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The article presents abstracts of medical research related to liver cancer. They include "Surgery of hepatocellular carcinoma - current status and future prospects," by Zhao-You Tang, "Natural history of hepatitis C virus," Harvey J. Alter and "The history of viral hepatitis: a tale of dogmas and misinterpretations," by Rudi Schmid.

Background and Aim: Burden of hepatitis C in India is not known. We therefore conducted a systematic review of the available data on anti‐hepatitis C virus (HCV) seroprevalence in the Indian population. Methods: We searched several publication databases for English language papers that reported data on anti‐HCV seroprevalence from India and also identified other unpublished sources of such data. Data on groups likely to represent seroprevalence in general population and in selected high‐risk groups were extracted and subjected to meta‐analysis. Results: Of the 3995 published papers and 94 additional data sources identified, 327 were selected; these provided 414 anti‐HCV seroprevalence data points. Pooled anti‐HCV seroprevalence rates in community‐based studies, blood donors, and pregnant women were 0.85% (95% confidence interval: 0.00–3.98%), 0.44% (0.40–0.49), and 0.88% (0.21–1.90), respectively. Among groups considered at high risk of HCV, pooled anti‐HCV seroprevalence rates were as follows: people living with HIV (40 studies from 17 states: 3.51% [2.43–4.76]), persons on maintenance hemodialysis (37, 13; 19.23% [13.52–25.65]), people who inject drugs (46, 14; 44.71% [37.50–52.03]), multi‐transfused persons (38, 12; 24.06% [20.00–28.36]), persons with sexually transmitted diseases (7, 5; 4.10% [0.98–9.04]), and those with high‐risk sex behavior (6, 5; 4.06% [1.79–7.10]). Conclusions: Community‐based data on HCV seroprevalence in India were limited. Large amount of data on blood donors and pregnant women were identified, with pooled anti‐HCV seroprevalence rates of 0.44% and 0.88%, respectively. Among high‐risk groups, anti‐HCV prevalence was higher among people living with HIV, those with sexually transmitted diseases, high‐risk sex behavior or injection drug use, and those receiving hemodialysis or frequent transfusions. [ABSTRACT FROM AUTHOR]

Background: Oxidative damage of the erythrocyte membrane plays an important role in ribavirin-induced anemia. The purpose of the present paper was to assess whether supplementation of α-tocopherol and ascorbic acid (vitamins) causes changes in the erythrocyte membrane fatty acid composition during interferon and ribavirin combination therapy for chronic hepatitis C patients. Methods: Fatty acid compositions in erythrocyte membrane phospholipids were determined by gas chromatography at 0, 2, 4, 8 weeks, and at the end of combination therapy (26 weeks) for interferon with ribavirin in 32 patients with chronic hepatitis C who were randomized to receive vitamins or not (controls). Results: Good compliance with orally administered vitamins and ribavirin were confirmed by their concentrations in erythrocytes or plasma. The hemoglobin level was negatively correlated with the ribavirin concentration at 8 weeks ( r = 0.59, P = 0.01) after initiation of therapy in controls, but not in the vitamin group. Among the 26 kinds of fatty acids analyzed, only eicosapentaenoic acid (EPA) significantly decreased at 8 weeks after initiation of therapy ( P = 0.03) and at the end of therapy ( P = 0.004) in controls. Vitamins did not inhibit ribavirin-induced anemia, but attenuated the decrease of EPA in erythrocytes. The EPA level was negatively correlated with the drop in hemoglobin levels at 8 weeks after initiation of therapy in controls ( r = 0.58, P = 0.015), but not in the vitamin group. Conclusions: Supplementation of α-tocopherol and ascorbic acid attenuates the ribavirin-induced decrease of EPA in erythrocyte membrane phospholipids in chronic hepatitis C patients. [ABSTRACT FROM AUTHOR]

Background: Steatosis occurs frequently in hepatitis C. However, the mechanisms leading to this lesion are still unknown, and the role of steatosis in the progression of the disease remains controversial. The aim of the present paper was to determine the prevalence of steatosis in hepatitis C and its association with hepatitis C virus (HCV) genotype, viral load and the presence of risk factors for steatosis, and to analyze the association between steatosis and the intensity of liver disease. Methods: Patients infected with HCV who underwent liver biopsy were included. Patients coinfected with hepatitis B virus and/or human immunodeficiency virus and those previously treated for hepatitis C were excluded. The following risk factors for steatosis were investigated: obesity (body mass index [BMI] > 25 kg/m2), diabetes mellitus, hyperlipidemia, alcoholism, and use of potential steatosis-inducing drugs. Histological analysis evaluated the presence of steatosis, the degree of periportal activity and staging. Patients with and without steatosis were compared regarding demographic, epidemiological, laboratory and histological characteristics. Logistic regression analysis was applied to identify variables that were independently associated with the presence of steatosis. Results: Ninety patients (55 men, 35 women) with a mean age of 45 ± 13 years were included. The prevalence of steatosis was 67%. Variables that remained independently associated with steatosis were age, female gender, obesity and genotype 3. Conclusions: The prevalence of steatosis in hepatitis C was high. Risk factors usually related to steatosis such as age, female gender and obesity, as well as genotype 3, were independently associated with the presence of steatosis. Steatosis was not independently associated with the intensity of histological liver disease. [ABSTRACT FROM AUTHOR]

Patients with dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection have responded poorly to interferon (IFN) monotherapy. The purpose of the present paper was to assess the effect of combined IFN-α and ribavirin therapy in patients infected with both hepatitis B and C.Thirty-six patients received 3 or 5 MU IFN-α-2b thrice weekly and oral ribavirin (800–1200 mg/day) for 24 weeks. All patients had positive hepatitis B surface antigen, antibody to HCV, and HCV-RNA. Before treatment, one patient had positive hepatitis B e antigen. Eighteen patients had positive HBV-DNA tested by Amplicor (Cobas Amplicor Monitor, Roche Diagnostics, Branchburg, NJ, USA), with a mean HBV-DNA level of 3.1 ± 0.9 log copies/mL. Another 72 patients with HCV infection alone served as controls.Adverse events led to withdrawal in three patients receiving 5 MU IFN. Based on an intent-to-treat analysis, the biochemical response and serum HCV clearance rate at the end of 48 weeks follow up was similar in patients with dual infection and HCV infection alone (56% vs 72%; and 69% vs 71%, respectively). There was no significant difference in sustained HCV clearance rate between the 3-MU group (n = 13) and the 5-MU group (n = 23; 85% vs 61%). At the end of 48 weeks follow up, two (11%) of 18 pretreatment viremic patients had negative serum HBV-DNA (<200 copies/mL), while eight of those without pretreatment viremia had reoccurrence of HBV-DNA.Combination therapy with IFN-α and ribavirin was effective in achieving sustained HCV clearance in patients with dual HBV and HCV infection, comparable to those with hepatitis C infection alone. Combination therapy using 3 MU IFN-α seemed as effective as 5 MU, and was well tolerated in the study population. However, large-scale control trials are necessary to clarify these findings. [ABSTRACT FROM AUTHOR]

