Hepatitis B virus(HBV)infection is a global health concern.The current sequen-tial endpoints for the treatment of HBV infection include viral suppression,hepatitis B e antigen(HBeAg)seroconversion,functional cure,and ...Hepatitis B virus(HBV)infection is a global health concern.The current sequen-tial endpoints for the treatment of HBV infection include viral suppression,hepatitis B e antigen(HBeAg)seroconversion,functional cure,and covalently closed circular DNA(cccDNA)clearance.Serum hepatitis B core-related antigen(HBcrAg)is an emerging HBV marker comprising three components:HBeAg,hepatitis B core antigen,and p22cr.It responds well to the transcriptional activity of cccDNA in the patient's liver and is a promising alternative marker for serolo-gical testing.There is a strong correlation,and a decrease in its level corresponds to sustained viral suppression.In patients with chronic hepatitis B(CHB),serum HBcrAg levels are good predictors of HBeAg seroconversion(both spontaneous and after antiviral therapy),particularly in HBeAg-positive patients.Both low baseline HBcrAg levels and decreasing levels early in antiviral therapy favored HBsAg seroconversion,which may serve as a good surrogate option for treatment endpoints.In this review,we summarize the role of serum HBcrAg in the treat-ment of CHB.Therefore,long-term continuous monitoring of serum HBcrAg levels contributes to the clinical management of patients with CHB and optimizes the choice of treatment regimen,making it a promising marker for monitoring HBV cure.展开更多
Hepatitis E virus(HEV)is the primary cause of acute viral hepatitis globally and is prevalent in many developing countries.Serological epidemiology studies[1,2]suggest that approximately onethird of the global populat...Hepatitis E virus(HEV)is the primary cause of acute viral hepatitis globally and is prevalent in many developing countries.Serological epidemiology studies[1,2]suggest that approximately onethird of the global population has been infected with HEV.There are an estimated 20 million new cases of HEV infection worldwide annually.World Health Organization(WHO)reported that HEV caused approximately 44000 deaths in 2015,which accounted for3.3%of deaths from viral hepatitis[3,4].Clinically,most cases of acute hepatitis E have a self-limiting course.However,co-infection with other viruses can increase the risk of acute or subacute liver failure.Hepatitis B virus(HBV)and HEV are highly prevalent in many regions worldwide,and these areas have high rates of coinfection with both viruses.The rate of co-infection with HEV among patients with chronic hepatitis B(CHB)is high,resulting in more severe health outcomes and a significantly elevated risk of liver failure and death.展开更多
BACKGROUND Existing assessment systems for chronic hepatitis B(CHB)-associated liver fibrosis(LF)exhibit insufficient accuracy,thereby requiring further improvements.AIM To investigate the association of LF staging wi...BACKGROUND Existing assessment systems for chronic hepatitis B(CHB)-associated liver fibrosis(LF)exhibit insufficient accuracy,thereby requiring further improvements.AIM To investigate the association of LF staging with hepatitis B core antibody(HBcAb),hepatitis B virus DNA(HBV-DNA),and hepatitis B surface antigen(HBsAg)in patients with CHB.METHODS We selected 120 patients with CHB receiving treatment in Hangzhou Linping District First People’s Hospital from January 2020 to June 2024.Participants were allocated into the mild(F0-F1,n=52)and moderate-to-severe groups(F2-F4,n=68)following the rigorous LF staging criteria.HBcAb,HBV-DNA,and HBsAg concentrations were measured.Pearson correlations were employed to examine the correlations of HBcAb with HBV-DNA and HBsAg,whereas Spearman correlation analysis was conducted to identify the associations of the three with LF staging.Receiver operating characteristic(ROC)curves were further used to analyze the performance of these biomarkers in diagnosing LF stages.Furthermore,binary logistic regression analysis was conducted to determine the association of these three with LF progression in CHB.RESULTS Markedly increased HBcAb and notably decreased HBV-DNA and HBsAg were observed in moderate-to-severe cases vs their mild counterparts.A positive correlation was observed between HBV-DNA and HBsAg,whereas both markers were inversely associated with HBcAb.Moreover,LF staging exhibited a significant positive correlation with HBcAb and an inverse connection with HBVDNA and HBsAg.The receiver operating characteristic analysis revealed area under the curve values of 0.715,0.799,and 0.662 for HBcAb,HBV-DNA,and HBsAg in diagnosing LF staging,respectively.Combining these markers improved the area under the curve to 0.851.The final analysis identified HBcAb as promoting fibrosis advancement(odds ratio=2.765),whereas HBVDNA demonstrated protective properties(odds ratio=0.247).CONCLUSION HBcAb is negatively correlated with HBV-DNA and HBsAg but positively associated with LF staging.All three markers are valuable in assessing LF staging,and their combined use presents the highest diagnostic efficacy.Importantly,a high HBcAb/low HBV-DNA profile markedly increased fibrosis progression risks in CHB-affected individuals.展开更多
BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HA...BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among adults.AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)infection.METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May 2024.Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed.To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed.Data regarding clinical and laboratory parameters were recorded.The yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among adults.RESULTS A total of 396 patients were found to have acute hepatitis during our study duration.HAV was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV infection.Additionally,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute hepatitis.Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years.The patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV infection.However,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in HEV.CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.展开更多
To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-ter...To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-term chronic damage caused by HCV leads to impaired liver function,portal hypertension,liver fibrosis,cirrhosis and even hepatocellular carcinoma(HCC)[1,2].Therefore,it is imperative to improve the diagnosis and treatment of hepatitis C.In 2016,World Health Organization(WHO)set the goal of“eliminating viral hep-atitis as a public health hazard by 2030”.Some associations intro-duced guidelines for hepatitis C screening and treatment.After a period of effort,in 2020,the number of people receiving treatment for chronic HCV infection had significantly increased compared to the number in 2015,and the HCV-related mortality rate had de-creased.Nevertheless,nearly 80%of infected individuals have not been timely diagnosed and treated[3,4].Like many other coun-tries,China still faces a significant gap in achieving the goal of hep-atitis C elimination,and some literature indicated limited public awareness and high medication costs might slow the progress of policy implementation[5-7].How to effectively improve the diag-nosis and treatment of hepatitis C has garnered widespread global attention.展开更多
BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with a...BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with autoimmune hepatitis(AIH)has not been clarified.This study reveals for the first time that HDV may induce AIH through abnormalities in immunoregulation in two specific cases.This is the first report of HDV-HBV co-infected patients who did not receive interferon therapy and achieved serological conversion and histological remission by combining antiviral(entecavir)with immunosuppression(prednisone+azathioprine)therapy,providing new evidence of the mechanism of this complex disease.CASE SUMMARY A 40-year-old female developed malaise and jaundice with an alanine aminotransferase/aspartate aminotransferase>20 upper limit of normal(ULN),total bilirubin:97.20μmol/L,immunoglobulin G(IgG)47.1 g/L(>3×ULN),HDV RNA 1.6×10^(7)copies/mL and liver biopsy showed G3S4.Tenofovir alafenamide combined with prednisone and azathioprine was administered,and three months later the Child-Turcotte-Pugh class C was reduced to class B and IgG decreased to 13.62 g/L.Another 58-year-old male complained of pain in the liver area,antinuclear antibody was 1:320,IgG 22.6 g/L(>1.3×ULN),and liver biopsy showed G2S3.Entecavir was administered in combination with prednisone and azathioprine,and after 3 months,liver function returned to normal,and IgG reduced to 14.22 g/L.CONCLUSION Patients with HDV-HBV co-infection combined with AIH can achieve clinical remission following combination therapy,and the study of immunomodulatory mechanisms should be emphasized.展开更多
An estimated 3%-4%of people are living with the hepatitis B virus(HBV),and without treatment,the risk of developing cirrhosis and hepatocellular cancer(HCC)is an omnipresent threat.Prevention of HCC is a major challen...An estimated 3%-4%of people are living with the hepatitis B virus(HBV),and without treatment,the risk of developing cirrhosis and hepatocellular cancer(HCC)is an omnipresent threat.Prevention of HCC is a major challenge,as the association between viral suppression and HCC risk reduction is multifactorial,involving the progressive depletion of hepatocytes through covalently closed circular DNA integration,as well as the prevention of liver fibrosis and cirrhosis.Despite effective and cheap antiviral treatment capable of suppressing HBV replication and thereby cirrhosis and HCC,the current indications for therapy need revision and more research to expand the gamut and treat more infected people.In this review,we discuss the possible expansion of antiviral treatment in chronic hepatitis B to prevent cirrhosis and,importantly,HCC.展开更多
Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus(HBV)infection within the first 12-24 hours.Detection of he-patitis B surface antibody(HBsAb)resulting from hepatitis B immu...Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus(HBV)infection within the first 12-24 hours.Detection of he-patitis B surface antibody(HBsAb)resulting from hepatitis B immunoglobulin administered at birth may be perceived as a real vaccine response.This makes it difficult to detect HBV infection.For this reason,it is recommended that infants born to hepatitis B surface antigen positive mothers and who received immunop-rophylaxis at birth should have HBsAb testing when they are 9-15 months old.展开更多
According to the World Health Organization,an estimated 58 million people worldwide are chronically infected with hepatitis C virus(HCV),yet only about 20%have been formally diagnosed.Traditional laboratory–based ant...According to the World Health Organization,an estimated 58 million people worldwide are chronically infected with hepatitis C virus(HCV),yet only about 20%have been formally diagnosed.Traditional laboratory–based antibody and RNA assays require infrastructure and trained personnel,limiting their uptake in resource-limited and hard-to-reach settings.The OraQuick HCV self-test(HCVST)is the first World Health Organization-prequalified HCVST,which delivers results in 20-40 min via an easy-to-use gum-swab format.Field evaluations report a sensitivity of about 97%–98%and a specificity of about 99%–100%that are comparable with those of blood-based lateral-flow assays(e.g.,Alere Truline,SD Bioline).Usability studies demonstrated an acceptability rate of over 90%and a correct self-test completion rate of over 85%in key populations.HCVST with the Ora-Quick HCVST kit provides a practical,evidence-based approach to closing diagnostic gaps,particularly among underserved or stigmatized populations.To maximize the public health impact,programs should integrate self-testing into national screening algorithms,ensure linkage to RNA confirmation and treatment,and consider economic and operational contexts.展开更多
BACKGROUND Whether rtS106C+H126Y+D134E/rtS106C+H126Y+D134E+L269I(rtCYE/rtCYEI)mutations in the hepatitis B virus(HBV)reverse-transcriptase(RT)region are associated with tenofovir disoproxil fumarate(TDF)resistance is ...BACKGROUND Whether rtS106C+H126Y+D134E/rtS106C+H126Y+D134E+L269I(rtCYE/rtCYEI)mutations in the hepatitis B virus(HBV)reverse-transcriptase(RT)region are associated with tenofovir disoproxil fumarate(TDF)resistance is controversial.AIM To evaluate the presence of the rtCYE/rtCYEI mutations in a large cohort of Chinese patients with chronic HBV infection.METHODS A total of 28236 patients who underwent drug resistance testing at the Fifth Medical Center of Chinese PLA General Hospital from 2007 to 2019 were enrolled.All patients received nucleoside/nucleotide analogues(NAs)therapy,and serum samples were collected for sequence analysis of the HBV RT domain with mutation analysis.RESULTS The detection rates of a single mutation of rtS106C,rtH126Y,rtD134E,and rtL269I were 8.21%,3.20%,2.55%and 61.49%in 23718 genotype C patients,and 1.31%,1.76%,0.21%,and 92.33%in 4266 genotype B patients,respectively.The combined mutations of rtCYE/rtCYEI were only detected in 12 genotype C patients,accounting for 0.042%of all patients.These 12 patients had received NA treatments except TDF before testing.Among them,6 patients had coexisting rtCYE/rtCYEI and lamivudine-resistance mutations,and 2 patients had coexisting rtCYE/rtCYEI and adefovir-resistance mutations.Compared with the wild-type(WT)strain,the replication capacity of rtCYE/rtCYEI mutants from representative patients decreased by 41.1%-71.8%,and TDF susceptibility reduced by less than 2-fold,but rtCYEI+rtA181V/N236T mutants exhibited a 6.2-/9.9-fold decrease in TDF susceptibility.Molecular modeling showed that rtCYE/rtCYEI mutants had a slight decrease in binding energy to TDF compared to the WT strain.In the clinic,emergence of the rtCYE/rtCYEI mutations was not specifically associated with TDF treatment.CONCLUSION HBV rtCYE/rtCYEI mutations have a limited effect on TDF susceptibility and are not sufficient to cause TDF resistance.展开更多
