HEPWATCH.com 5月刊

zasxz

Hepatocellular Carcinoma (HCC) in Taiwanese Children Prospective study of Taiwanese children with chronic HBV infection. A strong association between HBV infection and HCC has been shown by epidemiologic studies. HCC usually occurs after decades of HBV infection, but the incidence of childhood HCC is high in Taiwan, a region hyperendemic for HBV. The nearly 100% seropositive rate of HBsAg in Taiwanese children with HCC indicates the important role of HBV infection in childhood HCC. Wan-Hun Wen and colleagues prospectively followed 426 children with chronic HBV infection in Taiwan recruited from the years 1974 to 1995 (6,250 person-years). The median age at study entry was 6.3 years (range, 3 days to 14.8 years), and the median duration of observation was 14.9 years (range, 5.1 to 27.2 years). Three patients progressed to cirrhosis and 2 of these patients developed HCC (incidence, 32 per 100,000 person-years). The 2 patients who developed HCC were among only 8 children who had seroconverted from HBeAg-positivity to anti-HBe before the age of 3 years. The authors speculated that the extremely young age of HBeAg seroconversion and preceding hepatocyte necrosis may explain the vulnerability of the liver to fibrosis and early malignant transformation. These data need to be confirmed as HBeAg seroconversion in adults is associated with reduced incidence of HCC. (Wen W-H, et al. J Pediatr 2004;144:397-399) Treatment with Alpha-Interferon (IFN) Long-term follow-up. The aim of treatment for chronic HBV is inactivation of liver disease as indicated by the disappearance of serum HBV DNA and HBeAg seroconversion. IFN has been reported to be associated with an HBeAg seroconversion rate as high as 33%. To further evaluate the long-term effects of IFN therapy, Monika van Zonneveld and others from the Erasmus Medical Center (Rotterdam, The Netherlands) performed a retrospective cohort study of all HBeAg-positive patients treated with IFN-based therapy in their liver unit between 1978 and 2002. The study population consisted of 165 patients (133 patients were treated in trials and 32 patients were treated electively). In addition, 62 of these patients (38%) had received nucleoside analogues in combination with IFN. The median duration of therapy was 16 weeks (range, 1 - 92 weeks) and the median follow-up time was 8.8 years (range, 0.3 - 24 years). A response (HBeAg seroconversion within 12 months after the end of IFN therapy) was achieved by 54 patients (33%). HBeAg reactivation occurred in 7 (13%) of the responders. HBsAg seroconversion developed in 52% of responders compared to 9% of nonresponders. Decreased necroinflammatory activity and decreased progression of fibrosis were observed in liver biopsy specimens of responders. HCC developed in 8 patients (6 of these patients were nonresponders). Multivariate analysis identified response to IFN-based therapy as an independent predictor of survival and reduced risk for HCC. These findings demonstrated that response to IFN-based therapy was associated with prolonged clinical remission and improved clinical and histopathological outcomes. (van Zonneveld M, et al. Hepatology 2004;39:804-810) Epidemiology Changes in a US community. The incidence of newly acquired HBV infection in the US has declined steadily since the mid-1980s. This trend is thought to be due to a number of public health interventions such as the screening of pregnant women, the vaccination of infants and adolescents, and the use of safe injection practices. In the current study, W. Ray Kim and coworkers at the Mayo Clinic analyzed the demographic and clinical characteristics of subjects with chronic HBV infection in Olmsted County, Minnesota. There were 191 county residents identified with chronic HBV infection from The Rochester Epidemiology Project records. The ethnic origins of these residents with HBV infection were 53% Asian, 29% African, 13% Caucasian, and 5% other. The overall age- and sex-adjusted prevalence of HBV infection in this community was 0.15%. The prevalence was highest among Asians (2.1%) and African-Americans (1.9%). The prevalence among Caucasians was 0.02%. A large majority of the 191 county residents with HBV infection had been born outside of the US (86%). Among 131 HBsAg-positive residents tested for HBV replicative status, 27% had viral replication as defined by the presence of HBeAg or HBV DNA. Among 184 residents tested for ALT levels, 28% had an abnormal value at least once. These findings demonstrated that most residents with chronic HBV infection in this Midwestern community were immigrants from other parts of the world endemic for HBV and underscore the importance of screening immigrants for HBV infection. (Kim WR, et al. Hepatology 2004;39:811-816) Treatment Guidelines Recommendation updates. Based on new developments in the diagnosis and treatment of chronic HBV infection, two treatment guidelines were recently published. The first guideline (Anna Lok and Brian McMahon) was developed under the auspices of the Practice Guideline Committee of the AASLD and published in the March 2004 issue of Hepatology. A complete version, including a review of recently published literature, can be found at the AASLD web site. The recommendations were based on literature review and the experience of the authors, and reviewed and approved by the AASLD Governing Board. The second guideline is a treatment algorithm for chronic HBV infection developed by a panel of US hepatologists and published in the February 2004 issue of Clinical Gastroenterology and Hepatology. The algorithm was based on available evidence and also clinical experience and expert opinion. The recommendations of the two guidelines are generally similar but there are differences in some areas (e.g., consideration of treatment of patients with serum HBV DNA levels <105 copies/mL, possible use of combination therapy). (Lok ASF and McMahon BJ. Hepatology 2004;39: 857-861 and Keeffe EB, et al. Clin Gastroenterol Hepatol 2004;2:87-106)