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
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 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
Objective： To compare the clinical characteristics and prognosis between hepatitis virus-related hepatocellular carcinoma（viral HCC） and non-B, non-C HCC（NBC-HCC） among Uyghur patients in Xinjiang province, China...Objective： To compare the clinical characteristics and prognosis between hepatitis virus-related hepatocellular carcinoma（viral HCC） and non-B, non-C HCC（NBC-HCC） among Uyghur patients in Xinjiang province, China. Methods： Between 01/01/2000 and 31/12/2012, 319 Uyghur HCC patients were treated at the Cancer Centre of The First Affiliated Hospital of Xinjiang Medical University. The data for the patients were obtained from a retrospective review of the patients＇ medical records. A total of 18 patients were excluded from the study because of incomplete information. The patients were classified into two groups： viral HCC and NBC-HCC. The clinical characteristics and prognostic factors were statistically analysed.Results： For all 301 patients, gender（P=0.000）, area of residence（P=0.002）, diabetes mellitus（P=0.009）, BMI（P=0.000）, cirrhosis（P=0.000）, tumour stage（P=0.004）, Child-Pugh class（P=0.000）, the TBIL level（P=0.000）, and the alpha-fetoprotein（AFP） level（P=0.000） were significantly different between the NBC-HCC and viral HCC groups. The NBC-HCC patients tended to be diagnosed at advanced stages; however, the NBC-HCC patients exhibited lower Child-Pugh scores than the viral HCC patients. In all patients examined, the 0.5-, 1-, 3- and 5-year overall survival（OS） rates were 35.6%, 20.3%, 12.6% and 4.5%, respectively. No significant difference in OS was observed between the two groups（P=0.124）. Cox multivariate analysis revealed that age（RR =1.539, P=0.001）, TNM stage（RR =12.708, P=0.000）, portal vein tumour thrombus（PVTT）（RR =2.003, P=0.000）, Child-Pugh class（RR =1.715, P=0.000）, and TACE ＋ radiotherapy/RFA（RR =0.567, P=0.000） were significant independent prognostic factors for HCC patients. Conclusions： The clinical characteristics differ between Uyghur patients with NBC-HCC and viral HCC. HCC in the Xinjiang region displays specific regional characteristics. Age, TNM stage, PVTT, Child-Pugh class and TACE ＋ radiotherapy/RFA are significant risk factors that influence patient survival.展开更多
There are cases of hepatitis involving occult hepatitis B virus(HBV)infection in which,even though the HB surface antigen(HBsAg)is negative,HBV-DNA is detected by a polymerase chain reaction(PCR).We con-ducted a seque...There are cases of hepatitis involving occult hepatitis B virus(HBV)infection in which,even though the HB surface antigen(HBsAg)is negative,HBV-DNA is detected by a polymerase chain reaction(PCR).We con-ducted a sequence analysis of the entire HBV region in a case of non-B non-C chronic hepatitis in a 46-yearold female.A diagnosis of non-B non-C chronic hepatitis was made.Although HBV markers,such as HBs antibody(anti-HBs),anti-HBc,HBeAg and anti-HBe,were negative,HBV-DNA was positive.Nested PCR was performed to amplify the precore region of HBV-DNA and all remaining regions by long nested PCR.Sequence analysis of the two obtained bands was conducted by direct sequencing.Compared with the control strains,the ATG(Methionine)start codon in the X region had mut ated to GTG(Valine).It is assumed that a mutation at the start codon in the X region may be the reason why HBV markers are negative in some cases of hepatitis that involve occult HBV infection.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
AIM To investigate the prevalence, clinicopathological characteristics and surgical outcomes of occult hepatitis B virus(HBV) infection(OBI) in patients with non-B, non-C(NBNC) hepatocellular carcinoma(HCC).METHODS Th...AIM To investigate the prevalence, clinicopathological characteristics and surgical outcomes of occult hepatitis B virus(HBV) infection(OBI) in patients with non-B, non-C(NBNC) hepatocellular carcinoma(HCC).METHODS This study retrospectively examined the cases of 78 NBNC patients with curative resection for HCC for whom DNA could be extracted from formalin-fixed paraffin-embedded tissue. OBI was determined by the HBV-DNA amplification of at least two different sets of primers by TaqM an realtime polymerase chain reaction. Possibly