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
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
Oncology Research Editorial Office Published:23 March 2026 The published article titled“MicroRNA 125a-5p Inhibits Cell Proliferation and Induces Apoptosis in Hepatitis B Virus-Related Hepatocellular Carcinoma by Down...Oncology Research Editorial Office Published:23 March 2026 The published article titled“MicroRNA 125a-5p Inhibits Cell Proliferation and Induces Apoptosis in Hepatitis B Virus-Related Hepatocellular Carcinoma by Downregulation of ErbB3”has been retracted from Oncology Research,Vol.27,No.4,2019,pp.449-458.DOI:10.3727/096504017X15016337254623 URL:https://www.techscience.com/or/v27n4/48558.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
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
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
Background:Liver failure(LF)is a disorder with a high mortality rate and large resource costs.In regions where liver transplantation resources are limited,artificial liver support systems(ALS)such as selective plasma ...Background:Liver failure(LF)is a disorder with a high mortality rate and large resource costs.In regions where liver transplantation resources are limited,artificial liver support systems(ALS)such as selective plasma exchange with dialysis(PED)may serve as a bridge to transplantation or hepatic recovery.This retrospective study aimed to evaluate the clinical outcomes,biochemical parameters,and prognostic factors associated with PED therapy in patients with hepatitis B-related acute-on-chronic liver failure(ACLF).Methods:This was a single-center,retrospective,observational cohort study.A total of 63 consecutive patients with HBV-related ACLF who received PED treatment between January 2020 and December 2022 were analyzed.Patients who underwent liver transplantation(n=11)were included in the survival group,as PED successfully functioned as a bridge to transplantation.The study was approved by the Institutional Review Board and informed consent was obtained.Variables with P<0.10 in univariate analysis were included in a stepwise binary logistic regression model to identify independent predictors of 3-month mortality.Results:Significant improvements in biochemical parameters,including MELD score,INR,TBIL,and blood ammonia,were observed following PED treatment(P<0.05).The overall 3-month mortality rate was 38.10%(24/63).No significant difference in mortality was found between HBeAg-positive patients(15/40,37.50%)and HBeAg-negative patients(9/23,39.13%)(P>0.05).In univariate analysis,3-month mortality was significantly associated with HBV DNA load(P<0.001),ALT(P=0.020),TBIL(P=0.036),DBIL(P=0.009),Cl^(-)(P<0.001),CO_(2)CP(P=0.011),INR(P=0.044),and blood ammonia reduction(P=0.033).However,the MELD score showed no significant association in univariate analysis(P=0.896).By multivariate binary logistic regression analysis,blood ammonia reduction(OR:0.85;95%CI:0.72-0.98;P=0.035)and MELD score(OR:1.12;95%CI:1.01-1.25;P=0.028)were identified as independent predictors of 3-month mortality in all patients.Conclusion:PED treatment was associated with improved biochemical parameters in patients with hepatitis B-related ACLF.Higher blood ammonia reduction was associated with improved survival.In multivariate analysis,blood ammonia reduction and MELD score were independent predictors of 3-month mortality.However,due to the limitations of this single-center,retrospective,observational study,further prospective controlled studies comparing PED with standard medical therapy or conventional plasma exchange are needed to establish the definitive role of PED in mortality reduction.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
BACKGROUND Patients with hepatitis B virus(HBV)infection require chronic and personalized care to improve outcomes.Large language models(LLMs)can potentially provide medical information for patients.AIM To examine the...BACKGROUND Patients with hepatitis B virus(HBV)infection require chronic and personalized care to improve outcomes.Large language models(LLMs)can potentially provide medical information for patients.AIM To examine the performance of three LLMs,ChatGPT-3.5,ChatGPT-4.0,and Google Gemini,in answering HBV-related questions.METHODS LLMs’responses to HBV-related questions were independently graded by two medical professionals using a four-point accuracy scale,and disagreements were resolved by a third reviewer.Each question was run three