Systematic review with meta-analysis: the efficacy and safety of #tenofovir to prevent mother-to-child transmission of hepatitis #B virus
http://onlinelibrary.wiley.com/doi/10.1111/apt.14068/abstract
For pregnant women with high hepatitis B virus DNA levels, tenofovir administration in the second or third trimester can prevent mother to child transmission when combined with hepatitis B immunoglobulin and the hepatitis B vaccine. Tenofovir is safe and tolerable for both the mother and foetus.
http://onlinelibrary.wiley.com/doi/10.1111/apt.14068/abstract
For pregnant women with high hepatitis B virus DNA levels, tenofovir administration in the second or third trimester can prevent mother to child transmission when combined with hepatitis B immunoglobulin and the hepatitis B vaccine. Tenofovir is safe and tolerable for both the mother and foetus.
Wiley
Systematic review with meta‐analysis: the efficacy and safety of tenofovir to prevent mother‐to‐child transmission of hepatitis…
Preventing mother to child transmission of chronic hepatitis B infection in the setting of a high maternal viral load is challenging. The idea has emerged from antepartum tenofovir treatment with combination...
Long-Term, Supplemental, One-Carbon Metabolism–Related Vitamin #B Use in Relation to #Lung Cancer Risk in the Vitamins and Lifestyle (VITAL) Cohort
http://ascopubs.org/doi/abs/10.1200/JCO.2017.72.7735
Use of supplemental vitamins B6, folate, and B12 was not associated with lung cancer risk among women. In contrast, use of vitamin B6 and B12 from individual supplement sources, but not from multivitamins, was associated with a 30% to 40% increase in lung cancer risk among men. When the 10-year average supplement dose was evaluated, there was an almost two-fold increase in lung cancer risk among men in the highest categories of vitamin B6 (> 20 mg/d; hazard ratio, 1.82; 95% CI, 1.25 to 2.65) and B12 (> 55µg/d; hazard ratio, 1.98; 95% CI, 1.32 to 2.97) compared with nonusers. For vitamin B6 and B12, the risk was even higher among men who were smoking at baseline. In addition, the B6 and B12 associations were apparent in all histologic types except adenocarcinoma, which is the type less related to smoking.
Conclusion
This sex- and source-specific association provides further evidence that vitamin B supplements are not chemopreventive for lung cancer and may be harmful
http://ascopubs.org/doi/abs/10.1200/JCO.2017.72.7735
Use of supplemental vitamins B6, folate, and B12 was not associated with lung cancer risk among women. In contrast, use of vitamin B6 and B12 from individual supplement sources, but not from multivitamins, was associated with a 30% to 40% increase in lung cancer risk among men. When the 10-year average supplement dose was evaluated, there was an almost two-fold increase in lung cancer risk among men in the highest categories of vitamin B6 (> 20 mg/d; hazard ratio, 1.82; 95% CI, 1.25 to 2.65) and B12 (> 55µg/d; hazard ratio, 1.98; 95% CI, 1.32 to 2.97) compared with nonusers. For vitamin B6 and B12, the risk was even higher among men who were smoking at baseline. In addition, the B6 and B12 associations were apparent in all histologic types except adenocarcinoma, which is the type less related to smoking.
Conclusion
This sex- and source-specific association provides further evidence that vitamin B supplements are not chemopreventive for lung cancer and may be harmful
Hepatitis #B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention.
http://annals.org/aim/fullarticle/2664089/hepatitis-b-vaccination-screening-linkage-care-best-practice-advice-from
Clinicians should vaccinate against hepatitis B virus (HBV) in all unvaccinated adults (including pregnant women) at risk for infection due to sexual, percutaneous, or mucosal exposure; health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including hemodialysis patients), or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection.
Best Practice Advice 2:
Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers.
Best Practice Advice 3:
Clinicians should provide or refer all patients identified with HBV (HBsAg-positive) for posttest counseling and hepatitis B–directed care.
http://annals.org/aim/fullarticle/2664089/hepatitis-b-vaccination-screening-linkage-care-best-practice-advice-from
Clinicians should vaccinate against hepatitis B virus (HBV) in all unvaccinated adults (including pregnant women) at risk for infection due to sexual, percutaneous, or mucosal exposure; health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including hemodialysis patients), or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection.