carcinogenetic factors such as alcohol abuse, diabetes mellitus, obesity and non-alcoholic steatohepatitis(NASH) were examined. Surgical outcomes were evaluated according to diseasefree survival(DFS), overall survival(OS) and diseasespecific survival(DSS).RESULTS OBI was found in 27/78 patients(34.6%) with NBNC HCC. The OBI patients were significantly younger than the non-OBI cases at the time of surgery(average age 63.0 vs 68.1, P = 0.0334) and the OBI cases overlapped with other etiologies significantly more frequently compared to the non-OBI cases(P = 0.0057). OBI had no impact on the DFS, OS or DSS. Only tumorrelated factors affected these surgical outcomes.CONCLUSION Our findings indicate that OBI had no impact on surgical outcomes. The surgical outcomes of NBNC HCC depend on early tumor detection; this reconfirms the importance of a periodic medical examination for individuals who have NBNC HCC risk factors.展开更多
BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of d...BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral(DAA)treatment in HCV-infected patients.METHODS The study included consecutive 9457 women and 9529 men,treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project.Women were divided into pre-menopausal(15-44 years),menopausal(45-55 years)and post-menopausal(>55 years)and compared with age-matched men.RESULTS Regardless of age,women had a significantly lower body mass index,prevalence of genotype 3 infection and proportion of cirrhosis compared to men.Psychiatric disorders(except depression),hepatitis B virus and human immunodeficiency virus co-infections,as well as alcohol and drug addiction,were significantly less common in women than in men in all age groups.The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4%and 96.6%,respectively(P<0.001).Independent predictors of treatment failure in women were genotype 3 infection,cirrhosis and postmenopausal age.Mild adverse events were reported significantly more often by women,regardless of age with the highest percentage in the postmenopausal group.CONCLUSION DAA treatment is more effective in women than in men,regardless of age,but in postmenopausal women,the effectiveness is relatively the lowest.展开更多
In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following tran...In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.展开更多
In this editorial,we comment on the article by Mu et al,published in the recent issue of the World Journal of Gastrointestinal Oncology.We pay special attention to the immune tolerance mechanism caused by hepatitis B ...In this editorial,we comment on the article by Mu et al,published in the recent issue of the World Journal of Gastrointestinal Oncology.We pay special attention to the immune tolerance mechanism caused by hepatitis B virus(HBV)infection,the pathogenesis of hepatocellular carcinoma(HCC),and the role of antiviral therapy in treating HCC related to HBV infection.HBV infection leads to systemic innate immune tolerance by directly inhibiting pattern recognition receptor recognition and antiviral signaling pathways,as well as by inhibiting the immune functions of macrophages,natural killer cells and dendritic cells.In addition,HBV leads to an immunosuppressive cascade by expressing inhibitory molecules to induce exhaustion of HBV-specific cluster of differentiation 8+T cells,ultimately leading to long-term viral infection.The loss of immune cell function caused by HBV infection ultimately leads to HCC.Long-term antiviral therapy can improve the prognosis of patients with HCC and prevent tumor recurrence and metastasis.展开更多
BACKGROUND 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
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
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
BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated l...BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.展开更多