times using three LLMs.Readability was assessed via the Gunning Fog index and Flesch-Kincaid grade level.RESULTS Overall,all three LLM chatbots achieved high average accuracy scores for subjective questions(ChatGPT-3.5:3.50;ChatGPT-4.0:3.69;Google Gemini:3.53,out of a maximum score of 4).With respect to objective questions,ChatGPT-4.0 achieved an 80.8%accuracy rate,compared with 62.9%for ChatGPT-3.5 and 73.1%for Google Gemini.Across the six domains,ChatGPT-4.0 performed better in terms of diagnosis,whereas Google Gemini demonstrated excellent clinical manifestations.Notably,in the readability analysis,the mean Gunning Fog index and Flesch-Kincaid grade level scores of the three LLM chatbots were significantly higher than the standard level eight,far exceeding the reading level of the normal population.CONCLUSION Our results highlight the potential of LLMs,especially ChatGPT-4.0,for delivering responses to HBV-related questions.LLMs may be an adjunctive informational tool for patients and physicians to improve outcomes.Nevertheless,current LLMs should not replace personalized treatment recommendations from physicians in the management of HBV infection.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 Hepatic steatosis,characterized by fat accumulation in hepatocytes,can result from metabolic dysfunction-associated steatotic liver disease(MASLD),infections,alcoholism,chemotherapy,and toxins.MASLD is diag...BACKGROUND Hepatic steatosis,characterized by fat accumulation in hepatocytes,can result from metabolic dysfunction-associated steatotic liver disease(MASLD),infections,alcoholism,chemotherapy,and toxins.MASLD is diagnosed via imaging or biopsy with metabolic criteria and may progress to metabolic dysfunction–asso-ciated steatohepatitis,potentially leading to fibrosis,cirrhosis,or cancer.The coexistence of hepatic steatosis with chronic hepatitis B(CHB)is mainly related to metabolic factors and increases mortality and cancer risks.As a noninvasive method,attenuation imaging(ATI)shows promise in quantifying liver fat,demonstrating strong correlation with liver biopsy.AIM To investigate the disparity of ATI for assessing biopsy-based hepatic steatosis in CHB patients and MASLD patients.METHODS The study enrolled 249 patients who underwent both ATI and liver biopsy,including 78 with CHB and 171 with MASLD.Hepatic steatosis was classified into grades S0 to S3 according to the proportion of fat cells present.Liver fibrosis was staged from 0 to 4 according to the meta-analysis of histological data in viral hepatitis scoring system.The diagnostic performance of attenuation coefficient(AC)values across different groups was compared for each grade of steatosis.Factors associated with the AC values were determined through linear regression analysis.A multivariate logistic regression model was established to predict≥S2 within the MASLD group.RESULTS In both the CHB and the MASLD groups,AC values increased significantly with higher steatosis grade(P<0.001).In the CHB group,the areas under the curve(AUCs)of AC for predicting steatosis grades≥S1,≥S2 and S3 were 0.918,0.960 and 0.987,respectively.In contrast,the MASLD group showed AUCs of 0.836,0.774,and 0.688 for the same steatosis grades.The diagnostic performance of AC for detecting≥S2 and S3 indicated significant differences between the two groups(both P<0.001).Multivariate linear regression analysis identified body mass index,trigly-cerides,and steatosis grade as significant factors for AC.When the steatosis grade is≥S2,it can progress to more serious liver conditions.A clinical model integrating blood biochemical parameters and AC was developed in the MASLD group to enhance the prediction of≥S2,achieving an AUC of 0.848.CONCLUSION The AC could effectively discriminate the degree of steatosis in both the CHB and MASLD groups.In the MASLD group,when combined with blood biochemical parameters,AC exhibited better predictive ability for moderate to severe steatosis.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
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
