNA and ALT. The immune cells and their features that govern these clinical disease transitions remain unknown. In the current study, we performed RNA sequencing on purified B cells from blood (n = 42) and liver (n = 10) of healthy controls and chronic HBV patients. We found distinct gene expression profiles between healthy controls and chronic HBV patients, as evidenced by 190 differentially expressed genes (DEG), but also between the clinical phenotypes of a chronic HBV infection (17-110 DEG between each phase). Numerous immune pathways, including the B cell receptor pathway were upregulated in liver B cells when compared to peripheral B cells. Further investigation of the detected DEG suggested an activation of B cells during HBeAg seroconversion and an active regulation of B cell signalling in the liver.
Collapse
Affiliation(s)
- Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Bart Cuypers
- Department of Biomedical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium; Department of Mathematics and Computer Science, University of Antwerp, Middelheimlaan 1, 2020 Antwerp, Belgium
| | - Stefan Bourgeois
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium; Department of Gastroenterology and Hepatology, ZNA Stuivenberg, Antwerp, Belgium
| | - Zwier M A Groothuismink
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Pieter Meysman
- Department of Mathematics and Computer Science, University of Antwerp, Middelheimlaan 1, 2020 Antwerp, Belgium
| | | | - Rob de Knegt
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Luisa Vonghia
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Peter Michielsen
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Kris Laukens
- Department of Mathematics and Computer Science, University of Antwerp, Middelheimlaan 1, 2020 Antwerp, Belgium
| | - Andre Boonstra
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Antwerp, Belgium; Laboratory of Experimental Medicine and Paediatrics, Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium; Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, the Netherlands.
| |
Collapse
|
15
|
Van Hees S, Siewe Fodjo JN, Wijtvliet V, Van den Bergh R, Faria de Moura Villela E, da Silva CF, Weckhuysen S, Colebunders R. Access to healthcare and prevalence of anxiety and depression in persons with epilepsy during the COVID-19 pandemic: A multicountry online survey. Epilepsy Behav 2020; 112:107350. [PMID: 32920373 PMCID: PMC7481834 DOI: 10.1016/j.yebeh.2020.107350] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to assess access to healthcare and to estimate the prevalence of depression and anxiety among persons with epilepsy (PWE) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS We conducted a multicountry online survey among PWE. Persons with epilepsy were invited to participate through various social media channels. The Hospital Anxiety and Depression Scale (HADS) and 9-item Patient Health Questionnaire (PHQ-9) scale were used to score anxiety and depression. Logistic regression modeling was used to investigate factors associated with anxiety and depression. RESULTS Three hundred ninety-nine PWE were included (mean age: 38.22 ± 12.09 years), the majority were female (80.2%) and living in high-income countries (83.2%). Two hundred three PWE reported symptoms of a cold since January 2020. Nine (25%) of the 36 PWE tested for COVID were positive. A total of 72 PWE (19.6%) reported problems to obtain antiseizure medication (ASM), which in 25% of cases was directly COVID-related. Of the 399 PWE, 201 (50.4%) screened positive for anxiety according to the HADS; 159 (39.8%) and 187 (46.9%) PWE screened positive for depression based on the HADS and PHQ-9 scale, respectively. Female gender and financial problems were associated with both depression and anxiety. A planned follow-up consultation with the treating physician was associated with a lower risk of depression, whereas difficulties to access ASM treatment increased the odds of depression. In 65/137 (47.4%) PWE with a planned follow-up visit with the treating physician, this consultation was canceled. CONCLUSIONS Innovative approaches are needed to ensure continuity in access to ASM treatment. Healthcare workers should ensure continued follow-up, either through inperson or telehealth appointments, to timely identify symptoms of anxiety and depression and act accordingly.
Collapse
Affiliation(s)
- Stijn Van Hees
- Global Health Institute, University of Antwerp, Belgium,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | - Veerle Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | | | | | - Sarah Weckhuysen
- Department of Neurology, University Hospital Antwerp, Belgium,VIB-Center for Molecular Neurology, University of Antwerp, Belgium
| | | |
Collapse
|
16
|
Van Hees S, Muyindike W, Erem G, Ocama P, Seremba E, Paska A, Michielsen P, Okwir M, Vanwolleghem T. Challenges associated with the roll-out of HCC surveillance in sub-Saharan Africa - the case of Uganda. J Hepatol 2020; 73:1271-1273. [PMID: 32800587 DOI: 10.1016/j.jhep.2020.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/08/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | - Winnie Muyindike
- Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Geoffrey Erem
- Department of Radiology, Nsambya Hospital, Kampala, Uganda; Makerere University School of Medicine, Kampala, Uganda
| | | | | | - Apiyo Paska
- Department of Internal Medicine, Gulu Regional Referral Hospital, Gulu, Uganda
| | - Peter Michielsen
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | - Mark Okwir
- Department of Internal Medicine, Lira University Faculty of Health, Lira, Uganda
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium.
