Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Friday, 09 / 21 / 2018

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GUIDELINE

Guideline of Prevention and Treatment for Chronic Hepatitis B (2015 Update)

Jinlin Hou*,1, Guiqiang Wang2, Fusheng Wang3, Jun Cheng4, Hong Ren5, Hui Zhuang6, Jian Sun1, Lanjuan Li7, Jie Li6, Qinghua Meng8, Jingmin Zhao9, Zhongping Duan10, Jidong Jia11, Hong Tang12, Jifang Sheng7, Jie Peng1, Fengmin Lu6, Qing Xie13, Lai Wei*,14, Chinese Society of Hepatology, Chinese Medical Association and Chinese Society of Infectious Diseases, Chinese Medical Association

1Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
2Department of Infectious Diseases, Center for Liver Diseases, Peking University First Hospital, Beijing, China
3The Institute of Translational Hepatology, 302 Hospital of PLA, Peking University, Beijing, China
4Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
5Institute for Viral Hepatitis, the Key Laboratory of Molecular Biology for Infectious Diseases, the second Affiliated Hospital of Chongqing Medical University, Chongqing, China
6Department of Microbiology of Peking University Health Science Center, Beijing, China
7State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
8Serious Illness Medicine Inpatient Area, Beijing Youan Hospital, Capital Medical University, Beijing, China
9Department of Pathology, 302 Hospital of PLA, Peking University, Beijing, China
10Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
11Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
12Center of Infectious Diseases, West China Hospital of Sichuan University, Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
13Department of Infectious Diseases, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, Shanghai, China
14Hepatology Institute, Peking University People’s Hospital, Beijing, China

*Correspondence to: Jinlin Hou, Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou avenue, Guangzhou 510515, China. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; Lai Wei, Peking University People’s Hospital, Peking University Hepatology Institute, No. 11 Xizhimen South Street, Beijing 100044, China. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2017;5(4):297-318 DOI: 10.14218/JCTH.2016.00019

Received: May 3, 2016 Accepted: January 16, 2017 Published online: November 12, 2017

This guideline is established to standardize the prevention, diagnosis and antiviral therapy of chronic hepatitis B (CHB). For other treatment regimens and methods involving CHB, please refer to relevant guidelines and consensuses.

The Chinese Society of Hepatology, Chinese Medical Association (CMA) and the Society of Infectious Diseases, CMA organized relevant native experts to establish this Guideline of Prevention and Treatment for Chronic Hepatitis B (1st version) in 2005, and made the first revision in 2010. In the past 5 years, great progress has been made in the native and foreign fundamental and clinical research with respect to CHB, necessitating additional revision of this guideline.

This guideline is intended to help clinicians make reasonable decisions in the diagnosis, prevention and antiviral therapy of CHB. However, it is not a compulsory standard and does not include or solve all problems in CHB diagnosis, treatment and management. Therefore, clinicians must develop comprehensive and reasonable diagnosis as well as treatment plan for individual patients according to his/her own professional knowledge, clinical experience and available medical resources, based on a full understanding of best clinical evidence relating to this disease and careful consideration of the patient’s specific condition and intention. We will continue to update and improve this guideline according to relevant native and foreign developments.

 

Journal of Clinical and Translational Hepatology 2017 vol. 5 297-318 Html ] [ PDF Full-text ]

© The Authors 2017. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

 

ORIGINAL ARTICLE

Occult HCV Infection (OCI) Diagnosis in Cirrhotic and Non-cirrhotic Naïve Patients by Intra-PBMC Nested Viral RNA PCR

Mohamed Darwish Ahmed Abd Alla*,1, Saleh Ahmed Elibiary1, George Y. Wu2 and Mostafa Kamel El-Awady3

1Tropical Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
2Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
3Department of Microbial Biotechnology, National Research Center, Cairo, Egypt

*Correspondence to: Mohamed Darwish Ahmed Abd Alla, El-Hussein University Hospital, Al-Azhar University, Gouhar Al-Kaed Street, Al-Darasah, Cairo 11675, Egypt. Tel: +20-109-417-5209, Fax: +20-25123091, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2017;5(4):319-326 DOI: 10.14218/JCTH.2017.00034

Received: May 26, 2017 Accepted: August 11, 2017 Published online: September 7, 2017

Abstract

Background and Aims: Occult HCV infections (OCIs) include IgG antibody seronegative cryptogenic (COCIs), as well as seropositive secondary naïve (SNOCIs) and experienced (SEOCIs) cases. We used peripheral-blood-mononuclear-cell (PBMC)-PCR to evaluate COCIs and SNOCIs prevalence, serum HCV spontaneous disappearance (SCSD) in naïve cirrhotics and non-cirrhotics, intra-PBMC HCV-RNA strands in relation to cirrhosis density in naïve non-viremia cases, and HCV-RNA seroconversion after 1 year of solitary naïve intra-PBMC infection.