For the majority of cases of acute liver failure in western Europe and North America an etiology cannot be defined. The condition is most often called fulminant non-A, non-B (NANB) hepatitis. Features such as female preponderance and presence of serum autoantibodies suggest a possible autoimmune basis. The aim of the present paper was to examine a possible human leukocyte antigen (HLA) association with fulminant NANB hepatitis.HLA A, B, and DR data of 55 adult Caucasian fulminant NANB patients were compared with those of 1449 local Caucasian controls.In Caucasian patients, homozygosity (but not heterozygosity) for the alleles A1, B8, and DR3 were associated with fulminant NANB hepatitis (Pcorrected = 0.02,<0.00001 and 0.002, respectively). Greatest relative risk (RR) was associated with homozygosity for the A1-B8-DR3 haplotype (P < 0.00001; RR: 12.8; 95% confidence interval[CI]: 5.7–22.3). HLA DR8 was also associated with development of the syndrome (RR: 4.2; 95%CI: 1.6–9.2).Homozygosity for the HLA haplotype A1-B8-DR3 confers susceptibility to the development of fulminant NANB hepatitis. This observation may imply a role for the immune response genes (which are flanked by HLA B and DR) in the pathogenesis of this syndrome. [ABSTRACT FROM AUTHOR]

Recently it has been found that iron is an important element in the natural history of hepatitis C. Serum markers of iron stores are frequently increased in chronic hepatitis C virus (HCV)-infected carriers but the real impact of the hepatic iron overload is poorly understood. The purpose of the present paper was to determine the prevalence of iron overload and to study the relationship between hepatic iron concentration (HIC) and clinical, biochemical and histological characteristics in chronic HCV-infected carriers.Patients presenting with anti-HCV and HCV-RNA were included. Hepatic iron concentration was determined in liver tissue by atomic absorption spectrophotometry. The association between HIC and age, gender, risk factor of transmission, duration of infection, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, iron and serum ferritin, transferrin saturation, HCV-RNA level, grading of inflammatory activity, staging of fibrosis, hepatic steatosis, and stainable iron was analyzed. Statistical analysis included the Mann–Whitney test and a multiple linear regression model.Ninety-six patients (58% male) with a mean age of 44 ± 10 years were studied. Serum iron, ferritin and transferrin saturation were elevated in 28%, 27% and 12.5% of patients, respectively. Stainable iron was detected in few patients (15.6%). Higher grades of stainable iron (2 and 3) were observed in only 7%. The HIC (>30 mmol/g dry weight) was elevated in five patients (5%). Neither grading nor staging were related to HIC. Higher HIC were observed in male patients (P < 0.001), in patients with elevated serum ferritin (P = 0.001) and in patients with stainable iron (grades 2 and 3;P = 0.001). Multiple linear regression analysis showed that only stainable iron was independently correlated with HIC (P = 0.003).Iron overload in chronically HCV-infected patients was uncommon and hepatic iron content seemed not to be related to the liver damage process. In the eventuality of iron overload, histochemical liver iron is a useful marker to estimate HIC. [ABSTRACT FROM AUTHOR]

This paper discusses nonalcoholic fatty liver disease (NAFLD) and hepatitis C virus (HCV) in terms of their clinical presentation, natural history, pathogenesis and treatment. Important interactions between these two diseases are then discussed, as well as fertile areas for further research. [ABSTRACT FROM AUTHOR]

Increased serum γ-glutamyl transferase (GGT) levels are frequently observed in chronic hepatitis C virus (HCV) infection. However, the significance of this finding remains unclear. The purpose of the present paper was to assess the relationship between GGT levels and clinical, biochemical and histological features in chronic HCV-infected carriers. Patients with a liver biopsy presenting anti-HCV and HCV-RNA were evaluated. Age, gender, risk factors of transmission, serum alanine aminotransferase (ALT), GGT and alkaline phosphatase (ALP) levels and histological features were assessed in all. Data were analyzed statistically by the χ2 test and multivariate logistic regression analysis. Among 201 patients studied, elevated GGT levels and bile duct damage were observed in 48% and 35% of them, respectively. No association was seen between GGT level and bile duct damage or between GGT level and hepatic steatosis. Inititally, age > 40 years ( P = 0.007), elevated ALT ( P = 0.01), grading of inflammatory activity ( P = 0.004) and staging of fibrosis ( P < 0.001) were found to be associated with elevated GGT levels. After multivariate regression analysis, histology grading 3 and 4 inflammation activity ( P = 0.01) and staging 3 and 4 fibrosis ( P = 0.01) remained independently associated with elevated GGT level. A significant number of patients with chronic HCV infection had elevated serum GGT levels. Furthermore, this enzyme seemed to be useful as an indirect marker of more advanced liver disease in chronic hepatitis C. © 2004 Blackwell Publishing Asia Pty Ltd [ABSTRACT FROM AUTHOR]

The purpose of the present paper was to determine recent patterns of hepatitis C virus (HCV) transmission in Australia through a national system of enhanced surveillance of newly acquired hepatitis C. Demographic, clinical, and risk behavior information on newly acquired hepatitis C cases from 1997 to 2000 was collected. Newly acquired hepatitis C included cases of HCV antibody sero-conversion within a 12 month period and acute clinical hepatitis C cases. Nine hundred and twelve cases of newly acquired hepatitis C were identified, representing 2.8% of all HCV notifications for this period. The majority of cases (72%) were diagnosed in people aged between 20 and 39 years. Injecting drug use was reported in the vast majority of cases (93%), with sexual transmission (2%) and tattooing (2%) reported in small numbers. HCV antibody sero-conversion was the mode of diagnosis in most cases (78%). Injecting drug use is the main route of HCV transmission in Australia. As only a small proportion of HCV infections are detected as newly acquired, enhanced surveillance procedures, including increased regular HCV testing of at-risk populations are required to more effectively monitor recent patterns of transmission. © 2004 Blackwell Publishing Asia Pty Ltd [ABSTRACT FROM AUTHOR]

This document contains a collection of articles and case reports related to liver diseases. The articles cover a range of topics, including predictive models for liver-related outcomes in primary biliary cholangitis (PBC) patients, the effects of ancient Chinese herbal remedies on liver health, health-related quality of life outcomes in hepatocellular carcinoma (HCC) patients, and the prevalence of intestinal failure-associated liver disease (IFALD) in patients on long-term home parenteral nutrition (HPN). The case reports discuss the development of IFALD in patients on HPN, a predictive model for portal hypertension-related decompensation events in cirrhosis patients, a quality improvement project for assessing non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes, and a case of hepatosplenic candidiasis following endoscopic cholangiopancreatography (ERCP). These reports provide valuable insights into the diagnosis, management, and outcomes of various liver diseases. [Extracted from the article]

