HBV杂志回顾 2013年9月1日， 由M. Kukka

StephenW

HBV Journal Review
September 1, 2013, Vol 10, no 9
by Christine M. Kukka


39.2% of U.S. Newborns Aren't Getting Hepatitis B Vaccine at Birth
Which newborns aren't getting immunized against hepatitis B in the U.S.? The infants who:

    Do not have health insurance
    Live in states without a universal hepatitis B vaccine supply policy
    And have only one provider who administered vaccines.

According to a U.S. Centers for Disease Control and Prevention study, published in the August issue of the journal Preventive Medicine, an alarming 39.2% of newborns missed the first, critical birth dose of hepatitis B vaccination that can protect newborns from hepatitis B even if their mothers are infected.

These results come from data analysis of the 2009 National Immunization Survey of 17,053 U.S. children, aged 19-35 months.

"Children who reside in states without a universal hepatitis B vaccine supply policy, and are not covered by health insurance are two important modifiable risk factors for not receiving the birth dose hepatitis B vaccination, future intervention studies could be needed to help control those modifiable risk factors," CDC researchers wrote.

Source: www.ncbi.nlm.nih.gov/pubmed/23988497

Researchers Suggest Banning or Restricting Lamivudine to Avoid Drug Resistance
A global team of researchers suggest lamivudine (Epivir-HBV) never be used to treat hepatitis B patients because it frequently leads to drug resistance and sets the stage for resistance to other antivirals, such as entecavir (Baraclude).

Lamivudine, the first antiviral approved for hepatitis B treatment, has fallen out of favor in North America and Europe because of its high rate of drug resistance. But because of its low cost, it continues to be commonly used to treat hepatitis B virus (HBV) infection in Asia and Africa, where the majority of the world's hepatitis B patients live.

This report, published in the July 30 issue of PLoS One, examined the molecular make-up of the virus in many patients who had been treated with lamivudine as well as patients who had never been treated. They found the many untreated patients carry a mutation that allows HBV to quickly mutate and develop resistance to lamivudine.

"Our findings strongly suggest that the use of lamivudine will not benefit ...patients," they wrote because of the high risk of lamivudine resistance.

"Finally, since patients can quickly develop drug resistance to entecavir in the presence of lamivudine mutations, the lamivudine mutations can significantly compromise the efficacy of entecavir," they concluded.

They proposed that doctor screen patients for these mutations before ever prescribing lamivudine,"... to most effectively treat chronic hepatitis B patients by selecting only sensitive drugs."

An unrelated article published in the Annals of Medical and Health Sciences Research, also criticized the over-use of lamivudine in hepatitis B patients in Sub-Saharan Africa. Lamivudine was originally developed to treat HIV, but today African providers use it frequently to treat anyone with hepatitis B (when HIV is not present) because it is inexpensive and more effective hepatitis B antivirals, such as tenofovir (Viread) or entecavir, are more costly or unavailable.

But over-prescription of lamivudine for hepatitis B in this region has:

    Increased drug resistance in African hepatitis B patients
    Reduced availability of the antiviral to both HIV and HBV patients
    And driven up the drug’s cost, which reduces its availability for more appropriate HIV treatment.

Critics say a bioethical dilemma has evolved, where doctors prescribe lamivudine to hepatitis B patients without explaining alternative treatment because they assume the patients don’t understand or are too poor to pay for more effective antivirals.

“Implied consent is no justification to embark on a particular treatment course,” researchers from Njala University in Sierra Leone wrote. “To tackle the growing problems of drug resistance and shortages with respect to lamivudine and other antivirals in HIV/AIDS treatment, health care resources should be prescribed with caution, irrespective of whether implied or explicit informed consent has been sought.”