BACKGROUND Autoimmune hepatitis(AIH)is typically treated with immunomodulators and steroids.However,some patients are refractory to these treatments,necessitating alternative approaches.Biological therapies have recen...BACKGROUND Autoimmune hepatitis(AIH)is typically treated with immunomodulators and steroids.However,some patients are refractory to these treatments,necessitating alternative approaches.Biological therapies have recently been explored for these difficult cases.AIM To assess the efficacy and safety of biologics in AIH,focusing on patients unresponsive to standard treatments and evaluating outcomes such as serological markers and histological remission.METHODS A case-based systematic review was performed following the PRISMA protocol to evaluate the efficacy and safety of biological therapies in AIH.The primary focus was on serological improvement and histological remission.The secondary focus was on assessing therapy safety and additional outcomes.A standardized search command was applied to MEDLINE,EMBASE,and Cochrane Library databases to identify relevant studies.Inclusion criteria encompassed adult AIH patients treated with biologics.Data were analyzed based on demographics,prior treatments,and therapy-related outcomes.A narrative synthesis was employed to address biases and provide a comprehensive overview of the evidence.RESULTS A total of 352 studies were reviewed,with 30 selected for detailed analysis.Key findings revealed that Belimumab led to a favourable response in five out of eight AIH patients across two studies.Rituximab demonstrated high efficacy,with 41 out of 45 patients showing significant improvement across six studies.Basiliximab was assessed in a single study,where the sole patient treated experienced a beneficial outcome.Additionally,a notable number of AIH cases were induced by anti-tumor necrosis factor(TNF)medications,including 16 cases associated with infliximab and four cases with adalimumab.All these cases showed improvement upon withdrawal of the biologic agent.CONCLUSION Belimumab and Rituximab show promise as effective alternatives for managing refractory AIH,demonstrating significant improvements in clinical outcomes and liver function.However,the variability in patient responses to different therapies highlights the need for personalized treatment strategies.The risk of AIH induced by anti-TNF therapies underscores the need for vigilant monitoring and prompt symptom recognition.These findings support the incorporation of biologic agents into AIH treatment protocols,particularly for patients who do not respond to conventional therapies.展开更多
Chronic hepatitis B(CHB)remains a significant global health challenge,affecting more than 250 million individuals worldwide.A functional cure,defined as the loss of hepatitis B surface antigen(HBsAg)and suppression of...Chronic hepatitis B(CHB)remains a significant global health challenge,affecting more than 250 million individuals worldwide.A functional cure,defined as the loss of hepatitis B surface antigen(HBsAg)and suppression of hepatitis B virus(HBV)DNA to undetectable levels,represents the optimal therapeutic endpoint for managing CHB.However,the complex pathogenesis of CHB,which includes HBV DNA integration,persistence of covalently closed circular DNA,and impaired immune responses,presents substantial barriers to HBsAg clearance.Current therapies offer limited success in achieving a functional cure,with HBsAg seroclearance occurring in only 3%-5%of patients after 10 years of nucleos(t)ide analogs(NAs)therapy and 8%-14%within 3-5 years of pegylated interferon treatment.To overcome these limitations,novel direct-acting antivirals targeting different stages of the HBV life cycle are being investigated.Additionally,immunomodulatory approaches,including therapeutic vaccines and immune checkpoint inhibitors,are being explored to enhance HBV-specific immune responses.The concept of NAs cessation in carefully selected non-cirrhotic patients may accelerate HBsAg loss,although the risks of hepatic flare and hepatocellular carcinoma necessitate rigorous monitoring.This review provides a comprehensive overview of the current understanding of HBsAg seroclearance in CHB,discussing its clinical significance,therapeutic challenges,and evolving treatment landscape in the pursuit of a functional cure.展开更多
