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Risk assessment and management of hepatitis B reactivation from direct-acting antivirals for hepatitis C

Liver Research 2019年第2期3卷 75-79页

作者： maureen whitsett David M.Feldman Calvin Q.Pan Division of Gastroenterology and Hepatology Department of MedicineNYU Langone HealthNew York University School of MedicineNew YorkNYUSA

Although hepatitis B virus(HBV)reactivation has been reported in hepatitis C patients who received interferon therapy,rare cases of HBV reactivation occur in the context of direct-acting antiviral(DAA)agent therapy for treatment of hepatitis C virus(HCV)*** studies observed that the reactivations were predominantly in hepatitis B surface antigen(HBsAg)positive patients,but reactivation can rarely occur in patients who are HBsAg negative and hepatitis B core antibody(HBcAb)*** severity of an HBV flare *** some cases,severe liver injury or fulminant hepatic failure may *** reactivation may occur regardless of HCV genotype and type of DAA *** onset of HBV reactivation can range from 4 to 48 weeks after initiating DAA *** patients may have undetectable levels of HBV deoxyribonucleic acid(DNA)prior to DAA ***-emptive antiviral therapy for HBV should be considered in HBsAg-positive patients with high levels of viremia who are not receiving HBV *** HBV DNA viral load is less than the guideline criteria for HBV treatment,one should consider pre-emptive HBV antiviral versus HBV DNA monitoring during DAA *** patients who are HBsAg negative but HBcAb positive,close monitoring of serum alanine aminotransferase(ALT)levels during/post-treatment is highly *** current review summarizes the recommendations of different society guidelines and discusses the appropriate management strategies in various patient profiles.

关键词： Co-infection Treatment induced flares Hepatitis B exacerbation Hepatitis C therapy Prevention of disease reactivation

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Physical activity as a treatment of non-alcoholic fatty liver disease:A systematic review

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World Journal of Hepatology 2015年第16期7卷 2041-2052页

作者： maureen whitsett Lisa B VanWagner Department of Medicine Division of Gastroenterology and Hepatology Northwestern University Feinberg School of Medicine Chicago

AIM: To review the effectiveness of exercise as a therapy for nonalcoholic fatty liver disease(NAFLD) and potential benefits in treating insulin resistance and ***: Medline(EBSCOhost) and Pub Med were searched for English-language randomized controlled trials and prospective cohort studies in human adults aged ≥ 18 which investigated the various effects of exercise alone, a combination of exercise and diet, or exercise and diet coupled with behavioral modification on NAFLD from 2010 to Feburary ***: Eighteen of 2298 available studies were chosen for critical review, which included 6925 patients. Nine(50%) studies were randomized controlled trials. Five(27.8%) studies utilized biopsy to examine the effects of physical activity on hepatic histology. The most commonly employed imaging modality to determine change in hepatic steatosis was hydrogen-magnetic resonance spectroscopy. Only two studies examined the effects of low impact physical activity for patients with significant mobility limitations and one compared the efficacy of aerobic and resistance exercise. No studies examined the exact duration of exercise required for hepatic and metabolic improvement in ***: While exercise improved hepatic steatosis and underlying metabolic abnormalities in NAFLD, more studies are needed to define the most beneficial form and duration of exercise treatment.

关键词： Nonalcoholic fatty liver disease Nonalcoholicsteatohepatitis Fatty liver Exercise Obesity

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