BACKGROUND The relationship between hepatitis B surface antigen(HBsAg)concentrations,hepatitis B virus(HBV)DNA levels,and hepatic function in individuals with chronic hepatitis B(CHB)remains incompletely characterized...BACKGROUND The relationship between hepatitis B surface antigen(HBsAg)concentrations,hepatitis B virus(HBV)DNA levels,and hepatic function in individuals with chronic hepatitis B(CHB)remains incompletely characterized.AIM To examine the association of serum HBsAg concentrations with HBV DNA levels and hepatic function parameters in patients with CHB.METHODS A total of 110 individuals with CHB admitted to Kunming Third People’s Hospital between January 2023 and January 2025 were enrolled as the observation group,whereas 70 age-and sex-matched healthy individuals served as the control group.Fasting peripheral venous blood(5 mL)was collected from all participants.Serum HBsAg and HBV DNA levels(in the observation group),along with hepatic function markers,including total bilirubin(TBIL),aspartate aminotransferase(AST),and alanine aminotransferase(ALT),were measured in both groups.Pearson correlation analysis was used to assess the association between serum HBsAg levels and HBV DNA,TBIL,AST,and ALT levels in patients with CHB.Receiver operating characteristic(ROC)curve analysis was conducted to determine optimal cutoff values of HBsAg for predicting high viral load(HBV DNA≥10^(5) IU/mL)and significant liver injury(ALT≥2×upper limit of normal[ULN]).RESULTS HBsAg levels differed significantly across CHB phases:Immune tolerance(IT)phase(4.62±1.51 lgIU/mL),immune clearance(IC)phase(3.84±1.16 lgIU/mL),low replication(LR)phase(2.99±0.66 lgIU/mL),and HBV e antigen-negative hepatitis(ENH)phase(3.40±0.69 lgIU/mL).Corresponding HBV DNA levels were highest in the IT phase(7.41±1.83 log copies/mL),followed by the IC phase(6.03±1.92 log copies/mL),ENH phase(3.89±1.23 log copies/mL),and LR phase(2.55±1.00 log copies/mL).All hepatic function parameters in patients with CHB were significantly elevated compared to the healthy controls.Pearson correlation analysis showed significant positive associations between serum HBsAg levels and HBV DNA,TBIL,AST,and ALT levels.ROC analysis revealed that an HBsAg cutoff>4.09 lgIU/mL predicted HBV DNA≥105 IU/mL(high viral load)with 88.57%sensitivity,78.67%specificity,and an area under the curve(AUC)of 0.868(P<0.001),while a cutoff>4.07 lgIU/mL predicted ALT≥2×ULN(significant liver injury)with 69.70%sensitivity,90.91%specificity,and an AUC of 0.821(P<0.001).CONCLUSION Serum HBsAg,a noninvasive serological marker,holds significant clinical value in CHB management by aiding in the stratification of viral burden and the prediction of hepatic impairment.展开更多
Viral hepatitis represents a major danger to public health,and is a globally leading cause of death.The five liver-specific viruses:Hepatitis A virus,hepatitis B virus,hepatitis C virus,hepatitis D virus,and hepatitis...Viral hepatitis represents a major danger to public health,and is a globally leading cause of death.The five liver-specific viruses:Hepatitis A virus,hepatitis B virus,hepatitis C virus,hepatitis D virus,and hepatitis E virus,each have their own unique epidemiology,structural biology,transmission,endemic patterns,risk of liver complications,and response to antiviral therapies.There remain few options for treatment,in spite of the increasing prevalence of viral-hepatitiscaused liver disease.Furthermore,chronic viral hepatitis is a leading worldwide cause of both liver-related morbidity and mortality,even though effective treatments are available that could reduce or prevent most patients’complications.In 2016,the World Health Organization released its plan to eliminate viral hepatitis as a public health threat by the year 2030,along with a discussion of current gaps and prospects for both regional and global eradication of viral hepatitis.Today,treatment is sufficiently able to prevent the disease from reaching advanced phases.However,future therapies must be extremely safe,and should ideally limit the period of treatment necessary.A better understanding of pathogenesis will prove beneficial in the development of potential treatment strategies targeting infections by viral hepatitis.This review aims to summarize the current state of knowledge on each type of viral hepatitis,together with major innovations.展开更多
BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of d...BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral(DAA)treatment in HCV-infected patients.METHODS The study included consecutive 9457 women and 9529 men,treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project.Women were divided into pre-menopausal(15-44 years),menopausal(45-55 years)and post-menopausal(>55 years)and compared with age-matched men.RESULTS Regardless of age,women had a significantly lower body mass index,prevalence of genotype 3 infection and proportion of cirrhosis compared to men.Psychiatric disorders(except depression),hepatitis B virus and human immunodeficiency virus co-infections,as well as alcohol and drug addiction,were significantly less common in women than in men in all age groups.The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4%and 96.6%,respectively(P<0.001).Independent predictors of treatment failure in women were genotype 3 infection,cirrhosis and postmenopausal age.Mild adverse events were reported significantly more often by women,regardless of age with the highest percentage in the postmenopausal group.CONCLUSION DAA treatment is more effective in women than in men,regardless of age,but in postmenopausal women,the effectiveness is relatively the lowest.展开更多
In this editorial,we comment on the article by Meng et al.Chronic hepatitis B(CHB)is a significant global health problem,particularly in developing countries.Hepatitis B virus(HBV)infection is one of the most importan...In this editorial,we comment on the article by Meng et al.Chronic hepatitis B(CHB)is a significant global health problem,particularly in developing countries.Hepatitis B virus(HBV)infection is one of the most important risk factors for cirrhosis and hepatocellular carcinoma.Prevention and treatment of HBV are key measures to reduce complications.At present,drug therapy can effectively control virus replication and slow disease progression,but completely eliminating the virus remains a challenge.Anti-HBV treatment is a long-term process,and there are many kinds of antiviral drugs with different mechanisms of action,it is essential to evaluate the safety and efficacy of these drugs to reduce side effects and improve patients’compliance.We will summarize the current status of CHB drug treatment,hoping to provide a reference for the selection of clinical antiviral drugs.展开更多
In this editorial,we comment on the article by Mu et al,published in the recent issue of the World Journal of Gastrointestinal Oncology.We pay special attention to the immune tolerance mechanism caused by hepatitis B ...In this editorial,we comment on the article by Mu et al,published in the recent issue of the World Journal of Gastrointestinal Oncology.We pay special attention to the immune tolerance mechanism caused by hepatitis B virus(HBV)infection,the pathogenesis of hepatocellular carcinoma(HCC),and the role of antiviral therapy in treating HCC related to HBV infection.HBV infection leads to systemic innate immune tolerance by directly inhibiting pattern recognition receptor recognition and antiviral signaling pathways,as well as by inhibiting the immune functions of macrophages,natural killer cells and dendritic cells.In addition,HBV leads to an immunosuppressive cascade by expressing inhibitory molecules to induce exhaustion of HBV-specific cluster of differentiation 8+T cells,ultimately leading to long-term viral infection.The loss of immune cell function caused by HBV infection ultimately leads to HCC.Long-term antiviral therapy can improve the prognosis of patients with HCC and prevent tumor recurrence and metastasis.展开更多
BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vul...BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vulnerable populations such as people who use illicit drugs,those experiencing homelessness,and men who have sex with men disproportionately affected.AIM To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.METHODS We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020.Adults(≥18 years)hospitalized with a primary diagnosis of HAV infection were included.We identified active substance use as a secondary diagnosis.Statistical analysis involved descriptive statistics,trend analysis,and propensity score matching to compare HAV hospitalizations with and without substance use.Outcomes included hospitalization trends,complications,length of stay(LOS),and mortality.RESULTS From 2011 to 2020,there were 56972 hospitalizations for HAV infections.Hospitalizations increased from 3917 in 2011 to 8290 in 2020,peaking at 9800 in 2018.Caucasian males(55%)were the most affected,with a mean age of 49 years.The prevalence of active substance use among HAV hospitalizations was 27%,with these patients being younger(mean age:39 years)and predominantly male(63.1%).HAV hospitalizations associated with substance use increased significantly,rising from 235 cases in 2011 to 3200 in 2020(P<0.001).Compared to HAV hospitalizations without substance use,those with substance use had higher rates of co-infections(hepatitis C virus 45%vs 11%,hepatitis B virus 11%vs 6%)and complications,including sepsis(1.9%vs 1%)and infective endocarditis(1.4%vs 0.15%,P<0.001).Hospitalizations with substance use also had longer LOS(4.34 days vs 3.97 days,P<0.05),but mortality rates were comparable.Predictors of mortality in HAV-substance use hospitalizations included acute liver failure,sepsis,and acute respiratory failure.CONCLUSION HAV hospitalizations in the United States have significantly increased over the past decade,with the rise driven by cases involving substance use.These patients face a higher burden of complications and healthcare utilization.Tailored public health strategies,including targeted vaccination and outreach programs for at-risk populations,are essential to reduce the morbidity,mortality,and economic burden associated with HAV.展开更多
Current treatment options for hepatitis D are limited,with pegylated interferonalpha(PEG-IFNα)being the only therapy available in the Asia-Pacific region.However,PEG-IFNαhas limited efficacy and significant side eff...Current treatment options for hepatitis D are limited,with pegylated interferonalpha(PEG-IFNα)being the only therapy available in the Asia-Pacific region.However,PEG-IFNαhas limited efficacy and significant side effects.Pegylated interferon lambda acts on interferon-lambda(Type III)receptors predominantly expressed in hepatocytes.In 2023,bulevirtide was approved in the European Union and Russia for treating chronic hepatitis D.This drug works by binding to and inhibiting the sodium taurocholate co-transporting polypeptide receptor on liver cells,which is the primary entry point for the virus.Recently,several new drugs have entered various stages of development,offering hope for improved hepatitis D virus(HDV)management.Two more viral entry inhibitors are HH003 and tobevibart.Other agents include nucleic acid polymers(REP 2139-Mg),prenylation inhibitors(lonafarnib),and RNA interference-based therapies(elebsiran).Emerging trials are now considering combination therapies,such as SOLSTICE,a Phase 2 clinical trial evaluating tobevibart alone or combined with elebsiran.The combination dosed monthly achieved>50%virologic and biochemical response at 24 weeks of therapy.The efficacy and safety of these drugs will further be evaluated in ECLIPSE 1,2,and 3 trials.With these new treatments on the horizon,the prospects for improved HDV patient outcomes are promising.展开更多
This editorial provides commentary on the study by Dobrowolska et al,highlighting the influence of biological sex on hepatitis C virus(HCV)infection risk and disease progression.HCV infection is more common in men;how...This editorial provides commentary on the study by Dobrowolska et al,highlighting the influence of biological sex on hepatitis C virus(HCV)infection risk and disease progression.HCV infection is more common in men;however,women,regardless of age,show a lower prevalence of genotype 3 infection,diabetes mellitus,and coinfections with hepatitis B virus and human immunodeficiency virus.Women also experience slower liver fibrosis progression.Despite this,mild adverse events,autoimmune diseases,and depression occur more frequently in women.Sustained virologic response at 12 weeks post-treatment was significantly higher in women(98.4%)than in men(96.6%).In women,postmenopausal status,genotype 3 infection,and cirrhosis were independently associated with treatment failure.Early diagnosis and timely antiviral therapy in women are critical to preventing vertical transmission and mitigating disease advancement.展开更多
Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher ...Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher prevalence of carotid atherosclerosis in patients with chronic hepatitis C infection,with viral load and steatosis emerging as independent risk factors.HCV-related athero-sclerosis appears to develop through complex processes involving endothelial dysfunction,inflammation,oxidative stress,and immune dysregulation.Key cytokines,including tumor necrosis factor-alpha and interleukin-6,increase inflammatory responses,while oxidative stress markers,such as malondial-dehyde,are associated with an increased risk of atherogenesis.In addition,HCV infection has been linked to cardiomyopathy.Direct viral effects,including HCV replication within cardiomyocytes and cytotoxicity induced by viral proteins,lead to myocardial injury and functional decline.Indirectly,HCV triggers immune-mediated damage,with heightened pro-inflammatory cytokines exacerbating cardiomyocyte apoptosis and fibrosis.Furthermore,HCV infection promotes a procoagulant imbalance,as evidenced by elevated factor VIII levels and thrombin potential,contributing to the increased cardiovascular risk.While substantial evidence indicates a relationship between HCV and cardiovascular disease,further research is needed to establish causality and guide therapeutic interventions.展开更多
Severe alcoholic hepatitis remains one of hepatology’s most urgent challenges,with rapid clinical deterioration and high early mortality.This manuscript comments on and contextualizes the recent systematic review by ...Severe alcoholic hepatitis remains one of hepatology’s most urgent challenges,with rapid clinical deterioration and high early mortality.This manuscript comments on and contextualizes the recent systematic review by Quiñones-Calvo et al,which redirects attention from short-term endpoints toward 90-day survival,integrating evidence from associated clinical studies.For decades,corticosteroids have been the mainstay of treatment,reducing 28-day mortality but offering limited benefit for three months.The review emphasizes that the most critical threats to recovery,late infections,renal decline,and relapse,often emerge after the first month.By synthesizing recent studies,it highlights promising interventions such as fecal microbiota transplantation(FMT),which improved 90-day survival in a small randomized trial,and granulocyte colony-stimulating factor(G-CSF),which showed a robust survival benefit in a large retrospective cohort,alongside emerging strategies like plasma exchange and targeted biologics.These findings support a shift toward a two-phase care model:Early stabilization followed by recovery consolidation.For clinicians,such a model may help guide treatment decisions,with therapies like FMT or G-CSF warranting consideration in corticosteroid non-responders,pending further validation in larger randomized controlled trials.Adoption of 90-day survival as a central metric could bridge the gap between initial rescue and sustained remission,providing a more realistic measure of therapeutic success in one of hepatology’s most unforgiving conditions.展开更多
基金Supported by The Chongqing Talents Project,No.cstc2021ycjh-bgzxm0150The First Batch of Key Disciplines on Public Health in Chongqing,The Health Commission of Chongqing,No.2022(72)+1 种基金The Remarkable Innovation-Clinical Research Project,The Second Affiliated Hospital of Chongqing Medical UniversityThe Scientific and Technological Research Program of Chongqing Municipal Education Commission,the Second Affiliated Hospital of Chongqing Medical University,No.KJZD-K202300404.
