HBV Jpurnal Review February 2012 by Christine M Kukka

StephenW

http://www.hbvadvocate.org/news/HBJ9.2.htm
Extracts from HBV Journal Review February 2012 by Christine M  Kukka

HBV Cases Climb 17 million Worldwide Between 1990 and 2005

Despite the availability of the hepatitis B vaccine, the number of people with chronic hepatitis B (who tested positive for hepatitis B surface antigen—HBsAg) increased from 223 million in 1990 to 240 million in 2005, according to a World Health Organization report in the January issue of Vaccine.

WHO officials, who analyzed available data and reports published between 1990 and 2005, found HBV infections decreased in some regions of Africa, Central America, Southeast Asia and Central Europe, but increased in East Asia for a total net increase of 17 million people.

The highest prevalence was in sub-Saharan Africa and the lowest prevalence (below 2%) was in Central America, North America and Western Europe. Some Asian regions showed some declines, especially among children as a result of immunization initiatives, but rates increased 8.6% in East Asia.

The increasing number of HBV infections and widespread differences in HBV prevalence rates call for targeted approaches to tackle hepatitis B, researchers noted. “HBV infection prevalence data are needed at country and subnational levels to estimate disease burden and guide health and vaccine policy,” they wrote.

Statins May Lower Risk of Liver Cancer in Hepatitis B Patients

Statins (HMG-CoA reductase inhibitors) used to lower cholesterol may confer protection against liver cancer, according to a study published in the January issue of the Journal of Clinical Oncology.

Statins lower “bad” cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays an important role in the liver’s production of cholesterol. Taiwanese researchers investigated liver cancer rates among 33,413 HBV patients.

Over 328,946 person-years, researchers identified 1,021 liver cancers in HBV-infected patients--representing 310.4 liver cancers per 100,000 person-years. They found that hepatitis B patients who took statins had lower cancer rates, and the longer patients took statins the lower their liver cancer rates were.

HBIG—Used to Prevent Reinfection after Liver Transplants—May Soon Be Phased Out

Antivirals, which disrupt viral replication, may soon replace costly hepatitis B immune globulin (HBIG—hepatitis B antibodies) to prevent hepatitis B reinfection after liver transplants, according to a new report published in the Journal of Hepatology.

For nearly 30 years, HBIG has been the key tool to prevent HBV recurrence after liver transplantation. Increasingly, it is now used along with antivirals to prevent reinfection, and that treatment combination is successful in 90% of transplant recipients.

However, HBIG is extremely expensive and researchers have been experimenting successfully with using lower doses of HBIG or stopping use of HBIG entirely as long as antivirals are used.

The recent successful practice of lowering a transplant patient’s HBV DNA (viral load) before surgery has also contributed to the high efficacy of these reduced HBIG regimens. “Additionally, the success of antiviral rescue therapy for those patients who fail (HBIG) and develop recurrent HBV infection (after) transplant has provided the impetus to move increasingly towards HBIG-free approaches,” researchers wrote.

New techniques to detect low levels or occult HBV (which replicates despite an absence of HBsAg) may allow clinicians to use only antivirals—without HBIG—in some patients.

Patient Age, Along with Viral Load and ALT Levels, May Affect Treatment Choices

Increasingly, doctors are treating patients with high viral loads because research shows high HBV DNA levels increase the risk of liver damage and cancer. However, many young adults often have high viral loads, so should these young patients be treated, which could commit them to decades of antiviral treatment?

A team of Chinese researchers, writing in the European Journal of Gastroenterology and Hepatolpogy, tackled the relationship between age and when-to-treat in a recent study. They segregated 1,572 hepatitis B patients by age: younger than 20; between ages 20 and 40; and over 40.

    As expected, 86% of those younger than 20 were in the “immune tolerant” stage and had high viral loads.
    About 36% in the 20-40 age group were experiencing immune clearance, with antibodies and immune cells fighting the infection and producing elevated alanine aminotransferase (ALT) levels, indicating intermittent liver damage as the immune system attacked the infected liver cells.
    Patients in the plus-40 group had more reactivation cases, with spikes in HBV DNA and ALT levels.

More than half of the younger cases undergoing immune clearance achieved spontaneous HBeAg seroconversion within four years without treatment, and the younger the patient, the shorter the time to seroconversion.

