Posts filed under ‘Hepatitis B’

Revisiones – Diagnóstico microbiológico de las hepatitis virales

Enf Infecc & Microbiol. Clínica Noviembre 2015 V.33 N.9 e53-e62

Roberto Alonso, Antonio Aguilera, Juan Córdoba, Antonio Fuertes

a Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España

b Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España

c Servicio de Microbiología, Hospital Universitari i Politècnic La Fe, Valencia, España

d LABCO QualityDiagnostics, Madrid, España

La inflamación hepática o hepatitis tiene causas diversas, tanto infecciosas como no infecciosas. Entre las primeras, cabe destacar la etiología viral que es la causa de, al menos, la mitad de todas las hepatitis en el mundo.

Se han descrito distintos virus con tropismo primario por el tejido hepático. Estos microorganismos se han ido nombrando sucesivamente con las letras del abecedario: A, B, C, D, E y G.

El objetivo de este artículo es revisar este grupo heterogéneo de virus en sus aspectos más básicos, sus implicaciones clínicas, su tratamiento, las principales medidas preventivas frente a estas infecciones y, con especial interés, las aproximaciones diagnósticas, tanto serológicas como moleculares, que se utilizan para su detección, cuantificación y caracterización

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90443319&pident_usuario=0&pcontactid=&pident_revista=28&ty=51&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=es&fichero=28v33n09a90443319pdf001.pdf

February 20, 2017 at 3:26 pm

Requirements for global elimination of hepatitis B: a modelling study

Lancet Infectious Diseases December 2016 V.16 N.12 P.1399–1408

Dr Shevanthi Nayagam, MBBS, Prof Mark Thursz, MD, Elisa Sicuri, PhD, Lesong Conteh, PhD, Stefan Wiktor, MD, Daniel Low-Beer, PhD, Prof Timothy B Hallett, PhD

Background

Despite the existence of effective prevention and treatment interventions, hepatitis B virus (HBV) infection continues to cause nearly 1 million deaths each year. WHO aspires to global control and elimination of HBV infection. We aimed to evaluate the potential impact of public health interventions against HBV, propose targets for reducing incidence and mortality, and identify the key developments required to achieve them.

Methods

We developed a simulation model of the global HBV epidemic, incorporating data on the natural history of HBV, prevalence, mortality, vaccine coverage, treatment dynamics, and demographics. We estimate the impact of current interventions and scaling up of existing interventions for prevention of infection and introducing wide-scale population screening and treatment interventions on the worldwide epidemic.

Findings

Vaccination of infants and neonates is already driving a large decrease in new infections; vaccination has already prevented 210 million new chronic infections by 2015 and will have averted 1·1 million deaths by 2030. However, without scale-up of existing interventions, our model showed that there will be a cumulative 63 million new cases of chronic infection and 17 million HBV-related deaths between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people already infected. A target of a 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up the coverage of infant vaccination (to 90% of infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of hepatitis B e antigen-positive mothers), and population-wide testing and treatment (to 80% of eligible people). These interventions would avert 7·3 million deaths between 2015 and 2030, including 1·5 million cases of cancer deaths. An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide. The annual cost would peak at US$7·5 billion worldwide ($3·4 billion in low-income and lower-middle-income countries), but decrease rapidly and this would be accelerated if a cure is developed.

Interpretation

Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious population-wide testing and treatment are needed to eliminate HBV as a major public health threat. Achievement of these targets could make a major contribution to one of the Sustainable Development Goals of combating hepatitis.

Funding

Medical Research Council.

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(16)30204-3.pdf

November 15, 2016 at 12:19 pm

Comment – Eliminating hepatitis B virus as a global health threat

Lancet Infectious Diseases December 2016 V.16 N.12 P.1313–1314

Grace Lai-Hung Wong, Vincent Wai-Sun Wong

In The Lancet Infectious Diseases, Shevanthi Nayagam and colleagues1 report a modelling study on the effectiveness of different interventions on the incidence and mortality rate of chronic hepatitis B virus (HBV) infection. To appreciate the implications of this report, we need to understand the context. Chronic viral hepatitis is the seventh leading cause of death worldwide.2 Chronic HBV infection alone affects over 240 million people worldwide and is one of the most common causes of cirrhosis and liver cancer.3 In May, 2014, the World Health Assembly requested WHO to provide the necessary technical support to enable member states to develop robust national viral hepatitis prevention, diagnosis, and treatment strategies. In response, WHO set ambitious goals of reducing new cases of chronic viral hepatitis by 90%, and reducing mortality rates from these infections by 65% between 2015 and 2030.4 Achievement of these goals might at least eliminate chronic viral hepatitis as a major global health threat. What can we do to make this happen?

