Background and AimsAutoimmune hepatitis(AIH)frequently coexists with extrahepatic autoimmune diseases(EADs),but their prevalence,characteristics,progression,and treatment effect in the Han Chinese population remain un...Background and AimsAutoimmune hepatitis(AIH)frequently coexists with extrahepatic autoimmune diseases(EADs),but their prevalence,characteristics,progression,and treatment effect in the Han Chinese population remain unclear.This study aimed to evaluate the prevalence and spectrum of EADs and to assess their clinical features,disease course,and treatment outcomes in Han Chinese patients with AIH.MethodsMedical records of 371 Han Chinese patients with AIH(diagnosed from March 2016 to October 2023)were retrospectively analyzed.ResultsAmong the 371 AIH patients,304(81.94%)were female,with a median age of 52.5 years(interquartile range,46.0-61.0).A total of 23.98%(89/371)had at least one EAD,including 27.06%(82/303)in type 1 AIH,11.11%(7/63)in antibody-negative AIH,and none in type 2.A single EAD was the most common(20.21%,75/371).The most frequent EADs were Sjogren’s syndrome(8.63%)and autoimmune thyroid disease(8.36%).Compared with patients without EADs,those with EADs had lower alanine aminotransferase,red blood cell,and hemoglobin levels,but higher aspartate aminotransferase/alanine aminotransferase ratio and antinuclear antibody(ANA)positivity(all P<0.05).ANA positivity was independently associated with EADs(odds ratio=2.209,95%confidence interval=1.242-3.927,P=0.007).After three months of treatment,the complete biochemical response rate was lower in the EADs group than in the non-EADs group(40.0%vs.55.3%,P=0.024),whereas no significant differences were observed at 6,12,24,or 36 months(all P>0.05).ConclusionsIn the Han Chinese population,23.98%of AIH patients had EADs,with Sjogren’s syndrome and autoimmune thyroid disease being the most common.ANA positivity was a significant risk factor for EADs.EAD patients had a poorer initial treatment response at three months,but comparable long-term biochemical response from six months.展开更多
Objective:To evaluate the effectiveness of direct-acting antivirals(DAAs)in patients with chronic hepatitis C,assess changes in liver function and hepatic fibrosis following treatment,and identify independent predicto...Objective:To evaluate the effectiveness of direct-acting antivirals(DAAs)in patients with chronic hepatitis C,assess changes in liver function and hepatic fibrosis following treatment,and identify independent predictors of treatment failure.Methods:This retrospective cohort study included patients who received DAA therapy at Hospital Kuala Lumpur between January 2020 and December 2023.Sustained virologic response(SVR)was assessed at least 12 weeks post-treatment by reverse transcription-polymerase chain reaction for hepatitis C virus(HCV)RNA.Demographic,clinical,and laboratory data were collected and analyzed.Multiple logistic regression analysis was performed to identify independent predictors of treatment failure.Results:A total of 335 patients in the study.The overall SVR rate was 89%.After achieving SVR,significant improvements were observed in liver enzyme levels and non-invasive liver fibrosis scores,whereas the overall Model for End-Stage Liver Disease(MELD)scores remained unchanged.Significant independent predictors of treatment failure included non-compliance with DAA therapy[adjusted odds ratio(aOR)68.3;95%confidence interval(95%CI)16.3-285.0;P<0.001],treatment with sofosbuvir/velpatasvir(aOR 6.1;95%CI 1.4-26.5;P=0.015),MELD score of 10-15(aOR 4.6;95%CI 1.1-18.2;P=0.031),HCV genotype 3 infection(aOR 4.5;95%CI 1.1-17.6;P=0.031),and elevated serum total bilirubin level(aOR 1.1;95%CI 1.0-1.1;P=0.003).Conclusions:DAA therapy yielded a high SVR rate,and treatment failure was strongly associated with non-adherence to therapy and advanced liver disease.These findings underscore the necessity of adherence support,early diagnosis,and individualized clinical management to optimize treatment outcomes in patients with chronic hepatitis C.展开更多
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
The highly conserved human leukocyte antigen-A2(HLA-A2)-restricted epitope NS3-1073 represents a promising candidate for a therapeutic vaccine against hepatitis C virus(HCV).In this study,we engineered a set of fusion...The highly conserved human leukocyte antigen-A2(HLA-A2)-restricted epitope NS3-1073 represents a promising candidate for a therapeutic vaccine against hepatitis C virus(HCV).In this study,we engineered a set of fusion proteins based on the artificial self-assembling peptide(SAP),which were expressed in Escherichia coli and spontaneously self-assembled into nanosized particles displaying HCV epitopes,including NS3-1073.To enhance immunogenicity,we incorporated the T helper epitope PADRE into the construct.Alpha-helical linkers were introduced between SAP and the epitopes to facilitate proper protein folding.Notably,a helical linker with a high supercoiling propensity enabled soluble expression of the fusion protein containing both the NS3-1073 and PADRE epitopes,allowing purification of the in vivo-formed nanoparticles by metal affinity chromatography.Human dendritic cells derived from peripheral blood monocytes showed robust activation in response to the fusion proteins and preferentially stimulated T lymphocytes toward a Th1-biased immune response.In mice,immunization with nanoparticles carrying NS3-1073 induced splenocyte proliferation in response to in vitro stimulation with a mixture of NS3 peptides.These results demonstrate that recombinant nanoparticle-based carriers presenting the NS3-1073 epitope can be produced in bacterial systems and hold strong potential as a foundation for a therapeutic HCV vaccine.展开更多