文摘Hepatitis B virus(HBV)infection is a global health concern.The current sequen-tial endpoints for the treatment of HBV infection include viral suppression,hepatitis B e antigen(HBeAg)seroconversion,functional cure,and covalently closed circular DNA(cccDNA)clearance.Serum hepatitis B core-related antigen(HBcrAg)is an emerging HBV marker comprising three components:HBeAg,hepatitis B core antigen,and p22cr.It responds well to the transcriptional activity of cccDNA in the patient's liver and is a promising alternative marker for serolo-gical testing.There is a strong correlation,and a decrease in its level corresponds to sustained viral suppression.In patients with chronic hepatitis B(CHB),serum HBcrAg levels are good predictors of HBeAg seroconversion(both spontaneous and after antiviral therapy),particularly in HBeAg-positive patients.Both low baseline HBcrAg levels and decreasing levels early in antiviral therapy favored HBsAg seroconversion,which may serve as a good surrogate option for treatment endpoints.In this review,we summarize the role of serum HBcrAg in the treat-ment of CHB.Therefore,long-term continuous monitoring of serum HBcrAg levels contributes to the clinical management of patients with CHB and optimizes the choice of treatment regimen,making it a promising marker for monitoring HBV cure.
基金supported by a grant from the Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project(2019ZB101)。
文摘Hepatitis E virus(HEV)is the primary cause of acute viral hepatitis globally and is prevalent in many developing countries.Serological epidemiology studies[1,2]suggest that approximately onethird of the global population has been infected with HEV.There are an estimated 20 million new cases of HEV infection worldwide annually.World Health Organization(WHO)reported that HEV caused approximately 44000 deaths in 2015,which accounted for3.3%of deaths from viral hepatitis[3,4].Clinically,most cases of acute hepatitis E have a self-limiting course.However,co-infection with other viruses can increase the risk of acute or subacute liver failure.Hepatitis B virus(HBV)and HEV are highly prevalent in many regions worldwide,and these areas have high rates of coinfection with both viruses.The rate of co-infection with HEV among patients with chronic hepatitis B(CHB)is high,resulting in more severe health outcomes and a significantly elevated risk of liver failure and death.
文摘BACKGROUND Existing assessment systems for chronic hepatitis B(CHB)-associated liver fibrosis(LF)exhibit insufficient accuracy,thereby requiring further improvements.AIM To investigate the association of LF staging with hepatitis B core antibody(HBcAb),hepatitis B virus DNA(HBV-DNA),and hepatitis B surface antigen(HBsAg)in patients with CHB.METHODS We selected 120 patients with CHB receiving treatment in Hangzhou Linping District First People’s Hospital from January 2020 to June 2024.Participants were allocated into the mild(F0-F1,n=52)and moderate-to-severe groups(F2-F4,n=68)following the rigorous LF staging criteria.HBcAb,HBV-DNA,and HBsAg concentrations were measured.Pearson correlations were employed to examine the correlations of HBcAb with HBV-DNA and HBsAg,whereas Spearman correlation analysis was conducted to identify the associations of the three with LF staging.Receiver operating characteristic(ROC)curves were further used to analyze the performance of these biomarkers in diagnosing LF stages.Furthermore,binary logistic regression analysis was conducted to determine the association of these three with LF progression in CHB.RESULTS Markedly increased HBcAb and notably decreased HBV-DNA and HBsAg were observed in moderate-to-severe cases vs their mild counterparts.A positive correlation was observed between HBV-DNA and HBsAg,whereas both markers were inversely associated with HBcAb.Moreover,LF staging exhibited a significant positive correlation with HBcAb and an inverse connection with HBVDNA and HBsAg.The receiver operating characteristic analysis revealed area under the curve values of 0.715,0.799,and 0.662 for HBcAb,HBV-DNA,and HBsAg in diagnosing LF staging,respectively.Combining these markers improved the area under the curve to 0.851.The final analysis identified HBcAb as promoting fibrosis advancement(odds ratio=2.765),whereas HBVDNA demonstrated protective properties(odds ratio=0.247).CONCLUSION HBcAb is negatively correlated with HBV-DNA and HBsAg but positively associated with LF staging.All three markers are valuable in assessing LF staging,and their combined use presents the highest diagnostic efficacy.Importantly,a high HBcAb/low HBV-DNA profile markedly increased fibrosis progression risks in CHB-affected individuals.
文摘BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among adults.AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)infection.METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May 2024.Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed.To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed.Data regarding clinical and laboratory parameters were recorded.The yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among adults.RESULTS A total of 396 patients were found to have acute hepatitis during our study duration.HAV was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV infection.Additionally,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute hepatitis.Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years.The patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV infection.However,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in HEV.CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.
基金supported by a grant from the R&D Program of China(2022YFC2304500).
文摘To the Editor:Hepatitis caused by the hepatitis C virus(HCV)infection has a long course,insidious onset,and slow progression.Patients with hepatitis C are often in the late stages by the time of diagnoses.The long-term chronic damage caused by HCV leads to impaired liver function,portal hypertension,liver fibrosis,cirrhosis and even hepatocellular carcinoma(HCC)[1,2].Therefore,it is imperative to improve the diagnosis and treatment of hepatitis C.In 2016,World Health Organization(WHO)set the goal of“eliminating viral hep-atitis as a public health hazard by 2030”.Some associations intro-duced guidelines for hepatitis C screening and treatment.After a period of effort,in 2020,the number of people receiving treatment for chronic HCV infection had significantly increased compared to the number in 2015,and the HCV-related mortality rate had de-creased.Nevertheless,nearly 80%of infected individuals have not been timely diagnosed and treated[3,4].Like many other coun-tries,China still faces a significant gap in achieving the goal of hep-atitis C elimination,and some literature indicated limited public awareness and high medication costs might slow the progress of policy implementation[5-7].How to effectively improve the diag-nosis and treatment of hepatitis C has garnered widespread global attention.