Regarding patient cohorts, 13 studies only included patients with decompensated cirrhosis, including three studies specifically of patients with hepatic encephalopathy. B I Conclusion: i b We found that the kinetics of quantitative HBsAg levels in treatment-naive patients with phase 3 CHB, as well as HBeAg-negative patients receiving NA treatment, decrease over time but were numerically similar between the treatment-naïve Phase 3 CHB group and the HBeAg-negative treatment-experienced patients. All five compensated patients were Child-Pugh A, and four of the five decompensated patients were Child-Pugh B. Median Model for End-Stage Liver Disease score was 8.0 ± 0.8 for the compensated group and 14.0 ± 3.6 in decompensated patients. B I Results: i b A total of 269 patients with CHD were included; 64 and 115 patients were treated with BLV 2 or 10 mg, respectively, 51 were control patients, and 39 patients were treated with peg-IFN . B I Methods: i b The predictive utility of end-of-treatment (EOT) and off-treatment HBcrAg level was evaluated among patients previously enrolled in the published HBV-STOP study (non-cirrhotic HBeAg-negative patients with CHB). SP 1 sp All patients were followed for 96 weeks after stopping NA therapy. [Extracted from the article]

Background: The purpose of the present paper was to investigate the factors possibly involved in the failure of pegylated interferon (Peg IFN) plus ribavirin treatment at standard dosage in hepatitis C virus (HCV) 1b patients, with chronic hepatitis. Methods: A fully screened population of 40 virological non-responders (NR) to combined antiviral therapy was selected and matched, 1:1, with a similar cohort of end-therapy virological responders (R). Results: Waist circumference, glucose metabolic impairment, body mass index, non-genetic iron overload, steatosis and fibrosis severity and, finally, arterial hypertension were statistically more frequent in the NR group on Peg IFN plus ribavirin. Increased waist circumference was the strong independent predictor of therapeutical failure. Interestingly, the concomitant presence of cofactors was more significantly represented in NR, whereas in the R cohort this association was found in a few cases only. Conclusion: Insulin-resistance syndrome could contribute to non-response in treated chronic HCV patients, suggesting the presence of dysmetabolic factors that frequently cluster in a critical combination. [ABSTRACT FROM AUTHOR]

Background: This systematic review was aimed to estimate hepatitis C virus (HCV) seroprevalence and burden in disease in WHO South East Asia Region (SEAR). Methods: Electronic databases (PubMed, Scopus, Embase, and Google Scholar) and websites of non‐indexed national medical journals, government and international health agencies were searched to identify English language literature published between 1991 and June 2020. We selected the studies reporting HCV seroprevalence in asymptomatic general (low‐risk) and high‐risk adult populations, that is, persons living with HIV (PLHIV), persons who inject drugs (PWID), sex workers, persons on maintenance hemodialysis (MHD), people in prison, and men sex with men (MSM). Seroprevalence data were combined to estimate weighted pooled prevalence (95% confidence interval) in each group and in each country, using the random‐effects model. Estimated pooled seroprevalences were multiplied with estimated populations at risk to estimate the overall HCV burden. Results: The analysis included 538 studies (35 Bangladesh, 6 Bhutan, 2 DPR Korea, 323 India, 43 Indonesia, 2 Maldives, 18 Myanmar, 29 Nepal, 11 Sri Lanka, 67 Thailand, and 2 Timor‐Leste). In SEAR, the weighted pooled anti‐HCV seroprevalence was estimated as 0.84% (0.56–1.12) in low‐risk population and 13.67% (10.95–16.40) in PLHIV, 51.44% (43.67–59.20) in PWID, 25.80% (20.34–32.09) in MHD, 8.39% (5.84–11.51) in prison inmates, 2.69% (1.43–4.13) in people with high‐risk sex behavior, and 11.43% (8.61–14.74) in MSM. The total HCV burden in low‐risk and high‐risk populations in SEAR countries was estimated as 12.45 million and 1.65 million, respectively. Conclusion: Our estimates of HCV seroprevalence and burden should help the respective countries in planning their HCV elimination strategies. [ABSTRACT FROM AUTHOR]

Background and Aim: Several barriers prevent the proper screening, diagnosis, and treatment of hepatitis C virus (HCV) infection. We aimed to evaluate the status of HCV screening, confirmation, and treatment rates in a tertiary academic medical center in Korea. Methods: Patients who visited Severance Hospital between 2015 and 2019 were eligible in this retrospective study. The testing and positivity rates for anti‐HCV antibodies and HCV RNA were sequentially analyzed. Results: Between 2015 and 2019, 252 057 patients (117 131 men, 46.5%) who underwent anti‐HCV antibody testing were retrospectively reviewed. The median age of the study population was 51.0 years. Patients with positive anti‐HCV antibody test results (n = 2623, 1.0%) showed a higher proportion of liver cirrhosis (17.6% vs 2.0%) and unfavorable laboratory test results (all P < 0.05). The positivity rates were 1.3% and 0.8% in the medical and surgical departments, respectively. HCV RNA was tested in 1628 (62.1%) patients, with a 57.4% (n = 928) positivity rate. The medical department had a higher HCV RNA testing rate than the surgical department (75.4% vs 40.8%). Among the 928 patients who showed positivity for HCV RNA, 847 (90.7%) underwent genotype testing (mostly 1 and 2 [95.4%]). The treatment rate was 66.9% (n = 567); it was higher in the gastroenterology department (70.8%) than in the non‐gastroenterology departments (62.3%). Conclusions: A considerable proportion of patients testing positive for anti‐HCV antibodies were not referred for proper management. Systematic and automated screening and referral systems, which may help identify patients requiring treatment for HCV infection, are necessary even in tertiary academic medical centers. [ABSTRACT FROM AUTHOR]

Background and Aims: The rising incidence of chronic liver disease (CLD) has increased the need for early recognition. This systematic review assesses the diagnostic accuracy of the enhanced liver fibrosis (ELF) test in cases of advanced fibrosis and cirrhosis due to multiple etiologies in at‐risk populations. Methods: Studies evaluating the ELF accuracy in identifying advanced fibrosis or cirrhosis, defined as METAVIR stage F ≥ 3 and F = 4 or equivalent, in patients with non‐alcoholic fatty liver disease (NAFLD), alcohol liver disease (ALD), or viral hepatitis were included. Liver biopsy was used as the reference standard. Medline and Embase databases were searched. The QUADAS‐2 tool was used as a framework to assess risk of bias and applicability. The area under the receiver operator curve (AUROC) was extracted as a summary measure of diagnostic accuracy. Results: Thirty‐six studies were included: 11 hepatitis C, 4 hepatitis B, 9 NAFLD, 2 ALD, and 10 mixed. The ELF test showed good diagnostic performance in detecting advanced fibrosis in patients with viral hepatitis (AUROC 0.69 to 0.98) and excellent performance in NAFLD (AUROC 0.78 to 0.97) and ALD (AUROC from 0.92 to 0.94). There is also evidence of good diagnostic performance for detecting cirrhosis in patients with viral hepatitis (AUROC 0.63 to 0.99), good performance in NAFLD (AUROC 0.85 to 0.92), and excellent performance in patients with ALD (AUROC 0.93 to 0.94). Conclusion: This systematic review supports the use of the ELF test across a range of CLD as a possible alternative to liver biopsy in selected cases. [ABSTRACT FROM AUTHOR]

