Viral level is an indicator of long-term outcome of hepatiti…He

682256

Author: [email protected]
Date: 2011-07-04 05:36 +800
To: hbv_research
Subject: Hepatitis B surface antigen monitoring and management of chronic hepatitis B

J Viral Hepat. 2011 Jul;18(7):449-57. doi: 10.1111/j.1365-2893.2011.01465.x. Epub 2011 May 23.Hepatitis B surface antigen monitoring and management of chronic hepatitis B.Sonneveld MJ, Zoutendijk R, Janssen HL.SourceDepartment of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.AbstractSummary.  Serum hepatitis B surface antigen (HBsAg) levels reflect intrahepatic hepatitis B virus (HBV) covalently closed circular DNA and may be a valuable addition to HBV DNA in the management of patients with chronic hepatitis B (CHB). Among HBeAg-negative CHB patients with low HBV DNA levels, HBsAg quantification may help distinguish those with active CHB from true inactive carriers with a very favourable prognosis, thus limiting the need for long-term intensive monitoring of ALT and HBV DNA levels. In patients treated with peginterferon (PEG-IFN), achievement of a decline in HBsAg during therapy appears to be an important marker for treatment outcome, and several groups have proposed stopping rules based on HBsAg thresholds. A recently described stopping rule incorporating a combination of HBsAg and HBV DNA levels can accurately identify HBeAg-negative patients, especially those with HBV genotype D, not responding to PEG-IFN. Current applications of HBsAg levels in the monitoring of patients treated with nucleo(s)tide analogues are still being evaluated. First data from these studies show that HBsAg decline, and thus subsequent clearance, is confined to those with an active immune response to HBV, such as HBeAg-positive patients with elevated ALT, or those who achieve HBeAg clearance.© 2011 Blackwell Publishing Ltd.PMID: 21692954 [PubMed - in process]


Author: [email protected]
Date: 2011-07-04 05:59 +800
To: hbv_research
Subject: Viral level is an indicator of long-term outcome of hepatitis B virus e antigen-negative carriers with persistently normal serum alanine aminotransferase levels

J Viral Hepat. 2011 Jul;18(7):e191-9. doi: 10.1111/j.1365-2893.2010.01427.x. Epub 2011 Jan 11.



Viral level is an indicator of long-term outcome of hepatitis B virus e antigen-negative carriers with persistently normal serum alanine aminotransferase levels.



Nakazawa T, Shibuya A, Takeuchi A, Shibata Y, Hidaka H, Okuwaki Y, Takada J, Tanaka Y, Watanabe M, Minamino T, Sakurai K, Koizumi W.




Source

Department of Gastroenterology, Kitasato University East Hospital, Sagamihara Nakazawa Medical Clinic, Sagamihara Department of Clinical Laboratory, Kitasato University East Hospital, Sagamihara, Japan.




Abstract

Summary.  The association between viral level and the long-term outcomes of hepatitis B virus (HBV) carriers who test negative for hepatitis B virus e antigen (HBeAg) but have persistently normal serum alanine aminotransferase levels (PNALT) remains unclear. We examined hepatocarcinogenesis, hepatitis reactivation, predictive factors and the time course of HBV DNA levels during follow-up in 104 HBeAg-negative Japanese carriers with PNALT. During a mean follow-up period of 6.4 ± 3.4 years, 5 patients (4.8%) had hepatocarcinogenesis and 14 (13.5%) had hepatitis reactivation. At 5 and 10 years, the cumulative rates of hepatocarcinogenesis were 2.4% and 9.9%, while those of hepatitis activation were 13.7% and 15.5%, respectively. An HBV DNA level of ≥5 log(10)  copies/mL was the sole predictor of hepatocarcinogenesis with a univariate analysis. An HBV DNA level of ≥5 log(10)  copies/mL and an alanine aminotransferase (ALT) level of >20 to ≤40 IU/L were independent predictors of hepatitis reactivation in a Cox model. Because there was no association between hepatocarcinogenesis and ALT activity, the HBV DNA level was considered an essential predictor. In addition, the baseline HBV DNA level was related to the future level and was not subject to wide fluctuations. Our results showed that an HBV DNA level of ≥5 log(10)  copies/mL predicts subsequent hepatocarcinogenesis and hepatitis reactivation in HBeAg-negative carriers with PNALT. As the baseline HBV DNA level reflects the future level, appropriate clinical management according to the viral level is expected to decrease future risk.