Objective:To assess the knowledge and attitudes of the general population regarding hepatitis B virus(HBV)infection,their association with sociodemographic factors,and the community’s willingness to pay for hepatitis...Objective:To assess the knowledge and attitudes of the general population regarding hepatitis B virus(HBV)infection,their association with sociodemographic factors,and the community’s willingness to pay for hepatitis B vaccination.Methods:This cross-sectional study was conducted from January to March 2025 in Ho Chi Minh City,Vietnam.A self-administered questionnaire was distributed to 1098 adults who were recruited via nonprobability convenience sampling.Descriptive analysis was conducted to calculate the frequencies and percentages of the categorical variables.A Chi-square test was carried out to explore the association between the independent and categorical dependent variables.Results:A total of 926 complete questionnaires were returned and included in the analysis.Among the participants,524(56.6%)exhibited good knowledge about HBV infection and vaccination,while 651(70.3%)showed positive attitudes toward the issues of interest.The factors associated with knowledge and attitudes were household incomes,health insurance,family history of HBV infection,vaccination intention,reasons for nonvaccination,sources of HBV information,and awareness of immunization programs and vaccination sites.Conclusions:Although most participants had limited knowledge of HBV symptoms and transmission,their attitudes toward vaccination remained positive.Targeted national strategies and intervention initiatives are needed since public awareness and attitudes toward the condition greatly impact intervention success.展开更多
This study evaluated the accuracy,completeness,and comprehensibility of responses from mainstream large language models(LLMs)to hepatitis C virus(HCV)-related questions,aiming to assess their performance in addressing...This study evaluated the accuracy,completeness,and comprehensibility of responses from mainstream large language models(LLMs)to hepatitis C virus(HCV)-related questions,aiming to assess their performance in addressing patient queries about disease and lifestyle behaviors.The models selected were ChatGPT-4o,Gemini 2.0 Pro,Claude 3.5 Sonnet,and DeepSeek V3,with 12 questions chosen by two HCV experts from the domains of prevention,diagnosis,and treatment.展开更多
Liver is prone to viral infection.Viral hepatitis can be roughly divided into hepatitis A,B,C,D and E.Accurate diagnosis of viral hepatitis is crucial for accurate treatments.Different types of biomarkers,including no...Liver is prone to viral infection.Viral hepatitis can be roughly divided into hepatitis A,B,C,D and E.Accurate diagnosis of viral hepatitis is crucial for accurate treatments.Different types of biomarkers,including non-invasive biomarkers have been explored for the diagnosis of viral hepatitis.With the fast development of multi-omics technology,non-invasive biomarkers can be detected from blood,saliva,urine,stool,and other body fluids.The advantages of non-invasive biomarkers are:1)non-invasive;2)convenient to test and 3)repeatable.The application of non-invasive biomarkers significantly improves the diagnostic accuracy of viral hepatitis.The non-invasive biomarkers can be sugars,proteins,nucleic acids,and even microorganisms.In this review,we summarized recent advances in identifying non-invasive biomarkers using multi-omics technology and discussed their potential diagnostic values for viral hepatitis.展开更多
OBJECTIVE:To elucidate the therapeutic efficacy and mechanism of action of Chaihu Guizhi Ganjiang decoction(柴胡桂枝干姜汤,CGGD)in autoimmune hepatitis.METHODS:CGGD components and potential target genes were extracted...OBJECTIVE:To elucidate the therapeutic efficacy and mechanism of action of Chaihu Guizhi Ganjiang decoction(柴胡桂枝干姜汤,CGGD)in autoimmune hepatitis.METHODS:CGGD components and potential target genes were extracted from previously published databases.The autoimmune hepatitis(AIH)-related regulatory genes were obtained from the Dis Ge NET database.Intersections were taken,and enrichment analyses were performed on the extracted data.Concanavalin A(Con A)-induced AIH model mice were treated with CGGD via gavage.The results of network pharmacological analysis were experimentally validated.RESULTS:Network pharmacology revealed 228 genes at the intersection of AIH and CGGD.Kyoto Encyclopedia of Genes and Genomes analysis revealed that CGGD primarily regulates the phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)signaling pathway and cellular metabolism in AIH.Gene Ontology enrichment analysis revealed that CGGD modulates inflammation through transcription factor-mediated signaling pathways.As predicted,CGGD attenuated Con A-induced AIH in a dose-dependent manner by activating the PI3K/AKT signaling pathway.Histopathological assessment confirmed the protective effects of CGGD against Con Ainduced AIH.Further investigation revealed that CGGD regulated the T helper cell 17(Th17)/regulatory T cell(Treg)balance by modulating the PI3K/Akt/nuclear factor kappa-B(NF-κB)pathway.CONCLUSIONS:This study demonstrated the therapeutic effect of CGGD on AIH through a combination of network pharmacological prediction and experimental validation.Its mechanism of action involves PI3K/Akt/NF-κB-mediated regulation of Th17/Treg cells.展开更多