So who should be treated? Should treatment be postponed for younger patients despite elevated ALTs and viral load?

“Generally, there were significantly different HBV clinical virological characteristics in patients with chronic HBV infection of different ages,” researchers wrote. “Different features were observed in relapse (older) patients and patients with immune clearance at different ages, and these two types of patients needed antiretroviral therapy. Our study suggests that revisions of the timing and elevated ALT standards for chronic hepatitis B antiretroviral therapy in Chinese relapse patients and patients with immune clearance in different age groups are warranted.”

Study Suggests 20%-30% of Teens Immunized at Birth May Require Booster Shots

For how long does a hepatitis B vaccine administered at birth continue to protect against infection? To find out, CDC officials administered hepatitis B booster shot (containing just HBsAg) to hundreds of youth 10 to 15 years after they were immunized at birth to see if their immune systems remembered the virus and quickly developed antibodies to guard against infection.

A robust response would show the immune systems retained a “memory” of the virus and could still effectively fight off infection. A weak response would underscore the need for booster shots to reboot the immune system’s “memory” to fight HBV.

Among 108 participants in the study who had steep declines in protective antibodies since their birth vaccine, more than 70% had an effective response to the booster dose and generated a large volume of protective antibodies.

However, 20% to 30% were unable to mount a robust immune response even after receiving the booster.

“Hepatitis B revaccination might be required for persons vaccinated starting at birth if opportunities for hepatitis B virus exposure exist,” researchers wrote in the January issue of Vaccine. They recommend more studies to determine if booster shots should be recommended for teens.

Antiviral Treatment Plus Freezing Tumors Increases Liver Cancer Survival

A dual approach using antiviral treatment and cryoablation (freezing and destroying tumors) greatly improved liver cancer survival rates among hepatitis B patients, according to a Japanese report published in the Journal of Vascular and Interventional Radiology.

Cryoablation is a U.S. Food and Drug Administration-approved, safe and painless technique for killing tumor using ultra-cold. The procedure is conducted under CT scan and involves placing a thin needle through the skin into a selected tumor.  A freezing gas is injected into the tumor, creating a lethal ice ball. The ball is readily visible under the CT scan so it can be used to kill only tumor tissue.

Japanese researchers studied 81 patients (most male, average age 60) who received cryoablation treatment for liver cancer. They found that the patients who received both antiviral and cryoablation treatment had significantly higher survival rates. The 1-, 3-, and 5-year survival rates in patients also treated with antivirals plus cryoablation were 89.5%, 66.8%, and 40.5%, compared to survival rates of 72.6%, 27.5%, and 14.3% in the patients who experienced only cryoablation.

Researchers Find HBV, Nearly Identical to Human HBV, in Chickens

Researchers have found HBV, nearly identical to the type that infects humans, in chicken livers, according to a report in the Virology Journal.

Researchers in China examined 129 blood samples from broiler chickens for HBV antigens and antibodies, and 193 chicken liver samples were tested for HBV DNA and tested for HBV antigens.

The overall prevalence of HBsAg, surface antibodies, and core antibodies (showing past infection), was 28.68%, 53.49%, 17.05%, respectively. However, the hepatitis B “e” antigen and antibody were barely detectable, but three samples were positive for both surface and “e” antigens.

The HBV DNA identified in two of the chicken livers shared 92.2% of one known HBV strain and 97.9% nucleotide sequence of another HBV strain. “Our results showed the existence of HBV in chickens,” researchers wrote. “This would present a significant risk to people who work with live chickens or chicken products if HBV found in chicken could be confirmed to be the same as human HBV.”

Interferon Treatment Should Stop after 12 Weeks If There Is No Sign of Success

Dutch researchers confirmed through two studies that if HBeAg-negative patients do not respond to pegylated interferon after 12 weeks of treatment, they are unlikely to respond positively over several months more of treatment.

They identified patients who failed to experience declines in HBsAg or more than a 100-fold drop in HBV DNA decline after 12 weeks of treatment, but who continued to receive treatment for up to 48 to 96 total weeks. The patients had a variety of HBV strains or genotypes.

They found that none of the patients who failed to respond after 12 weeks of treatment fared any better after 48 or 96 weeks of interferon, according to the report published in the Journal of Hepatology.