BACKGROUND C-X-C chemokine receptor type 5(CXCR5)^(+)CD8^(+)T cells represent a unique immune subset with dual roles,functioning as cytotoxic cells in persistent viral infections while promoting B cell responses.Despi...BACKGROUND C-X-C chemokine receptor type 5(CXCR5)^(+)CD8^(+)T cells represent a unique immune subset with dual roles,functioning as cytotoxic cells in persistent viral infections while promoting B cell responses.Despite their importance,the specific role of CXCR5^(+)CD8^(+)T cells in chronic hepatitis B(CHB),particularly during interferon-alpha(IFN-α)treatment,is not fully understood.This study aims to elucidate the relationship between CXCR5^(+)CD8^(+)T cells and sustained serologic response(SR)in patients undergoing 48 weeks of pegylated IFN-α(peg-IFN-α)treatment for CHB.AIM To elucidate the relationship between CXCR5^(+)CD8^(+)T cells and sustained SR in patients undergoing 48 weeks of peg-IFN-αtreatment for CHB.METHODS This study enrolled 60 patients with hepatitis Be antigen(HBeAg)-positive CHB undergoing 48 weeks of peg-IFN-αtreatment.Participants were assessed for eligibility based on criteria such as persistent HBsAg-positive status for at least six months,HBeAb-negative,hepatitis B virus DNA levels exceeding 2×10^(4) copies/mL,and alanine aminotransferase(ALT)levels between 2 and 10 times the upper limit of normal.Blood samples were collected at baseline and at weeks 12,24,48,and a 24-week treatment-free follow-up(week 72)to measure serum interleukin(IL)-21 concentration via ELISA and to analyze CXCR5 and programmed death-ligand 1(PD-L1)expression on CD8^(+)T cells by flow cytometry,CXCR5 is a chemokine receptor that directs immune cells to specific tissues,while PD-L1 is a protein that regulates immune responses by inhibiting T cell activity.RESULTS Patients with CHB exhibited significantly lower levels of circulating CXCR5^(+)CD8^(+)T cells compared to healthy controls(P<0.01).Notably,CXCR5^(+)CD8^(+)T cells were prominently expressed in patients who achieved sustained SR compared to non-SR(NSR).A significant correlation was observed between CXCR5 and PD-L1 expression(r=-0.189,P=0.002).However,there was no significant correlation between serum IL-21 levels and CXCR5+CD8+lymphocytes(r=-0.03,P=0.625)or serum ALT levels(r=0.026,P=0.678).CONCLUSION The enhanced expression of CXCR5^(+)CD8^(+)T cells in patients achieving HBeAg seroconversion during IFN-αtreatment suggests that these cells play a crucial role in antiviral immune responses against hepatitis B.This study highlights the potential of CXCR5^(+)CD8^(+)T cells as immune regulators in CHB,which may inform future therapeutic strategies to optimize antiviral treatments.展开更多
Background: Hepatitis B virus (HBV) is a primary reason for liver cancer and continues to be a worldwide public health issue. The likelihood of contracting HBV is greater in healthcare workers (HCWs) compared to indiv...Background: Hepatitis B virus (HBV) is a primary reason for liver cancer and continues to be a worldwide public health issue. The likelihood of contracting HBV is greater in healthcare workers (HCWs) compared to individuals who are not in healthcare professions. Medical students are classified as a high-risk demographic since, like HCWs, they often come into contact with bodily fluids and blood during their clinical training. By 2030, a greater proportion of people will have received HBV vaccinations, thereby halting the spread of new infections—The Somali Ministry of Health with the help of various agencies announced to eradicate hepatitis from Somalia. The priority actions are national hepatitis strategy, hepatitis survey, public awareness, training, and capacity building. Objectives: This study aims to assess the knowledge, attitude, and vaccination status of Hepatitis B infection among medical university students in Mogadishu, Somalia, 2024. Methods: Cross-sectional study design was used in this study and the survey was carried out among medical students enrolled in Universities from April 1, 2023 to June 30, 2023. The data was analyzed using SPSS version 26.0 software, Chi-square analysis and Logistic regression analysis to identify associations between demographic factors and HBV knowledge, attitudes, and vaccination status, as well as perspectives and immunization status concerning viral hepatitis. Results: The study achieved a response rate of (96%), with 230 participants. Most students (76.5%) were aged 26 - 30 years, and (60.8%) were male. Nearly half (48.7%) were in their third year of study, and the majority (36.1%) were from the Medicine and Surgery department. While 92.2% had heard of HBV, gaps in understanding were evident. About 37.8% erroneously believed HBV could spread via handshakes, and only 33.9% were aware HBV is treatable. Awareness of HBV’s severe complications, such as liver cirrhosis and liver cancer, was