The discovery of direct acting antivirals (DAA) with high rates of sustained virusological response is the biggest epoch‐making event in the history of hepatitis C virus (HCV) treatment. DAAs improve liver function, prevent hepatic decompensation, and might even reverse liver fibrosis. Although initial research pointed towards a potential drawback, it is now known beyond doubt that DAA treatment reduces hepatocellular carcinoma (HCC) occurrence or recurrence after curative treatments. Unfortunately, the story has reached another plot twist, as several other issues have emerged: (i) Should we treat patients with early HCC and HCV before or after surgery/ablation? (ii) Should patients with HCC on the waiting list receive DAA before or after liver transplantation? (iii) Should we use interferon‐free in patients with intermediate stage HCC or in patients under systemic treatments? In this review, we aim to offer some evidence‐based answers to these changing clinical dilemmas where possible, or at least some educated guesses in cases were no or little data exists. [ABSTRACT FROM AUTHOR]

Background and Aim: Various all‐oral direct‐acting antiviral (DAA) regimens are being widely used in the treatment of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co‐infected patients; however, the comparative efficacy and safety of different types and combinations of DAAs are not completely clear. There is still a lack of integration of evidence for optimized therapies for HIV/HCV co‐infection. Methods: We conducted a systematic literature search in several databases up to January 1, 2020. All the studies that reported the sustained virologic response (SVR) and adverse events of DAAs in HIV/HCV co‐infected patients were included. The Bayesian Markov Chain Monte Carlo method was used for the pooled estimates of network meta‐analysis. Results: We identified 33 eligible articles with 7 combinations of all‐oral DAAs for the analyses of efficacy and safety. Grazoprevir–elbasvir ± ribavirin (GZR/EBR ± RBV: 95.6%; 95% CrI, 91.7–98.1%), ombitasvir/paritaprevir/ritonavir and dasabuvir ± ribavirin (3D ± RBV: 95.3%; 95% CrI, 93.4–96.9%), sofosbuvir–ledipasvir ± ribavirin (SOF/LDV ± RBV: 95.2%; 95% CrI, 93.7–96.6%), and sofosbuvir–daclatasvir ± ribavirin (SOF/DCV ± RBV: 94.8%; 95% CrI, 92.5–96.6%) were the most effective combinations for HIV/HCV co‐infected patients, with SVR rates of approximately 94% and above while severe adverse events were rare. However, the SVR rates of sofosbuvir–ribavirin (SOF/RBV) and sofosbuvir–simeprevir ± ribavirin (SOF/SMV ± RBV) both failed to reach 90%, and the incidences of adverse events were higher than 5%. Conclusions: Efficacy and safety of all‐oral DAAs were in prospect for HIV/HCV co‐infection patients. GZR/EBR ± RBV was the optimal combination recommended for HIV/HCV co‐infected patients based on the excellent treatment effects and insignificant adverse events. [ABSTRACT FROM AUTHOR]

Background and Aim: Duration of treatment for chronic hepatitis C infection has been shortened since the introduction of highly effective direct‐acting antivirals (DAAs). Presented is our experience in successful treatment of veterans with chronic hepatitis C infection, with a shorter than currently recommended duration of therapy. Methods: Retrospective chart review of veterans with chronic hepatitis C infection who received more than 1 week and up to 6 weeks (8–42 days) of DAA therapy with the initiation day between January 1, 2015, and October 15, 2018, at Bay Pines Veterans Affairs Healthcare System. Successful treatment was defined by a sustained virologic response at 12 weeks (SVR‐12) since the end of treatment. Results: Of the 1841 veterans treated, 27 met the criteria for this review. Overall, SVR‐12 was achieved in 92.6% of veterans treated for a duration of more than 1 week and up to 6 weeks. Amongst those who completed only 4 weeks of therapy, 93.3% achieved SVR‐12. All four veterans (100%) treated for a duration of more than 4 weeks and up to 6 weeks achieved SVR‐12. Conclusions: Amongst the chronically infected hepatitis C population, a subpopulation who could achieve SVR with a shorter course of treatment than currently recommended does exist. A prospective study of a larger scale will likely provide helpful data in this regard. Our findings could be an impetus for further work. [ABSTRACT FROM AUTHOR]

Background and Aim Hepatitis B virus (HBV) may reactivate when treating chronic hepatitis C (CHC) with direct acting antivirals (DAA). We aim to investigate the risk of HBV reactivation during DAA therapy. Methods Chronic hepatitis C patients receiving pan-oral DAA therapy from December 2013 to August 2016 were evaluated. Fifty-seven patients that had a past HBV infection (negative hepatitis B surface antigen [HBsAg] and positive hepatitis B core antibody) and seven patients that had a current HBV infection (positive HBsAg) were enrolled. Serum HBV and hepatitis C virus (HCV) markers were regularly measured. The endpoints were the HCV sustained virological response (SVR) and the HBV virological/clinical reactivation. Results The overall SVR12 rate was 96.9%, and two patients, one with positive HBsAg, had a relapse of HCV. No episodes of HBV virological reactivation were observed among the patients with a past HBV infection. For the seven patients with a current HBV infection, HBV virological reactivation was found in four (57.1%) of the seven patients. Clinical reactivation of HBV was observed in one patient with pretreatment detectable HBV DNA and recovered after entecavir administration. For the other three patients with HBV virological reactivation, the reappearance of low level HBV DNA without clinical reactivation was observed. HBsAg levels demonstrated only small fluctuations in all the patients. Conclusions There was a minimal impact of hepatitis B core antibody seropositivity on HCV efficacy and safety. For CHC patients with current HBV infection, the risk of HBV reactivation was present, and monitoring the HBV DNA level during therapy is warranted. [ABSTRACT FROM AUTHOR]

Background and Aim Virological cure becomes available for most patients with chronic hepatitis C (CHC), but residual fibrosis can be an independent risk factor for liver-related complications. We aimed to characterize fibrosis change in CHC patients achieved virological cure. Methods We did a systematic literature search for studies that had pre and post-treatment evaluations of histologic fibrosis in CHC patients with sustained virological response (SVR). We identified the association of SVR with the incidence, extent, and velocity of fibrosis change. Results Overall, 3243 patients were included. Interferon-based regimens were used for all the patients, achieving a median SVR prevalence of 36.2%. Biopsy interval ranged from 1 to 10 years. Mean baseline fibrosis score (METAVIR) was 2.3 points. Compared with non-SVR patients, SVR patients could have higher incidence of fibrosis regression (35.1% vs 17.0%; OR: 3.3; P < 0.001), regardless of baseline fibrosis severity, way of biopsy evaluation, treatment regimen, or study design, and could have more extent of reduction (−0.31 points vs −0.00 points; P = 0.004). Baseline advanced fibrosis (F > 2) was associated with more rapid regression in both SVR and non-SVR patients ( P < 0.05 for both). SVR patients could have lower incidence of fibrosis progression and maintenance than non-SVR patients by 4.8% versus 23.1% (OR: 0.20; P = 0.008) and 42.9% versus 55.2% (OR: 0.53; P < 0.001), respectively. Conclusions There could be a favorable characteristic of fibrosis regression in SVR patients. However, residential fibrosis may remain an issue because of a non-ignorable prevalence of fibrosis maintenance among these patients. [ABSTRACT FROM AUTHOR]