Best Practice Advice 2:
Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers.
Best Practice Advice 3:
Clinicians should provide or refer all patients identified with HBV (HBsAg-positive) for posttest counseling and hepatitis B–directed care.
Hepatitis #B virus reactivation during direct-acting antiviral therapy for hepatitis #C: a systematic review and meta-analysis
http://www.thelancet.com/journals/langas/article/PIIS2468-1253(18)30002-5/fulltext
Direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection might pose a risk for hepatitis B virus (HBV) reactivation in patients coinfected with chronic or resolved HBV infection. The need for HBV antiviral prophylaxis during DAA treatment remains controversial. The pooled proportion of patients who had HBV reactivation was 24% (95% CI 19–30) in patients with chronic HBV infection and 1·4% (0·8–2·4) in those with resolved HBV infection. In patients with chronic HBV infection, the pooled proportion of patients with HBV-reactivation-related hepatitis was 9% (95% CI 5–16) and the relative risk (RR) of HBV-reactivation-related hepatitis was significantly lower in patients with HBV DNA below the lower limit of quantification at baseline than in those with quantifiable HBV DNA (RR 0·17, 95% CI 0·06–0·50; p=0·0011). Three major clinical events related to HBV reactivation in patients with chronic HBV infection were reported (one patient had liver decompensation and two had liver failure, one of whom required liver transplantation). In patients with resolved HBV infection, no HBV-reactivation-related hepatitis was reported.
Interpretation
HBV reactivation occurs frequently in patients with chronic HBV and HCV coinfection receiving DAA therapy but is rare among patients with resolved HBV infection. Use of antiviral prophylaxis might be warranted in patients who test positive for hepatitis B surface antigen (HBsAg), particularly those with quantifiable HBV DNA
http://www.thelancet.com/journals/langas/article/PIIS2468-1253(18)30002-5/fulltext
Direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection might pose a risk for hepatitis B virus (HBV) reactivation in patients coinfected with chronic or resolved HBV infection. The need for HBV antiviral prophylaxis during DAA treatment remains controversial. The pooled proportion of patients who had HBV reactivation was 24% (95% CI 19–30) in patients with chronic HBV infection and 1·4% (0·8–2·4) in those with resolved HBV infection. In patients with chronic HBV infection, the pooled proportion of patients with HBV-reactivation-related hepatitis was 9% (95% CI 5–16) and the relative risk (RR) of HBV-reactivation-related hepatitis was significantly lower in patients with HBV DNA below the lower limit of quantification at baseline than in those with quantifiable HBV DNA (RR 0·17, 95% CI 0·06–0·50; p=0·0011). Three major clinical events related to HBV reactivation in patients with chronic HBV infection were reported (one patient had liver decompensation and two had liver failure, one of whom required liver transplantation). In patients with resolved HBV infection, no HBV-reactivation-related hepatitis was reported.
Interpretation
HBV reactivation occurs frequently in patients with chronic HBV and HCV coinfection receiving DAA therapy but is rare among patients with resolved HBV infection. Use of antiviral prophylaxis might be warranted in patients who test positive for hepatitis B surface antigen (HBsAg), particularly those with quantifiable HBV DNA
Development and validation of a scoring system to predict progression to acute-on-chronic liver #failure in patients with acute exacerbation of chronic hepatitis #B
http://onlinelibrary.wiley.com/doi/10.1111/hepr.13062/full
Hepatitis B virus (HBV) DNA, international normalized ratio (INR) of prothrombin time, and patient age were identified as independent risk factors associated with progressing to ACLF. The prediction model was established as R=-13.323+0.553×log HBV DNA (copies/mL)+3.631× INR+0.053×age. The AUROCs of our prediction model were higher than those of the Model for End-Stage Liver Disease (MELD) and MELD-sodium (Na) for both cohorts. At the cut-off value of -2.43, our prediction model had higher sensitivity (87.5%), specificity (73.6%), positive predictive value (23.0%), positive likelihood ratio (3.30), and lower negative likelihood ratio (0.17) in the validation cohort than those of the MELD and MELD-Na.