    Association of Preexisting Drug-Resistance Mutations and Treatment Failure in Hepatitis B Patients
    Source: ww.ncbi.nlm.nih.gov/pmc/articles/PMC3728369/
    Lurking Dangers Behind Overuse of Lamivudine to Treat Non-HIV Hepatitis B Patients in Africa
    Source: ww.ncbi.nlm.nih.gov/pmc/articles/PMC3728885/

Knowledge Gap About Hepatitis B Persists Among Asian-Americans
Despite a nationwide campaign to screen, immunize and treat Asian-Americans who are at high risk of hepatitis B, a recent study of 58 HBV-infected Asian-American patients found that most of them did not know how they were infected or whether their family members were also infected months after they were diagnosed.

The survey was conducted by University of California San Francisco researchers. They questioned 58 HBV-infected patients treated at a university liver clinic. The group studied were not hindered by poverty. While 89% were born outside the United States, most had health insurance, their average age was 46, most were married and 55% were male.

Yet they showed little knowledge about hepatitis B, and although they had been diagnosed with hepatitis B and told about the infection, the patients knew little about whether their extended family members (totaling 803) were infected. Among their immediate family members, patients did not know the hepatitis B status of 28% of them.

"This knowledge gap existed despite extensive counseling regarding family testing at every clinic visit," researchers wrote. "In addition, patients, including those with a known family history of liver cancer who have a higher risk of developing (cancer), did not know the serostatus (infection status) of over a quarter (91 of 325) of first-degree relatives or spouses.

"Furthermore, our study suggests that language barriers may play an important role, even with the availability of interpreters, as non-English speakers were less likely to know their family members’ serostatus than English speakers," they noted in their report published in the August issue of the Journal of Immigrant and Minority Health. "It is possible that the language barrier is also a proxy for acculturation; that is, the less English a patient speaks, the less likely that patient may feel comfortable with the specific cultural practices expected in our health care system."

Clearly the health care system must conduct more research to develop a better strategy to reach, educate and screen Asian-Americans for hepatitis B, they noted.

"Focusing efforts on screening family members of individuals with HBV infection will likely increase case finding exponentially and furthermore, improve the efficiency of public health endeavors," they wrote. "The means to achieve this goal, however, remain to be determined."

In an unrelated article published in the journal Gastroenterology & Hepatology, researchers reported a poor response when they tried to screen people at a cultural fair in Miami for hepatitis B and C. Despite the presence of translators and education material, only 2-3% of attendees were screened. "Other strategies will be required to enhance participation in screening programs for viral hepatitis," they wrote.

In a third article on screening Asian-Americans, published in the August issue of the Journal of Viral Hepatitis, researchers followed Los Angeles people who were diagnosed with hepatitis B at community screenings conducted between 2007 and 2010.

About 5.2% of Asian-Americans screened had chronic hepatitis B, nearly all were foreign-born and only 27% could read/write English. Six months after diagnosis, 43% of those interviewed had not received any follow-up care, primarily due to lack of insurance.

    "Survey of Asian patients with hepatitis B infection: Limited Knowledge of transmission and screening of family members."
    Source: www.ncbi.nlm.nih.gov/pubmed/23913129
    "Screening for hepatitis B virus and hepatitis C virus at a community fair: a single-center experience."
    Source: www.ncbi.nlm.nih.gov/pubmed/23943664
    "Demographic and serological characteristics of Asian-Americans with hepatitis B infection diagnosed at community screenings."
    Source: www.medscape.com/viewarticle/807628

Even Liver Specialists Fail to Immunize Patients Against Viral Hepatitis
Hepatologists—physicians who specialize in treating liver disease—fail to recommend hepatitis A and B immunizations to patients with chronic hepatitis C and other liver ailments, according to a study by University of Pittsburgh School of Medicine researchers. The study, published in the July issue of PLoS One, found that even in an academic clinic specializing in liver disease, hepatologists recommended immunization for hepatitis A in only 63% of eligible patients and for hepatitis B in 59.7% of eligible patients.

Appropriate immunization recommendations, which matched current medical practice recommendations, varied from 30% to 98.6% among the liver specialist.