| |
Collapse
|
17
|
Van Hees S, Raimon S, Fodjo JNS, Colebunders R. Safety of ivermectin during pregnancy. Lancet Glob Health 2020; 8:e338. [PMID: 32087169 DOI: 10.1016/s2214-109x(19)30555-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Stijn Van Hees
- Global Health Institute, University of Antwerp, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, Antwerp University, 2610 Antwerp, Belgium
| | | | | | | |
Collapse
|
18
|
Ho E, Van Hees S, Goethals S, Smits E, Huizing M, Francque S, De Winter B, Michielsen P, Vanwolleghem T. Biobanking for Viral Hepatitis Research. Front Med (Lausanne) 2019; 6:183. [PMID: 31482092 PMCID: PMC6710323 DOI: 10.3389/fmed.2019.00183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction: Viral hepatitis is a worldwide, important health issue. The optimal management of viral hepatitis infections faces numerous challenges. In this paper, we describe how biobanking of biological samples derived from viral hepatitis patients collected both in-hospital and during community outreach screenings provides a unique collection of samples. Materials and Methods: All samples and materials were provided with a study code within the SLIMS system Study protocols and an informed consent form were approved by the Antwerp University Hospital/University of Antwerp Ethical Committee. Systematic biobanking was initiated in October 2014. Collected sample types include: (1) serum and plasma of all newly diagnosed HBV, HCV, HDV, and HEV positive patients; (2) left-over serum and plasma samples from all PCR analyses for HBV and HCV performed in the context of routine clinical care; (3) left-over liver tissue not needed for routine histological diagnosis after liver biopsy; and (4) additional virus-specific, appropriate sample types using a scientific rationale-based approach. A community outreach screening program was performed in three major Belgian cities. Serum, EDTA, Tempus Blood RNA and BD Vacutainer CPT were collected. CPT tubes were centrifuged on-site and mononuclear cells collected within 24 h. Results: Concerning community screening: 298 individuals supplied all 4 sample types. Samples were stored at -150°C and were logged in the biobank SLIMS database. Samples were used for HBV-related immunological and biomarker studies. DNA isolated from plasma samples derived from chronic HBV patients was used to investigate Single Nucleotide Polymorphism rs 1790008. Serum samples collected from chronic hepatitis C patients were used to assess the efficacy of HCV treatment. Peripheral Blood Mononuclear Cells (PBMC) isolated from chronic HBV patients and healthy controls were used for different immunological study purposes. Virus isolated from biobanked stool of a chronic hepatitis E patient was used to establish a mouse model for Hepatitis E infections, allowing further HEV virology studies. Conclusion: The establishment of a biobank with samples collected both in-hospital and during community-outreach screening resulted in a unique, continuously expanding collection of biological samples which provides an excellent platform for prompt answers to clinically and translational relevant research questions.
Collapse
Affiliation(s)
- Erwin Ho
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Paediatrics and Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Paediatrics and Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Sofie Goethals
- Biobank Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Elke Smits
- Biobank Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Manon Huizing
- Biobank Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Paediatrics and Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Benedicte De Winter
- Laboratory of Paediatrics and Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Peter Michielsen
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Paediatrics and Experimental Medicine, University of Antwerp, Antwerp, Belgium
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Paediatrics and Experimental Medicine, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
| |
Collapse
|
19
|
Van Hees S, Chi H, Hansen B, Bourgeois S, Van Vlierberghe H, Sersté T, Francque S, Wong D, Sprengers D, Moreno C, Nevens F, Janssen H, Vanwolleghem T. Caucasian Ethnicity, but Not Treatment Cessation is Associated with HBsAg Loss Following Nucleos(t)ide Analogue-Induced HBeAg Seroconversion. Viruses 2019; 11:E687. [PMID: 31357522 PMCID: PMC6723144 DOI: 10.3390/v11080687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/17/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023] Open
Abstract
It is well appreciated that ethnicity influences the natural history and immune responses during a chronic hepatitis B infection. In this study, we explore the effect of ethnicity and treatment cessation on Hepatitis B surface Antigen (HBsAg) seroclearance in patients with Nucleos(t)ide Analogue (NA)-induced Hepatitis B e Antigen (HBeAg) seroconversion. We performed a multi-ethnic, multicentric observational cohort study. The analyzed cohort consisted of 178 mono-infected, predominantly male (75.3%) chronic hepatitis B patients of mixed ethnicity (44.4% Asians, 48.9% Caucasians) with nucleos(t)ide analogue-induced HBeAg seroconversion. Treatment was withdrawn in 105 patients and continued in 73, leading to HBsAg loss in 14 patients off- and 16 patients on-treatment, respectively. Overall, HBsAg loss rates were not affected by treatment cessation (hazard ratio 1.45, p = 0.372), regardless of consolidation treatment duration. Caucasian ethnicity was associated with an increased chance of HBsAg loss (hazard ratio 6.70, p = 0.001), but hepatitis B virus genotype was not (p = 0.812). In conclusion, ethnicity is the most important determinant for HBsAg loss after NA-induced HBeAg seroconversion, with up to six-fold higher HBsAg loss rates in Caucasians compared to Asians, irrespective of treatment cessation and consolidation treatment duration.
