Posts filed under ‘Hepatitis B’

Serum HBeAg and HBV DNA levels are not always proportional and only high levels of HBeAg most likely correlate with high levels of HBV DNA.

MEDICINE August 2017 V.96 N.33

Chen, Ping PhDa,b; Xie, Qinfen MSa; Lu, Xuan BAb; Yu, Chengbo PhDb; Xu, Kaijin PhDb; Ruan, Bing PhDb; Cao, Hongcui PhDb; Gao, Hainv PhDa; Li, Lanjuan MDb,*

Abstract

This study aimed to investigate the correlation between quantitative hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA levels, and to determine whether semiquantitative measurement of HBeAg can indicate the extent of HBV replication in HBeAg-positive subjects in the immune tolerant phase.

A cross-sectional, community-based survey was carried out in 12 communities of 2 counties in Zhejiang Province, China.

A panel of 788 HBeAg-positive subjects was divided into 4 groups according to HBV DNA level.

Groups I (n = 111), II (n = 91), III (n = 124), and IV (n = 462) had HBV DNA levels below 103 copies/mL (PCR undetectable), between 103 and 105 copies/mL (PCR detectable), between 105 and 2 × 107 copies/mL (hybridization detectable), and >2 × 107 copies/mL, respectively.

The HBeAg level correlated well with the HBV DNA level (R2 = 0.658; P < .01) on a log scale.

The average HBeAg level in group IV was significantly higher than those in the other 3 groups, and the best HBeAg cut-off value for differentiating group IV from the other 3 groups was 768 S/CO, with a sensitivity of 94.4% and specificity of 91.1%.

Semiquantification of HBeAg could indicate a relative HBV DNA level in HBeAg-positive subjects in the immune tolerant phase.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/08180/Serum_HBeAg_and_HBV_DNA_levels_are_not_always.22.aspx

PDF (hacer CLIC en “Article as PDF”)

Advertisements

August 19, 2017 at 12:08 pm

Time to re-evaluate the effect of the adolescent booster of hepatitis B vaccine

International Journal of Infectious Diseases July 2017 V.60 N.7 P.88-90

Editorial –

Ellie Carmody

Division of Infectious Diseases and Immunology, New York University School of Medicine, New York, New York, USA

Neutralizing antibodies (anti-HBs) conferred by immunization with hepatitis B virus (HBV) vaccine against HBV surface antigen (HBsAg) have been found to wane or reach undetectable levels in many individuals after 10–15 years of the vaccination (Wainwright et al., 1997, Dentinger et al., 2005).

It is uncertain whether individuals with low or absent levels of anti-HBs remain protected against HBV infection.

HBV vaccine does elicit immunologic memory, in which memory B cells can appropriately generate a robust anamnestic response to HBsAg even if the anti-HBs titer falls below 10 mIU/mL (West and Calandra, 1996, Watson et al., 2001, van der Sande et al., 2007).

However, the duration and uniformity of this immunologic memory after primary vaccination at infancy is unclear. HBV breakthrough infection in young adults may occur if the immunologic memory to HBsAg is absent upon sexual, parenteral, or horizontal (household) HBV exposure….

PDF

http://www.ijidonline.com/article/S1201-9712(17)30131-5/pdf

July 30, 2017 at 12:41 pm

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

Older Posts


Calendar

September 2017
M T W T F S S
« Aug    
 123
45678910
11121314151617
18192021222324
252627282930  

Posts by Month

Posts by Category