Each hepatitis virus—Hepatitis A,B,C,D,E,and G—poses a distinct scenario to the patient and clinician alike.Since the discovery of each virus,extensive knowledge regarding epidemiology,virologic properties,and the n...Each hepatitis virus—Hepatitis A,B,C,D,E,and G—poses a distinct scenario to the patient and clinician alike.Since the discovery of each virus,extensive knowledge regarding epidemiology,virologic properties,and the natural clinical and immunologic history of acute and chronic infections has been generated.Basic discoveries about host immunologic responses to acute and chronic viral infections,combined with virologic data,has led to vaccines to prevent Hepatitis A,B,and E and highly efficacious antivirals for Hepatitis B and C.These therapeutic breakthroughs are transforming the fields of hepatology,transplant medicine in general,and public and global health.Most notably,there is even an ambitious global effort to eliminate chronic viral hepatitis within the next decade.While attainable,there are many barriers to this goal that are being actively investigated in basic and clinical labs on the local,national,and international scales.Herein,we discuss pertinent clinical information and recent organizational guidelines for each of the individual hepatitis viruses while also synthesizing this information with the latest research to focus on exciting future directions for each virus.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
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
Viral hepatitis,secondary to infection with hepatitis A,B,C,D,and E viruses,are a major public health problem and an important cause of morbidity and mortality.Despite the huge medical advances achieved in recent year...Viral hepatitis,secondary to infection with hepatitis A,B,C,D,and E viruses,are a major public health problem and an important cause of morbidity and mortality.Despite the huge medical advances achieved in recent years,there are still points of conflict concerning the pathogenesis,immune response,development of new and more effective vaccines,therapies,and treatment.This review focuses on the most important research topics that deal with issues that are currently being solved,those that remain to be solved,and future research directions.For hepatitis A virus we will address epidemiology,molecular surveillance,new susceptible populations as well as environmental and food detections.In the case of hepatitis B virus,we will discuss host factors related to disease,diagnosis,therapy,and vaccine improvement.On hepatitis C virus,we will focus on pathogenesis,immune response,direct action antivirals treatment in the context of solid organ transplantation,issues related to hepatocellular carcinoma development,direct action antivirals resistance due to selection of resistanceassociated variants,and vaccination.Regarding hepatitis D virus,we describe diagnostic methodology,pathogenesis,and therapy.Finally,for hepatitis E virus,we will address epidemiology(including new emerging species),diagnosis,clinical aspects,treatment,the development of a vaccine,and environmental surveillance.展开更多
In this review the current overall knowledge on hepatitis A,B,C,D,and E will be discussed.These diseases are all characterized by liver inflammation but have significant differences in distribution,transmission routes...In this review the current overall knowledge on hepatitis A,B,C,D,and E will be discussed.These diseases are all characterized by liver inflammation but have significant differences in distribution,transmission routes,and outcomes.Hepatitis B virus and hepatitis C virus are transmitted by exposure to infected blood,and in addition to acute infection,they can cause chronic hepatitis,which in turn can evolve into cirrhosis.It is estimated that more than 300 million people suffer from chronic hepatitis B or C worldwide.Hepatitis D virus,which is also transmitted by blood,only affects hepatitis B virus infected people,and this dual infection results in worse liver-related outcomes.Hepatitis A and E spread via the fecal-oral route,which corresponds mainly to the ingestion of food or water contaminated with infected stools.However,in developed countries hepatitis E is predominantly a zoonosis.Although hepatitis A virus and hepatitis E virus are usually responsible for a self-limiting hepatitis,a serious,rarely fatal illness is also possible,and in immunosuppressed patients,such as organ transplant recipients,hepatitis E virus infection can become chronic.The description of goals achieved,unresolved issues,and the latest research on this topic may make it possible to speculate on future scenarios in the world of viral hepatitis.展开更多