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(16)30214-6.pdf

November 15, 2016 at 12:15 pm

Review article: novel therapies for hepatitis B virus cure – advances and perspectives.

Aliment Pharmacol Ther. 2016 Aug V.44 N.3 P.213-22.

Lin CL1,2, Kao JH3,4,5,6.

Author information

1Department of Gastroenterology, Renai branch, Taipei City Hospital, Taipei, Taiwan.

2Department of Psychology, National Chengchi University, Taipei, Taiwan.

3Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

5Hepatitis Research Center, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan.

6Department of Medical Research, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

BACKGROUND:

Current anti-viral therapies, interferon and nucleos(t)ide analogues, have been proven to reduce the progression of chronic hepatitis B (CHB). However, covalently closed circular DNA (cccDNA) of hepatitis B virus (HBV)  persists, resulting in viral relapse after the discontinuation of treatment.

 

AIM:

To discuss and review novel therapies for chronic hepatitis B infection.

 

METHODS:

Recent published studies which searched from PubMed were comprehensive reviewed. The key words include chronic hepatitis B, hepatitis B virus cure, covalently closed circular DNA, direct acting anti-virals and host targeting agents.

 

RESULTS:

Several novel agents through viral and host targets approaches are under investigations towards functional cure of HBV. On the one hand, direct acting anti-virals targeting virus itself, such as HBV new polymerase inhibitor,  entry inhibitor, engineered site-specific nucleases and RNA interference, could inhibit amplification of cccDNA as well as intrahepatic HBV infection and eliminate or silence cccDNA transcription. Inhibitors of HBV nucleocapsid assembly suppress capsid formation and prevent synthesis of HBV DNA. On the other hand, host targeting agents (HTA) include lymphotoxin-β receptor agonist, toll-like receptor agonist, immune checkpoint inhibitors and adenovirus-based therapeutic vaccine. Through enhancing innate and adaptive immune responses, these agents could induce noncytolytic destruction of cccDNA or attack HBV-infected hepatocytes.

 

CONCLUSION:

With these promising approaches, we hope to reach global hepatitis B virus control in the middle of this century.

 

PDF

http://onlinelibrary.wiley.com/doi/10.1111/apt.13694/epdf

September 10, 2016 at 10:30 am

Hepatitis B – Consenso Argentino 2011 AAEEH

Coordinadores:

Dres. Hugo Fainboim y Adrián Gadano.

Secretarios:

Dres. Nicolás Di Benedetto y Sebastián Marciano.

INDICE

PREFACIO……………………………………………………………………………………………………..7

GLOSARIO…………………………………………………………………………………………………….8

VIROLOGIA: REPLICACION DEL VIRUS DE LA HEPATITIS B ………………… 9

DIAGNOSTICO …………………………………………………………………………………………….9

  1. Métodos serológicos ……………………………………………………………………………………9
  2. Ensayos cuantitativos de HBsAg………………………………………………………………… 10
  3. Detección de HBV-DNA …………………………………………………………………………… 10
  4. Detección de resistencia a antivirales………………………………………………………….. .11

EPIDEMIOLOGIA…………………………………………………………………………………………..12

HISTORIA NATURAL ……………………………………………………………………………………12

  1. Historia natural en adultos inmunocompetentes …………………………………………….. 12
  2. Historia natural en pediatría ……………………………………………………………………….. 12
  3. Historia natural en inmunocomprometidos……………………………………………………. 12

CARCINOMA HEPATOCELULAR………………………………………………………………… 13

TAMIZAJE DE HEPATITIS B………………………………………………………………………… 13

PROFILAXIS DE HEPATITIS ……………………………………………………………………….. 14

  1. Gamaglobulina hiperinmune para Hepatitis B (HBIG) …………………………………… 14
  2. Vacuna anti hepatitis B ……………………………………………………………………………… 14
  3. Profilaxis en grupos especiales……………………………………………………………………. 15