Conclusion
The independent risk factors associated with progressing to ACLF in patients with AE of CHB are HBV DNA, INR, and old age. Our risk prediction model is useful for predicting the development of ACLF
http://onlinelibrary.wiley.com/doi/10.1111/hepr.13062/full
Hepatitis B virus (HBV) DNA, international normalized ratio (INR) of prothrombin time, and patient age were identified as independent risk factors associated with progressing to ACLF. The prediction model was established as R=-13.323+0.553×log HBV DNA (copies/mL)+3.631× INR+0.053×age. The AUROCs of our prediction model were higher than those of the Model for End-Stage Liver Disease (MELD) and MELD-sodium (Na) for both cohorts. At the cut-off value of -2.43, our prediction model had higher sensitivity (87.5%), specificity (73.6%), positive predictive value (23.0%), positive likelihood ratio (3.30), and lower negative likelihood ratio (0.17) in the validation cohort than those of the MELD and MELD-Na.
Conclusion
The independent risk factors associated with progressing to ACLF in patients with AE of CHB are HBV DNA, INR, and old age. Our risk prediction model is useful for predicting the development of ACLF
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High risk of #hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis #B
http://gut.bmj.com/content/67/5/945
The clinical outcomes of 413 untreated IT-phase patients with normal alanine aminotransferase (ALT) levels (females, <19 IU/mL; males, <30 IU/mL) were compared with those of 1497 immune-active (IA)-phase patients (ALT ≥80 IU/mL) treated with nucleos(t)ide analogues.
Results The IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p<0.001) were significantly higher in the IT group than the IA group. In multivariable analyses, the IT group showed a significantly higher risk of HCC (HR 2.54; 95% CI 1.54 to 4.18) and death/transplantation (HR 3.38; 95% CI 1.85 to 6.16) than the IA group, which was consistently identified through inverse probability treatment weighting, propensity score-matched and competing risks analyses.
Conclusions Untreated IT-phase patients with CHB had higher risks of HCC and death/transplantation than treated IA-phase patients. Unnecessary deaths could be prevented through earlier antiviral intervention in select IT-phase patients
High risk of #hepatocellular carcinoma and death in patients with immune-tolerant-phase chronic hepatitis #B
http://gut.bmj.com/content/67/5/945
The clinical outcomes of 413 untreated IT-phase patients with normal alanine aminotransferase (ALT) levels (females, <19 IU/mL; males, <30 IU/mL) were compared with those of 1497 immune-active (IA)-phase patients (ALT ≥80 IU/mL) treated with nucleos(t)ide analogues.
Results The IT group was significantly younger than the IA group (mean age, 38 vs 40 years at baseline, p=0.04). The 10-year estimated cumulative incidences of HCC (12.7% vs 6.1%; p=0.001) and death/transplantation (9.7% vs 3.4%; p<0.001) were significantly higher in the IT group than the IA group. In multivariable analyses, the IT group showed a significantly higher risk of HCC (HR 2.54; 95% CI 1.54 to 4.18) and death/transplantation (HR 3.38; 95% CI 1.85 to 6.16) than the IA group, which was consistently identified through inverse probability treatment weighting, propensity score-matched and competing risks analyses.
Conclusions Untreated IT-phase patients with CHB had higher risks of HCC and death/transplantation than treated IA-phase patients. Unnecessary deaths could be prevented through earlier antiviral intervention in select IT-phase patients
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Increased #NK Cell Function After Cessation of Long-Term Nucleos(t)ide Analogue Treatment in Chronic Hepatitis #B Is Associated With Liver Damage and HBsAg Loss
https://academic.oup.com/jid/article-abstract/217/10/1656/4868650?redirectedFrom=fulltext
Unsupervised stochastic neighbor embedding analysis revealed NA-treated CHB patients to have a significantly affected NK cell compartment compared to controls. Cessation of NA treatment resulted in minor phenotypic alterations, but it significantly augmented NK cell natural cytotoxicity responses in the CHB patients. This increased NK cell functionality correlated with alanine aminotransferase flares in the patients and was particularly enhanced in patients experiencing HBsAg seroclearance at long-term follow-up.