Methods: The anti-HCV IgG antibody-positive naïve-patients (n = 785) were classified into viremic (n = 673) and non-viremic [n = 112, including non-cirrhotics (n = 55) and cirrhotics (n = 57)], and 62 controls without evidence of HCV-infection. Controls and post-HCV non-viremia cases (n = 62+112 = 174) were submitted to hepatic Fibroscan-Elastography evaluation. All subjects (n = 847) were screened for intra-PBMC HCV-RNA sense and antisense strands by nested-PCR.

Results: Naïve-OCI cases (4.84%) that were diagnosed by PBMC-PCR significantly raised the total numbers of HCV-infection to 714 (p = 0.01). The percent positivity of SNOCIs (34.82%) was significantly higher than for asymptomatic-COCIs (3.125%, p = 0.0001). Comparing PBMC-PCR with single-step-reverse-transcription (SRT)-PCR for identification of SCSD in naïve IgG antibody-positive non-viremia patients (n = 112) revealed a decline in SCSD prevalence by PBMC-PCR (from 14.27% to 9.3%), regardless of presence of hepatic cirrhosis (p = 0.03). SCSD was found to be higher by PBMC-PCR in non-cirrhotics compared to cirrhotics (p = 0.0001), with an insignificant difference when using SRT-PCR (p = 0.45). Intra-PBMC HCV-RNA infection was significantly more frequent in cirrhotics compared to both non-cirrhotics and controls (p < 0.0005). An increased hepatic fibrosis density was recognized in intra-PBMC HCV-RNA infection with sense (p = 0.0001) or antisense strand (p = 0.003). HCV-RNA seroconversion was associated with intra-PBMC infection when both sense and antisense strands were detected (p = 0.047).

Conclusions: Intracellular HCV-RNA evaluation is crucial for diagnosing OCIs and addressing relapse probability.

Keywords

OCIs, PBMCs, Naïve, Cirrhosis

 

Journal of Clinical and Translational Hepatology 2017 vol. 5, 319-326  Html ] [ PDF Full-text ]

© The Authors 2017. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0 ), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

ORIGINAL ARTICLE

Efficacy and Safety of Direct-acting Antivirals in Hepatitis C Virus-infected Patients Taking Proton Pump Inhibitors

Karn Wijarnpreecha*,1, Supavit Chesdachai2, Charat Thongprayoon1, Veeravich Jaruvongvanich3, Patompong Ungprasert4 and Wisit Cheungpasitporn4

1Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
2Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
4Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

*Correspondence to: Karn Wijarnpreecha, Department of Internal Medicine, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA. Tel: +1-607-547-4805, Fax: +1-604-547-6612, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2017;5(4):327-334 DOI: 10.14218/JCTH.2017.00017

Received: March 6, 2017 Accepted: July 12, 2017 Published online: August 18, 2017

Abstract

Background and Aims: Direct-acting antiviral (DAA) therapy is the cornerstone of the treatment of chronic hepatitis C virus (HCV) infection. Eradication of HCV, predicted by the attainment of a sustained virologic response (SVR) 12 weeks following DAA therapy, is the goal of this treatment. Interestingly, recent studies have reported the possible association between HCV-infected patients with DAA therapy concomitant use of proton pump inhibitors (PPIs) and lower odds of achieving SVR. This meta-analysis was conducted to summarize all available data and to estimate this potential association.

Methods: Comprehensive literature review was conducted by first searching the Medline and Embase databases through March 2017 to identify all studies that investigated the safety and efficacy of DAAs in patients with HCV infection taking PPIs versus those without PPIs. Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.

Results: Nine cohort studies with 32,684 participants met the eligibility criteria and were included in the meta-analysis. The use of PPIs concomitant with DAAs among HCV-infected patients was associated with lower odds of achieving SVR compared with non-PPI users (pooled odds ratio (OR): 0.74, 95% confidence interval (CI): 0.63–0.88, I2 = 24%). Subgroup analysis addressed the association between PPIs use and SVR12 demonstrated the association of PPI users showing lower odds of achieving SVR12 compared with those with no use of PPIs (pooled OR: 0.68, 95% CI: 0.51–0.9, I2 = 33%).

Conclusions: This study demonstrated a significantly increased risk of failure to achieve SVR in HCV-infected patients taking DAA with PPIs compared to non-PPI users. Providers should consider whether PPI therapy is indicated for patients and withdraw of PPI therapy in the absence of indications, especially while on DAA therapy.

Keywords

Hepatitis C, Antiviral agents, Proton pump inhibitors, Sustained virologic response, Meta-analysis

 

Journal of Clinical and Translational Hepatology 2017 vol. 5, 327-334  Html ] [ PDF Full-text ]

© The Authors 2017. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

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