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Chronic hepatitis B in 2014: Great therapeutic progress, large diagnostic deficit

World Journal of Gastroenterology 2014年第33期20卷 11595-11617页

作者： claus niederau Katholisches Klinikum Oberhausen GmbH St. Josef Hospital Klinik für Innere Medizin Akademisches Lehr-krankenhaus der Universit?t Duisburg-Essen 46045 Oberhausen Germany

This review analyzes progress and limitations of diagnosis, screening, and therapy of patients with chronic hepatitis B infection. A literature review was carried out by framing the study questions. Vaccination in early childhood has been introduced in most countries and reduces the infection rate. Treatment of chronic hepatitis B can control viral replication in most patients today. It reduces risks for progression and may reverse liver fibrosis. The treatment effect on development of hepatocellular carcinoma is less pronounced when cirrhosis is already present. Despite the success of vaccination and therapy chronic hepatitis B remains a problem since many infected patients do not know of their disease. Although all guidelines recommend screening in high risk groups such as migrants, these suggestions have not been implemented. In addition, the performance of hepatocellular cancer surveillance under real-life conditions is poor. The majority of people with chronic hepatitis B live in resource-constrained settings where effective drugs are not available. Despite the success of vaccination and therapy chronic hepatitis B infection remains a major problem since many patients do not know of their disease. The problems in diagnosis andscreening may be overcome by raising awareness, promoting partnerships, and mobilizing resources.

关键词： Chronic hepatitis B HBsAg Screening Liv-er cirrhosis Hepatocellular cancer Entecavir Tenofovi Telbivudine Adefovir Lamivudine Interferon

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Chronic hepatitis C:Treat or wait? Medical decision making in clinical practice

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World Journal of Gastroenterology 2012年第12期18卷 1339-1347页

作者： claus niederau Dietrich Hüppe Elmar Zehnter Bernd Mller Renate Heyne Stefan Christensen Rainer Pfaff Arno Theilmeier Ulrich Alshuth Stefan Mauss Katholische Kliniken Oberhausen St.Josef HospitalKlinik für Innere MedizinOberhausen 46045Germany Medical Office for Gastroenterology and Hepatology Herne 44623Germany Medical Office for Gastroenterology and Hepatology Dortmund 44263Germany Medical Office for Gastroenterology and Hepatology Berlin 10969Germany Center for Interdisciplinary Medicine Münster 48143Germany Medical Office for Gastroenterology and Hepatology Gie en 35392Germany Medical Office for Gastroenterology and Hepatology Mnchengladbach 41239Germany Pharma AG Medical Management Virology Grenzach-Wyhlen 79639Germany Center for HIV and Hepatogastroenterology Düsseldorf 40237Germany

AIM:To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or ***:This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α2 a/ribavirin,involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings).A structured questionnaire had to be answered prior to the treatment decision,which included demographic data,information about the personal life situation of the patients,anamnesis and symptomatology of hepatitis C,virological data,laboratory data and data on concomitant diseases.A second part of the study analyzes patients treated with pegylated interferon α*** questionnaires included reasons against treatment mentioned by the ***:Overall treatment uptake was 45%.By multivariate analysis,genotype 1/4/5/6,HCV-RNA ≤ 520 000 IU/mL,normal alanine aminotransferase (ALT),platelets ≤ 142 500/μL,age > 56 years,female gender,infection length > 12.5 years,concomitant diseases,human immunodeficiency virus co-infection,liver biopsy not performed,care in private practice,asymptomatic disease,and unemployment were factors associated with reduced treatment *** and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language *** rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were ***:Some reasons against treatment were medically based whereas others were related to fears,socio-economical problems,and information deficits both on the side of physicians and patients.

关键词： Hepatitis C virus Interferon, Ribavirin Livercirrhosis Migrants Treatment barrier

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