BACKGROUND Steroids remain the primary treatment for severe alcohol-associated hepatitis(AAH),though there is little available tools to predict patient response to steroids.It was hypothesized that phosphatidylethanol...BACKGROUND Steroids remain the primary treatment for severe alcohol-associated hepatitis(AAH),though there is little available tools to predict patient response to steroids.It was hypothesized that phosphatidylethanol(PEth)value will inversely corre-late with response to steroid therapy based on Lille score in AAH.AIM To assess the relationship of patient factors,focusing on pre-steroid therapy PEth value,to steroid therapy response in AAH.METHODS A retrospective case control study was performed on patients who received≥4 days of steroid therapy for AAH at our hospital between July 1,2019 and June 30,2022.A total of 2087 patients were screened for AAH and those treated with steroids were included for statistical analysis utilizing independent sample t-test and for categorical variables using the χ^(2) test.RESULTS No correlation was found between PEth value,pre-steroids abstinence length,or number of drinks per week pre-steroids and response to steroids.Non-responder status significantly correlated with older age(P=0.024),lower albumin(P=0.003),and higher bilirubin(P=0.010)pre-steroids.Our study suggests that age,pre-steroid albumin,and pre-steroid bilirubin levels may predict nonresponse to steroid therapy.Non-responders have increased incidence of death and higher medical costs.CONCLUSION Identifying non-responders through these identified factors should prompt early referral for liver transplantation.Future prospective studies with larger population size are needed to assess the efficacy of combined pre-steroid age,albumin,bilirubin and other biochemical markers as predictors of steroid response.展开更多
This letter evaluates Shahid et al’s study in 2025 on the rising hepatitis A virus(HAV)among adults in Pakistan,highlighting a shift in the virus’s epidemiology.Once primarily a childhood disease in low-income regio...This letter evaluates Shahid et al’s study in 2025 on the rising hepatitis A virus(HAV)among adults in Pakistan,highlighting a shift in the virus’s epidemiology.Once primarily a childhood disease in low-income regions,HAV is now increasingly affecting adults,also seen globally due to improved sanitation.The study highlights public health challenges from adult HAV infections,which can lead to complications like coagulopathy and acute liver failure.It also has limitations,including being a single-center study and lacking seroprevalence and socioeconomic data,indicating the need for further research.This letter calls for urgent public health measures to extend adult vaccination programs and improve sanitation to address the increasing HAV infection in adult populations.展开更多
Chronic hepatitis B virus(HBV)infection affects approximately 254 million individuals globally,contributing to significant morbidity and mortality due to HBV-related liver failure and cirrhosis,which result in million...Chronic hepatitis B virus(HBV)infection affects approximately 254 million individuals globally,contributing to significant morbidity and mortality due to HBV-related liver failure and cirrhosis,which result in millions of fatalities each year.Although approved antiviral nucleos(t)ide analogues can effectively suppress HBV replication,their ability to reduce hepatitis B surface antigen(HBsAg)levels in plasma remains limited.The clinical application of the immunomodulator interferon-alpha is restricted by concerns regarding its safety and the severity of associated adverse reactions,rendering long-term administration challenging.Therefore,current drug development efforts for chronic hepatitis B aim to achieve a functional cure,which is defined as HBsAg serological clearance and sustained suppression of HBV DNA.This review discusses recent advancements in novel direct-acting therapeutic strategies for the treatment of chronic hepatitis B by focusing on the progresses in HBV entry inhibitors,monoclonal antibodies,RNA interferences,and other agents that directly target the virus.Furthermore,we discuss the development of immunomodulatory therapies,including TLR-7/8 agonists,immune checkpoint inhibitors,and therapeutic vaccines.In the end,we conclude by highlighting the importance of the rational combination-strategy design to improve the functional cure rate of HBV.展开更多
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.
文摘Oncology Research Editorial Office Published:23 March 2026 The published article titled“MicroRNA 125a-5p Inhibits Cell Proliferation and Induces Apoptosis in Hepatitis B Virus-Related Hepatocellular Carcinoma by Downregulation of ErbB3”has been retracted from Oncology Research,Vol.27,No.4,2019,pp.449-458.DOI:10.3727/096504017X15016337254623 URL:https://www.techscience.com/or/v27n4/48558.
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.
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 Beijing Gandan Xiangzhao Charity Foundation(iGandanF-1082022-RGG023).