HEPATITIS AGUDA…………………………………………………………………………………….. 16

HEPATITIS B EN TRABAJADORES DE SALUD……………………………………………. 17

INFECCION OCULTA POR HEPATITIS B……………………………………………………… 17

VÍAS DE TRANSMISIÓN………………………………………………………………………………. 18

INDICACIONES DE BIOPSIA HEPÁTICA……………………………………………………… 18

MARCADORES NO INVASIVOS DE FIBROSIS ……………………………………………. 18

GENOTIPIFICACIÓN Y CUANTIFICACIÓN DEL ANTÍGENO DE SUPERFICIE ….. 19

OBJETIVOS DEL TRATAMIENTO…………………………………………………………………. 19

INDICACIONES DE TRATAMIENTO……………………………………………………………… 20

PREDICTORES DE RESPUESTA TERAPEUTICA …………………………………………… 20

  1. Predictores de respuesta pre-tratamiento en pacientes HBeAg positivos ……………… 20
  2. Predictores de respuesta pre-tratamiento en pacientes HBeAg negativos ……………… 21
  3. Predictores de respuesta intra-tratamiento en pacientes HBeAg positivos y negativos.. 21

ESTRATEGIAS DE TRATAMIENTO Y DROGAS DISPONIBLES……………………….. 21

  1. Drogas disponibles …………………………………………………………………………………………. 21
  2. Efectos adversos……………………………………………………………………………………………… 21
  3. Monitoreo del tratamiento: definiciones de respuesta y falla terapéutica ……………….. 22
  4. Estrategia terapéutica………………………………………………………………………………………. 23

Tratamiento de pacientes HBeAg positivo ……………………………………………………………. 23

Tratamiento de pacientes HBeAg negativo …………………………………………………………… 24

  1. Tratamiento en pacientes con cirrosis compensada y descompensada…………………… 24
  2. Tratamiento de pacientes coinfectados con HIV ………………………………………………… 24
  3. Tratamiento en pacientes coinfectados con HCV ……………………………………………….. 25
  4. Tratamiento en pacientes coinfectados con el HDV……………………………………………. 25
  5. Tratamiento en pacientes con manifestaciones extra-hepáticas…………………………….. 25
  6. Tratamiento en pacientes en diálisis y trasplantados renales………………………………. 26

TRATAMIENTO DEL HBV ANTE RESISTENCIA ANTIVIRAL ………………………… 26

TRATAMIENTO DE LA HEPATITIS B AGUDA GRAVE……………………………………. 27

TRASPLANTE HEPATICO EN PACIENTES CON HBV ……………………………………… 27

ESTRATEGIAS TERAPEUTICAS EN PACIENTES CON HBV QUE RECIBIRAN INMUNOSUPRESORES …………………………………………………………………28

ESTRATEGIAS MANEJO DE LA HBV EN GESTACION Y EL PERIODO PERINATAL …. 28

TRATAMIENTO DEL HBV EN PEDIATRIA…………………………………………………………… 29

SEGUIMIENTO DE PACIENTES SIN INDICACION DE TRATAMIENTO……………….. 30

A pesar de la disponibilidad de una vacuna segura y efectiva la hepatitis B continúa siendo un problema de salud en todo el mundo. En los últimos años se ha avanzado en forma considerable en varios tópicos de esta infección, lo que condujo a la Asociación Argentina para el Estudio de las Enfermedades del Hígado (AAEEH) a actualizar el Consenso Argentino de Hepatitis B.

Las novedades más importantes están referidas, entre otras, al diagnóstico molecular de infección por HBV (mayor sensibilidad de las diferentes técnicas de detección del HBV), el mayor conocimiento de la historia natural y su correlación con las indicaciones de tratamiento, el valor de la cuantificación del HBsAg y su utilidad en la historia natural y en el manejo del tratamiento, nuevos datos de resistencia a antivirales, manejo de las reactivaciones con el uso de inmunosupresores y manejo en situaciones especiales como el embarazo y la cirrosis descompensada, entre otras…..

PDF

http://www.aaeeh.org.ar/img-noticias-portada/aaeeh_consenso_hb.pdf

July 28, 2016 at 3:30 pm

Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection – MARCH 2015

These are the first World Health Organization (WHO) guidelines for the prevention, care and treatment of persons living with chronic hepatitis B (CHB) infection, and complement similar recently published guidance by WHO on the prevention, care and treatment of infection due to the hepatitis C virus (HCV).

The recommendations in these guidelines promote the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and eligibility for treatment; prioritize treatment for those with most advanced liver disease and at greatest risk of mortality; and recommend the preferred use of nucleos(t)ide analogues with a high barrier to drug resistance (tenofovir and entecavir, and entecavir in children aged 2–11 years) for first- and second-line treatment. Recommendations for the treatment of HBV/HIV-coinfected persons are based on the WHO 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which will be updated in 2015.

These recommendations provide opportunities to save lives, improve clinical outcomes of persons living with CHB, reduce HBV incidence and transmission, and stigma due to disease, but they also pose practical challenges to policymakers and implementers in low- and middle-income countries….