Conclusions
Increased NK cell function is associated with active hepatitis and HBsAg seroclearance following structured NA cessation. This adds to our knowledge of the immunological events that develop following cessation of NA treatment in CHB
Increased #NK Cell Function After Cessation of Long-Term Nucleos(t)ide Analogue Treatment in Chronic Hepatitis #B Is Associated With Liver Damage and HBsAg Loss
https://academic.oup.com/jid/article-abstract/217/10/1656/4868650?redirectedFrom=fulltext
Unsupervised stochastic neighbor embedding analysis revealed NA-treated CHB patients to have a significantly affected NK cell compartment compared to controls. Cessation of NA treatment resulted in minor phenotypic alterations, but it significantly augmented NK cell natural cytotoxicity responses in the CHB patients. This increased NK cell functionality correlated with alanine aminotransferase flares in the patients and was particularly enhanced in patients experiencing HBsAg seroclearance at long-term follow-up.
Conclusions
Increased NK cell function is associated with active hepatitis and HBsAg seroclearance following structured NA cessation. This adds to our knowledge of the immunological events that develop following cessation of NA treatment in CHB
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Normal on-treatment #ALT during antiviral treatment is associated with a lower risk of hepatic events in patients with chronic hepatitis #B
https://www.journal-of-hepatology.eu/article/S0168-8278(18)32055-5/fulltext
21,182 CHB patients (10,437 with and 10,745 without ALT-N at 12 months after antiviral treatment) were identified and followed for 4.0±1.7 years. Patients with and without ALT-N differed in baseline ALT (58 vs 61 U/L), HBV DNA (4.9 vs. 5.1 log10 IU/mL) and cirrhosis status (8.8% vs. 10.5%). 627 (3.0%) patients developed composite hepatic events. Compared to no ALT-N, ALT-N at 3, 6, 9 and 12 months reduced the risk of hepatic events, after adjustment for baseline ALT and other important co-variates, with adjusted hazard ratios (95% CI) of 0.61 (0.49-0.77), 0.55 (0.45-0.67), 0.54 (0.44-0.65) and 0.51 (0.42-0.61) respectively (all P<0.001). The cumulative incidence (95% CI) of composite hepatic events at 6 years was 3.51% (3.06%-4.02%) in ALT-N and 5.70% (5.15%-6.32%) in no ALT-N group (P<0.001).
Conclusions
Normal on-treatment ALT can be translated into improved clinical outcomes in CHB patients receiving NA treatment.
Normal on-treatment #ALT during antiviral treatment is associated with a lower risk of hepatic events in patients with chronic hepatitis #B
https://www.journal-of-hepatology.eu/article/S0168-8278(18)32055-5/fulltext
21,182 CHB patients (10,437 with and 10,745 without ALT-N at 12 months after antiviral treatment) were identified and followed for 4.0±1.7 years. Patients with and without ALT-N differed in baseline ALT (58 vs 61 U/L), HBV DNA (4.9 vs. 5.1 log10 IU/mL) and cirrhosis status (8.8% vs. 10.5%). 627 (3.0%) patients developed composite hepatic events. Compared to no ALT-N, ALT-N at 3, 6, 9 and 12 months reduced the risk of hepatic events, after adjustment for baseline ALT and other important co-variates, with adjusted hazard ratios (95% CI) of 0.61 (0.49-0.77), 0.55 (0.45-0.67), 0.54 (0.44-0.65) and 0.51 (0.42-0.61) respectively (all P<0.001). The cumulative incidence (95% CI) of composite hepatic events at 6 years was 3.51% (3.06%-4.02%) in ALT-N and 5.70% (5.15%-6.32%) in no ALT-N group (P<0.001).
Conclusions
Normal on-treatment ALT can be translated into improved clinical outcomes in CHB patients receiving NA treatment.