© 2011 Blackwell Publishing Ltd.




PMID: 21692932 [PubMed - in process]

Subject: Hepatitis B surface antigen Quantification: Why and How to use it in 2011 - A Core Group Report

J Hepatol. 2011 Jun 27. [Epub ahead of print]



Hepatitis B surface antigen Quantification: Why and How to use it in 2011 - A Core Group Report.



Chan HL, Thompson A, Martinot-Peignoux M, Piratvisuth T, Cornberg M, Brunetto MR, Tillmann HL, Kao JH, Jia JD, Wedemeyer H, Locarnini S, Janssen HL, Marcellin P; for the Good Practice in using sAg in Chronic Hepatitis B Study Group (GPs-CHB Study Group).




Source

Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong.




Abstract



Quantitative HBsAg had been suggested to be helpful in management of HBV, but assays were cumbersome. The recent availability of commercial quantitative assays has restarted the interest in quantitative serum hepatitis B surface antigen (HBsAg) as a biomarker for prognosis and treatment response in chronic hepatitis B. HBsAg level reflects the transcriptional activity of cccDNA rather than the absolute amount of cccDNA copies. Serum HBsAg level tend to be higher in hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients. Among patients with a low HBV DNA (<2000 IU/ml), HBsAg <1000 IU/ml in genotype D HBV infection and HBsAg <100 IU/ml in genotype B/C HBV infection is associated with inactive carrier state in HBeAg-negative patients. The HBsAg reduction by nucleos(t)ide analogues (NA) is not as pronounced as by interferon treatment. On peginterferon treatment, sustained responders tend to show greater HBsAg decline than the non-responders. The optimal on-treatment HBsAg cutoff to predict response needs further evaluation in HBeAg-positive patients, but an absence of HBsAg decline together with a <2 log reduction in HBV DNA at week 12 can serve as stopping rule in HBeAg-negative patients with genotype D HBV infection. A rapid serum HBsAg decline during NA therapy may identify patients who will clear HBsAg in the long-term. There are early reports among Asian patients that an HBsAg level of <100 IU/ml might predict lower risk of relapse after stopping NA treatment. In clinical practice, serum HBsAg level should be used together with, but not as a substitute for, HBV DNA.



Copyright © 2011. Published by Elsevier B.V.


PMID: 21718667 [PubMed - as supplied by publisher]





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HBsAg level reflects the transcriptional activity of cccDNA rather than the absolute amount of cccDNA copies
HBsAg定量反映cccDNA 转录的活跃程度而非cccDNA的绝对数量



but an absence of HBsAg decline together with a <2 log reduction in HBV DNA at week 12 can serve as stopping rule in HBeAg-negative patients with genotype D HBV infection. A rapid serum HBsAg decline during NA therapy may identify patients who will clear HBsAg in the long-term. There are early reports among Asian patients that an HBsAg level of <100 IU/ml might predict lower risk of relapse after stopping NA treatment.
在12周HBsAg 不下降并且HBV减少小于2log 可以作为 HBeAg-，D基因型的HBV病人的停药标准。在核苷类药物治疗中，HBsAg水平的快速下降或许预示着病人可在长远的未来清除HBsAg. 早些时候有报告表明，对于应用核苷类治疗的亚洲病人，HBV水平小于100IU/ml的停药复发风险更小。


“In clinical practice, serum HBsAg level should be used together with, but not as a substitute for, HBV DNA”在临床实践中，HBsAg 定量应该和HBVDNA定量一起使用（但HBsAg不能代替HBVDNA）。