Endpoints of hepatitis B treatment

The goal of hepatitis B treatment is to prevent the development of cirrhosis, liver failure, and hepatocellular carcinoma. Ideally, clinical studies should demonstrate that hepatitis B therapies can prevent liver-related complications; however, these clinical endpoints evolve over years or decades. Therefore, clinical trials have relied on intermediate endpoints to evaluate the efficacy of treatment and to determine when treatment can be stopped. Intermediate endpoints that have been used include biochemical, histological, virological, and serological endpoints. This review will discuss the validity of these intermediate endpoints as surrogates of clinical endpoints, and the rates at which these intermediate endpoints can be achieved with currently available therapies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79271/1/j.1365-2893.2010.01369.x.pd

Adherence to nucleos(t)ide analogues for chronic hepatitis B in clinical practice and correlation with virological breakthroughs

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90278/1/j.1365-2893.2011.01494.x.pd

Adherence to nucleos(t)ide analogue therapies for chronic Hepatitis B infection: A systematic review and meta-analysis

Successful treatment outcomes for chronic hepatitis B virus (HBV) infection requires high levels of adherence to treatment. We searched three databases and abstracts from two conferences up to January 2018 for studies reporting the proportion of patients who were adherent to HBV antiviral therapy and pooled data using random effects meta‐analysis. We included 30 studies, providing data for 23,823 patients. Overall, adherence to treatment was 74.6% (95% confidence interval [CI] 67.1%‐82.1%). Adherence was similar in high‐income settings (75.1%; 95% CI, 65.4%‐85.0%) and in low‐income and middle‐income settings (72.9%; 95% CI, 57.8%‐88.0%). Reported barriers to adherence included forgetting, limited understanding of the importance of adherence, and change to routine. Conclusion: There is a need to reinforce assessment and reporting of adherence as a routine part of HBV care and to assess the extent to which evidence‐based interventions to improve adherence to medication for human immunodeficiency virus [HIV] and other chronic diseases are effective for HBV infection

Genome Wide Association Study Identifies Genetic Variants Associated With Early And Sustained Response To (Peg)Interferon In Chronic Hepatitis B Patients: The GIANT-B Study

(Peg)interferon ((Peg)IFN) therapy leads to response in a minority of chronic hepatitis B (CHB) patients. Host genetic determinants of response are therefore in demand

A retrospective Thai nationwide study of the incidence of acute hepatitis A infection and the impact of chronic liver disease comorbidity on survival

Hepatitis A virus (HAV) infection is common in developing countries. An accurate incidence of HAV infection and the effect of HAV infection on patients with chronic liver disease (CLD) are not well defined in Thailand. We aimed to determine the incidence of HAV infection in Thailand and the impact of CLD comorbidity on clinical outcomes among hospitalized patients. This was a nationwide, retrospective observational study conducted using hospital admission data during 2008 to 2013 from Nationwide Hospital Admission Data, National Health Security Office. All patients with a primary diagnosis of HAV infection were included in this study. Data regarding baseline characteristics, comorbidities, hospital course and survival were collected. Overall, 1,481 patients from 347 hospitals across Thailand were included in the study. Fifty-four point eight percent of patients (n=812) were from northeastern Thailand. Seventy-four point six percent of patients (n=1,105) contracted the infection during the rainy season (June to November) which was significantly more often (p60 years, history of liver cirrhosis and history of chronic hepatitis B or C infection were significantly positively associated with 30-day mortality. CLD was associated with a greater risk of mortality among study subjects. People in the study population with CLD, and those aged > 60 years should consider hepatitis A vaccination to reduce mortality risk associated with HAV infection

Factors affecting mortality and resource use for hospitalized patients with cirrhosis: A population-based study

Hospitalizations for advanced liver disease are costly and associated with significant mortality. This population-based study aimed to evaluate factors associated with in-hospital mortality and resource use for the management of hospitalized patients with cirrhosis.Mortality records and resource utilization for 52,027 patients hospitalized with cirrhosis and/or complications of portal hypertension (ascites, hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis, or hepatorenal syndrome) were extracted from a nationally representative sample of Thai inpatients covered by Universal Coverage Scheme during 2009 to 2013.The rate of dying in the hospital increased steadily by 12% from 9.6% in 2009 to 10.8% in 2013 (P < .001). Complications of portal hypertension were independently associated with increased in-hospital mortality except for ascites. The highest independent risk for hospital death was seen with hepatorenal syndrome (odds ratio [OR], 5.04; 95% confidence interval [CI], 4.38-5.79). Mortality rate remained high in patients with infection, particularly septicemia (OR, 4.26; 95% CI, 4.0-4.54) and pneumonia (OR, 2.44; 95% CI, 2.18-2.73). Receiving upper endoscopy (OR, 0.29; 95% CI, 0.27-0.32) and paracentesis (OR, 0.93; 95% CI, 0.87-1.00) were associated with improved patient survival. The inflation-adjusted national annual costs (P = .06) and total hospital days (P = .07) for cirrhosis showed a trend toward increasing during the 5-year period. Renal dysfunction, infection, and sequelae of portal hypertension except for ascites were independently associated with increased resource utilization.Renal dysfunction, infection, and portal hypertension-related complications are the main factors affecting in-hospital mortality and resource utilization for hospitalized patients with cirrhosis. The early intervention for modifiable factors is an important step toward improving hospital outcomes