The poor adherence to medical guidelines when recommending immunization did not vary based on patients’ ethnicity, age, gender etc. It instead varied by individual provider, which shows the glaring need for additional training for even physicians whose expertise is liver disease.
Source www.ncbi.nlm.nih.gov/pubmed/23923056

Many Seek Viral Hepatitis Tests Only When Symptoms Appear
About half of patients infected with the hepatitis C virus (HCV) sought testing only after they experienced symptoms or had a lab test indicating liver damage, according to a report in the Aug. 16, 2013, issue of the CDC's Morbidity and Mortality Weekly Report.

Researchers collected data on what factors spurred 4,689 adults with confirmed chronic HCV or HBV infections to be tested.

According to their findings, 60.4% of those who responded said their initial HCV test occurred in a physician's office. Only 22.3% of HCV patients cited injection drug use and hemodialysis--two common risk factors for hepatitis C--as reasons for getting tested. About 45.2% said lab tests, including abnormal liver function tests or liver-related symptoms, prompted them to be tested.

An estimated half of all people infected with hepatitis C in the United States are unaware of their infection status, as are tens of thousands of people with hepatitis B. In 2012, CDC recommended one-time testing for all persons born between 1945 and 1965, as they are at higher risk for infection.

Source: www.cdc.gov/mmwr/preview/mmwrhtml/mm6232a3.htm

After Six Years of Tenofovir Treatment, Still No Signs of Drug Resistance
Tenofovir, one of the leading antiviral drugs for hepatitis B treatment, produced no drug resistance in 585 patients treated for six years.

The report, published in the August issue of Hepatology, followed 347 hepatitis B "e" antigen-negative (HBeAg-negative) patients and 238 HBeAg-positive patients who had been treated with the daily antiviral pill for six years.

They examined the molecular make-up of the virus in 52 patients who still had detectable HBV DNA after lengthy tenofovir treatment to see if any of them had developed drug mutations that enabled the HBV to "resist" tenofovir's ability to block viral replication.

The researchers found that the lingering viral load resulted from failure in some patients to take the antiviral as prescribed. Other patients had HBV with natural mutations (that were not induced by tenofovir treatment) that contributed to the low viral loads.
These two groups of patients either switched to an antiviral combination of tenofovir and emtricitabine or they began taking tenofovir as prescribed. To date, all patients have all achieved undetectable viral load.

Source: www.ncbi.nlm.nih.gov/pubmed/23939953

More Studies Examine Link Between Vitamin D and Liver Damage
Researchers are exploring the link between liver damage and low levels of vitamin D, a vitamin that is critical for the body to absorb calcium and maintain strong bones. This area is of special concern because antivirals may cause some bone loss.

In one study published in the August issue of the journal of Antiviral Therapy, a global team of researchers examined vitamin D levels and liver fibrosis (inflammation) in 158 people coinfected with HIV and HBV who were screened before and after treatment with tenofovir.

They found that vitamin D deficiency in the patients increased from 72.2% before treatment started to 84.2% after five years of tenofovir treatment. Vitamin D deficiency was highest among women. This occurred in a region where there is plenty of sunshine, which helps the body absorb vitamin D. However, researchers found no link between low vitamin D levels and significant liver fibrosis in these treated patients.

"Since HIV-HBV co-infection requires long term use of ... (tenofovir) that can also contribute to bone loss, routine vitamin D assessment and supplementation as necessary should be considered," researchers concluded.

An unrelated study, published in a Chinese journal of hepatology, examined the relationship between vitamin D levels and cirrhosis (severe scarring of the liver.) They compared vitamin D levels in 282 people with cirrhosis and compared it to levels in a healthy control group. They found that the risk of cirrhosis significantly increased as vitamin D levels declined. "Vitamin D might function as a protective factor against development of cirrhosis," they suggested.