reported by 61.3%, and 83% understood that vaccination could prevent infection. Positive attitudes towards HBV vaccination were prevalent. Most participants (81.3%) supported vaccination before sexual activity, and 78.3% endorsed mandatory HBV vaccination policies for healthcare workers. However, 87.4% expressed concerns about the vaccine promoting unsafe sexual behavior, and 96.1% cited cultural resistance as a barrier to vaccination. A significant proportion (80.86%) of students had not been vaccinated against HBV. Among vaccinated students, 17.4%, 15.7%, and 47.82% had received one, two, and three doses, respectively. Barriers to vaccination included safety concerns (77.4%), lack of time (86.52%), and doubts about efficacy (42.61%). Conclusion: This study highlights gaps in knowledge and vaccination coverage among medical students, which are critical for their health and future clinical practice. Enhancing awareness and vaccination rates can empower students to advocate for preventative measures in their professional environments. Despite high awareness of HBV, knowledge gaps and cultural barriers persist, affecting attitudes and vaccination uptake among medical students. Educational interventions addressing misconceptions, cultural resistance, and vaccine safety are critical. Increased advocacy for mandatory vaccination policies in healthcare settings is also essential to improve HBV prevention methods.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
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
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
Background:Hepatitis E virus(HEV)may induce acute self-limiting illnesses or persistent infections.Chronic hepatitis E frequently occurs in immunocompromised persons,including organ transplant recipients,HIV-positive ...Background:Hepatitis E virus(HEV)may induce acute self-limiting illnesses or persistent infections.Chronic hepatitis E frequently occurs in immunocompromised persons,including organ transplant recipients,HIV-positive patients,and those with hematological malignancies.It poses a risk of liver fibrosis and cirrhosis.Data sources:Relevant articles published till September 2024 were located using Pub Med searches.The further search terms utilized were:“immunocompromised”,“solid organ transplant”,“HIV”,“hematological malignancy”,and“hepatitis E virus”.A manual search of references from pivotal articles extended further publications.The search parameters encompass publications in English.Results:The epidemiology,clinical manifestations,diagnostic measures,and therapeutic modalities of chronic hepatitis E were discussed.Immunocompromised individuals who are infected with HEV are at an increased risk of developing chronic infections,which may progress to liver fibrosis and cirrhosis.Current understanding of HEV is still limited,and there is no medicine that specifically targets hepatitis E.Consequently,the prevention and management of hepatitis E continue to present a significant challenge.Conclusions:Chronic hepatitis E patients need special attention in clinical practice.The relevant risk factors must be identified to facilitate accurate diagnosis and the implementation of more effective preventive measures,thereby enhancing the monitoring,treatment,and prevention of immunocompromised individuals.展开更多
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 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.
文摘BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among adults.AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)infection.METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May 2024.Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed.To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed.Data regarding clinical and laboratory parameters were recorded.The yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among adults.RESULTS A total of 396 patients were found to have acute hepatitis during our study duration.HAV was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV infection.Additionally,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute hepatitis.Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years.The patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV infection.However,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in HEV.CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.