文摘Background:Liver failure(LF)is a disorder with a high mortality rate and large resource costs.In regions where liver transplantation resources are limited,artificial liver support systems(ALS)such as selective plasma exchange with dialysis(PED)may serve as a bridge to transplantation or hepatic recovery.This retrospective study aimed to evaluate the clinical outcomes,biochemical parameters,and prognostic factors associated with PED therapy in patients with hepatitis B-related acute-on-chronic liver failure(ACLF).Methods:This was a single-center,retrospective,observational cohort study.A total of 63 consecutive patients with HBV-related ACLF who received PED treatment between January 2020 and December 2022 were analyzed.Patients who underwent liver transplantation(n=11)were included in the survival group,as PED successfully functioned as a bridge to transplantation.The study was approved by the Institutional Review Board and informed consent was obtained.Variables with P<0.10 in univariate analysis were included in a stepwise binary logistic regression model to identify independent predictors of 3-month mortality.Results:Significant improvements in biochemical parameters,including MELD score,INR,TBIL,and blood ammonia,were observed following PED treatment(P<0.05).The overall 3-month mortality rate was 38.10%(24/63).No significant difference in mortality was found between HBeAg-positive patients(15/40,37.50%)and HBeAg-negative patients(9/23,39.13%)(P>0.05).In univariate analysis,3-month mortality was significantly associated with HBV DNA load(P<0.001),ALT(P=0.020),TBIL(P=0.036),DBIL(P=0.009),Cl^(-)(P<0.001),CO_(2)CP(P=0.011),INR(P=0.044),and blood ammonia reduction(P=0.033).However,the MELD score showed no significant association in univariate analysis(P=0.896).By multivariate binary logistic regression analysis,blood ammonia reduction(OR:0.85;95%CI:0.72-0.98;P=0.035)and MELD score(OR:1.12;95%CI:1.01-1.25;P=0.028)were identified as independent predictors of 3-month mortality in all patients.Conclusion:PED treatment was associated with improved biochemical parameters in patients with hepatitis B-related ACLF.Higher blood ammonia reduction was associated with improved survival.In multivariate analysis,blood ammonia reduction and MELD score were independent predictors of 3-month mortality.However,due to the limitations of this single-center,retrospective,observational study,further prospective controlled studies comparing PED with standard medical therapy or conventional plasma exchange are needed to establish the definitive role of PED in mortality reduction.
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 National Natural Science Foundation of China,No.82260133the Key Laboratory Project of Digestive Diseases in Jiangxi Province,No.2024SSY06101Jiangxi Clinical Research Center for Gastroenterology,No.20223BCG74011.
文摘BACKGROUND Patients with hepatitis B virus(HBV)infection require chronic and personalized care to improve outcomes.Large language models(LLMs)can potentially provide medical information for patients.AIM To examine the performance of three LLMs,ChatGPT-3.5,ChatGPT-4.0,and Google Gemini,in answering HBV-related questions.METHODS LLMs’responses to HBV-related questions were independently graded by two medical professionals using a four-point accuracy scale,and disagreements were resolved by a third reviewer.Each question was run three times using three LLMs.Readability was assessed via the Gunning Fog index and Flesch-Kincaid grade level.RESULTS Overall,all three LLM chatbots achieved high average accuracy scores for subjective questions(ChatGPT-3.5:3.50;ChatGPT-4.0:3.69;Google Gemini:3.53,out of a maximum score of 4).With respect to objective questions,ChatGPT-4.0 achieved an 80.8%accuracy rate,compared with 62.9%for ChatGPT-3.5 and 73.1%for Google Gemini.Across the six domains,ChatGPT-4.0 performed better in terms of diagnosis,whereas Google Gemini demonstrated excellent clinical manifestations.Notably,in the readability analysis,the mean Gunning Fog index and Flesch-Kincaid grade level scores of the three LLM chatbots were significantly higher than the standard level eight,far exceeding the reading level of the normal population.CONCLUSION Our results highlight the potential of LLMs,especially ChatGPT-4.0,for delivering responses to HBV-related questions.LLMs may be an adjunctive informational tool for patients and physicians to improve outcomes.Nevertheless,current LLMs should not replace personalized treatment recommendations from physicians in the management of HBV infection.
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 the National Natural Science Foundation of China,No.82202185and Shanghai Science and Technology Development Foundation,No.22Y11911500.