Collapse
Affiliation(s)
- Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2650 Antwerp, Belgium
| | - Heng Chi
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 3015 AA Rotterdam, The Netherlands
| | - Bettina Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 3015 AA Rotterdam, The Netherlands
- Toronto Centre of Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON M5G2C4, Canada
| | - Stefan Bourgeois
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Department of Gastroenterology and Hepatology, ZNA Stuivenberg, 2060 Antwerp, Belgium
| | - Hans Van Vlierberghe
- Department of Gastroenterology and Hepatology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Thomas Sersté
- Department of Gastroenterology and Hepatology, Saint-Pierre University Hospital, 1000 Brussels, Belgium
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2650 Antwerp, Belgium
| | - David Wong
- Toronto Centre of Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON M5G2C4, Canada
| | - Dirk Sprengers
- Department of Gastroenterology and Hepatology, GZA Antwerp, 2610 Antwerp, Belgium
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Frederik Nevens
- Department of Hepatology, University Hospitals KULeuven, 3000 Leuven, Belgium
| | - Harry Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 3015 AA Rotterdam, The Netherlands
- Toronto Centre of Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON M5G2C4, Canada
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650 Antwerp, Belgium.
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2650 Antwerp, Belgium.
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 3015 AA Rotterdam, The Netherlands.
| |
Collapse
|
20
|
Van Hees S, Chi H, Hansen B, Bourgeois S, Van Vlierberghe H, Sersté T, Francque S, Wong D, Sprengers D, Moreno C, Nevens F, Janssen HLA, Vanwolleghem T. Sustained off-treatment viral control is associated with high hepatitis B surface antigen seroclearance rates in Caucasian patients with nucleos(t)ide analogue-induced HBeAg seroconversion. J Viral Hepat 2019; 26:766-769. [PMID: 30801868 DOI: 10.1111/jvh.13084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Stijn Van Hees
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Antwerp University, Antwerp, Belgium
| | - Heng Chi
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bettina Hansen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Toronto Centre of Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Stefan Bourgeois
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Gastroenterology and Hepatology, ZNA Stuivenberg, Antwerp, Belgium
| | - Hans Van Vlierberghe
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Sersté
- Department of Gastroenterology and Hepatology, Saint-Pierre University Hospital, Brussels, Belgium
| | - Sven Francque
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Antwerp University, Antwerp, Belgium
| | - David Wong
- Toronto Centre of Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Dirk Sprengers
- Department of Gastroenterology and Hepatology, GZA Antwerp, Antwerp, Belgium
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Frederik Nevens
- Department of Hepatology, University Hospitals KULeuven, Leuven, Belgium
| | - Harry L A Janssen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.,Toronto Centre of Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Antwerp, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Antwerp University, Antwerp, Belgium.,Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
21
|
Van Hees S, Bourgeois S, Van Vlierberghe H, Sersté T, Francque S, Michielsen P, Sprengers D, Reynaert H, Henrion J, Negrin Dastis S, Delwaide J, Lasser L, Decaestecker J, Orlent H, Janssens F, Robaeys G, Colle I, Stärkel P, Moreno C, Nevens F, Vanwolleghem T, Van Hees S, Bourgeois S, Van Vlierberghe H, Sersté T, Francque S, Michielsen P, Sprengers D, Reynaert H, Henrion J, Negrin‐Dastis S, Delwaide J, Lasser L, Decaestecker J, Orlent H, Janssens F, Robaeys G, Colle I, Stärkel P, Moreno C, Nevens F, Vanwolleghem T. Stopping nucleos(t)ide analogue treatment in Caucasian hepatitis B patients after HBeAg seroconversion is associated with high relapse rates and fatal outcomes. Aliment Pharmacol Ther 2018; 47:1170-1180. [PMID: 29498078 PMCID: PMC5900846 DOI: 10.1111/apt.14560] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 