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StephenW

从的HBV杂志回顾二月2012年提取物恭中号Kukka

乙肝案件在1990年和2005年登上全球17万

尽管乙肝疫苗的可用性，慢性乙型肝炎（检测乙肝表面抗原，乙肝表面抗原阳性）的人的数量从1990年的223万上升到240万美元，2005年，根据世界卫生组织的报告一月号的疫苗。

世界卫生组织的官员，分析现有的数据，1990年和2005年间发表的报告，发现乙肝病毒感染，在非洲，中美洲，东南亚和中欧一些地区有所下降，但在东亚增加总净增加17万人。

患病率最高的是撒哈拉以南非洲和中美洲，北美和西欧的发生率最低（低于2％）。亚洲一些地区表现出了一定下降，尤其是儿童免疫措施，但东亚率增加8.6％。

研究人员指出，乙肝患病率在乙肝病毒感染和广泛的差异日益呼吁进行有针对性的办法来解决B型肝炎。 “乙肝病毒感染率的数据需要在国家和地方各级估计疾病负担和引导健康和疫苗政策，”他们写道。

他汀类药物可降低B型肝炎患者肝癌的风险

用于降低胆固醇的他汀类药物（HMG-CoA还原酶抑制剂）可能对肝癌赋予的保护，根据在一月号的“临床肿瘤学杂志发表的一项研究。

他汀类药物降低“坏”胆固醇水平，抑制酶HMG-CoA还原酶，它起着重要的作用，在肝脏的胆固醇生产。台湾研究人员调查了33,413乙肝患者肝脏的癌症发病率的。

超过328946人年，研究人员发现了1021 HBV感染患者的肝癌症 - 占310.4％100,000肝癌的人 - 年。他们发现了他汀类药物的乙肝患者有降低癌症发病率，较长的患者服用他汀类药物降低肝脏的癌症发病率。

乙肝免疫球蛋白，用来防止再感染的肝脏移植手术后，可能很快就会被淘汰

抗病毒药物，扰乱病毒的复制，可能很快取代昂贵的肝炎B免疫球蛋白（乙肝免疫球蛋白，B型肝炎抗体），以防止术后乙肝再感染肝移植，肝脏病杂志发表的一份新的报告。

近30年来，乙肝免疫球蛋白，以防止肝移植术后乙肝复发的关键工具。越来越多，现在一起使用，以防止再感染与抗病毒药物，治疗相结合是成功的，在移植的90％。

然而，乙肝免疫球蛋白是极其昂贵的，研究人员一直在尝试使用低剂量HBIG，或停止使用HBIG，完全只要抗病毒药物用于成功。

手术前降低移植病人的乙型肝炎病毒DNA（病毒载量）近期的成功实践，也有助于这些减少乙肝免疫球蛋白疗法的疗效高。 “此外，（后）的抗病毒药物抢救治疗成功谁失败球蛋白（HBIG）和发展的经常性的乙肝病毒感染的患者移植提供了动力走向免费乙肝免疫球蛋白，办法越来越多，”研究人员写道。

新的技术来检测水平低或隐匿性HBV（乙肝表面抗原的情况下，尽管复制）可能会允许临床医生只使用抗病毒药物，没有乙肝免疫球蛋白的一些病人。

病人的年龄，随着病毒载量和ALT水平，可能会影响治疗的选择

越来越多的医生治疗高病毒载量的患者，因为研究表明，高HBV DNA水平的肝功能损害和癌症的风险增加。然而，许多年轻人往往有病毒载量高，所以应该这些年轻的患者进行治疗，可以提交他们几十年的抗病毒药物治疗？

一个中国研究人员的团队，在欧洲胃肠病学和Hepatolpogy杂志写作，处理与年龄的关系时，在最近的一项研究治疗。他们分开1,572 B型肝炎患者：按年龄20岁以下，20至40岁之间;超过40。

    正如所料，那些20岁以下的86％是在“免疫耐受”的阶段，并有较高的病毒载量。
    约36％在20-40岁年龄组的免疫清除，抗体和免疫细胞对抗感染和生产谷丙转氨酶升高（ALT）水平，表明间歇性肝损伤的免疫系统攻击感染的肝细胞。
    在加40组患者有更多的激活情况下，HBV DNA和ALT水平的尖峰。