基金supported by a grant from the Urumqi Science and Technology Project Foundation of China(No.H111313001)
文摘Objective： To compare the clinical characteristics and prognosis between hepatitis virus-related hepatocellular carcinoma（viral HCC） and non-B, non-C HCC（NBC-HCC） among Uyghur patients in Xinjiang province, China. Methods： Between 01/01/2000 and 31/12/2012, 319 Uyghur HCC patients were treated at the Cancer Centre of The First Affiliated Hospital of Xinjiang Medical University. The data for the patients were obtained from a retrospective review of the patients＇ medical records. A total of 18 patients were excluded from the study because of incomplete information. The patients were classified into two groups： viral HCC and NBC-HCC. The clinical characteristics and prognostic factors were statistically analysed.Results： For all 301 patients, gender（P=0.000）, area of residence（P=0.002）, diabetes mellitus（P=0.009）, BMI（P=0.000）, cirrhosis（P=0.000）, tumour stage（P=0.004）, Child-Pugh class（P=0.000）, the TBIL level（P=0.000）, and the alpha-fetoprotein（AFP） level（P=0.000） were significantly different between the NBC-HCC and viral HCC groups. The NBC-HCC patients tended to be diagnosed at advanced stages; however, the NBC-HCC patients exhibited lower Child-Pugh scores than the viral HCC patients. In all patients examined, the 0.5-, 1-, 3- and 5-year overall survival（OS） rates were 35.6%, 20.3%, 12.6% and 4.5%, respectively. No significant difference in OS was observed between the two groups（P=0.124）. Cox multivariate analysis revealed that age（RR =1.539, P=0.001）, TNM stage（RR =12.708, P=0.000）, portal vein tumour thrombus（PVTT）（RR =2.003, P=0.000）, Child-Pugh class（RR =1.715, P=0.000）, and TACE ＋ radiotherapy/RFA（RR =0.567, P=0.000） were significant independent prognostic factors for HCC patients. Conclusions： The clinical characteristics differ between Uyghur patients with NBC-HCC and viral HCC. HCC in the Xinjiang region displays specific regional characteristics. Age, TNM stage, PVTT, Child-Pugh class and TACE ＋ radiotherapy/RFA are significant risk factors that influence patient survival.
文摘There are cases of hepatitis involving occult hepatitis B virus(HBV)infection in which,even though the HB surface antigen(HBsAg)is negative,HBV-DNA is detected by a polymerase chain reaction(PCR).We con-ducted a sequence analysis of the entire HBV region in a case of non-B non-C chronic hepatitis in a 46-yearold female.A diagnosis of non-B non-C chronic hepatitis was made.Although HBV markers,such as HBs antibody(anti-HBs),anti-HBc,HBeAg and anti-HBe,were negative,HBV-DNA was positive.Nested PCR was performed to amplify the precore region of HBV-DNA and all remaining regions by long nested PCR.Sequence analysis of the two obtained bands was conducted by direct sequencing.Compared with the control strains,the ATG(Methionine)start codon in the X region had mut ated to GTG(Valine).It is assumed that a mutation at the start codon in the X region may be the reason why HBV markers are negative in some cases of hepatitis that involve occult HBV infection.
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AIM To investigate the prevalence, clinicopathological characteristics and surgical outcomes of occult hepatitis B virus(HBV) infection(OBI) in patients with non-B, non-C(NBNC) hepatocellular carcinoma(HCC).METHODS This study retrospectively examined the cases of 78 NBNC patients with curative resection for HCC for whom DNA could be extracted from formalin-fixed paraffin-embedded tissue. OBI was determined by the HBV-DNA amplification of at least two different sets of primers by TaqM an realtime polymerase chain reaction. Possibly carcinogenetic factors such as alcohol abuse, diabetes mellitus, obesity and non-alcoholic steatohepatitis(NASH) were examined. Surgical outcomes were evaluated according to diseasefree survival(DFS), overall survival(OS) and diseasespecific survival(DSS).RESULTS OBI was found in 27/78 patients(34.6%) with NBNC HCC. The OBI patients were significantly younger than the non-OBI cases at the time of surgery(average age 63.0 vs 68.1, P = 0.0334) and the OBI cases overlapped with other etiologies significantly more frequently compared to the non-OBI cases(P = 0.0057). OBI had no impact on the DFS, OS or DSS. Only tumorrelated factors affected these surgical outcomes.CONCLUSION Our findings indicate that OBI had no impact on surgical outcomes. The surgical outcomes of NBNC HCC depend on early tumor detection; this reconfirms the importance of a periodic medical examination for individuals who have NBNC HCC risk factors.