This review aims to summarize the current evidence on the treatment of viral hepatitis,focusing on its clinical management.Also,future treatment options and areas of potential research interest are detailed.PubMed and...This review aims to summarize the current evidence on the treatment of viral hepatitis,focusing on its clinical management.Also,future treatment options and areas of potential research interest are detailed.PubMed and Scopus databases were searched for primary studies published within the last ten years.Keywords included hepatitis A virus,hepatitis B virus(HBV),hepatitis C virus,hepatitis D virus(HDV),hepatitis E virus,and treatment.Outcomes reported in the studies were summarized,tabulated,and synthesized.Significant advances in viral hepatitis treatment were accomplished,such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A,hepatitis B,and hepatitis E vaccination.Drugs that cure hepatitis B,going beyond viral suppression,are so far unavailable;however,targeted antiviral drugs against HBV(immunomodulatory therapies and gene silencing technologies)are promising approaches to eradicating the virus.Ultimately,high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems.The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B,albeit further investigation is required.Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.展开更多
Hepatitis C virus (HCV) elimination by 2030, using direct-acting antiviraltreatments, has been promoted by the World Health Organization. Thisachievement is not attainable, however, particularly after the 2020 pandemi...Hepatitis C virus (HCV) elimination by 2030, using direct-acting antiviraltreatments, has been promoted by the World Health Organization. Thisachievement is not attainable, however, particularly after the 2020 pandemic ofthe coronavirus disease 2019. Consequently, the more realistic objective ofeliminating HCV from population segments for which targeted strategies ofprevention and treatment are easily attained has been promoted in Europe, as avalid alternative. The underlying idea is that micro-elimination will ultimatelylead to macro-elimination. The micro-elimination strategy may target differentspecific populations and at-risk groups. Different settings, including prisons andhospitals, have also been identified as micro-elimination scenarios. In addition,dedicated micro-elimination strategies have been designed that are tailored at thegeographical level according to HCV epidemiology and individual country’sincome. The main elements of a valid and successful micro-elimination project arereliable epidemiological data and active involvement of all the stakeholders.Community involvement represents another essential component for a successfulprogram.展开更多
Drug-induced autoimmune-like hepatitis(DI-ALH)is an increasingly recognized phenotype within the spectrum of drug-induced liver injury.Several drugs,including nitrofurantoin,minocycline,hydralazine,methyldopa and infl...Drug-induced autoimmune-like hepatitis(DI-ALH)is an increasingly recognized phenotype within the spectrum of drug-induced liver injury.Several drugs,including nitrofurantoin,minocycline,hydralazine,methyldopa and infliximab,have a well-documented capacity to induce DI-ALH.Distinguishing DI-ALH from classic de novo autoimmune hepatitis(AIH)can be challenging due to overlapping clinical,biochemical,and serological features.Accurate distinction from classic AIH is crucial,as management and prognosis differ.While some DIALH cases resolve spontaneously after drug withdrawal,others show persistent or worsening liver injury.Histological studies have shown that fibrosis and cirrhosis are more prevalent in classic AH.Unfortunately,there are no pathognomic clinical,biochemical or immunological features that reliably distinguish DI-ALH from classic AIH.However,most patients with DI-ALH do not relapse after corticosteroid withdrawal,in contrast to the high relapse rate observed in classic AIH.Most patients respond well to corticosteroids,and once liver tests normalize,biochemical parameters should be monitored,and long-term immunosuppression should not be indicated.However,DI-ALH is not exempt from risk of relapse,underscoring the need for long-term follow-up.Most patients with DIALH have a favorable prognosis;however,although rare,cases of cirrhosis and,in exceptional instances,acute liver failure have been reported.International collaborative studies are needed to further characterize DI-ALH.In this review,we update current controversies,present emerging concepts,and outline future challenges in the diagnosis and management of this complex condition learned so far.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
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
基金Jiangsu Province Traditional Chinese Medicine Science and Technology Development Program(YB2020037)Nanjing Infectious Disease Clinical Medical Center,Innovation Center for Infectious Disease of Jiangsu Province(NO.CXZX202232)Nanjing Health Science and Technology Development Special Fund Project(YKK22127).