基金Supported by Xinjiang“Tianshan Talents”Medical and Health High-Level Talent Training Program-Young and Middle-Aged Backbone Medical Talents.
文摘BACKGROUND Hepatitis D virus-hepatitis B virus(HDV-HBV)co-infection accelerates liver disease progression and increases the risk of hepatocellular carcinoma,but the immunopathogenic mechanism of its combination with autoimmune hepatitis(AIH)has not been clarified.This study reveals for the first time that HDV may induce AIH through abnormalities in immunoregulation in two specific cases.This is the first report of HDV-HBV co-infected patients who did not receive interferon therapy and achieved serological conversion and histological remission by combining antiviral(entecavir)with immunosuppression(prednisone+azathioprine)therapy,providing new evidence of the mechanism of this complex disease.CASE SUMMARY A 40-year-old female developed malaise and jaundice with an alanine aminotransferase/aspartate aminotransferase>20 upper limit of normal(ULN),total bilirubin:97.20μmol/L,immunoglobulin G(IgG)47.1 g/L(>3×ULN),HDV RNA 1.6×10^(7)copies/mL and liver biopsy showed G3S4.Tenofovir alafenamide combined with prednisone and azathioprine was administered,and three months later the Child-Turcotte-Pugh class C was reduced to class B and IgG decreased to 13.62 g/L.Another 58-year-old male complained of pain in the liver area,antinuclear antibody was 1:320,IgG 22.6 g/L(>1.3×ULN),and liver biopsy showed G2S3.Entecavir was administered in combination with prednisone and azathioprine,and after 3 months,liver function returned to normal,and IgG reduced to 14.22 g/L.CONCLUSION Patients with HDV-HBV co-infection combined with AIH can achieve clinical remission following combination therapy,and the study of immunomodulatory mechanisms should be emphasized.
文摘An estimated 3%-4%of people are living with the hepatitis B virus(HBV),and without treatment,the risk of developing cirrhosis and hepatocellular cancer(HCC)is an omnipresent threat.Prevention of HCC is a major challenge,as the association between viral suppression and HCC risk reduction is multifactorial,involving the progressive depletion of hepatocytes through covalently closed circular DNA integration,as well as the prevention of liver fibrosis and cirrhosis.Despite effective and cheap antiviral treatment capable of suppressing HBV replication and thereby cirrhosis and HCC,the current indications for therapy need revision and more research to expand the gamut and treat more infected people.In this review,we discuss the possible expansion of antiviral treatment in chronic hepatitis B to prevent cirrhosis and,importantly,HCC.
文摘Immunoprophylaxis is routinely recommended for infants born to mothers with hepatitis B virus(HBV)infection within the first 12-24 hours.Detection of he-patitis B surface antibody(HBsAb)resulting from hepatitis B immunoglobulin administered at birth may be perceived as a real vaccine response.This makes it difficult to detect HBV infection.For this reason,it is recommended that infants born to hepatitis B surface antigen positive mothers and who received immunop-rophylaxis at birth should have HBsAb testing when they are 9-15 months old.
文摘According to the World Health Organization,an estimated 58 million people worldwide are chronically infected with hepatitis C virus(HCV),yet only about 20%have been formally diagnosed.Traditional laboratory–based antibody and RNA assays require infrastructure and trained personnel,limiting their uptake in resource-limited and hard-to-reach settings.The OraQuick HCV self-test(HCVST)is the first World Health Organization-prequalified HCVST,which delivers results in 20-40 min via an easy-to-use gum-swab format.Field evaluations report a sensitivity of about 97%–98%and a specificity of about 99%–100%that are comparable with those of blood-based lateral-flow assays(e.g.,Alere Truline,SD Bioline).Usability studies demonstrated an acceptability rate of over 90%and a correct self-test completion rate of over 85%in key populations.HCVST with the Ora-Quick HCVST kit provides a practical,evidence-based approach to closing diagnostic gaps,particularly among underserved or stigmatized populations.To maximize the public health impact,programs should integrate self-testing into national screening algorithms,ensure linkage to RNA confirmation and treatment,and consider economic and operational contexts.
基金Supported by The National Natural Science Foundation of China,No.82470632.
文摘BACKGROUND Whether rtS106C+H126Y+D134E/rtS106C+H126Y+D134E+L269I(rtCYE/rtCYEI)mutations in the hepatitis B virus(HBV)reverse-transcriptase(RT)region are associated with tenofovir disoproxil fumarate(TDF)resistance is controversial.AIM To evaluate the presence of the rtCYE/rtCYEI mutations in a large cohort of Chinese patients with chronic HBV infection.METHODS A total of 28236 patients who underwent drug resistance testing at the Fifth Medical Center of Chinese PLA General Hospital from 2007 to 2019 were enrolled.All patients received nucleoside/nucleotide analogues(NAs)therapy,and serum samples were collected for sequence analysis of the HBV RT domain with mutation analysis.RESULTS The detection rates of a single mutation of rtS106C,rtH126Y,rtD134E,and rtL269I were 8.21%,3.20%,2.55%and 61.49%in 23718 genotype C patients,and 1.31%,1.76%,0.21%,and 92.33%in 4266 genotype B patients,respectively.The combined mutations of rtCYE/rtCYEI were only detected in 12 genotype C patients,accounting for 0.042%of all patients.These 12 patients had received NA treatments except TDF before testing.Among them,6 patients had coexisting rtCYE/rtCYEI and lamivudine-resistance mutations,and 2 patients had coexisting rtCYE/rtCYEI and adefovir-resistance mutations.Compared with the wild-type(WT)strain,the replication capacity of rtCYE/rtCYEI mutants from representative patients decreased by 41.1%-71.8%,and TDF susceptibility reduced by less than 2-fold,but rtCYEI+rtA181V/N236T mutants exhibited a 6.2-/9.9-fold decrease in TDF susceptibility.Molecular modeling showed that rtCYE/rtCYEI mutants had a slight decrease in binding energy to TDF compared to the WT strain.In the clinic,emergence of the rtCYE/rtCYEI mutations was not specifically associated with TDF treatment.CONCLUSION HBV rtCYE/rtCYEI mutations have a limited effect on TDF susceptibility and are not sufficient to cause TDF resistance.