文摘BACKGROUND Hepatic steatosis,characterized by fat accumulation in hepatocytes,can result from metabolic dysfunction-associated steatotic liver disease(MASLD),infections,alcoholism,chemotherapy,and toxins.MASLD is diagnosed via imaging or biopsy with metabolic criteria and may progress to metabolic dysfunction–asso-ciated steatohepatitis,potentially leading to fibrosis,cirrhosis,or cancer.The coexistence of hepatic steatosis with chronic hepatitis B(CHB)is mainly related to metabolic factors and increases mortality and cancer risks.As a noninvasive method,attenuation imaging(ATI)shows promise in quantifying liver fat,demonstrating strong correlation with liver biopsy.AIM To investigate the disparity of ATI for assessing biopsy-based hepatic steatosis in CHB patients and MASLD patients.METHODS The study enrolled 249 patients who underwent both ATI and liver biopsy,including 78 with CHB and 171 with MASLD.Hepatic steatosis was classified into grades S0 to S3 according to the proportion of fat cells present.Liver fibrosis was staged from 0 to 4 according to the meta-analysis of histological data in viral hepatitis scoring system.The diagnostic performance of attenuation coefficient(AC)values across different groups was compared for each grade of steatosis.Factors associated with the AC values were determined through linear regression analysis.A multivariate logistic regression model was established to predict≥S2 within the MASLD group.RESULTS In both the CHB and the MASLD groups,AC values increased significantly with higher steatosis grade(P<0.001).In the CHB group,the areas under the curve(AUCs)of AC for predicting steatosis grades≥S1,≥S2 and S3 were 0.918,0.960 and 0.987,respectively.In contrast,the MASLD group showed AUCs of 0.836,0.774,and 0.688 for the same steatosis grades.The diagnostic performance of AC for detecting≥S2 and S3 indicated significant differences between the two groups(both P<0.001).Multivariate linear regression analysis identified body mass index,trigly-cerides,and steatosis grade as significant factors for AC.When the steatosis grade is≥S2,it can progress to more serious liver conditions.A clinical model integrating blood biochemical parameters and AC was developed in the MASLD group to enhance the prediction of≥S2,achieving an AUC of 0.848.CONCLUSION The AC could effectively discriminate the degree of steatosis in both the CHB and MASLD groups.In the MASLD group,when combined with blood biochemical parameters,AC exhibited better predictive ability for moderate to severe steatosis.
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.
文摘BACKGROUND Autoimmune hepatitis(AIH)is typically treated with immunomodulators and steroids.However,some patients are refractory to these treatments,necessitating alternative approaches.Biological therapies have recently been explored for these difficult cases.AIM To assess the efficacy and safety of biologics in AIH,focusing on patients unresponsive to standard treatments and evaluating outcomes such as serological markers and histological remission.METHODS A case-based systematic review was performed following the PRISMA protocol to evaluate the efficacy and safety of biological therapies in AIH.The primary focus was on serological improvement and histological remission.The secondary focus was on assessing therapy safety and additional outcomes.A standardized search command was applied to MEDLINE,EMBASE,and Cochrane Library databases to identify relevant studies.Inclusion criteria encompassed adult AIH patients treated with biologics.Data were analyzed based on demographics,prior treatments,and therapy-related outcomes.A narrative synthesis was employed to address biases and provide a comprehensive overview of the evidence.RESULTS A total of 352 studies were reviewed,with 30 selected for detailed analysis.Key findings revealed that Belimumab led to a favourable response in five out of eight AIH patients across two studies.Rituximab demonstrated high efficacy,with 41 out of 45 patients showing significant improvement across six studies.Basiliximab was assessed in a single study,where the sole patient treated experienced a beneficial outcome.Additionally,a notable number of AIH cases were induced by anti-tumor necrosis factor(TNF)medications,including 16 cases associated with infliximab and four cases with adalimumab.All these cases showed improvement upon withdrawal of the biologic agent.CONCLUSION Belimumab and Rituximab show promise as effective alternatives for managing refractory AIH,demonstrating significant improvements in clinical outcomes and liver function.However,the variability in patient responses to different therapies highlights the need for personalized treatment strategies.The risk of AIH induced by anti-TNF therapies underscores the need for vigilant monitoring and prompt symptom recognition.These findings support the incorporation of biologic agents into AIH treatment protocols,particularly for patients who do not respond to conventional therapies.