文摘Background and AimsAutoimmune hepatitis(AIH)frequently coexists with extrahepatic autoimmune diseases(EADs),but their prevalence,characteristics,progression,and treatment effect in the Han Chinese population remain unclear.This study aimed to evaluate the prevalence and spectrum of EADs and to assess their clinical features,disease course,and treatment outcomes in Han Chinese patients with AIH.MethodsMedical records of 371 Han Chinese patients with AIH(diagnosed from March 2016 to October 2023)were retrospectively analyzed.ResultsAmong the 371 AIH patients,304(81.94%)were female,with a median age of 52.5 years(interquartile range,46.0-61.0).A total of 23.98%(89/371)had at least one EAD,including 27.06%(82/303)in type 1 AIH,11.11%(7/63)in antibody-negative AIH,and none in type 2.A single EAD was the most common(20.21%,75/371).The most frequent EADs were Sjogren’s syndrome(8.63%)and autoimmune thyroid disease(8.36%).Compared with patients without EADs,those with EADs had lower alanine aminotransferase,red blood cell,and hemoglobin levels,but higher aspartate aminotransferase/alanine aminotransferase ratio and antinuclear antibody(ANA)positivity(all P<0.05).ANA positivity was independently associated with EADs(odds ratio=2.209,95%confidence interval=1.242-3.927,P=0.007).After three months of treatment,the complete biochemical response rate was lower in the EADs group than in the non-EADs group(40.0%vs.55.3%,P=0.024),whereas no significant differences were observed at 6,12,24,or 36 months(all P>0.05).ConclusionsIn the Han Chinese population,23.98%of AIH patients had EADs,with Sjogren’s syndrome and autoimmune thyroid disease being the most common.ANA positivity was a significant risk factor for EADs.EAD patients had a poorer initial treatment response at three months,but comparable long-term biochemical response from six months.
文摘Objective:To evaluate the effectiveness of direct-acting antivirals(DAAs)in patients with chronic hepatitis C,assess changes in liver function and hepatic fibrosis following treatment,and identify independent predictors of treatment failure.Methods:This retrospective cohort study included patients who received DAA therapy at Hospital Kuala Lumpur between January 2020 and December 2023.Sustained virologic response(SVR)was assessed at least 12 weeks post-treatment by reverse transcription-polymerase chain reaction for hepatitis C virus(HCV)RNA.Demographic,clinical,and laboratory data were collected and analyzed.Multiple logistic regression analysis was performed to identify independent predictors of treatment failure.Results:A total of 335 patients in the study.The overall SVR rate was 89%.After achieving SVR,significant improvements were observed in liver enzyme levels and non-invasive liver fibrosis scores,whereas the overall Model for End-Stage Liver Disease(MELD)scores remained unchanged.Significant independent predictors of treatment failure included non-compliance with DAA therapy[adjusted odds ratio(aOR)68.3;95%confidence interval(95%CI)16.3-285.0;P<0.001],treatment with sofosbuvir/velpatasvir(aOR 6.1;95%CI 1.4-26.5;P=0.015),MELD score of 10-15(aOR 4.6;95%CI 1.1-18.2;P=0.031),HCV genotype 3 infection(aOR 4.5;95%CI 1.1-17.6;P=0.031),and elevated serum total bilirubin level(aOR 1.1;95%CI 1.0-1.1;P=0.003).Conclusions:DAA therapy yielded a high SVR rate,and treatment failure was strongly associated with non-adherence to therapy and advanced liver disease.These findings underscore the necessity of adherence support,early diagnosis,and individualized clinical management to optimize treatment outcomes in patients with chronic hepatitis C.