文摘BACKGROUND The relationship between hepatitis B surface antigen(HBsAg)concentrations,hepatitis B virus(HBV)DNA levels,and hepatic function in individuals with chronic hepatitis B(CHB)remains incompletely characterized.AIM To examine the association of serum HBsAg concentrations with HBV DNA levels and hepatic function parameters in patients with CHB.METHODS A total of 110 individuals with CHB admitted to Kunming Third People’s Hospital between January 2023 and January 2025 were enrolled as the observation group,whereas 70 age-and sex-matched healthy individuals served as the control group.Fasting peripheral venous blood(5 mL)was collected from all participants.Serum HBsAg and HBV DNA levels(in the observation group),along with hepatic function markers,including total bilirubin(TBIL),aspartate aminotransferase(AST),and alanine aminotransferase(ALT),were measured in both groups.Pearson correlation analysis was used to assess the association between serum HBsAg levels and HBV DNA,TBIL,AST,and ALT levels in patients with CHB.Receiver operating characteristic(ROC)curve analysis was conducted to determine optimal cutoff values of HBsAg for predicting high viral load(HBV DNA≥10^(5) IU/mL)and significant liver injury(ALT≥2×upper limit of normal[ULN]).RESULTS HBsAg levels differed significantly across CHB phases:Immune tolerance(IT)phase(4.62±1.51 lgIU/mL),immune clearance(IC)phase(3.84±1.16 lgIU/mL),low replication(LR)phase(2.99±0.66 lgIU/mL),and HBV e antigen-negative hepatitis(ENH)phase(3.40±0.69 lgIU/mL).Corresponding HBV DNA levels were highest in the IT phase(7.41±1.83 log copies/mL),followed by the IC phase(6.03±1.92 log copies/mL),ENH phase(3.89±1.23 log copies/mL),and LR phase(2.55±1.00 log copies/mL).All hepatic function parameters in patients with CHB were significantly elevated compared to the healthy controls.Pearson correlation analysis showed significant positive associations between serum HBsAg levels and HBV DNA,TBIL,AST,and ALT levels.ROC analysis revealed that an HBsAg cutoff>4.09 lgIU/mL predicted HBV DNA≥105 IU/mL(high viral load)with 88.57%sensitivity,78.67%specificity,and an area under the curve(AUC)of 0.868(P<0.001),while a cutoff>4.07 lgIU/mL predicted ALT≥2×ULN(significant liver injury)with 69.70%sensitivity,90.91%specificity,and an AUC of 0.821(P<0.001).CONCLUSION Serum HBsAg,a noninvasive serological marker,holds significant clinical value in CHB management by aiding in the stratification of viral burden and the prediction of hepatic impairment.
基金Supported by the JSPS Kakenhi Grant,No.JP24K15491.
文摘Viral hepatitis represents a major danger to public health,and is a globally leading cause of death.The five liver-specific viruses:Hepatitis A virus,hepatitis B virus,hepatitis C virus,hepatitis D virus,and hepatitis E virus,each have their own unique epidemiology,structural biology,transmission,endemic patterns,risk of liver complications,and response to antiviral therapies.There remain few options for treatment,in spite of the increasing prevalence of viral-hepatitiscaused liver disease.Furthermore,chronic viral hepatitis is a leading worldwide cause of both liver-related morbidity and mortality,even though effective treatments are available that could reduce or prevent most patients’complications.In 2016,the World Health Organization released its plan to eliminate viral hepatitis as a public health threat by the year 2030,along with a discussion of current gaps and prospects for both regional and global eradication of viral hepatitis.Today,treatment is sufficiently able to prevent the disease from reaching advanced phases.However,future therapies must be extremely safe,and should ideally limit the period of treatment necessary.A better understanding of pathogenesis will prove beneficial in the development of potential treatment strategies targeting infections by viral hepatitis.This review aims to summarize the current state of knowledge on each type of viral hepatitis,together with major innovations.
文摘BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral(DAA)treatment in HCV-infected patients.METHODS The study included consecutive 9457 women and 9529 men,treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project.Women were divided into pre-menopausal(15-44 years),menopausal(45-55 years)and post-menopausal(>55 years)and compared with age-matched men.RESULTS Regardless of age,women had a significantly lower body mass index,prevalence of genotype 3 infection and proportion of cirrhosis compared to men.Psychiatric disorders(except depression),hepatitis B virus and human immunodeficiency virus co-infections,as well as alcohol and drug addiction,were significantly less common in women than in men in all age groups.The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4%and 96.6%,respectively(P<0.001).Independent predictors of treatment failure in women were genotype 3 infection,cirrhosis and postmenopausal age.Mild adverse events were reported significantly more often by women,regardless of age with the highest percentage in the postmenopausal group.CONCLUSION DAA treatment is more effective in women than in men,regardless of age,but in postmenopausal women,the effectiveness is relatively the lowest.
基金Supported by the Project of Guizhou Provincial Department of Science and Technology,No.Qiankehechengguo-LC[2024]109.
文摘In this editorial,we comment on the article by Meng et al.Chronic hepatitis B(CHB)is a significant global health problem,particularly in developing countries.Hepatitis B virus(HBV)infection is one of the most important risk factors for cirrhosis and hepatocellular carcinoma.Prevention and treatment of HBV are key measures to reduce complications.At present,drug therapy can effectively control virus replication and slow disease progression,but completely eliminating the virus remains a challenge.Anti-HBV treatment is a long-term process,and there are many kinds of antiviral drugs with different mechanisms of action,it is essential to evaluate the safety and efficacy of these drugs to reduce side effects and improve patients’compliance.We will summarize the current status of CHB drug treatment,hoping to provide a reference for the selection of clinical antiviral drugs.
基金Supported by the Natural Science Foundation of China,No.81970529the Natural Science Foundation of Jilin Province,No.20230508074RC and No.YDZJ202401218ZYTS.
文摘In this editorial,we comment on the article by Mu et al,published in the recent issue of the World Journal of Gastrointestinal Oncology.We pay special attention to the immune tolerance mechanism caused by hepatitis B virus(HBV)infection,the pathogenesis of hepatocellular carcinoma(HCC),and the role of antiviral therapy in treating HCC related to HBV infection.HBV infection leads to systemic innate immune tolerance by directly inhibiting pattern recognition receptor recognition and antiviral signaling pathways,as well as by inhibiting the immune functions of macrophages,natural killer cells and dendritic cells.In addition,HBV leads to an immunosuppressive cascade by expressing inhibitory molecules to induce exhaustion of HBV-specific cluster of differentiation 8+T cells,ultimately leading to long-term viral infection.The loss of immune cell function caused by HBV infection ultimately leads to HCC.Long-term antiviral therapy can improve the prognosis of patients with HCC and prevent tumor recurrence and metastasis.