文摘BACKGROUND Sex is one of the known factors influencing the risk of hepatitis C virus(HCV)infection and the natural course of the disease.AIM To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral(DAA)treatment in HCV-infected patients.METHODS The study included consecutive 9457 women and 9529 men,treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project.Women were divided into pre-menopausal(15-44 years),menopausal(45-55 years)and post-menopausal(>55 years)and compared with age-matched men.RESULTS Regardless of age,women had a significantly lower body mass index,prevalence of genotype 3 infection and proportion of cirrhosis compared to men.Psychiatric disorders(except depression),hepatitis B virus and human immunodeficiency virus co-infections,as well as alcohol and drug addiction,were significantly less common in women than in men in all age groups.The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4%and 96.6%,respectively(P<0.001).Independent predictors of treatment failure in women were genotype 3 infection,cirrhosis and postmenopausal age.Mild adverse events were reported significantly more often by women,regardless of age with the highest percentage in the postmenopausal group.CONCLUSION DAA treatment is more effective in women than in men,regardless of age,but in postmenopausal women,the effectiveness is relatively the lowest.
基金Supported by Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province,No.2023GBYJ-YL-1.
文摘In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.
基金Supported by the Natural Science Foundation of China,No.81970529the Natural Science Foundation of Jilin Province,No.20230508074RC and No.YDZJ202401218ZYTS.
文摘In this editorial,we comment on the article by Mu et al,published in the recent issue of the World Journal of Gastrointestinal Oncology.We pay special attention to the immune tolerance mechanism caused by hepatitis B virus(HBV)infection,the pathogenesis of hepatocellular carcinoma(HCC),and the role of antiviral therapy in treating HCC related to HBV infection.HBV infection leads to systemic innate immune tolerance by directly inhibiting pattern recognition receptor recognition and antiviral signaling pathways,as well as by inhibiting the immune functions of macrophages,natural killer cells and dendritic cells.In addition,HBV leads to an immunosuppressive cascade by expressing inhibitory molecules to induce exhaustion of HBV-specific cluster of differentiation 8+T cells,ultimately leading to long-term viral infection.The loss of immune cell function caused by HBV infection ultimately leads to HCC.Long-term antiviral therapy can improve the prognosis of patients with HCC and prevent tumor recurrence and metastasis.
文摘BACKGROUND 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.
基金Supported by the Foundation of Health Commission of Hubei Province,No.WJ2019H053Natural Science Foundation of Hubei Province,No.2023AFB169+1 种基金Foundation of Health Commission of Hubei Province,No.ZY2021Q019Open Fund Hubei Provincial Clinical Research Center for Umbilical Cord Blood Hematopoietic Stem Cells,Taihe Hospital,No.2024SCOF008.
文摘BACKGROUND Large number of decompensated liver cirrhosis patients in China have been diagnosed with hepatitis B virus(HBV).Human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)can possibly cure decompensated liver cirrhosis because of their self-renewal and multidirectional differentiation potential.AIM To explore the safety and effect of treating liver cirrhosis with HBV by hUC-MSCs.METHODS Twenty-four participants were recruited,divided into 3 groups,and injected with different amounts of hUC-MSCs via the peripheral vein.Therapy was administered 3 times.A 24-week follow-up examination of each patient’s liver function,coagulation function,general condition,and immune system was performed.Adverse events were also recorded.A 2-year survival assessment was subsequently performed.RESULTS Infusion therapy rapidly improved liver function.Serum albumin transiently increased on days 57 and 85 but returned to baseline by day 169,while prothrombin time activity demonstrated sustained improvement from day 29 through day 169.Interleukin-8 levels decreased persistently throughout treatment.All dosage groups achieved 100%6-month survival;2-year survival rates were 66.7%(low-dose),100%(medium-dose),and 87.5%(high-dose).The interaction between dosage and efficacy was weak.Notably,the improvement in liver function was statistically significant and sustained for almost 3 months,suggesting clinically meaningful therapeutic durability.CONCLUSION hUC-MSCs can be considered a safe treatment for patients with decompensated liver cirrhosis associated with HBV.However,larger-scale randomized controlled trials are needed to prove its therapeutic effect.