    "Decline in serum 25-OH vitamin D levels in HIV/hepatitis B virus (HBV) co-infected patients after long term antiretroviral therapy."
    Source:www.ncbi.nlm.nih.gov/pubmed/23970149
    "Prospective study on the relation between serum vitamin D levels and liver cirrhosis risk."
    Source: www.ncbi.nlm.nih.gov/pubmed/23967742

Study Examines Which Hepatitis B Patients Relapse with Chemotherapy
Researchers know that chemotherapy drugs used to treat cancer and arthritis weaken the immune system and often cause a reactivation of hepatitis B virus infection, even in people who have undetectable viral load and hepatitis B surface antibodies. In a recent Japanese study, researchers tried to determine which patients with resolved HBV infections were at risk of viral reactivation.

They followed patients with blood cancers who were treated with rituximab chemotherapy. This drug contains manufactured antibodies that attach to defects in cancer cells in order to contain or slow cancer cell reproduction.
They focused on 59 patients who had been infected with HBV (they were positive for the hepatitis B core antibody) but who currently had undetectable viral load and no hepatitis B surface antigen.

Four of the 59 patients (6.8%) had minor HBV reactivation over the 20-plus months of rituximab treatment and follow-up. All of them, researchers noted, had lower levels of protective “peripheral lymphocyte counts” before chemotherapy began, which may predispose them in some way to viral reactivation due to their weakened health.

The four did not experience severe hepatitis B reactivation, and were able to continue their chemotherapy without liver damage.

The study, published in the August issue of the Journal of Medical Virology, underscores the importance of screening all patients for current or resolved hepatitis B infection (including HBV DNA) before starting chemotherapy, and to continually monitor even patients with undetectable viral load during treatment and follow-up.

Source www.ncbi.nlm.nih.gov/pubmed/23926082

Interferon Treatment May Cause Some Hearing Loss
Interferon causes a wide array of side effects, ranging from depression to fatigue and body aches, but Iranian researchers have identified a new malady to add to the list of side effects—hearing loss.

The Iranian researchers followed 24 hepatitis B and C patients treated with interferon and 30 healthy individuals who made up the control group. Their hearing was evaluated through questionnaires and hearing tests one week before treatment began and one month into treatment.

Patients reported minor ringing in their ears, but hearing tests found “progressive decreases in amplitude” in the 1, 2 and 4 frequencies in 41.66%, 18.75% and 32.75% respectfully.

Hearing loss was more common among older males. Researchers, writing in the July issue of the journal Biomedical Research International, suggest doctors monitor hearing during interferon treatment.

Source: www.ncbi.nlm.nih.gov/pubmed/23984336

African-Americans Suffer the Highest Rates of New HBV Infections in the U.S.
According to a study by University of Pennsylvania researchers, African-Americans make up the largest percentage of people who are newly infected with hepatitis B today.

In 2010, African-Americans had the highest rate of acute or new HBV infection with 1.7 cases per 100,000 people. In contrast, Asian-Americans had an acute infection rate of 0.6 per 100,000. Asian-Americans may have higher rates of chronic infection due to infection at birth, but most new infections occurring in the United States are in the African-American community.

In America, being black means you have a 3.9-fold chance of being infected with hepatitis B, compared to whites. According to the study, published in the August issue of the journal of Clinical Gastroenterology and Hepatology, African-Americans tend to be infected with HBV genotype A (84%), which is associated with a 4- to 5-fold increase in liver cancer compared to other genotypes.

To make matters worse, the few hepatitis B studies that have been performed in African-Americans and immigrants from Africa found that liver cancer occurs at a younger age in these populations than in other ethnic groups.

In contrast, among Asian-Americans genotypes B and C are most prevalent. Those genotypes appear not to be less virulent than HBV genotype A.

Additionally, African-Americans may have genetic risk factors that predispose them to developing chronic hepatitis B following exposure to the virus that other ethnic groups do not face. Yet, few doctors screen African-American patients for hepatitis B.

A long-term follow-up study of patients treated with interferon found that African American patients were, "... much more likely to respond to therapy," researchers wrote. "Of note, all African American responders not only cleared the hepatitis B "e" antigen and (achieved undetectable) HBV DNA ... but all cleared HBsAg, a relatively rare milestone with HBV therapy that (usually) occurs in (only) 7.8% of patients on therapy."

