Perbedaan Kadar Pentraxin 3 pada Penderita Hepatitis B Kronis dengan Cirrosis dan Tanpa Cirrosis

This study aims to see differences in pentraxin 3 levels in chronic hepatitis B sufferers with cirrosis and without cirrosis. The method uses cross sectional consecutive sampling. The results of this study found a significant difference between the average value of Pentraxin 3 in chronic Hepatitis B patients with liver cirrhosis group compared to the group without liver cirrhosis (p<0.001). There was a significant difference between the Pentraxin 3 levels in the group of Chronic Hepatitis B sufferers with liver cirrhosis compared to the group of Chronic Hepatitis B sufferers without liver cirrhosis (p<0.001) where the Pentraxin 3 levels in the Chronic Hepatitis B group with liver cirrhosis were higher compared to the group without liver cirrhosis. In conclusion, Pentraxin 3 levels can be used as an alternative marker to assess the development of liver cirrhosis in Chronic Hepatitis B patients.   Keywords: Chronic Hepatitis B, Liver cirrhosis, Pentraxin

New Approaches to Chronic Hepatitis B

Chronic hepatitis B is caused by the hepatitis B virus (HBV), a hepatotropic DNA virus that can replicate at high levels and cause minimal disease or severe liver injury. The clinical spectrum of chronic hepatitis B ranges from no symptoms to progressive hepatic fibrosis, advanced cirrhosis, and hepatocellular carcinoma. An estimated 296 million people have chronic hepatitis B, of whom 221 million live in low- and middle-income countries. Without intervention, deaths from HBV are expected to peak at 1.14 million by 2035

Icteric flare of chronic hepatitis B in a 95-year old patient

A 95-year old gentleman developed fatal icteric flare of chronic hepatitis B despite lamivudine treatment. This article highlights the atypical presentations of chronic hepatitis B in elderly patient and the need to consider this possibility for acute fulminant hepatitis in endemic areas.published_or_final_versio

HBeAg and Anti HBe Status in Patients with Chronic Hepatitis B Infection

Background: Data on HBeAg and anti HBe status in patients with chronic hepatitis B infection are not yet available in Indonesia. This study was done to acquire data on HBeAg and anti HBe status in patients with hepatitis B chronic infection. Method: The material of this study was sera, collected from 105 patients with chronic hepatitis B infection from June to November 2007, divided into four groups of hepatoma, liver cirrhosis, chronic hepatitis B and asymptomatic HBsAg carriers. All sera were examined for HBsAg, HbeAg, anti HBe aside from liver function examinations. The sera consisted of 23 sera of patients with hepatoma, 27 with liver cirrhosis, 12 with chronic hepatitis B, and 43 with HBsAg asymptomatic carriers. Results: From 105 samples, only 18.1% samples were in replicative phase, as shown with the positivity of HBeAg and the negativity of anti-HBe. Sera with negative HbeAg and positive anti-HBe were mainly found in liver cirrhosis (70.73%) and least in chronic hepatitis B (50.00%) Conclusion: The high frequency of HBeAg negative and anti-HBe positive in this study might indicate the possible high frequency of pre core mutation. A study using quantitative HBV DNA should be done to confirm it

Evaluation of prescribing pattern of drugs and compliance to standard treatment guidelines in patients of chronic hepatitis B: a prospective observational study

Background: Hepatitis B is a major global health problem. Chronic hepatitis B is characterized by hepatic inflammation, necrosis and persistence of HbsAg for at least 6 months. Chronic liver disease is more predictably associated with impaired metabolism of drugs than acute liver dysfunction. Prescribing drugs in patients with chronic hepatitis B is challenging because of concerns that the drug may exacerbate the liver disease. There is also the fear that the altered liver state may change metabolism and excretion of the drug. Methods: A cross-sectional prospective study was conducted involving patients diagnosed with chronic hepatitis B at the liver clinic outpatient department (OPD) of AIIMS Bhopal. A total of 102 patients with chronic hepatitis B who met the inclusion criteria were recruited in the study. Results: Out of 102 prescriptions, 492 drugs were prescribed for the 102 patients. Out of 102 patients, 81 patients (81.66%) were on entecavir monotherapy and rest 21 patients (18.34%) were on tenofovir disoproxil fumarate (TDF) monotherapy. Of the 102-prescription issued, 92.15% (94/102) were compliant and 7.85% (8/102) were noncompliant.  Conclusions: Entecavir was the most common antiviral drug prescribed, followed by tenofovir in patients of chronic hepatitis B. Spironolactone plus torasemide combination was the most common fixed dose combination used among study participants. Liver cirrhosis followed by portal hypertension was the most common complication. Majority of prescriptions were compliant with recommendations for pharmacotherapy and safety guidelines in patients of chronic hepatitis B.