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 the Russian Science Foundation(Grant No.24-25-20087 to V.K.)。
文摘The highly conserved human leukocyte antigen-A2(HLA-A2)-restricted epitope NS3-1073 represents a promising candidate for a therapeutic vaccine against hepatitis C virus(HCV).In this study,we engineered a set of fusion proteins based on the artificial self-assembling peptide(SAP),which were expressed in Escherichia coli and spontaneously self-assembled into nanosized particles displaying HCV epitopes,including NS3-1073.To enhance immunogenicity,we incorporated the T helper epitope PADRE into the construct.Alpha-helical linkers were introduced between SAP and the epitopes to facilitate proper protein folding.Notably,a helical linker with a high supercoiling propensity enabled soluble expression of the fusion protein containing both the NS3-1073 and PADRE epitopes,allowing purification of the in vivo-formed nanoparticles by metal affinity chromatography.Human dendritic cells derived from peripheral blood monocytes showed robust activation in response to the fusion proteins and preferentially stimulated T lymphocytes toward a Th1-biased immune response.In mice,immunization with nanoparticles carrying NS3-1073 induced splenocyte proliferation in response to in vitro stimulation with a mixture of NS3 peptides.These results demonstrate that recombinant nanoparticle-based carriers presenting the NS3-1073 epitope can be produced in bacterial systems and hold strong potential as a foundation for a therapeutic HCV vaccine.
基金funded by Vietnam National University Ho Chi Minh City(VNU-HCM)under grant number 36-2025-44-02.
文摘Objective:To assess the knowledge and attitudes of the general population regarding hepatitis B virus(HBV)infection,their association with sociodemographic factors,and the community’s willingness to pay for hepatitis B vaccination.Methods:This cross-sectional study was conducted from January to March 2025 in Ho Chi Minh City,Vietnam.A self-administered questionnaire was distributed to 1098 adults who were recruited via nonprobability convenience sampling.Descriptive analysis was conducted to calculate the frequencies and percentages of the categorical variables.A Chi-square test was carried out to explore the association between the independent and categorical dependent variables.Results:A total of 926 complete questionnaires were returned and included in the analysis.Among the participants,524(56.6%)exhibited good knowledge about HBV infection and vaccination,while 651(70.3%)showed positive attitudes toward the issues of interest.The factors associated with knowledge and attitudes were household incomes,health insurance,family history of HBV infection,vaccination intention,reasons for nonvaccination,sources of HBV information,and awareness of immunization programs and vaccination sites.Conclusions:Although most participants had limited knowledge of HBV symptoms and transmission,their attitudes toward vaccination remained positive.Targeted national strategies and intervention initiatives are needed since public awareness and attitudes toward the condition greatly impact intervention success.
基金funded by the National Key Research and Development Program of China(No.2021YFA1100500)the National Natural Science Foundation of China(No.82370662)the Key Research&Development Plan of Zhejiang Province(No.2024C03051).
文摘This study evaluated the accuracy,completeness,and comprehensibility of responses from mainstream large language models(LLMs)to hepatitis C virus(HCV)-related questions,aiming to assess their performance in addressing patient queries about disease and lifestyle behaviors.The models selected were ChatGPT-4o,Gemini 2.0 Pro,Claude 3.5 Sonnet,and DeepSeek V3,with 12 questions chosen by two HCV experts from the domains of prevention,diagnosis,and treatment.
文摘Liver is prone to viral infection.Viral hepatitis can be roughly divided into hepatitis A,B,C,D and E.Accurate diagnosis of viral hepatitis is crucial for accurate treatments.Different types of biomarkers,including non-invasive biomarkers have been explored for the diagnosis of viral hepatitis.With the fast development of multi-omics technology,non-invasive biomarkers can be detected from blood,saliva,urine,stool,and other body fluids.The advantages of non-invasive biomarkers are:1)non-invasive;2)convenient to test and 3)repeatable.The application of non-invasive biomarkers significantly improves the diagnostic accuracy of viral hepatitis.The non-invasive biomarkers can be sugars,proteins,nucleic acids,and even microorganisms.In this review,we summarized recent advances in identifying non-invasive biomarkers using multi-omics technology and discussed their potential diagnostic values for viral hepatitis.