Unfortunately, this was a small study and no additional research into African-American's remarkable ability to reportedly clear hepatitis B infection after interferon treatment has been repeated to verify these results.

Few clinical trials have examined the effectiveness of antivirals in this population.

As with Asian-Americans, few African-Americans who qualify for treatment ever receive it. A small study that included patients from an urban medical center found that only 7% of a predominantly African-American and Hispanic population received treatment.

The study cited lack of health insurance, failure to take medication as prescribed and ongoing drug and alcohol use as possible reasons for poor access to treatment. Not surprising, access to liver transplants was also far lower among African-Americans than whites.

Source: www.ncbi.nlm.nih.gov/pubmed/23811241

StephenW

39.2 ％的美国新生儿出生时没有得到B型肝炎疫苗
哪些新生儿没有得到免疫对乙肝在美国？婴儿谁：

    没有健康保险
    住在国家没有一个普遍的乙肝疫苗供应政策
    并只有一个供应商，谁管理的疫苗。

据一家美国疾病控制和预防研究，预防医学“杂志刊登在八月号的中心，一个令人震惊的39.2 ％的新生儿即使错过第一，关键的出生接种乙肝疫苗的剂量，可以保护新生儿B型肝炎，他们母亲被感染。

这些结果来自美国17,053名儿童，年龄19-35个月的2009年全国免疫调查数据分析。

“谁住在国家没有一个普遍的乙肝疫苗供应政策，而不是医疗保险覆盖的儿童是两个重要的可改变的危险因素，不接受出生剂量乙肝疫苗接种，未来的干预研究需要，以帮助控制那些可改变的危险因素， “疾病预防控制中心的研究人员写道。

资料来源： www.ncbi.nlm.nih.gov/pubmed/23988497

研究人员认为，禁止或限制拉米夫定，以避免耐药性
一个全球性的团队的研究人员建议拉米夫定（拉米HBV ）永远不会被用于治疗B型肝炎患者，因为它往往会导致耐药性的耐其他抗病毒药物如恩替卡韦（博路定） ，并设置了舞台。

第一个批准用于乙肝治疗的抗病毒药物，拉米夫定，已经失宠，在北美和欧洲，由于其较高的耐药率。但是，由于其成本低，它仍然是常用于治疗乙型肝炎病毒（ HBV）感染，在亚洲和非洲，其中的大多数世界上乙型肝炎患者的生活。

该报告发表在7月30日出版的PLoS一，审议分子病毒与拉米夫定，以及谁从来没有处理的患者经治疗后已在许多患者。他们发现许多未经治疗的患者进行乙肝病毒快速变异和发展对拉米夫定的耐药突变，允许。

“我们的研究结果强烈表明，使用拉米夫定将不利于患者，”他们写道，因为拉米夫定耐药性的高风险。

最后，因为病人可以迅速发展耐药恩替卡韦，拉米夫定突变的存在，拉米夫定的突变可显着危及恩替卡韦的疗效，他们的结论。 “

他们提出了这些突变的患者，医生屏幕之前，处方拉米夫定， “只选择敏感的药物，最有效的治疗慢性乙型肝炎患者。 ”

一个不相关的文章，发表在医学和健康科学研究史册，也批评过在撒哈拉以南非洲地区的乙肝患者使用拉米夫定。拉米夫定最初开发用于治疗艾滋病，但今天非洲的供应商经常使用它来治疗B型肝炎的人（当HIV是不存在的） ，因为它价格低廉，更有效的乙肝抗病毒药物，如替诺福韦（ Viread的）或恩替卡韦，更昂贵的或不可用。

