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International audience; Background: Although the FibroTest has been validated as a biomarker to determine the stage of fibrosis in non‐alcoholic fatty liver disease (NAFLD) with results similar to those in chronic hepatitis C (CHC), B (CHB), and alcoholic liver disease (ALD), it has not yet been confirmed for the prediction of liver‐related death. Aim: To validate the 10‐year prognostic value of FibroTest in NAFLD for the prediction of liver‐ related death. Method: Patients in the prospective FibroFrance cohort who underwent a FibroTest between 1997 and 2012 were pre‐included. Mortality status was obtained from physicians, hospitals or the national register. Survival analyses were based on univariate (Kaplan‐Meier, log rank, AUROC) and multivariate Cox risk ratio taking into account age, sex and response to anti‐viral treatment as covariates. The comparator was the performance of the FibroTest in CHC, the most validated population. Results: 7082 patients were included; 1079, 3449, 2051, and 503 with NAFLD, CHC, CHB, and ALD, respectively. Median (range) follow‐up was 6.0 years (0.1‐19.3). Ten year survival (95% CI) without liver‐related death in patients with NAFLD was 0.956 (0.940‐0.971; 38 events) and 0.832 (0.818‐0.847; 226 events; P = 0.004)in CHC. The prognostic value (AUROC / Cox risk ratio) of FibroTest in patients with NAFLD was 0.941 (0.905‐0.978)/1638 (342‐7839) and even higher than in patients with CHC 0.875 (0.849‐0.901; P = 01)/2657 (993‐6586). Conclusions: The FibroTest has a high prognostic value in NAFLD for the prediction of liver‐related death. (ClinicalTrials.gov number, NCT01927133).

Hepatitis B (HBV) virus infection is characterized by the overproduction of subviral particles (SVP) over infectious Dane particles (VP). Precise regulation of the ratio between these forms is unknown, but its fluctuation may have a clinical impact. An enrichment method was applied to assess the SVP/VP ratio in chronically infected patients (CHB) and to compare the sensitivity of HBs antigen (HBsAg) and DNA detection methods. Plasmas from 9 genotype A-D CHB patients were fractionated on Nycodenz(®) gradients, and both HBV DNA and HBsAg were quantified in each collected fraction using standardized techniques expressed in IU/mL. Infection of primary human hepatocytes (PHHs) was performed with crude or fractionated plasma. Independently of the genotype, all plasmas showed a similar rate-zonal separation profile characterized by a bottom DNA-enriched peak surmounted by HBsAg-enriched fractions. Inoculation of PHH with plasma-derived VP-enriched fractions led to long-lasting production of virus in cell supernatants with a SVP/VP ratio similar to that observed in patient plasmas. In the VP fraction, one IU of HBsAg corresponded to approximately 5 million IU of HBV DNA. Rate-zonal gradient separation directly applied on patient plasma allows a better insight into the distribution of VP in HBeAg-positive CHB carriers. This study highlights the sensitivity difference of the techniques classically used to monitor HBV infection and indicates that VP-associated HBsAg contributes modestly to the overall amount of total circulating HBsAg in CHB. Such a fractionation approach should help to understand the fine regulation of HBsAg production over replication at different stages of CHB.

The combination of a high incidence of thalassemia and a high fertility rate in the Southeast Asian refugee population mandates effective screening programs, but unique cultural and psychosocial factors often impede optimal screening and genetic counseling. This paper identifies cultural and psychosocial barriers often associated with refugee thalassemia screening, and offers practical guidelines for remediation. © 1993 Wiley-Liss, Inc.