基金Supported by the Nanjing Health Science and Technology Key Medical Science and Technology Development Program:Mechanism of Action of the Modified Si-Miao Powder with Sanguisorba Carbonisata in Regulating Microbiota and Microecology for the Treatment of Recurrent Vulvovaginal Candidiasis(ZKX22039)。
文摘OBJECTIVE:To elucidate the therapeutic efficacy and mechanism of action of Chaihu Guizhi Ganjiang decoction(柴胡桂枝干姜汤,CGGD)in autoimmune hepatitis.METHODS:CGGD components and potential target genes were extracted from previously published databases.The autoimmune hepatitis(AIH)-related regulatory genes were obtained from the Dis Ge NET database.Intersections were taken,and enrichment analyses were performed on the extracted data.Concanavalin A(Con A)-induced AIH model mice were treated with CGGD via gavage.The results of network pharmacological analysis were experimentally validated.RESULTS:Network pharmacology revealed 228 genes at the intersection of AIH and CGGD.Kyoto Encyclopedia of Genes and Genomes analysis revealed that CGGD primarily regulates the phosphoinositide 3-kinase(PI3K)/protein kinase B(AKT)signaling pathway and cellular metabolism in AIH.Gene Ontology enrichment analysis revealed that CGGD modulates inflammation through transcription factor-mediated signaling pathways.As predicted,CGGD attenuated Con A-induced AIH in a dose-dependent manner by activating the PI3K/AKT signaling pathway.Histopathological assessment confirmed the protective effects of CGGD against Con Ainduced AIH.Further investigation revealed that CGGD regulated the T helper cell 17(Th17)/regulatory T cell(Treg)balance by modulating the PI3K/Akt/nuclear factor kappa-B(NF-κB)pathway.CONCLUSIONS:This study demonstrated the therapeutic effect of CGGD on AIH through a combination of network pharmacological prediction and experimental validation.Its mechanism of action involves PI3K/Akt/NF-κB-mediated regulation of Th17/Treg cells.
文摘Each hepatitis virus—Hepatitis A,B,C,D,E,and G—poses a distinct scenario to the patient and clinician alike.Since the discovery of each virus,extensive knowledge regarding epidemiology,virologic properties,and the natural clinical and immunologic history of acute and chronic infections has been generated.Basic discoveries about host immunologic responses to acute and chronic viral infections,combined with virologic data,has led to vaccines to prevent Hepatitis A,B,and E and highly efficacious antivirals for Hepatitis B and C.These therapeutic breakthroughs are transforming the fields of hepatology,transplant medicine in general,and public and global health.Most notably,there is even an ambitious global effort to eliminate chronic viral hepatitis within the next decade.While attainable,there are many barriers to this goal that are being actively investigated in basic and clinical labs on the local,national,and international scales.Herein,we discuss pertinent clinical information and recent organizational guidelines for each of the individual hepatitis viruses while also synthesizing this information with the latest research to focus on exciting future directions for each virus.
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 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Viral hepatitis,secondary to infection with hepatitis A,B,C,D,and E viruses,are a major public health problem and an important cause of morbidity and mortality.Despite the huge medical advances achieved in recent years,there are still points of conflict concerning the pathogenesis,immune response,development of new and more effective vaccines,therapies,and treatment.This review focuses on the most important research topics that deal with issues that are currently being solved,those that remain to be solved,and future research directions.For hepatitis A virus we will address epidemiology,molecular surveillance,new susceptible populations as well as environmental and food detections.In the case of hepatitis B virus,we will discuss host factors related to disease,diagnosis,therapy,and vaccine improvement.On hepatitis C virus,we will focus on pathogenesis,immune response,direct action antivirals treatment in the context of solid organ transplantation,issues related to hepatocellular carcinoma development,direct action antivirals resistance due to selection of resistanceassociated variants,and vaccination.Regarding hepatitis D virus,we describe diagnostic methodology,pathogenesis,and therapy.Finally,for hepatitis E virus,we will address epidemiology(including new emerging species),diagnosis,clinical aspects,treatment,the development of a vaccine,and environmental surveillance.