文摘Chronic hepatitis B(CHB)remains a significant global health challenge,affecting more than 250 million individuals worldwide.A functional cure,defined as the loss of hepatitis B surface antigen(HBsAg)and suppression of hepatitis B virus(HBV)DNA to undetectable levels,represents the optimal therapeutic endpoint for managing CHB.However,the complex pathogenesis of CHB,which includes HBV DNA integration,persistence of covalently closed circular DNA,and impaired immune responses,presents substantial barriers to HBsAg clearance.Current therapies offer limited success in achieving a functional cure,with HBsAg seroclearance occurring in only 3%-5%of patients after 10 years of nucleos(t)ide analogs(NAs)therapy and 8%-14%within 3-5 years of pegylated interferon treatment.To overcome these limitations,novel direct-acting antivirals targeting different stages of the HBV life cycle are being investigated.Additionally,immunomodulatory approaches,including therapeutic vaccines and immune checkpoint inhibitors,are being explored to enhance HBV-specific immune responses.The concept of NAs cessation in carefully selected non-cirrhotic patients may accelerate HBsAg loss,although the risks of hepatic flare and hepatocellular carcinoma necessitate rigorous monitoring.This review provides a comprehensive overview of the current understanding of HBsAg seroclearance in CHB,discussing its clinical significance,therapeutic challenges,and evolving treatment landscape in the pursuit of a functional cure.
文摘BACKGROUND Steroids remain the primary treatment for severe alcohol-associated hepatitis(AAH),though there is little available tools to predict patient response to steroids.It was hypothesized that phosphatidylethanol(PEth)value will inversely corre-late with response to steroid therapy based on Lille score in AAH.AIM To assess the relationship of patient factors,focusing on pre-steroid therapy PEth value,to steroid therapy response in AAH.METHODS A retrospective case control study was performed on patients who received≥4 days of steroid therapy for AAH at our hospital between July 1,2019 and June 30,2022.A total of 2087 patients were screened for AAH and those treated with steroids were included for statistical analysis utilizing independent sample t-test and for categorical variables using the χ^(2) test.RESULTS No correlation was found between PEth value,pre-steroids abstinence length,or number of drinks per week pre-steroids and response to steroids.Non-responder status significantly correlated with older age(P=0.024),lower albumin(P=0.003),and higher bilirubin(P=0.010)pre-steroids.Our study suggests that age,pre-steroid albumin,and pre-steroid bilirubin levels may predict nonresponse to steroid therapy.Non-responders have increased incidence of death and higher medical costs.CONCLUSION Identifying non-responders through these identified factors should prompt early referral for liver transplantation.Future prospective studies with larger population size are needed to assess the efficacy of combined pre-steroid age,albumin,bilirubin and other biochemical markers as predictors of steroid response.
文摘This letter evaluates Shahid et al’s study in 2025 on the rising hepatitis A virus(HAV)among adults in Pakistan,highlighting a shift in the virus’s epidemiology.Once primarily a childhood disease in low-income regions,HAV is now increasingly affecting adults,also seen globally due to improved sanitation.The study highlights public health challenges from adult HAV infections,which can lead to complications like coagulopathy and acute liver failure.It also has limitations,including being a single-center study and lacking seroprevalence and socioeconomic data,indicating the need for further research.This letter calls for urgent public health measures to extend adult vaccination programs and improve sanitation to address the increasing HAV infection in adult populations.
文摘Chronic hepatitis B virus(HBV)infection affects approximately 254 million individuals globally,contributing to significant morbidity and mortality due to HBV-related liver failure and cirrhosis,which result in millions of fatalities each year.Although approved antiviral nucleos(t)ide analogues can effectively suppress HBV replication,their ability to reduce hepatitis B surface antigen(HBsAg)levels in plasma remains limited.The clinical application of the immunomodulator interferon-alpha is restricted by concerns regarding its safety and the severity of associated adverse reactions,rendering long-term administration challenging.Therefore,current drug development efforts for chronic hepatitis B aim to achieve a functional cure,which is defined as HBsAg serological clearance and sustained suppression of HBV DNA.This review discusses recent advancements in novel direct-acting therapeutic strategies for the treatment of chronic hepatitis B by focusing on the progresses in HBV entry inhibitors,monoclonal antibodies,RNA interferences,and other agents that directly target the virus.Furthermore,we discuss the development of immunomodulatory therapies,including TLR-7/8 agonists,immune checkpoint inhibitors,and therapeutic vaccines.In the end,we conclude by highlighting the importance of the rational combination-strategy design to improve the functional cure rate of HBV.