The evolution of management of hepatitis C virus ( HCV) has seen a majority of patients treated being regarded as cured. Despite this development, uptake of treatment remains low in Australia, and this is particularly true in rural and remote areas. The largest state in Australia, Western Australia ( WA), covers an area of 2500 km2. As the rural and remote population of WA is scattered in small areas rather than major centers, poor accessibility to remote areas and lack of adequate of medical and nursing resources pose major problems in providing equity of care to patients with chronic HCV. A statewide hepatitis model of care, established in 2009, has led to an increase in identification and treatment of patients living with HCV. Strategies used to facilitate these changes include telehealth, a nurse practitioner model, and general practitioner shared-care model. The statewide program will be modified to meet the changing needs of patients as all-oral treatment regimens become available, with further emphasis being placed on the role of rural and remote health professionals in identifying patients with HCV and initiating and monitoring treatment. [ABSTRACT FROM AUTHOR]

Background and Aim Chronic hepatitis C genotype 2 patients show high susceptibility to pegylated interferon plus ribavirin therapy ( PEG/ RBV). However, the differences in response to therapy between genotypes 2a and 2b, and the efficacy of prolonged therapy for refractory patients have not been evaluated. We investigated the differences in response to PEG/ RBV between each genotype and examined the efficacy of prolonged therapy. Methods A total of 343 chronic hepatitis patients infected with hepatitis C virus ( HCV) genotype 2 (2a: n = 195; 2b: n = 148) were enrolled in this study. All patients received PEG/ RBV for 24 (24 week group, n = 242) or more weeks (prolonged group, n = 101). We analyzed the differences in virological response between genotypes 2a and 2b. Clinical and virological factors of patients in the 24-week group and the prolonged treatment group were matched using propensity score analysis, and the efficacy of prolonged therapy established by comparing time of serum HCV disappearance for each genotype. Results Virological response tended to be higher for genotype 2a compared with genotype 2b; however, there was no significant difference in sustained virological response rates between genotypes (2a: 78.3%; 2b: 70.2%; P = 0.19). After propensity score matching, the adjusted P-value for sustained virological response rate was significantly different for genotype 2b patients with undetectable HCV- RNA between weeks 5 and 8, and for genotype 2a patients with detectable HCV- RNA at week 8. Conclusion Prolonged therapy with PEG/ RBV may be effective when serum HCV- RNA is detectable at week 4 and week 8 for genotype 2b and 2a patients, respectively. [ABSTRACT FROM AUTHOR]

Present interferon-based therapy for chronic hepatitis C is limited by both efficacy and tolerability. Telaprevir and boceprevir are the first two direct-acting antiviral drugs ( DAAs) that inhibit hepatitis C virus replication to be licensed for use in conjunction with pegylated interferon and ribavirin. Numerous other DAAs are in clinical development, and phases 2 and 3 trials are evaluating interferon-free combination DAA therapy. Interferon-free sustained virologic responses have now been achieved with combinations of asunaprevir and daclatasvir; sofosbuvir and ribavirin; sofosbuvir and daclatasvir; faldaprevir and BI207127; ABT-450, ritonovir and ABT-333; ABT-450, ritonovir and ABT-072; miracitabine, danoprevir and ritonavir; and alisporivir and ribavirin. Some drugs are genotype-specific in their activity, whereas others are pan-genotypic, and differential responses for the genotype 1 subtypes 1a and 1b have emerged with many DAA combinations. Viral breakthrough and resistance are important considerations for future trial design. The prospect of interferon-free combination DAA therapy for hepatitis C virus is now finally becoming a reality. [ABSTRACT FROM AUTHOR]

Abstracts from the "Gastroenterology in Asia Pacific - Excellence in the New Decade" conference held September 19-22, 2010 in Kuala Lumpur, Malaysia are presented including "Ademetionine in chronic hepatitis C treatment," "Metoclopramide combined with right lateral position can increase the rate of complete small bowel examination in capsule endoscopy," and "A practical model to stratify dyspeptic patients based on the risk of gastric cancer."

The article presents abstracts on medical topics including infection with hepatitis B virus, hepatitis C treatment for injecting drug users, and hepatitis C treatment in pharmacotherapy services.

The article presents abstracts on medical topics including hepatitis C virus reinfection in injecting drug users, epidemiology of hepatitis C, and impact of HCV and HIV infections on mortality in a community.

The article presents abstracts on medical topics including co-infection of hepatitis A, B and C and HIV viruses among adults, hepatitis G infection in hemodialysis patients, and hepatitis C treatment.

Background and Aim: We have reported previously that synthetic small interfering RNA (siRNA) and DNA-based siRNA expression vectors efficiently and specifically suppress hepatitis C virus (HCV) replication in vitro. In this study, we investigated the effects of the siRNA targeting HCV-RNA in vivo. Methods: We constructed recombinant retrovirus and adenovirus expressing short hairpin RNA (shRNA), and transfected into replicon-expressing cells in vitro and transgenic mice in vivo. Results: Retroviral transduction of Huh7 cells to express shRNA and subsequent transfection of an HCV replicon into the cells showed that the cells had acquired resistance to HCV replication. Infection of cells expressing the HCV replicon with an adenovirus expressing shRNA resulted in efficient vector delivery and expression of shRNA, leading to suppression of the replicon in the cells by ∼10−3. Intravenous delivery of the adenovirus expressing shRNA into transgenic mice that can be induced to express HCV structural proteins by the Cre/ loxP switching system resulted in specific suppression of virus protein synthesis in the liver. Conclusion: Taken together, our results support the feasibility of utilizing gene targeting therapy based on siRNA and/or shRNA expression to counteract HCV replication, which might prove valuable in the treatment of hepatitis C. [ABSTRACT FROM AUTHOR]

Background and Aim: Cyclooxygenase-2 (COX-2), a target of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), is upregulated in chronic hepatitis B and may have a role in hepatocellular carcinoma. Little is known about the expression of COX-2 in chronic hepatitis C (HCV) infection. The aim the present study was to evaluate the extent of COX-2 expression in liver biopsies in patients with HCV infection and to determine the effect of treatment with interferon α (IFN). Methods: Percutaneous liver biopsy specimens were retrieved. Following formalin fixation and paraffin embedding, the biopsies were histologically evaluated for inflammation and fibrosis. The extent of COX-2 expression was measured by the avidin biotin immunohistochemical technique using a monoclonal COX-2 antibody. The extent of COX-2 expression was graded according to the number of hepatocytes expressing COX-2. Data were analyzed using Student's t-test. Results: Liver biopsies from 10 patients before and after treatment with IFN were obtained and compared with nine normal liver biopsies. All of the liver biopsies showed some COX-2 expression. COX-2 expression was confined to hepatocytes and bile duct epithelium and was not detected in vascular endothelium or inflammatory cells. The extent of COX-2 expression was greater in hepatitis C infected liver biopsies than in normal biopsies. Following treatment with IFN, there was a greater than threefold reduction in COX-2 expression ( P < 0.01). This result was independent of the sustained virological response. Conclusion: In this small pilot study we have shown that COX-2 is overexpressed in liver biopsies infected with HCV and COX-2 expression is reduced following treatment with IFN. [ABSTRACT FROM AUTHOR]