基金Supported by Changsha Science and Technology Program,No.kq2022397Natural Science Foundation of Hunan Province(Departmental Joint Fund),No.2023JJ60440+2 种基金Research Program of Health Commission of Hunan Province,No.202303088786Clinical Medical Research Center for Viral Hepatitis of Hunan Province,No.2023SK4009the Scientific Research Program of FuRong Laboratory,No.2023SK2108.
文摘BACKGROUND C-X-C chemokine receptor type 5(CXCR5)^(+)CD8^(+)T cells represent a unique immune subset with dual roles,functioning as cytotoxic cells in persistent viral infections while promoting B cell responses.Despite their importance,the specific role of CXCR5^(+)CD8^(+)T cells in chronic hepatitis B(CHB),particularly during interferon-alpha(IFN-α)treatment,is not fully understood.This study aims to elucidate the relationship between CXCR5^(+)CD8^(+)T cells and sustained serologic response(SR)in patients undergoing 48 weeks of pegylated IFN-α(peg-IFN-α)treatment for CHB.AIM To elucidate the relationship between CXCR5^(+)CD8^(+)T cells and sustained SR in patients undergoing 48 weeks of peg-IFN-αtreatment for CHB.METHODS This study enrolled 60 patients with hepatitis Be antigen(HBeAg)-positive CHB undergoing 48 weeks of peg-IFN-αtreatment.Participants were assessed for eligibility based on criteria such as persistent HBsAg-positive status for at least six months,HBeAb-negative,hepatitis B virus DNA levels exceeding 2×10^(4) copies/mL,and alanine aminotransferase(ALT)levels between 2 and 10 times the upper limit of normal.Blood samples were collected at baseline and at weeks 12,24,48,and a 24-week treatment-free follow-up(week 72)to measure serum interleukin(IL)-21 concentration via ELISA and to analyze CXCR5 and programmed death-ligand 1(PD-L1)expression on CD8^(+)T cells by flow cytometry,CXCR5 is a chemokine receptor that directs immune cells to specific tissues,while PD-L1 is a protein that regulates immune responses by inhibiting T cell activity.RESULTS Patients with CHB exhibited significantly lower levels of circulating CXCR5^(+)CD8^(+)T cells compared to healthy controls(P<0.01).Notably,CXCR5^(+)CD8^(+)T cells were prominently expressed in patients who achieved sustained SR compared to non-SR(NSR).A significant correlation was observed between CXCR5 and PD-L1 expression(r=-0.189,P=0.002).However,there was no significant correlation between serum IL-21 levels and CXCR5+CD8+lymphocytes(r=-0.03,P=0.625)or serum ALT levels(r=0.026,P=0.678).CONCLUSION The enhanced expression of CXCR5^(+)CD8^(+)T cells in patients achieving HBeAg seroconversion during IFN-αtreatment suggests that these cells play a crucial role in antiviral immune responses against hepatitis B.This study highlights the potential of CXCR5^(+)CD8^(+)T cells as immune regulators in CHB,which may inform future therapeutic strategies to optimize antiviral treatments.