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Draft Recommendation Statement
Hepatitis #B Virus Infection in Pregnant #Women: Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-b-virus-infection-in-pregnant-women-screening
Importance
Screening for HBV infection during pregnancy identifies women whose infants are at risk of perinatal transmission. Data from a nationally representative sample showed a prevalence of maternal HBV infection of 85.8 cases per 100,000 deliveries from 1998 to 2011 (0.09% of live-born singleton deliveries in the United States).1, 2 Although there are guidelines for universal infant HBV vaccination, rates of maternal HBV have increased annually by 5.5% since 1998.1, 2 Persons infected with HBV during infancy or childhood are more likely to progress to chronic infection. Chronic HBV infection increases long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.
USPSTF Assessment
Using a reaffirmation process, the USPSTF concludes with high certainty that the net benefit of screening for HBV infection in pregnant women is substantial.
Draft Recommendation Statement
Hepatitis #B Virus Infection in Pregnant #Women: Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-b-virus-infection-in-pregnant-women-screening
Importance
Screening for HBV infection during pregnancy identifies women whose infants are at risk of perinatal transmission. Data from a nationally representative sample showed a prevalence of maternal HBV infection of 85.8 cases per 100,000 deliveries from 1998 to 2011 (0.09% of live-born singleton deliveries in the United States).1, 2 Although there are guidelines for universal infant HBV vaccination, rates of maternal HBV have increased annually by 5.5% since 1998.1, 2 Persons infected with HBV during infancy or childhood are more likely to progress to chronic infection. Chronic HBV infection increases long-term morbidity and mortality by predisposing infected persons to cirrhosis of the liver and liver cancer.
USPSTF Assessment
Using a reaffirmation process, the USPSTF concludes with high certainty that the net benefit of screening for HBV infection in pregnant women is substantial.
www.uspreventiveservicestaskforce.org
Draft Recommendation Statement: Hepatitis B Virus Infection in Pregnant Women: Screening - US Preventive Services Task Force
This is a webpage on the US Preventive Services Task Force USPSTF site
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Unresolved issues of immune tolerance in chronic hepatitis #B
During the natural course of chronic hepatitis B virus infection, immune-tolerant phase is characterized by high viral replication, the presence of HBV e antigen (HBeAg), and normal or minimally elevated serum alanine aminotransferase. Immune-tolerant phase is usually regarded as a benign course of the disease. International guidelines recommend observation rather than treatment during immune-tolerant phase. In this article, we review unresolved issues related to the definition of true immune-tolerant phase and the benefit of antiviral treatment
https://bit.ly/2OOFH92
Unresolved issues of immune tolerance in chronic hepatitis #B
During the natural course of chronic hepatitis B virus infection, immune-tolerant phase is characterized by high viral replication, the presence of HBV e antigen (HBeAg), and normal or minimally elevated serum alanine aminotransferase. Immune-tolerant phase is usually regarded as a benign course of the disease. International guidelines recommend observation rather than treatment during immune-tolerant phase. In this article, we review unresolved issues related to the definition of true immune-tolerant phase and the benefit of antiviral treatment
https://bit.ly/2OOFH92
Journal of Gastroenterology
Unresolved issues of immune tolerance in chronic hepatitis B
During the natural course of chronic hepatitis B virus infection, immune-tolerant phase is characterized by high viral replication, the presence of HBV e antigen (HBeAg), and normal or minimally elevated serum alanine aminotransferase. Immune-tolerant phase…
#Pradefovir Treatment in Patients with Chronic Hepatitis #B: Week 24 Results from a Multicenter, Double-blind, Randomized, Noninferiority, Phase 2 Trial
https://2medical.news/2021/09/13/pradefovir-treatment-in-patients-with-chronic-hepatitis-b-week-24-results-from-a-multicenter-double-blind-randomized-noninferiority-phase-2-trial/
https://2medical.news/2021/09/13/pradefovir-treatment-in-patients-with-chronic-hepatitis-b-week-24-results-from-a-multicenter-double-blind-randomized-noninferiority-phase-2-trial/
2Medical.News
#Pradefovir Treatment in Patients with Chronic Hepatitis #B: Week 24 Results from a Multicenter, Double-blind, Randomized, Noninferiority…
Pradefovir is a liver-targeted prodrug of adefovir, a nucleotide analog with antiviral activity against hepatitis B virus (HBV) DNA polymerase. This phase 2 study compared the efficacy and safety o…