但在拉米夫定治疗乙肝的处方在本地区有：

    在非洲的乙肝患者耐药性增加
    HIV和乙肝患者的抗病毒药物供应减少
    并带动了药物的成本，从而降低了其可用性，更适当的艾滋病毒治疗。

批评者说，生命伦理困境的演变，那里的医生处方没有解释替代治疗，因为他们认为患者不理解或过于贫穷，更有效的抗病毒药物拉米夫定的乙肝患者。

“默示同意是没有道理的，走上一个特定的疗程， ”从塞拉利昂Njala大学的研究人员写道。 “为了解决越来越多的问题与艾滋病毒/艾滋病的治疗拉米夫定等抗病毒药物的耐药性和短缺，医疗资源应谨慎规定，不论是否已寻求明示或暗示的知情同意。 ”

    协会的存在乙型肝炎患者的耐药性突变和治疗失败
    来源： ww.ncbi.nlm.nih.gov/pmc/articles/PMC3728369 /
    背后潜伏的危险过度使用拉米夫定治疗非HIV乙型肝炎患者在非洲
    来源： ww.ncbi.nlm.nih.gov/pmc/articles/PMC3728885 /

在亚裔美国人中关于乙肝的知识差距仍然存在
尽管在全国范围内开展的屏幕，免疫和治疗亚裔美国人谁是高风险的B型肝炎，最近的一项研究， 58 HBV感染患者中发现亚裔美国人，他们大多不知道他们是如何感染或他们的家人是否成员也感染个月后，他们被诊断。

这项调查是由美国加州大学旧金山的研究人员。他们质疑58 HBV感染的患者在一所大学肝脏诊所。该小组研究并未阻碍贫困。虽然89％是在美国以外出生的，最有医疗保险，他们的平均年龄为46岁，大多数是已婚， 55 ％为男性。

然而，他们发现乙肝知之甚少，虽然他们已经确诊为乙肝感染讲述，患者知之甚少大家庭成员（共803 ）是否感染。在他们的直系家庭成员，患者不知道其中的28 ％， B型肝炎状态。

“这方面的知识存在差距尽管进行了广泛的咨询，有关家庭在每一个诊所访问测试， ”研究人员写道。 “此外，患者，包括那些与已知家族史的肝癌发展（癌症）有较高的风险，不知道感染状况血清状况（ ）较一季度（ 91 325 ）一级亲属或配偶。

“此外，我们的研究表明，语言障碍可能发挥了重要作用，即使有可用的口译，非英语不太可能知道他们的家庭成员'的serostatus ，比讲英语，他们指出： ”在他们的报告发表在8月发行的移民和少数族裔健康杂志。 “这是可能的语言障碍亦是涵化的代理，也就是，病人少英语说话，不太可能，患者会感到舒适，预计在我们的卫生保健系统的特定的文化习俗。”

显然，卫生保健系统必须进行更多的研究，开发出更好的策略，以达到教育和屏幕亚裔美国人B型肝炎，他们指出。

“集中甄别家庭成员个人的努力与HBV感染可能会增加的情况下，找到成倍此外，公共卫生努力提高工作效率， ”他们写道。的装置来实现这一目标，但是，仍有待确定。

在一个不相关的文章发表在杂志胃肠病学和肝病研究人员报告，反应不佳，当他们试图筛选尽管译员和教育材料的存在，只有2-3％的人文化博览会在迈阿密乙肝和丙肝与会者进行了筛选。 “将需要其他策略，以提高参与病毒性肝炎的筛查方案， ”他们写道。

研究人员随后在第三个亚裔美国人，刊登在八月号的杂志病毒性肝炎筛选文章，洛杉矶人被诊断患有B型肝炎在社区放映2007年和2010年之间进行。

约5.2 ％的亚裔美国人筛选慢性乙型肝炎，几乎所有外国出生的，只有27％能读/写英语。 6个月后诊断，43％的受访者没有收到任何后续护理，主要是由于缺乏保险。

    “亚洲乙肝感染患者：有限的知识的传播和家庭成员筛选调查。 ”
    资料来源： www.ncbi.nlm.nih.gov/pubmed/23913129
    “筛选乙型肝炎病毒和丙型肝炎病毒在社区公平：一个单中心的经验。 ”
    资料来源： www.ncbi.nlm.nih.gov/pubmed/23943664
    “人口和血清学诊断乙肝感染的亚裔美国人的特点，在社区放映。 ”
    资料来源： www.medscape.com/viewarticle/807628

