Treating HBV: 6 recent reports on therapy outcomes

As Hepatitis Awareness Month comes to a close, Healio.com/Hepatology presents several recently published studies on hepatitis B therapy outcomes and expert opinions on hepatitis awareness in both the public and clinical domains.

The following reports include data on improved survival after decompensation, efficacy of lamivudine therapy, and HBV clearance rates based upon alanine aminotransferase levels and immune-tolerant stages.

Interferon plus lamivudine therapy improves HBV clearance in children

Pediatric patients with chronic hepatitis B and immune-tolerant characteristics who underwent interferon therapy followed by treatment with lamivudine had significantly improved the rates of undetectable serum HBV DNA, HBV e-antigen seroconversion and HBV surface antigen loss compared with control, according to a recently published study.

“In children, chronic hepatitis B (CHB) is characterized by its natural course, including immune-tolerant phase, immune-active state and inactive carrier,” Shishu Zhu, MD, from the Beijing 302 Hospital, and colleagues wrote. “Ideally, a child with CHB should be treated early to prevent the development of cirrhosis and HCC. Nevertheless, to date, no therapeutic interventions have been recommended by the guidelines for the pediatric immune-tolerant CHB, because of the scarcity of available data. Read more

Q&A: Viral hepatitis awareness grows through patient, physician efforts

Viral hepatitis refers to several types of inflammatory liver infections that can lead to serious complications like fibrosis or cirrhosis. While some types of hepatitis may be prevented with vaccination and others can clear spontaneously, many patients remain unaware of the risks for infection or their current infection status.

In honor of Hepatitis Awareness Month and Hepatitis Testing Day on May 19th, HCV Next spoke with Nancy S. Reau, MD, from Rush University Medical Center and a member of the American Liver Foundation’s National Medical Advisory Committee, about the state of viral hepatitis awareness and the challenges that remain between screening and linkage to care. Read more

SVR to HBV therapy improves survival after decompensation

Patients with hepatitis B-related decompensated cirrhosis who achieved virologic response after treatment with either Baraclude or Epivir had significantly improved long-term and transplant-free survival, according to results of a 10-year observational study.

“Our study demonstrates for the first time that the benefits of [a sustained virologic response] are maintained for up to 10 years with significantly improved liver function even after decompensation, but patients are still at risk for [hepatocellular carcinoma (HCC)], highlighting the importance of close HCC surveillance,” Jeong Won Jang, MD, from the Catholic University of Korea, and colleagues wrote. Read more

PAGE BREAK

Normal ALT levels during HBV therapy improves outcomes

Normal on-treatment alanine aminotransferase levels correlated with improved clinical outcomes in patients with chronic hepatitis B during nucleo(s)tide analogue treatment, according to a recently published study.

“[Chronic HBV] patients would have a lower risk of hepatic events if they achieve normal on-treatment ALT in the first 12 months of [nucleos(t)ide analogue (NA)] treatment,” Grace Lai-Hung Wong, MD, from the Chinese University of Hong Kong, and colleagues wrote. “The higher the ALT levels during treatment, the higher the risk of hepatic events.” Read more

Patients with HBV, HCV should receive hepatitis A vaccination

Physicians should consider administering hepatitis A vaccines to their patients with hepatitis B and those with hepatitis C, according to a commentary published in Gastroenterology.

“Recent large outbreaks of HAV related to foodborne and person-to-person exposures have resulted in substantial rates of morbidity and mortality; these events underscored the relatively low prevalence of immunity against HAV infection among the U.S.-born adult population,” Anne C. Moorman, MPH, from the CDC, and colleagues wrote. Read more

Treatment during HBV immune-tolerant phase may prevent liver cancer

Untreated patients with chronic hepatitis B in the immune-tolerant phase had higher risks for hepatocellular carcinoma, death or need for liver transplantation compared with patients in the immune-active phase treated with nucleos(t)ide analogues, according to recently published data.

“Antiviral treatment is generally not recommended for these patients by most practice guidelines because of the notion that the histological activity is dormant, and the risk of disease progression is low in the [immune-tolerant] phase,” Gi-Ae Kim, MD, from the University of Ulsan College of Medicine, Republic of Korea, and colleagues wrote. “Our results suggest that many unnecessary deaths could be prevented by earlier antiviral intervention in the IT phases before the appearance of clinically active liver disease.” Read more