09/14/2017] [Revised: 10/05/2017] [Accepted: 01/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stopping nucleos(t)ide analogues (NA) after hepatitis B e antigen (HBeAg) seroconversion is associated with high relapse rates in Asian patients, but data in Caucasian cohorts are scarce. Clinical course, outcomes and immunological aspects of chronic hepatitis B infections differ substantially between distinct ethnicities. AIM The aim of this study was to determine relapse rates, factors predicting relapse and clinical outcomes after nucleos(t)ide analogue cessation in a large, predominantly Caucasian cohort of chronic hepatitis B patients with nucleos(t)ide analogue-induced HBeAg seroconversion. METHODS This is a nationwide observational cohort study including HBeAg positive, mono-infected chronic hepatitis B patients with nucleos(t)ide analogue-induced HBeAg seroconversion from 18 centres in Belgium. RESULTS A total of 98 patients with nucleo(s)tide analogue-induced HBeAg seroconversion were included in the study. Of the 62 patients who stopped treatment after a median consolidation treatment of 8 months, 30 relapsed. Higher gamma-glutamyl transferase levels at both treatment initiation (HR 1.004; P = 0.001 per unit increment) and HBeAg seroconversion (HR 1.006; P = 0.013 per unit increment) were associated with an increased risk of clinically significant relapse in a multivariate Cox regression model. Treatment cessation led to liver-related death in 2 patients, of whom one showed a severe flare. Of the patients who continued treatment after HBeAg seroconversion, none relapsed or developed severe hepatic outcomes. CONCLUSION Treatment withdrawal in Caucasian chronic hepatitis B patients after nucleos(t)ide analogue-induced HBeAg seroconversion results in viral relapses in more than half of patients with potential fatal outcomes. These real-world data further lend support to preferentially continue NA treatment after HBeAg seroconversion until HBsAg loss.
Collapse
|
22
|
Chi H, Wong D, Peng J, Cao J, Van Hees S, Vanwolleghem T, Qi X, Chen L, Feld JJ, de Knegt RJ, Hansen BE, Janssen HLA. Durability of Response After Hepatitis B Surface Antigen Seroclearance During Nucleos(t)ide Analogue Treatment in a Multiethnic Cohort of Chronic Hepatitis B Patients: Results After Treatment Cessation. Clin Infect Dis 2017; 65:680-683. [DOI: 10.1093/cid/cix353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/01/2017] [Indexed: 12/13/2022] Open
|
23
|
Van Hees S, Michielsen P, Vanwolleghem T. Circulating predictive and diagnostic biomarkers for hepatitis B virus-associated hepatocellular carcinoma. World J Gastroenterol 2016; 22:8271-8282. [PMID: 27729734 PMCID: PMC5055858 DOI: 10.3748/wjg.v22.i37.8271] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/18/2016] [Accepted: 08/05/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B virus (HBV) infected patients have an almost 100-fold increased risk to develop hepatocellular carcinoma (HCC). HCC is the fifth most common and third most deadly cancer worldwide. Up to 50% of newly diagnosed HCC cases are attributed to HBV infection. Early detection improves survival and can be achieved through regular screening. Six-monthly abdominal ultrasound, either alone or in combination with alpha-fetoprotein serum levels, has been widely endorsed for this purpose. Both techniques however yield limited diagnostic accuracy, which is not improved when they are combined. Alternative circulating or histological markers to predict or diagnose HCC are therefore urgently needed. Recent advances in systems biology technologies have enabled the identification of several new putative circulating biomarkers. Although results from studies assessing combinations of these biomarkers are promising, evidence for their clinical utility remains low. In addition, most of the studies conducted so far show limitations in design. Attention must be paid for instance to different ethnicities and different etiologies when studying biomarkers for hepatocellular carcinoma. This review provides an overview on the current understandings and recent progress in the field of diagnostic and predictive circulating biomarkers for hepatocellular carcinoma in chronically infected HBV patients and discusses the future prospects.
Collapse
|