Background: The role played by the immune system in the progression of chronic hepatitis C (CHC) is not completely clear. Opioids may facilitate the outbreak of infections through marked immunomodulating effects on the immune response against a virus. To asses if addicts can be treated successfully with interferon (IFN) during detoxification treatment, we evaluated some immune response mediators in addicts affected by CHC. Method: A cohort of heroin users with CHC were enrolled during the detoxification period, divided into two groups and treated with IFN pegilate plus ribavirin (group A treated during methadone administration and group B treated at week 8 after methadone treatment completed). A group of patients with CHC and no history of drug addiction were enrolled as controls. Leukocyte subpopulation NK, CD4+, CD8+ and some cytokines Th1 (IFNγ, interleukin [IL]2) and Th2 (IL-6, IL-10) were evaluated prior to, during and after methadone treatment. Sustained virological response was evaluated 24 weeks after antiviral treatment was completed. Results: During methadone treatment, significantly ( P < 0.05) higher cytokine Th1 and NK and lower cytokine Th2 levels were observed in groups A and B compared with levels obtained before treatment in the same groups. Relapse occurred at 56 ± 8 weeks in 34/55 group A patients, at 24 ± 8 weeks in 33/52 group B patients and at 24 ± 4 weeks in group C, there being a significant difference ( P < 0.05) between group A and B and between group A and C. No significant differences between all groups were detected in CD4+ and CD8+ cell counts. Conclusions: Our results revealed that drug addicts with CHC can be treated successfully with IFN pegilate and ribavirin. This therapy can be recommended during the early phase of detoxification treatment to achieve a sustained response. [ABSTRACT FROM AUTHOR]

Background and Aim: A significant proportion of cancer is attributable to DNA damage caused by chronic infection and inflammation. Because both hepatitis B and C viruses (HBV and HCV, respectively) cause chronic infection and inflammatory disease, the aim of the present study was to investigate whether there is a difference in peripheral DNA damage in patients with chronic HCV compared with patients with chronic HBV; and whether there is an association in the level of peripheral DNA damage with a natural history of HBV infection. Methods: Twenty patients with chronic hepatitis C, 20 patients with chronic hepatitis B, 11 patients with cirrhosis secondary to hepatitis B, 12 inactive hepatitis B s antigen (HBsAg) carriers and 21 healthy subjects were included in the study. The DNA damage in lymphocytes was determined using the alkaline comet assay. Results: Although the chronic hepatitis C group had similar levels of DNA damage compared with patients with cirrhosis due to hepatitis B ( P > 0.05) and non-cirrhotic patients with chronic hepatitis B ( P > 0.05), they had higher levels of DNA damage compared with inactive HBsAg carriers ( P = 0.021) and controls ( P = 0.001). Hepatitis B cirrhotic patients and patients with chronic hepatitis B had significantly higher levels of DNA damage than inactive HBsAg carriers ( P = 0.002 and P = 0.012, respectively) and controls (both P = 0.001). Linear logistic regression analysis showed that chronic hepatitis C and HBV-related cirrhosis were discriminators in determining DNA damage in lymphocytes (β 0.424 and P = 0.013, β 0.393 and P = 0.016, respectively). Conclusions: Chronic hepatitis C, based on the severity of liver disease, or cirrhosis as an advanced form of HBV infection increase DNA damage in lymphocytes independently of confounding factors such as age, gender, body mass index and smoking habits. [ABSTRACT FROM AUTHOR]

Background/Aims: Silybum marianum is a herbal preparation commonly used by subjects with chronic hepatitis C (CHC). The aims of this pilot study were to assess the efficacy and safety of S. marianum on serum hepatitis C virus (HCV) RNA, alanine aminotransferase levels and well-being in patients with CHC. Methods: Twenty-four subjects with CHC were enrolled into a randomized, double-blind, placebo-controlled, crossover study. Subjects received 12 weeks of S. marianum (either 600 mg or 1200 mg/day) and placebo separated by a 4-week washout interval. Baseline biochemical, virological, psychological and quality-of-life tests were performed, with biochemical tests repeated monthly, and HCV RNA titer and quality-of-life and psychological assessments repeated at the end of both treatment periods. Results: Seventeen patients completed the trial. Mean changes in HCV RNA titers, serum ALT levels and Short Form-36 scores were not significantly different for subjects on S. marianum compared to those on placebo. There was no significant change in mean State-Trait Anxiety Inventory State-Anxiety scores on S. marianum from baseline. Adverse events were similar with S. marianum and placebo. Conclusions: S. marianum is well tolerated in subjects with CHC, but does significantly affect serum HCV RNA, alanine aminotransferase levels, quality of life or psychological well-being in subjects with this condition. [ABSTRACT FROM AUTHOR]

The carcinogenic process can be modulated by exposure to endogenous or environmental substance(s) acting as carcinogens or protocarcinogens. Polymorphic enzymes of cytochrome P450 (CYP) that play a role in detoxication/toxication of such substances via metabolization may account for the interpatient variability of clinical course in cancers such as hepatocellular carcinoma (HCC). Many CYP genetic polymorphisms, which may change enzyme activity, are known to exist in Japanese. The aim of the present study was to compare the frequencies of CYP polymorphisms between hepatitis C virus (HCV)-related HCC patients and healthy subjects. Seven mutant alleles and related genotypes of CYP in 44 HCV-positive HCC patients were chosen as follows: *1C heterozygous, *1C homozygous and *1F homozygous for CYP1A2, *4A homozygous for CYP2A6, *2A or *3 heterozygous, *2A or *3 homozygous and *2A and *3 heterozygous for CYP2C19, and *10/*5 homozygous for CYP2D6. These mutant alleles have been reported to change the CYP enzyme activity in Japanese. The frequencies of the mutant alleles and genotypes were then compared with those reported in healthy Japanese. There is no statistically significant difference in genetic mutant alleles between the two groups, except for the genotype of CYP2A6*4A homozygous. The frequency of this genotype in the HCC patients (0.144) is significantly higher than that in healthy Japanese (0.034; P < 0.05; odds ratio 3.36). The clinical significance related to HCC is unknown. Further evaluation of CYP2A6*4A (deletion type) in HCV-related HCC patients is required. © 2005 Blackwell Publishing Asia Pty Ltd [ABSTRACT FROM AUTHOR]

