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Liver stiffness as a predictor of hepatocellular carcinoma behavior in patients with hepatitis c related liver cirrhosis

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 22-28页

作者： Sameh A Lashen Mohamed M Elshafei Fahmy H Hablass Eman A Alsayed Asmaa A Hassan Department of Internal Medicine Faculty of MedicineUniversity of AlexandriaAlexandriaEgypt Department of Radiology Faculty of MedicineUniversity of AlexandriaAlexandriaEgypt Department of Biomedical Informatics and Medical Statistics Medical Research InstituteUniversity of AlexandriaAlexandriaEgypt

Background: Risk strati cation and prognostication of hepatocellular carcinoma (Hcc) help to improve patient outcome. Herein we investigated the role of liver stiffness measurement (LSM) in the prediction of Hcc behavior. Methods: Totally 121 na ve patients with Hcc were included. Hcc radiological evaluation and staging were done. LSM was measured using virtual touch quanti cation. Patients were divided into early to intermediate Hcc (BcLc-0, A and B) and late Hcc (BcLcc and D). Hcc was treated according to the BcLc stage. Hcc recurrence-free interval was estimated. Results: The mean LSM inside the tumor was signi cantly lower than the peri-tumoral area and the cirrhotic non-cancerous liver parts (Pccs stage, the mean LSM inside the tumor and in the peri-tumoral tissue was lower than the corresponding values in the early to intermediate Hccs stage (Pcorrelated with serum AFP, tumor vascular invasion, and stage (Pcurrence-free interval was directly correlated to LSM inside the tumor and inversely to LSM in cirrhotic non tumorous liver part. Kaplan-Meier analysis showed that the recurrence-free interval was signi cantly longer in patients with LSM inside the tumor of ≥1.25m/s compared to those with LSM inside the tumor ofconclusions: LSM can serve as a potential non-invasive predictor for Hcc clinical behavior and the recurrence-free interval following loco-regional treatments.

关键词： Fibrosis hepatitis c Hepatocellular carcinoma Point shear wave Liver cirrhosis

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Toll-like receptors and hepatitis c virus infection

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Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 521-529页

作者： Yang Gao Narayan Nepal Shi-Zhu Jin Department of Gastroenterology and Hepatology The Second Affiliated Hospital of Harbin Medical UniversityHarbin 150086China

Background:hepatitis c virus(HcV)infection is a worldwide ***,the current treatment for hepatitis c has many ***-like receptors(TLRs)are pattern recognition receptors involved in HcV infection,and an increasing number of studies are focusing on the role of TLRs in the progression of hepatitis *** sources:We performed a Pub Med search up to January 2021 with the following keywords:hepatitis c,toll-like receptors,interferons,inflammation,and immune *** also used terms such as single-nucleotide polymorphisms(SNPs),susceptibility,fibrosis,cirrhosis,direct-acting antiviral agents,agonists,and antagonists to supplement the query *** reviewed relevant publications analyzing the correlation between hepatitis c and TLRs and the role of TLRs in HcV ***:TLRs 1–4 and 6–9 are involved in the process of HcV *** the host is exposed to the HcV,TLRs,as important participants in HcV immune evasion,trigger innate immunity to remove the virus and also promote inflammation and liver *** gene SNPs affect hepatitis c susceptibility,treatment,and *** contribution of each TLR to HcV is *** targeting various TLRs are developed and validated,and TLRs can synergize with classic hepatitis c drugs,including interferon and direct-acting antiviral agents,constituting a new direction for the treatment of hepatitis ***:TLRs are important receptors in HcV *** TLRs induce different mechanisms of virus clearance and inflammatory *** TLR-related antiviral therapy strategies exist,more studies are needed to explore the clinical application of TLR-related drugs.

关键词： hepatitis c Toll-like receptors Interferons Inflammation Immune evasion

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hepatitis c eradication with sofosbuvir leads to significant metabolic changes

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World Journal of Hepatology 2016年第35期8卷 1557-1563页

作者： Amilcar L Morales Zachary Junga Manish B Singla Maria Sjogren Dawn Torres Hepatology Service San Antonio Military Medical Center Gastroenterology Service Walter Reed National Military Medical Center Department of Internal Medicine Walter Reed National Military Medical Center