Is it better to treat chronic hepatitis B as early as possible?—Con

Ideally, treatment of chronic hepatitis B in its early stage prior to irreversible liver damage should be most effective in preventing adverse clinical outcome. However, currently available treatments have low efficacy in achieving sustained response among patients in the early phase of chronic hepatitis B infection when the immune response to hepatitis B virus is weak. This review will provide evidence why a ‘wait and monitor’ approach is appropriate for chronic hepatitis B patients who are in the immune tolerant phase.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73513/1/j.1440-1746.2004.03660.x.pd

Association between metabolic syndrome and its individual components with viral hepatitis B

BACKGROUND: The association between hepatitis B and metabolic syndrome (MetS) has not been well described. Overall epidemiologic evidences for this association have suggested conflicting results. The aim this study was to determine the association between hepatitis B infection and MetS using large U.S. population database, the Third National Health and Nutrition Examination Survey. METHODS: Individuals aged ≥18 years were included in this study. MetS was defined according to the Third Report of the National Cholesterol Education Program Adult Treatment Panel guideline. The chronic hepatitis B was defined as the presence of hepatitis B surface antigen. The presence of hepatitis B core antibody with/without surface antibody, in the absence of surface antigen, was considered as past exposure to hepatitis B. To represent national estimates, weighted frequencies for chronic hepatitis B and past exposure to hepatitis B are reported. Multivariate logistic regression analysis accounting for age, gender, race, smoking and alcohol status was conducted to identify the independent predictor(s) of MetS. RESULTS: This study cohort consisted of total population of 593,594 with chronic hepatitis B and 7,280,620 with past exposure to hepatitis B. Prevalence of MetS among included study cohort was 25.7%. Inverse association was observed between MetS and chronic hepatitis B (adjusted odds ratio, 0.32; 95% confidence interval, 0.12-0.84). Among individual components of MetS, waist circumference was inversely associated with chronic hepatitis B (adjusted odds ratio, 0.31; 95% confidence interval, 0.14-0.71). No significant association was noted between past exposure to hepatitis B and MetS or its individual components. CONCLUSIONS: In this study, the authors noted significant inverse association between MetS and chronic hepatitis B

52-week efficacy and safety of telbivudine with conditional tenofovir intensification at week 24 in HBeAg-positive chronic Hepatitis B

Background and Aims: The Roadmap concept is a therapeutic framework in chronic hepatitis B for the intensification of nucleoside analogue monotherapy based on early virologic response. The efficacy and safety of this approach applied to telbivudine treatment has not been investigated. Methods: A multinational, phase IV, single-arm open-label study (ClinicalTrials.gov ID NCT00651209) was undertaken in HBeAg-positive, nucleoside-naive adult patients with chronic hepatitis B. Patients received telbivudine (600 mg once-daily) for 24 weeks, after which those with undetectable serum HBV DNA (<300 copies/mL) continued to receive telbivudine alone while those with detectable DNA received telbivudine plus tenofovir (300 mg once-daily). Outcomes were assessed at Week 52. Results: 105 patients commenced telbivudine monotherapy, of whom 100 were included in the efficacy analysis. Fifty-five (55%) had undetectable HBV DNA at Week 24 and continued telbivudine monotherapy; 45 (45%) received tenofovir intensification. At Week 52, the overall proportion of undetectable HBV DNA was 93% (93/100) by last-observation-carried-forward analysis (100% monotherapy group, 84% intensification group) and no virologic breakthroughs had occurred. ALT normalization occurred in 77% (87% monotherapy, 64% intensification), HBeAg clearance in 43% (65% monotherapy, 16% intensification), and HBeAg seroconversion in 39% (62% monotherapy, 11% intensification). Six patients had HBsAg clearance. Myalgia was more common in the monotherapy group (19% versus 7%). No decrease in the mean glomerular filtration rate occurred in either treatment group at Week 52. Conclusions: Telbivudine therapy with tenofovir intensification at Week 24, where indicated by the Roadmap strategy, appears effective and well tolerated for the treatment of chronic hepatitis B. Trial Registration: ClinicalTrials.gov NCT0065120

Hepatitis B Virus Screening and Vaccination

Abstract Hepatitis B is a virus that mostly affects the liver, it could be asymptomatic and if left untreated or undetected, could lead to liver cancer, cirrhosis or even death. When Hepatitis B virus enters the body, it could be detected as early as 30 days post exposure and if it persists, may develop into a chronic condition. Chronic hepatitis B is the persistence of hepatitis B surface antigen for six months or more. It is a global health problem in which an estimated 2 billion people worldwide are infected and with about 2.2 million people infected in the United States. This manuscript discusses the importance of screening for chronic hepatitis B virus in eligible individuals so as to identify infected and/or susceptible individuals. It also discusses hepatitis B vaccination as the best way to prevent the virus, the geographic distribution of chronic hepatitis B virus, and the eligibility criteria for screening following the recommendations of the Centers of Disease Control and Prevention (CDC) and United States Preventive Services Task Force USPSTF). Keywords: hepatitis, chronic hepatitis b, hepatitis b screening, hepatitis b vaccination, and hepatitis b prevention