Parvovirus B19 has been reported to be detected in the sera of patients with acute or chronic hepatitis. The prevalence and clinical significance of B19 DNA in serum samples from patients with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were investigated.Serum samples from 54 patients with HBV infection, 51 with HCV infection and 53 normal controls were examined for anti-B19 antibodies and B19 DNA by enzyme-linked immunosorbent assay (ELISA), the nested polymerase chain reaction (PCR), Southern blotting and direct nucleotide sequencing, respectively.Anti-B19 IgM and IgG antibodies were detected in 19 (35.2%) and 46 (85.2%) of 54 serum samples from patients with HBV infection, and eight (15.7%) and 36 (70.6%) of 51 serum samples from patients with HCV infection. B19 DNA was detected in serum samples of 20 (37%) of 54 patients with HBV infection and 12 (23.5%) of 51 patients with HCV infection, but not in 53 serum samples from normal controls. The occurrence of liver dysfunction was not affected by B19 infection in patients with HBV and HCV infection (P > 0.05). All of the 20 serum samples with B19 DNA from patients with chronic HBV infection and all of the 12 serum samples with B19 DNA from patients with chronic HCV infection exhibited TW-3 subtype and TW-9 subtype, respectively. The variant subtypes of B19 were found to be distinctive in patients with HBV or HCV infection.These data revealed that human parvovirus B19 infection was frequently found in patients with chronic HBV or HCV infection. The variant genotypes were present in patients with different chronic hepatitis. The coinfection of B19 with HBV or HCV did not increase the frequency of liver dysfunction in patients with chronic hepatitis. Long-term longitudinal studies are required to determine the natural course of parvovirus B19 infection and whether its coinfection affects the natural history of chronic hepatitis B or hepatitis C. [ABSTRACT FROM AUTHOR]

In the treatment of hepatitis C virus (HCV) infection, regimens including pegylated interferon-α are superior to those including standard interferon; the present retrospective study was performed to verify whether the same is applicable to biopsy-proven recurrent hepatitis C (genotype 1b) after liver transplantation (OLT).Twenty-four patients (16 male) were studied. Twelve had received interferon-α2b (IFN), 9 MU weekly and 12 received pegylated interferon-α2b (PEG-IFN), 0.5 µg/kg weekly. All had received oral ribavirin 600–800 mg/day. Treatment duration was intended for 12 months. A repeat liver biopsy, with evaluation of the Ishak grading and staging scores, was obtained at 1 year.Only 12/24 patients (50%) completed a full year of therapy; 17 (71%) experienced side-effects requiring a 50% dosage reduction or discontinuation of the IFN, PEG-IFN and/or ribavirin. This was observed in 6/12 patients (50%) treated with IFN in comparison to 11/12 patients (92%) treated with PEG-IFN (P < 0.05). The difference was mainly accounted for by anemia and leukopenia that were reported in 4/12 IFN patients (33%) versus 9/12 PEG-IFN patients (75%;P < 0.05), respectively. End-of-treatment viral response (ETVR) and histological response were always associated and occurred in 4/24 patients (17%), two in each treatment arm. Patients with ETVR were younger, had always completed 1 year of therapy, had had recurrent hepatitis later after transplantation and presented a higher baseline grading score.In the OLT setting, the potential benefits of antiviral treatments including PEG-IFN may be limited by the poor tolerability of the adopted drugs. [ABSTRACT FROM AUTHOR]

Recurrent hepatitis C virus (HCV) is universal following liver transplantation. Patients are often treated with interferon and ribavirin in an attempt to eradicate the virus. We describe our experience with 38 patients with recurrent HCV from a single liver transplant program.Between October 2000 and November 2001, 38 patients with recurrent HCV were treated with interferon alpha 2b 3 million units three times a week and ribavirin 1000–1200 mg per day. HCV RNA and liver biopsies were performed before treatment at the end of treatment (EOT), and 6 months after EOT in patients who were HCV RNA negative at EOT.There were 29 males and nine females. Median age was 49 years. In total, 34 patients were genotype 1 and two each were genotype 3 and 4. Six patients received HCV positive donors and 24 patients (63%) completed treatment. The most common indication for discontinuation of treatment was severe fatigue in 14 patients (37%). On intention to treat analysis, a sustained biochemical and virological response occurred in 10 patients (26%). Unchanged or improved fibrosis scores were present in 37% of patients, of whom 71% were non-responders to therapy.Interferon alpha 2b and ribavirin were poorly tolerated in this series of recurrent HCV patients, with sustained HCV eradication occurring in only 26% of patients. However, the majority of non-responders demonstrated unchanged or improved fibrosis scores, suggesting that a subset of patients may benefit from maintenance antiviral therapy to prevent the development of cirrhosis. [ABSTRACT FROM AUTHOR]

Hepatitis A virus is considered directly cytopathic to the liver cell. Severity of the liver damage is dictated by viral load. Acute infection is followed by sustained immunity to the virus. Hepatitis B (HBV) and C (HCV) viruses are noncytopathic, hepatotropic viruses that cause acute and chronic hepatitis and hepatoma. Cellular and humoral immune responses are responsible not only for viral clearance but also for hepatocyte damage. T-cell response to HBV is vigorous, polyclonal, and multispecific in acutely infected patients who clear the virus while it is weak and narrowly focused in chronically infected patients. It is mainly executed by cytotoxic T lymphocytes (CTL), which destroy infected hepatocytes and secrete antiviral cytokines that interrupt the HBV life cycle. T-cell response to HCV is strong and multispecific in both acutely and chronically infected patients. Whether HCV is susceptible to a cytokine-mediated type of control is unknown. The ability of HCV to persist despite a strong CTL response suggests that HCV is either less visible to the CTL or less responsive to cytokine-mediated antiviral signals than HBV. Both viruses, but especially HCV, have a high mutation rate, leading to the occurrence of variant viral genomes with growth advantage and the ability of escaping immune recognition. [ABSTRACT FROM AUTHOR]

Thymalfasin (thymosin-alpha 1) is an immunomodulating agent able to enhance the Th1 immune response. It has been evaluated for its immunomodulatory activities and related therapeutic potential in several diseases, including chronic hepatitis B and C, AIDS, primary immunodeficiency diseases, depressed response to vaccination and cancer. The basis for effectiveness in these conditions is primarily through modulation of immunological responsiveness, as thymalfasin has been shown to have beneficial effects on numerous immune system parameters and to increase T-cell differentiation and maturation.Thymalfasin is responsible for reconstitution of immune function when thymic tissue is given back to thymectomized animals. In addition, thymalfasin has been shown to have efficacy in multiple experimental models of immune dysfunction, mainly, infectious diseases such as hepatitis (woodchuck) and influenza (mouse), and cancer such as melanoma (mouse) and colorectal carcinoma (rat) where thymalfasin has shown antitumor effects.© 2004 Blackwell Publishing Asia Pty Ltd [ABSTRACT FROM AUTHOR]

Abstract Background and Aim: Hepatitis viruses induce not only chronic liver diseases but also the impairment of other organs and tissues as extrahepatic manifestations. In particular, hepatitis C virus (HCV) is involved in various extrahepatic manifestations. The purpose of the present study was to evaluate Sjögren's syndrome (SS) and lichen planus (LP) involvement, which are various extrahepatic manifestations in patients with liver diseases related to hepatitis B virus (HBV) or HCV. Methods: We examined a total of 110 Japanese patients with chronic liver disease: 29 with HBV infections and 81 HCV infections. Results: The prevalence of SS according to European and Japanese criteria in patients with chronic HCV infection was significantly higher than in patients with chronic HBV infection (European criteria: 25.9 vs 3.4%; P < 0.05, Japanese criteria: 21.0 vs 3.4%; P = 0.05). Lichen planus was observed in one (3.4%) of 29 patients with chronic HBV infection, and in 11 (13.6%) of 81 patients with chronic HCV infection. Simultaneously combined LP and SS occurred in 8.6% (seven of 81) of patients with HCV infection, but in none with HBV infection. Conclusions: Clinicians should routinely follow the HCV-infected patients, paying sufficient attention to the presence of SS and LP, and they should also carefully monitor their prognosis. [ABSTRACT FROM AUTHOR]