AIMTo assess the effect of sofosbuvir (SOF) based regimens on glycemic and lipid control. METHODSThis is a retrospective analysis of hepatitis c virus (HcV)-infected patients treated and cured with a SOF regimen [SOF/ribavirin/interferon, SOF/simeprevir, or SOF/ledipasvir (LDV) ± ribavirin] from January 2014 to March 2015. Patients with hemoglobin A1c (HbA1c) and lipid panels within six months before and six months after therapy were identified and included in our study. Due to the known hemolytic effect of ribavirin, HbA1c was obtained a minimum of three months post-treatment for the patients treated with a ribavirin regimen. Medical history, demographics, HcV genotype, pre-therapy RNA, and liver biopsies were included in our analysis. The patients who started a new medication or had an adjustment of baseline medical management for hyperlipidemia or diabetes mellitus (DM) were excluded from our analysis. RESULTSTwo hundred and thirty-four patients were reviewed, of which 60 patients met inclusion criteria. Sixty-three point three percent were male, 26.7% were caucasian, 41.7% were African American and 91.7% were infected with hepatitis c genotype 1. Mean age was 60.6 ± 6.7 years. Thirty-nine patients had HbA1c checked before and after treatment, of which 22 had the diagnosis of DM type 2. HbA1c significantly decreased with treatment of HcV (pretreatment 6.66% ± 0.95% vs post-treatment 6.14% ± 0.65%, P vs 0.71% ± 0.83%, P = 0.070). Fifty-two patients had pre- and post-treatment lipid panels; there was a significant increase in low-density lipoprotein (LDL) and total cholesterol (Tc) after treatment (LDL: 99.5 ± 28.9 mg/dL vs 128.3 ± 34.9 mg/dL, P vs 199.7 ± 40.0 mg/dL, P P = 0.684). cONcLUSIONEradication of HcV with a SOF regimen resulted in a significant drop in HbA1c and an increase in LDL and Tc post therapy.

关键词： hepatitis c Sofosbuvir Hyperlipidemia Hemoglobin A1c Low-density lipoprotein

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Genotype 3 is the predominant hepatitis c genotype in a multi-ethnic Asian population in Malaysia

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Hepatobiliary & Pancreatic Diseases International 2015年第3期14卷 281-286页

作者： Shiaw-Hooi Ho Kee-Peng Ng Harvinder Kaur Khean-Lee Goh Gastroenterology and Hepatology Unit Department of Internal MedicineUniversity of Malaya Department of Medical Microbiology University of Malaya

BAcKGROUND： Genotypes of hepatitis c virus （HcV） are distributed differently across the world. There is a paucity of such data in a multi-ethnic Asian population like Malaysia. The objectives of this study were to determine the distribution of HcV genotypes between major ethnic groups and to ascer- tain their association with basic demographic variables like age and gender.

关键词： Asian genotype hepatitis c Malaysia multi-ethnic

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Treatment of hepatitis c in children and adolescents:how far have we reached?

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World Journal of Pediatrics 2023年第2期19卷 107-119页

作者： Vybhav Venkatesh Keerthivasan Seetharaman Neha Anushree Department of Gastroenterology and Hepatobiliary Sciences IMS and SUM HospitalSOA UniversityBhubaneswarIndia Department of Pediatrics Sri Manakula Vinayagar Medical College and HospitalPuducherryIndia Department of Pediatrics Command Hospital-Southern CommandPune411040India

Background hepatitis c virus(HcV)infection is a global public health problem and also generates a significant case load in children and *** the introduction of directly acting antivirals(DAA),the treatment and care of HcV-infected patients have progressed *** available treatment options in children are limited,and this review aims to provide an overview of treatment of HcV infection in children and adolescents with the current available DAA *** sources This comprehensive review was undertaken after searching the PubMed/Medline and Embase databases for the available up-to-date literature on pediatric HcV infection and treatment using hepatitis c virus infection/HcV,directly acting antivirals/DAA,natural history,treatment,pediatrics,children,and adolescents as *** combination therapies with highly effective DAA regimes,such as sofosbuvir/ledipasvir,sofosbuvir/velpatasvir,glecaprevir/pibrentasvir,sofosbuvir/daclatasvir,sofosbuvir/ribavirin and others,are available for use in *** of the DAA regimens have either received or are pending to receive regulatory approval by different medical/drug agencies for use in children and ***-genotypic regimens are also available in children and adolescents,and these regimens can be used while skipping genotype *** The literature on different DAA regimens for use in children shows that these regimens have higher cure rates with minimal side effects and shorter duration of therapy.