甚至肝专家无法进行免疫抗病毒肝炎患者
肝病专门治疗肝病不推荐A和B的免疫肝炎与慢性丙型肝炎和其他肝脏疾病的患者，根据一项研究由美国匹兹堡大学医学院的研究人员，医生谁。这项研究发表在7月发行的PLoS一，发现，即使是在一个专业肝病学术诊所，肝病专家建议在59.7 ％的符合条件的患者为A型肝炎在只有63％的符合条件的患者和乙肝免疫接种。

适当的免疫接种建议，符合当前的医疗实践中的建议，范围从30％到98.6％之间的肝病专家。

医疗指南的依从性差，建议免疫时没有根据患者的种族，年龄，性别等，而不是个别供应商，这说明需要额外的培训，甚至医生，其专长是肝病刺目的变化而有所不同。
Source www.ncbi.nlm.nih.gov/pubmed/23923056的

许多寻求病毒性肝炎测试，只有当症状出现
大约有一半的患者感染丙型肝炎病毒（HCV）要求测试后，才出现症状或实验室测试表明肝功能损害，根据CDC的发病率和死亡率周报8月16日， 2013年，发行了一份报告， 。

研究人员收集的数据是什么因素刺激了4,689名成年人确诊为慢性丙型肝炎或乙肝病毒感染进行测试。

根据他们的调查结果，60.4 ％的回应者说，他们最初的HCV测试发生在医生的办公室。只有22.3 ％的丙型肝炎患者引注射吸毒和血液透析 - 两个C型肝炎的常见危险因素 - “入门测试的原因。约45.2 ％的人表示，实验室检查，包括肝功能异常或肝脏相关症状，促使他们进行测试。

所有的人感染丙型肝炎在美国估计有一半是不知道自己的感染状态，数万成千上万的人与B型肝炎在2012年， CDC建议一次性测试，在1945年和1965年之间出生的所有的人，因为他们有较高的感染风险。

来源： www.cdc.gov/mmwr/preview/mmwrhtml/mm6232a3.htm的

泰诺福韦治疗六年后，仍然没有任何迹象耐药性
替诺福韦，一个领先的乙肝治疗的抗病毒药物，没有产生耐药性，在治疗的585例患者六年。

该报告发表在8月号的杂志，随后347乙肝的“e”抗原阴性（ HBeAg阴性）患者和238例HBeAg阳性患者经治疗后已六年的日常抗病毒药丸。

他们检查了52例患者，仍然有漫长的替诺福韦治疗后检测到HBV DNA ，如果他们任何人开发的药物基因突变，使乙肝“抵制”替诺福韦阻止病毒复制的能力的病毒的分子化妆。

研究人员发现，从失败中挥之不去的病毒负荷导致一些患者采取抗病毒所规定。其他患者的HBV自然突变（即没有诱导替诺福韦治疗） ，低病毒载量。
这两组患者切换到抗病毒药物替诺福韦和恩曲他滨的组合或他们开始服用泰诺福韦规定。至目前为止，所有的患者都实现了病毒载量检测不到。

资料来源： www.ncbi.nlm.nih.gov/pubmed/23939953

更多的研究维生素D与肝损害之间的联系
研究人员正在探索肝损害之间的联系和低水平维生素D ，维生素对身体对钙的吸收和保持强壮的骨骼是至关重要的。特别关注，因为这一地区是抗病毒药物可能会导致一些骨质流失。

一个全球性的团队的研究人员在一项研究发表在八月号的杂志的抗病毒治疗，检查维生素D水平与肝纤维化（炎症） ， 158人同时感染HIV和HBV谁替诺福韦治疗前后进行了筛选。