Abstract Aim and Methods: The effects of ursodeoxycholic acid (UDCA, 600 mg/day) on liver function test values, and serum and urinary bile acids levels in hepatitis C virus-related chronic hepatitis (CH, n = 39) and liver cirrhosis (LC, n = 25), and in primary biliary cirrhosis (PBC, n = 25) were compared. Results: The percentages of improvement in alanine transaminase (ALT) and gamma-glutamyl transpeptidase (gamma-GTP) in CH were almost the same in LC. The rates of improvement in ALT in PBC were negatively correlated with histological stages in the liver. Total serum bile acid levels in LC rose to the same extent as in CH, but the increases in PBC were significantly smaller at stages 3-4 than stages 1-2. The urinary levels of hydroxylated metabolites of UDCA only slightly increased in LC, but they increased significantly at PBC stages 3-4. Conclusions: The efficacy of UDCA was preserved in LC, but diminished at PBC stages 3-4. The poor enrichment of UDCA in the bile acid pool and extensive biotransformation of UDCA may cause the limited efficacy of UDCA in the cirrhotic stage of PBC. [ABSTRACT FROM AUTHOR]

Abstract Hepatitis C is a worldwide problem that frequently results in end-stage liver disease and its complications. Treatment for hepatitis C virus (HCV) has been rather ineffective but several recent studies have clarified the role of interferon and ribavirin therapy. In line with therapeutic progress in HIV infection, hepatitis C is now entering the era of multidrug antiviral therapy. Ribavirin is an orally active synthetic guanosine analogue with theoretical antiviral and immunomodulatory actions. In this review we have evaluated the role of interferon and ribavirin in treatment-naive patients, relapsers and non-responders. In naive patients the combination results in improved end-of-treatment and sustained response rates, with an overall 41% sustained virological response rate in patients treated for 48 weeks. Therapeutic benefit also extends to the traditionally difficult to treat patients (genotype 1, high viral load and advanced fibrosis). The addition of ribavirin to interferon has also resulted in an increased toxicity profile, which has made therapy more difficult for both the patient and managing physician. However, the significant improvement in response rates for all patients makes combination therapy the most appropriate choice as the first-line therapy for suitable patients with chronic viral hepatitis C. Appropriate management with interferon and ribavirin includes assessing the patient’s HCV genotype to determine the optimal duration of therapy, assessing therapeutic efficacy by measuring HCV-RNA at 24 weeks and monitoring for the additional ribavirin side-effects. [ABSTRACT FROM AUTHOR]

AbstractIntroduction: In Australia, to the end of 1997, more than 110 000 people have been diagnosed with hepatitis C virus (HCV) antibodies and reported to State/Territory surveillance systems. The available data indicate that the overwhelming majority (around 80%) of people with HCV antibodies were infected through injecting drug use. Methods: Models of the HCV epidemic in Australia were developed based on estimates of the pattern of injecting drug use in Australia. Estimates of HCV infections due to injecting drug use thus obtained were then adjusted to allow for HCV infections resulting from other transmission routes. Projections of cirrhosis and hepatocellular carcinoma (HCC) resulting from HCV were obtained by combining modelled HCV incidence with estimates of the progression rates to these outcomes. Results: Based on the models, it was estimated that there were 196 000 (lower and upper limits of 149 000 and 234 000) people in Australia living with HCV antibodies at the end of 1997, with HCV incidence in 1997 estimated to be 11 000 (8500–13 500). It was estimated that 8500 (4000–13 000) people were living with HCV-related cirrhosis in 1997 and that there were 80 (40–125) incident cases of HCV-related HCC. Discussion: Model-based estimates were broadly consistent with other sources of information on the HCV epidemic in Australia. These models suggest that the prevalence of HCV-related cirrhosis and the incidence of HCV-related HCC will more than double in Australia by 2010. © 1999 Blackwell Science Asia Pty Ltd. [ABSTRACT FROM AUTHOR]

Background: Hypergammaglobulinaemia and various auto-antibodies which are commonly seen in autoimmune hepatitis are also found in patients with chronic hepatitis C. We recently reported that ursodeoxycholic acid (UDCA) improved liver function tests and immunoserological markers in patients with type I autoimmune hepatitis. The aim of this study was to prospectively evaluate the efficacy of UDCA on autoimmune-associated chronic hepatitis C. Methods: Immunoglobulin G (IgG), anti-nuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA) were determined in 95 patients with chronic hepatitis C. All patients were positive for hepatitis C virus RNA. Autoimmune-associated chronic hepatitis C (C-AIH) was defined by elevated serum IgG level (≥ 2.0 g/dL) and high titres of ANA and/or ASMA (≥ 1: 160). Nine (9%) of 95 patients were diagnosed as C-AIH. All the C-AIH patients and 30 of the remaining 86 chronic hepatitis C patients without autoimmune features (CHC) were treated with UDCA (600 mg/day) for 1 year. Results: Autoimmune-associated chronic hepatitis C patients included one man and eight women and their AIH scores, as defined by the International Autoimmune Hepatitis Group, were significantly higher than the CHC patients. Before UDCA therapy, there were no significant differences in aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (γ-GTP) levels between C-AIH and CHC patients. However, after 1 year UDCA therapy, AST, ALT and γ-GTP were significantly lower in C-AIH patients (P < 0.05) than in CHC patients. In C-AIH, ANA titres in seven of nine patients and ASMA titres in five of seven patients were reduced after 1 year UDCA treatment. Conclusions: These results suggest that UDCA is a useful therapeutic agent for autoimmune-associated chronic hepatitis C. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics including hepatitis C treatment service, hepatitis C, and self managing chronic hepatitis.

Pediatric hepatitis C is a chronic infection in the majority of children and hence confers a lifetime risk of development of cirrhosis and hepatocellular carcinoma, potentially with a younger age of onset. Several recent studies have examined the natural history of HCV infection in children and although fibrosis is seen frequently, the majority of patients remain clinically well over three or more decades. Therapeutic options in children have not been studied fully but may play a role in certain patients. Well conducted, sufficiently powered studies are desperately needed to provide data on which sound therapeutic judgements can be made. [ABSTRACT FROM AUTHOR]

Abstract The global burden of chronic liver disease caused by persistent infection with hepatitis B and C viruses has meant the urgent development of therapeutic strategies designed to control active replication and therefore prevent subsequent clinical sequelae. Advances in these therapeutic strategies are now clearly happening, mainly as a consequence of a better understanding of the viral life cycle and the unique pathogenesis of each disease. Further progress should continue as further insights into the virus–cell relationship are derived, which will sharpen attention on specific viral targets as well as shift and enhance host cytokine responses. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the recurrence of hepatitis C after liver transplantation, the risks of hepatocellular carcinoma and clinical practice and treatment of hepatocellular carcinoma.