关键词： children Directly acting antivirals hepatitis c

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hepatitis c Associated B-cell Non-Hodgkin Lymphoma:clinical Features and the Role of Antiviral Therapy

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Journal of clinical and Translational Hepatology 2015年第2期3卷 134-139页

作者： Syed Tasleem Gagan K Sood Department of Surgery St.Luke's Center for Liver Disease Baylor College of Medicine Houston Texas USA Department of Surgery St.Luke's Center for Liver Disease Baylor College of Medicine Houston Texas USA Department of Gastroenterology and Hepatology Baylor College of Medicine Houston Texas USA

The link between chronic hepatitis c virus (HcV) infection and a subset of B-cell non-Hodgkin lymphomas (B-NHL) is strongly supported by epidemiological *** demonstrating complete regression of lymphoma after antiviral treatments suggests possible chronic antigenic stimulation for the origin of B-NHL and provides evidence for a virus-mediated lymphomagenesis.B-NHL is a heterogeneous group of lymphomas with varied clinical presentation and may be indolent or *** optimal management of HcV related B-NHL is not *** treatment may be sufficient for low-grade lymphomas,but chemotherapy is necessary in patients with high grade *** (IFN)-based antiviral treatment regimens for HcV infection are limited by poor tolerance and suboptimal antiviral *** approved novel direct acting antiviral (DAA) drugs are highly effective and *** has opened a new era for the treatment of HcV related B-NHL alone or in conjunction with *** of HcV associated B-NHL should be performed in an interdisciplinary approach in close consultation with hematologist and *** this review,we summarize data regarding clinical features and epidemiology of B-NHL and discuss novel therapeutic approaches,including DAAs,that may prove to be effective in the treatment of HcV associated lymphomas.

关键词： hepatitis c Non-Hodgkin lymphoma Mixed cryoglobulinemia Rituximab

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hepatitis c and double-hit B cell lymphoma successfully treated by antiviral therapy

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World Journal of Hepatology 2016年第29期8卷 1244-1250页

作者： Giovanni Galati Lorenzo Rampa Umberto Vespasiani-Gentilucci Mirella Marino Francesco Pisani carlo cota Alessandro Guidi Antonio Picardi Unit of Internal Medicine and Hepatology Department of Medicine Università Campus Bio-Medico di Roma Department of Pathology Regina Elena National Cancer Institute Hematology and Stem cell Transplant Unit Regina Elena National Cancer Institute Dermopahology Unit San Gallicano Dermatological Institute IRCCS

B cells lymphoma is one of the most challenging extrahepatic manifestations of hepatitis c virus(HcV). Recently, a new kind of B-cell lymphoma, named doublehit B(DHL), was characterized with an aggressive clinical course whereas a potential association with HcV was not investigated. The new antiviral direct agents(DAAs) against HcV are effective and curative in the majority of HcV infections. We report the first case, to our knowledge, of DHL and HcV-infection successfully treated by new DAAs. According to our experience, a DHL must be suspected in case of HcV-related lymphoma, and an early diagnosis could direct towards a different hematological management because a worse prognosis might be expected. A possible effect of DAAs on DHL regression should be investigated, but eradicating HcV would avoid life-threatening reactivation of viral hepatitis during pharmacological immunosuppression in oncohaematological diseases.

关键词： hepatitis c Lymphoma Direct antiviral agents Double hit lymphoma chronic hepatitis c

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hepatitis c Virus: A Review of Treatment Guidelines,cost-effectiveness, and Access to Therapy

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Journal of clinical and Translational Hepatology 2016年第4期4卷 310-319页

作者： Shaina M.Lynch George Y.Wu Department of Medicine Division of Gastroenterology-Hepatology University of Connecticut Health Center Hartford USA

hepatitis c virus (HcV) infection remains a significant medical concern in the United States and around the *** is still one of the leading causes of chronic liver disease,and,for more than 20 years,there has been little progress in the treatment of HcV *** advent of direct-acting antivirals (DAAs) initiated the era of high efficacy and well-tolerated medications with high cure *** efficacy of these medications has prompted many professional societies around the world to update their treatment guidelines to include DAAs as first-line *** by the American Association for the Study of Liver Disease/Infectious Disease Society of America,World Health Organization,Asian-Pacific Association for the Study of Liver and the European Association for the Study of Liver have all incorporated DAAs into their treatment *** the promising data supporting these medications,however,their cost represents a limiting factor to their use,even though studies have shown DAAs to be *** addition to the expense of these medications and limited resources,there are many barriers preventing patients from receiving this potentially life-saving *** order to overcome these barriers,these issues need to be recognized and addressed.

