Liver Cirrhosis: A Seven Year Follow-Up

The status of 121 patients who were found to have liver cirrhosis on liver biopsy in 1981 was assessed seven years later. The etiology of the cirrhosis was alcoholic in 52%, cryptogenic in 29.8%, hepatitis B-related in 9.1% and miscellaneous in 9.1%. In 1981, jaundice was present in 55 patients (45.8%), ascites in 52 (43%), gastrointestinal bleeding in 25 (20.7%) and encephalopathy in 10 (8.3%). During the following seven years an additional 20 patients developed ascites, 15 gastrointestinal bleeding, 32 encephalopathy and three hepatocellular carcinoma. The mortality race was 43.8% at five years and 53.7% at seven years. The principal cause of death was liver failure (40%), followed by nonliver causes (32.3%) and gastrointestinal bleeding (13.9%). One patient died of hepatocellular carcinoma. Patients who survived seven years had fewer complications when seen in 1981 than those who died during this period (P<0.025). It is concluded that, in Toronto, cirrhosis is often caused by ethanol abuse and hepatitis B infection; that it is associated with significant morbidity and mortality; and that the number of complications when the patient is first seen may be a useful indicator of prognosis. Since many cases of cirrhosis are preventable, the authors suggest that efforts directed towards prevention of cirrhosis may be more rewarding than those directed towards therapy

Hepatitis Delta Infections in Toronto, Ontario

This study assessed the prevalence of hepatitis delta virus infection, the relation of this infection to the clinical and histological status and to the geographic origin of 216 patients with hepatitis B virus infection in Toronto, Ontario. Evidence of delta infection was present in 13 of the 216 patients (6.0%). It was more common in patients with acute hepatitis (11.1%) and with chronic hepatitis (16.7%) than in asymptomatic carriers (3.6%). It was not present in the three patients with hepatocellular carcinoma. The clinical course of the two patients with acute hepatitis and delta markers was similar to patients with hepatitis B alone and both made a complete recovery. Of the five patients with chronic liver disease and delta markers, three had severe chronic active hepatitis. Three of the 13 patients with delta infection were born in Canada. All three patients were intravenous drug abusers. Of the 10 patients not born in Canada, eight were immigrants from countries where delta infection is endemic. The remaining two were from West Germany and China. From this study it was concluded that, in Toronto, delta infection was more common in patients with acute and chronic hepatitis B than in asymptomatic carriers. Patients with both acute hepatitis Band delta infection had a similar clinical course to patients with acute hepatitis B alone. Patients with chronic hepatitis B and delta infection frequently had severe chronic active hepatitis. In Canadian-born patients delta infection was present in intravenous drug abusers only. Most immigrants with evidence of delta infection came from countries where delta is endemic

Peginterferon alpha-2a (40kD) [Pegasys(R)] Improves HR-QOL Outcomes Compared with Unmodified Interferon alpha-2a [Roferon(R)-A]: In Patients with Chronic Hepatitis C

Background: Use of unmodified interferon alpha-2a in chronic hepatitis C is associated with impaired health-related quality of life during therapy. Treatment with peginterferon alpha-2a (40kD) provides an improved sustained response over unmodified interferon alpha-2a. Objectives: To compare health-related quality of life during treatment for patients receiving peginterferon alpha-2a (40kD) [Pegasys(R)] versus unmodified interferon alpha-2a [Roferon(R)]. Design: A randomised, international, multicentre, open-label, parallel group study. Setting: 36 centres worldwide. Patients: Interferon-naive patients (n = 531) with chronic hepatitis C. Interventions: Peginterferon alpha-2a (40kD) 180mug once a week (n = 267) for 48 weeks or unmodified interferon alpha-2a 6 million IU three times a week for 12 weeks followed by 36 weeks of 3 million IU three times a week (n = 264). Measurements: Fatigue Severity Scale and 36-item Short-Form Health Survey (SF-36). Results: At weeks 2 and 12, differences favouring peginterferon alpha-2a (40kD) were seen on seven of eight domains and both summary scores of the SF-36 (pAntivirals, Hepatitis C, Interferon alpha 2a, PEG interferon alpha 2a, Pharmacoeconomics, Quality of life

Sustained HBeAg and HBsAg loss after longterm follow-up of HBeAg positive patients treated with peginterferon alpha-2B

58th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases -- NOV 02-06, 2007 -- Boston, MAWOS: 000249910401228Amer Assoc Study Liver Di

Sustained HBeAg and HBsAg loss after long-term follow-up of HBeAg-positive patients treated with peginterferon alpha-2b

Background & Aims: The aim of this study was to evaluate the long-term sustainability of response in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B treated with pegylated interferon (PEG-IFN) alpha-2b alone or in combination with lamivudine. Methods: All 266 patients enrolled in the HBV99-01 study were offered participation in a long-term follow-up (LTFU) study. Patients were treated with PEG-IFN alpha-2b (100 mu g/wk) alone or in combination with lamivudine (100 mg/day) for 52 weeks. Initial response was defined as HBeAg negativity at 26 weeks posttreatment. For the LTFU study, patients had one additional visit after the initial study (mean interval, 3.0 +/- 0.8 years). Results: of 266 patients enrolled in the initial study, 72 (65%) participated in the LTFU study. At LTFU, HBeAg and hepatitis B surface antigen (HBsAg) negativity were observed in 37% and 11% of 172 patients, respectively. Sixty-four patients were classified as initial responders and 108 as nonresponders. Among the initial responders, sustained HBeAg negativity and HBsAg loss were observed in 81% and 30%, respectively. Significantly higher rates of HBeAg negativity were observed in genotype A-infected initial responders compared with those with genotype non-A (96% vs 76%; P = .06) as well as HBsAg loss (58% vs 11%; P <.001). Conclusions: HBeAg loss after treatment with PEG-IFN alpha-2b alone or in combination with lanlivudine is sustained in the majority of patients and is associated with a high likelihood of HBsAg loss, particularly in genotype A-infected patients. Therefore, PEG-IFN alpha-2b remains an important treatment option in this era of nucleos(t)ide analogue therapy