PDF

http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf?ua=1

July 27, 2016 at 2:20 pm

2016-07-14 Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Key Updates

What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient

The approval of 3 fixed-dose combination products containing tenofovir alafenamide (an oral prodrug of tenofovir) and emtricitabine (TAF/FTC) prompted several changes in the What to Start section. The key changes are highlighted below:

– TAF/FTC was added as a 2-NRTI option in several Recommended and Alternative regimens, as noted in Table 6 of the guidelines. The addition of TAF/FTC to these recommendations is based on data from comparative trials demonstrating that TAF-containing regimens are as effective in achieving or maintaining virologic suppression as tenofovir disoproxil fumarate (TDF)-containing regimens and with more favorable effects on markers of bone and renal health.

– In the What to Start section, the evidence quality rating “II” was expanded to include “relative bioavailability/bioequivalence studies or regimen comparisons from randomized switch studies.” This evidence rating was broadened because not all recommended regimens were evaluated in randomized, controlled trials in antiretroviral therapy (ART)-naive patients. The Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) based their recommendations for some regimens on either data from bioequivalence or relative bioavailability studies, or by extrapolating results from randomized “switch” studies that evaluated a drug’s or regimen’s ability to maintain virologic suppression in patients whose HIV was suppressed on a previous regimen. Guidance for clinicians on choosing between abacavir (ABC)-, TAF-, and TDF-containing regimens was added to What to Start.

– The lopinavir/ritonavir (LPV/r) plus 2-NRTI regimen was removed from the list of Other regimens because regimens containing this protease inhibitor (PI) combination have a larger pill burden and greater toxicity than other currently available options.

Regimen Switching

– Based on the most current data, this section was simplified to focus on switch strategies for virologically suppressed patients. The strategies are categorized as Strategies with Good Supporting Evidence, Strategies Under Evaluation, and Strategies Not Recommended.

HIV-Infected Women

– The Panel emphasizes that ART is recommended for all HIV-infected patients, including all HIV-infected women.

– The Panel also stresses the importance of early treatment for HIV-infected women during pregnancy and continuation of ART after pregnancy.

– This section was updated to include new data on interactions between antiretroviral (ARV) drugs and hormonal contraceptives.

Hepatitis B Virus (HBV)/HIV Coinfection

– This section was updated to include TAF/FTC as a treatment option for patients with HBV/HIV coinfection. Data on the virologic efficacy of TAF for the treatment of HBV in persons without HIV infection and TAF/FTC in persons with HBV/HIV coinfection are discussed.

– The Panel no longer recommends adefovir or telbivudine as options for HBV/HIV coinfected patients, as there is limited safety and efficacy data on their use in this population. In addition, these agents have a higher incidence of toxicities than other recommended treatments.

Hepatitis C Virus (HCV)/HIV Coinfection

– The text and Table 12 in this section were updated with information regarding the potential pharmacokinetic (PK) interactions between different ARV drugs and the recently approved hepatitis C drugs daclatasvir and the fixed-dose combination product of elbasvir and grazoprevir.

– Peginterferon alfa and ribavirin were removed from Table 12, as these agents do not have significant PK interactions with ARV drugs.

Tuberculosis (TB)/HIV Coinfection

– This section was updated to include a discussion on the treatment of latent tuberculosis infection (LTBI) in HIV-infected persons. The added discussion notes that a 12-week course of once-weekly rifapentine and isoniazid is an option for patients receiving either an efavirenz (EFV)- or a raltegravir (RAL)-based regimen.

– This section addresses the data from the TEMPRANO and START studies demonstrating a potential role of ART in reducing TB disease.

The recommendations and discussion regarding when to initiate ART in patients with active TB were simplified.

– As rifamycins are potent inducers of P-glycoprotein (P-gp), and TAF is a P-gp substrate, coadministration of TAF and rifamycins is not recommended.

Additional Updates

Minor revisions were made to the following sections:

– Laboratory Testing for Initial Assessment and Monitoring of HIV-Infected Patients on Antiretroviral Therapy

– Drug Resistance Testing

– Adverse Effects of Antiretroviral Agents and Tables 14 and 15

– Monthly Average Wholesale Price of Commonly Used Antiretroviral Drugs (Table 16)

– Drug Interaction Tables 18, 19a-e, and 20b

– Drug Characteristics Tables (Appendix B, Tables 1–7)

PDF

https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

 

July 25, 2016 at 2:17 pm

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