关键词： hepatitis c HcV Drug therapy Health care costs

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Impact of hepatitis c oral therapy in portal hypertension

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World Journal of Gastroenterology 2017年第26期23卷 4669-4674页

作者： Diogo Libanio Rui Tato Marinho Department of Gastroenterology Instituto Português de Oncologia do Porto Department of Gastroenterology and Hepatology Centro Hospitalar de Lisboa Norte/Hospital Santa Maria Faculty of Medicine University of Lisbon

chronic hepatitis c is a leading cause of morbidity and mortality, mainly related to fibrosis/cirrhosis and portal hypertension. Direct antiviral agents are highly effective and safe and can now cure > 90% of the patients. Sustained viral response (SVR) after interferon-based regimens has been associated with improvement in liver function, fibrosis and portal hypertension in a significant proportion of patients, although a point of no return seems to exist from which viral elimination is no longer capable of preventing portal hypertension progression and liver decompensation. Indeed, although SVR is associated with improvement of hepatic venous pressure gradients and therefore a decreased risk of de novo esophageal varices, several studies show that viral clearance does not eliminate the risk of variceal progression, liver decompensation and death in patients with pre-established portal hypertension. Although evidence about the effects of direct antiviral agents (DAAs) on clinically significant outcomes is still scarce and with short follow-up, DAAs can decrease the burden of the disease if patients are timely treated before significant fibrosis and portal hypertension develops. Studies with longer follow-up are waited to establish the real magnitude of hepatitis c treatment on portal hypertension. Future studies should also focus on predictors of portal hypertension resolution since it can influence management and avoid unnecessary monitoring

关键词： hepatitis c Portal hypertension Direct antiviral agents cirrhosis Fibrosis Interferon

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Effectiveness and safety of first-generation protease inhibitors in clinical practice:hepatitis c virus patients with advanced fibrosis

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World Journal of Gastroenterology 2015年第30期21卷 9163-9174页

作者： Javier Salmeron carmen Vinaixa Ruben Berenguer Juan Manuel Pascasio Juan Jose Sanchez Ruano Miguel angel Serra Ana Gila Moises Diago Manuel Romero-Gomez Jose Maria Navarro Milagros Testillano conrado Fernandez Dolores Espinosa Isabel carmona Jose Antonio Pons Francisco Jorquera Francisco Javier Rodriguez Ramon Perez Jose Luis Montero Rafael Granados Miguel Fernandez Ana Belen Martin Paloma Munoz de Rueda Rosa Quiles cIBERehd Instituto de Salud Carlos Ⅲ28029 MadridSpain Unit for clinical Management of Digestive Diseases Complejo Hospitalario Universitario de Granada Instituto de Investigacion Biosanitaria de Granada University Hospital Politecnico La Fe Unit for clinical Management of Digestive Diseases University Hospital Virgen Del Rocio Hospital Toledo University clinic Hospital of Valencia University General Hospital of Valencia Unit for clinical Management of Digestive Diseases University Hospital Nuestra Senora de Valme Department of Gastroenterology and Hepatology Agencia Sanitaria costa del Sol University Hospital cruces Gastroenterology Unit University Hospital Fundacion Alcorcon University Hospital Virgen Macarena University Hospital Virgen de la Arrixaca Hospital of Leon University General Hospital Reina Sofia Department Gastroenterology and Hepatology University Hospital Central de Asturias University Hospital Reina Sofia University Hospital De Gran canaria Dr. Negrin Hospital San Pedro de Alcantara

AIM:To evaluates the effectiveness and safety of the first generation,NS3/4A protease inhibitors(PIs) in clinical practice against chronic c virus,especially in patients with advanced fibrosis. METHODS:Prospective study and non-experimental analysis of a multicentre cohort of 38 Spanish hospitals that includes patients with chronic hepatitis c genotype 1,treatment-na?ve(TN) or treatment-experienced(TE),who underwent triple therapy with the first generation NS3/4A protease inhibitors,boceprevir(BOc) and telaprevir(TVR),in combination with pegylated interferon and ribavirin. The patients were treatment in routine practice settings. Data on the study population and on adverse clinical and virologic effects were compiled during the treatment period and during follow ***:One thousand and fifty seven patients were included,405(38%) were treated with BOc and 652(62%) with TVR. Of this total,30%(n = 319) were TN and the remaining were TE:28%(n = 298) relapsers,12%(n = 123) partial responders(PR),25%(n = 260) null-responders(NR) and for 5%(n = 57) with prior response unknown. The rate of sustained virologic response(SVR) by intention-to-treatment(ITT) was greater in those treated with TVR(65%) than in those treated with BOc(52%)(P cant differences. By degree of fibrosis,56% of patients were F4 and the highest SVR rates were recorded in the non-F4 patients,both TN and TE. In the analysis by groups,the TN patients treated with TVR by ITT showed a higher SVR(P = 0.005). However,by m ITT there were no significant differences between BOc and TVR. In the multivariate analysis by m ITT,the significant SVR factors were relapsers,IL28 B cc and non-F4; the type of treatment(BOc or TVR) was not significant. The lowest SVR values were presented by the F4-NR patients,treated with BOc(46%) or with TVR(45%). 28% of the patients interrupted the treatment,mainly by non-viral response(51%):this outcome was

关键词： hepatitis c Boceprevir Telaprevir First-generation protease inhibitors Advanced fibrosis

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