文摘BACKGROUND Hepatitis A virus(HAV)infection remains the most common cause of acute viral hepatitis globally.In the United States,recent outbreaks have been attributed primarily to person-to-person transmission,with vulnerable populations such as people who use illicit drugs,those experiencing homelessness,and men who have sex with men disproportionately affected.AIM To assess the trends in HAV hospitalizations over the past decade and evaluate the impact of substance use on these hospitalizations.METHODS We conducted a retrospective study using the National Inpatient Sample database from 2011 to 2020.Adults(≥18 years)hospitalized with a primary diagnosis of HAV infection were included.We identified active substance use as a secondary diagnosis.Statistical analysis involved descriptive statistics,trend analysis,and propensity score matching to compare HAV hospitalizations with and without substance use.Outcomes included hospitalization trends,complications,length of stay(LOS),and mortality.RESULTS From 2011 to 2020,there were 56972 hospitalizations for HAV infections.Hospitalizations increased from 3917 in 2011 to 8290 in 2020,peaking at 9800 in 2018.Caucasian males(55%)were the most affected,with a mean age of 49 years.The prevalence of active substance use among HAV hospitalizations was 27%,with these patients being younger(mean age:39 years)and predominantly male(63.1%).HAV hospitalizations associated with substance use increased significantly,rising from 235 cases in 2011 to 3200 in 2020(P<0.001).Compared to HAV hospitalizations without substance use,those with substance use had higher rates of co-infections(hepatitis C virus 45%vs 11%,hepatitis B virus 11%vs 6%)and complications,including sepsis(1.9%vs 1%)and infective endocarditis(1.4%vs 0.15%,P<0.001).Hospitalizations with substance use also had longer LOS(4.34 days vs 3.97 days,P<0.05),but mortality rates were comparable.Predictors of mortality in HAV-substance use hospitalizations included acute liver failure,sepsis,and acute respiratory failure.CONCLUSION HAV hospitalizations in the United States have significantly increased over the past decade,with the rise driven by cases involving substance use.These patients face a higher burden of complications and healthcare utilization.Tailored public health strategies,including targeted vaccination and outreach programs for at-risk populations,are essential to reduce the morbidity,mortality,and economic burden associated with HAV.
文摘Current treatment options for hepatitis D are limited,with pegylated interferonalpha(PEG-IFNα)being the only therapy available in the Asia-Pacific region.However,PEG-IFNαhas limited efficacy and significant side effects.Pegylated interferon lambda acts on interferon-lambda(Type III)receptors predominantly expressed in hepatocytes.In 2023,bulevirtide was approved in the European Union and Russia for treating chronic hepatitis D.This drug works by binding to and inhibiting the sodium taurocholate co-transporting polypeptide receptor on liver cells,which is the primary entry point for the virus.Recently,several new drugs have entered various stages of development,offering hope for improved hepatitis D virus(HDV)management.Two more viral entry inhibitors are HH003 and tobevibart.Other agents include nucleic acid polymers(REP 2139-Mg),prenylation inhibitors(lonafarnib),and RNA interference-based therapies(elebsiran).Emerging trials are now considering combination therapies,such as SOLSTICE,a Phase 2 clinical trial evaluating tobevibart alone or combined with elebsiran.The combination dosed monthly achieved>50%virologic and biochemical response at 24 weeks of therapy.The efficacy and safety of these drugs will further be evaluated in ECLIPSE 1,2,and 3 trials.With these new treatments on the horizon,the prospects for improved HDV patient outcomes are promising.
文摘This editorial provides commentary on the study by Dobrowolska et al,highlighting the influence of biological sex on hepatitis C virus(HCV)infection risk and disease progression.HCV infection is more common in men;however,women,regardless of age,show a lower prevalence of genotype 3 infection,diabetes mellitus,and coinfections with hepatitis B virus and human immunodeficiency virus.Women also experience slower liver fibrosis progression.Despite this,mild adverse events,autoimmune diseases,and depression occur more frequently in women.Sustained virologic response at 12 weeks post-treatment was significantly higher in women(98.4%)than in men(96.6%).In women,postmenopausal status,genotype 3 infection,and cirrhosis were independently associated with treatment failure.Early diagnosis and timely antiviral therapy in women are critical to preventing vertical transmission and mitigating disease advancement.
文摘Hepatitis C virus(HCV)infection has been increasingly associated with cardio-vascular complications,particularly atherosclerosis and cardiomyopathy,in addition to its primary hepatic effects.Studies indicate a higher prevalence of carotid atherosclerosis in patients with chronic hepatitis C infection,with viral load and steatosis emerging as independent risk factors.HCV-related athero-sclerosis appears to develop through complex processes involving endothelial dysfunction,inflammation,oxidative stress,and immune dysregulation.Key cytokines,including tumor necrosis factor-alpha and interleukin-6,increase inflammatory responses,while oxidative stress markers,such as malondial-dehyde,are associated with an increased risk of atherogenesis.In addition,HCV infection has been linked to cardiomyopathy.Direct viral effects,including HCV replication within cardiomyocytes and cytotoxicity induced by viral proteins,lead to myocardial injury and functional decline.Indirectly,HCV triggers immune-mediated damage,with heightened pro-inflammatory cytokines exacerbating cardiomyocyte apoptosis and fibrosis.Furthermore,HCV infection promotes a procoagulant imbalance,as evidenced by elevated factor VIII levels and thrombin potential,contributing to the increased cardiovascular risk.While substantial evidence indicates a relationship between HCV and cardiovascular disease,further research is needed to establish causality and guide therapeutic interventions.
文摘Severe alcoholic hepatitis remains one of hepatology’s most urgent challenges,with rapid clinical deterioration and high early mortality.This manuscript comments on and contextualizes the recent systematic review by Quiñones-Calvo et al,which redirects attention from short-term endpoints toward 90-day survival,integrating evidence from associated clinical studies.For decades,corticosteroids have been the mainstay of treatment,reducing 28-day mortality but offering limited benefit for three months.The review emphasizes that the most critical threats to recovery,late infections,renal decline,and relapse,often emerge after the first month.By synthesizing recent studies,it highlights promising interventions such as fecal microbiota transplantation(FMT),which improved 90-day survival in a small randomized trial,and granulocyte colony-stimulating factor(G-CSF),which showed a robust survival benefit in a large retrospective cohort,alongside emerging strategies like plasma exchange and targeted biologics.These findings support a shift toward a two-phase care model:Early stabilization followed by recovery consolidation.For clinicians,such a model may help guide treatment decisions,with therapies like FMT or G-CSF warranting consideration in corticosteroid non-responders,pending further validation in larger randomized controlled trials.Adoption of 90-day survival as a central metric could bridge the gap between initial rescue and sustained remission,providing a more realistic measure of therapeutic success in one of hepatology’s most unforgiving conditions.