文摘Background: Hepatitis B virus (HBV) is a primary reason for liver cancer and continues to be a worldwide public health issue. The likelihood of contracting HBV is greater in healthcare workers (HCWs) compared to individuals who are not in healthcare professions. Medical students are classified as a high-risk demographic since, like HCWs, they often come into contact with bodily fluids and blood during their clinical training. By 2030, a greater proportion of people will have received HBV vaccinations, thereby halting the spread of new infections—The Somali Ministry of Health with the help of various agencies announced to eradicate hepatitis from Somalia. The priority actions are national hepatitis strategy, hepatitis survey, public awareness, training, and capacity building. Objectives: This study aims to assess the knowledge, attitude, and vaccination status of Hepatitis B infection among medical university students in Mogadishu, Somalia, 2024. Methods: Cross-sectional study design was used in this study and the survey was carried out among medical students enrolled in Universities from April 1, 2023 to June 30, 2023. The data was analyzed using SPSS version 26.0 software, Chi-square analysis and Logistic regression analysis to identify associations between demographic factors and HBV knowledge, attitudes, and vaccination status, as well as perspectives and immunization status concerning viral hepatitis. Results: The study achieved a response rate of (96%), with 230 participants. Most students (76.5%) were aged 26 - 30 years, and (60.8%) were male. Nearly half (48.7%) were in their third year of study, and the majority (36.1%) were from the Medicine and Surgery department. While 92.2% had heard of HBV, gaps in understanding were evident. About 37.8% erroneously believed HBV could spread via handshakes, and only 33.9% were aware HBV is treatable. Awareness of HBV’s severe complications, such as liver cirrhosis and liver cancer, was reported by 61.3%, and 83% understood that vaccination could prevent infection. Positive attitudes towards HBV vaccination were prevalent. Most participants (81.3%) supported vaccination before sexual activity, and 78.3% endorsed mandatory HBV vaccination policies for healthcare workers. However, 87.4% expressed concerns about the vaccine promoting unsafe sexual behavior, and 96.1% cited cultural resistance as a barrier to vaccination. A significant proportion (80.86%) of students had not been vaccinated against HBV. Among vaccinated students, 17.4%, 15.7%, and 47.82% had received one, two, and three doses, respectively. Barriers to vaccination included safety concerns (77.4%), lack of time (86.52%), and doubts about efficacy (42.61%). Conclusion: This study highlights gaps in knowledge and vaccination coverage among medical students, which are critical for their health and future clinical practice. Enhancing awareness and vaccination rates can empower students to advocate for preventative measures in their professional environments. Despite high awareness of HBV, knowledge gaps and cultural barriers persist, affecting attitudes and vaccination uptake among medical students. Educational interventions addressing misconceptions, cultural resistance, and vaccine safety are critical. Increased advocacy for mandatory vaccination policies in healthcare settings is also essential to improve HBV prevention methods.
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 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 grants from the National Natural Science Foundation of China(82272396)Gusu Health Project of Suzhou(GSWS2022076 and GSWS2023004)。
文摘Background:Hepatitis E virus(HEV)may induce acute self-limiting illnesses or persistent infections.Chronic hepatitis E frequently occurs in immunocompromised persons,including organ transplant recipients,HIV-positive patients,and those with hematological malignancies.It poses a risk of liver fibrosis and cirrhosis.Data sources:Relevant articles published till September 2024 were located using Pub Med searches.The further search terms utilized were:“immunocompromised”,“solid organ transplant”,“HIV”,“hematological malignancy”,and“hepatitis E virus”.A manual search of references from pivotal articles extended further publications.The search parameters encompass publications in English.Results:The epidemiology,clinical manifestations,diagnostic measures,and therapeutic modalities of chronic hepatitis E were discussed.Immunocompromised individuals who are infected with HEV are at an increased risk of developing chronic infections,which may progress to liver fibrosis and cirrhosis.Current understanding of HEV is still limited,and there is no medicine that specifically targets hepatitis E.Consequently,the prevention and management of hepatitis E continue to present a significant challenge.Conclusions:Chronic hepatitis E patients need special attention in clinical practice.The relevant risk factors must be identified to facilitate accurate diagnosis and the implementation of more effective preventive measures,thereby enhancing the monitoring,treatment,and prevention of immunocompromised individuals.