四年内取得超过一半的年轻的情况下进行免疫清除自发性HBeAg血清转换，无需治疗，和年轻的患者，血清转换时间越短。

那么，谁应该如何治疗？应治疗年轻患者，尽管高架低价竞标和病毒载量被推迟？

“一般来说，有显着不同的乙肝病毒与慢性HBV感染不同年龄的患者临床病毒学特征，研究人员写道。” “不同的特点，观察复发（旧）患者和免疫清除患者在不同的年龄，这两类患者需要抗逆转录病毒疗法。我们的研究表明，慢性乙型肝炎的抗逆转录病毒疗法在中国的复发患者和患者在不同年龄组的免疫清除的时机和ALT升高标准的修订是必要的。“

研究表明，20％-30％，出生时免疫青少年可能需要加强注射

为了防止感染B型肝炎疫苗，出生时的管理继续多久？为了找到答案，疾病预防控制中心的官员管理的乙肝加强针（只含有乙肝表面抗原）数以百计的青年10至15年后，他们在出生时接种了疫​​苗，看看他们的免疫系统就想起防止感染病毒和抗体迅速发展。

一个强有力的反应，表明免疫系统保留“记忆”的病毒，仍然可以有效地抵御感染。弱的反应，强调有必要加强注射，以重新启动打乙肝免疫系统的“记忆”。

在108与会者​​中有保护性抗体急剧下降，因为他们出生的疫苗的研究中，70％以上，有一个助推器剂量的有效反应，并产生大量的保护性抗体。

然而，20％至30％，甚至无法装入一个强大的免疫反应后收到的助推器。

“B型肝炎的复种可能被接种在出生时，如果存在B型肝炎病毒接触的机会的人，需要研究人员写道，”在一月号的疫苗。他们建议更多的研究，以确定是否加强注射，应为青少年推荐。

抗病毒药物治疗加冷冻肿瘤，提高肝癌存活率

双管齐下的办法，其中乙肝患者使用抗病毒药物治疗和冷冻（冻结和摧毁肿瘤），大大提高肝癌生存率，根据日本在血管和介入放射学杂志“发表的报告。

冷冻治疗是美国食品和药物管理局批准，安全，无痛的技术使用超冷杀伤肿瘤。的程序进行了CT扫描下涉及放置细针经皮肤进入选定的肿瘤。冻结气体注入肿瘤，创造了一个致命的冰球。因此它可以用来只杀死肿瘤组织，球很容易根据CT扫描可见。

日本研究人员研究了81例患者（大多数男性，平均年龄60）接受冷冻治疗肝癌。他们发现，接受抗病毒药物和冷冻治疗的患者有显着较高的存活率。 1  -  3  - ，也与抗病毒药物，加上冷冻治疗的患者5年生存率分别为89.5％，66.8％和40.5％，比72.6％，27.5％和14.3％，患者的生存率经历只冷冻。

研究人员发现乙肝病毒，人乙肝病毒几乎相同，鸡

研究人员已经发现了乙肝病毒，几乎相同的类型，感染人类，在鸡肝，根据病毒学杂志报告。

在中国的研究人员检查了129肉鸡血液样本对乙肝病毒抗原和抗体，193鸡肝样品进行检测，HBV DNA和HBV抗原检测。

乙肝表面抗原，表面抗体和核心抗体（过去感染）的整体患病率是28.68％，53.49％，17.05％，分别。然而，乙肝“e”的抗原和抗体几乎检测不到，但有3个样本表面和“e”抗原阳性。

乙型肝炎病毒DNA鉴定鸡肝共享一个著名的乙肝病毒株的92.2％和97.9％，另一HBV株的核苷酸序列。 “我们的研究结果显示，乙肝病毒的鸡的存在，”研究人员写道。 “这将提出一个人活鸡或鸡肉产品的工作，如果乙肝病毒在鸡发现可以证实是人类HBV的重大风险”。

干扰素治疗12周后应该停止，如果没有成功的标志

荷兰研究人员通过两项研究，HBeAg阴性患者如果不响应聚乙二醇干扰素治疗12周后，他们不大可能积极回应了几个月的治疗证实。

他们发现病人谁没有遇到HBsAg的下降或以上，比在12周的治疗后的HBV DNA下降100倍下降，但谁继续接受治疗长达48至96周总。患者有乙型肝炎病毒株或基因型的品种。

他们发现，没有表现后，48或96周干扰素的患者12周的治疗后没有回应任何好转，根据肝病学杂志发表的报告。