文摘In this review the current overall knowledge on hepatitis A,B,C,D,and E will be discussed.These diseases are all characterized by liver inflammation but have significant differences in distribution,transmission routes,and outcomes.Hepatitis B virus and hepatitis C virus are transmitted by exposure to infected blood,and in addition to acute infection,they can cause chronic hepatitis,which in turn can evolve into cirrhosis.It is estimated that more than 300 million people suffer from chronic hepatitis B or C worldwide.Hepatitis D virus,which is also transmitted by blood,only affects hepatitis B virus infected people,and this dual infection results in worse liver-related outcomes.Hepatitis A and E spread via the fecal-oral route,which corresponds mainly to the ingestion of food or water contaminated with infected stools.However,in developed countries hepatitis E is predominantly a zoonosis.Although hepatitis A virus and hepatitis E virus are usually responsible for a self-limiting hepatitis,a serious,rarely fatal illness is also possible,and in immunosuppressed patients,such as organ transplant recipients,hepatitis E virus infection can become chronic.The description of goals achieved,unresolved issues,and the latest research on this topic may make it possible to speculate on future scenarios in the world of viral hepatitis.
文摘This review aims to summarize the current evidence on the treatment of viral hepatitis,focusing on its clinical management.Also,future treatment options and areas of potential research interest are detailed.PubMed and Scopus databases were searched for primary studies published within the last ten years.Keywords included hepatitis A virus,hepatitis B virus(HBV),hepatitis C virus,hepatitis D virus(HDV),hepatitis E virus,and treatment.Outcomes reported in the studies were summarized,tabulated,and synthesized.Significant advances in viral hepatitis treatment were accomplished,such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A,hepatitis B,and hepatitis E vaccination.Drugs that cure hepatitis B,going beyond viral suppression,are so far unavailable;however,targeted antiviral drugs against HBV(immunomodulatory therapies and gene silencing technologies)are promising approaches to eradicating the virus.Ultimately,high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems.The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B,albeit further investigation is required.Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.
文摘Hepatitis C virus (HCV) elimination by 2030, using direct-acting antiviraltreatments, has been promoted by the World Health Organization. Thisachievement is not attainable, however, particularly after the 2020 pandemic ofthe coronavirus disease 2019. Consequently, the more realistic objective ofeliminating HCV from population segments for which targeted strategies ofprevention and treatment are easily attained has been promoted in Europe, as avalid alternative. The underlying idea is that micro-elimination will ultimatelylead to macro-elimination. The micro-elimination strategy may target differentspecific populations and at-risk groups. Different settings, including prisons andhospitals, have also been identified as micro-elimination scenarios. In addition,dedicated micro-elimination strategies have been designed that are tailored at thegeographical level according to HCV epidemiology and individual country’sincome. The main elements of a valid and successful micro-elimination project arereliable epidemiological data and active involvement of all the stakeholders.Community involvement represents another essential component for a successfulprogram.
文摘Drug-induced autoimmune-like hepatitis(DI-ALH)is an increasingly recognized phenotype within the spectrum of drug-induced liver injury.Several drugs,including nitrofurantoin,minocycline,hydralazine,methyldopa and infliximab,have a well-documented capacity to induce DI-ALH.Distinguishing DI-ALH from classic de novo autoimmune hepatitis(AIH)can be challenging due to overlapping clinical,biochemical,and serological features.Accurate distinction from classic AIH is crucial,as management and prognosis differ.While some DIALH cases resolve spontaneously after drug withdrawal,others show persistent or worsening liver injury.Histological studies have shown that fibrosis and cirrhosis are more prevalent in classic AH.Unfortunately,there are no pathognomic clinical,biochemical or immunological features that reliably distinguish DI-ALH from classic AIH.However,most patients with DI-ALH do not relapse after corticosteroid withdrawal,in contrast to the high relapse rate observed in classic AIH.Most patients respond well to corticosteroids,and once liver tests normalize,biochemical parameters should be monitored,and long-term immunosuppression should not be indicated.However,DI-ALH is not exempt from risk of relapse,underscoring the need for long-term follow-up.Most patients with DIALH have a favorable prognosis;however,although rare,cases of cirrhosis and,in exceptional instances,acute liver failure have been reported.International collaborative studies are needed to further characterize DI-ALH.In this review,we update current controversies,present emerging concepts,and outline future challenges in the diagnosis and management of this complex condition learned so far.
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.
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.