他们发现，维生素D缺乏症的患者替诺福韦治疗五年后开始治疗前84.2％增加至72.2％ 。维生素D缺乏是最高的妇女。这发生在一个地区，那里有充足的阳光，这有助于身体吸收维生素D，但研究人员发现，维生素D水平低和显着的抗肝纤维化治疗的患者在这些之间没有联系。

“由于HIV - HBV合并感染需要长期使用（替诺福韦） ，也有助于骨质流失，常规的维生素D的评估和补充，必要时，应考虑，研究人员得出结论。 ”

一个不相关的研究，在一个中国的肝脏病学杂志“上发表，研究维生素D水平和肝硬化（严重的肝脏上的疤痕。 ） ，他们比较了282人，肝硬化患者的维生素D水平相比，它在健康对照组的水平之间的关系。他们发现，肝硬化的风险显着增加维生素D水平下降。 “维生素D可能充当防护因子对肝硬化的发展，”他们提出了建议。

    “衰落血清中25  - 羟基维生素D的水平后，在艾滋病毒/ B型肝炎病毒（HBV）合并感染患者长期接受抗逆转录病毒治疗。”
    资料来源： www.ncbi.nlm.nih.gov/pubmed/23970149
    “前瞻性研究血清维生素D水平和肝硬化风险之间的关系。 ”
    资料来源： www.ncbi.nlm.nih.gov/pubmed/23967742

研究探讨乙型肝炎患者复发化疗
研究人员知道，化疗药物，用于治疗癌症和关节炎削弱免疫系统，并经常导致重新激活B型肝炎病毒感染，甚至检测不到病毒载量和乙肝表面抗体的人谁也。在日本最近的一项研究中，研究人员试图确定哪些解决HBV感染患者病毒复发的风险。

他们跟着利妥昔单抗化疗治疗血癌患者。这种药物含有制造抗体附着在癌细胞的缺陷，以遏制或减缓肿瘤细胞的繁殖。
他们集中在59例患者已感染HBV （乙肝核心抗体呈阳性） ，但目前检测不到病毒载量并没有乙肝表面抗原。

四， 59例（6.8 ％ ）有轻微的乙肝病毒再激活超过20个多月的利妥昔单抗治疗和随访。所有这些，研究人员指出，保护外周血淋巴细胞计数“水平较低，在化疗开始之前，这可能会使他们在某种程度上病毒复发，由于其减弱的健康。

四没有遇到严重的B型肝炎恢复，能够继续化疗无肝功能损害。

这项研究发表在医学病毒学杂志八月号，下划线开始化疗前筛选所有患者目前或解决乙肝感染（ HBV-DNA ）的重要性，并持续监控，即使患者在治疗过程中的病毒载量检测不到和跟进。

来源www.ncbi.nlm.nih.gov/pubmed/23926082

干扰素治疗可能会导致一些听力损失
干扰素引起各种各样的副作用，从抑郁，疲劳和身体疼痛，但伊朗研究人员已经发现了一种新的弊病，要添加到列表中的副作用听力损失。

伊朗研究人员随后24乙型和丙型肝炎患者干扰素和谁组成的对照组的30名健康个体。通过问卷调查和听力测试评估他们的听力治疗开始前一周及一个月分为治疗。

患者报告自己的耳朵轻微耳鸣，但听力检查发现“逐步减少幅度41.66％ ， 18.75 ％和32.75％ ，恭敬地在1，2和4个频率。

听力损失更常见的老年男性。研究者们在7月的期刊生物医学研究国际问题，建议医生监测干扰素治疗过程中听到。

资料来源： www.ncbi.nlm.nih.gov/pubmed/23984336

非裔美国人遭受新的乙肝病毒感染在美国的发病率最高
根据大学宾夕法尼亚州的研究人员的一项研究，非裔美国人谁是新感染乙肝的人所占比例最大。

在2010年，非裔美国人有急性或新的HBV感染率最高的每10万人1.7例。相比之下，亚裔美国人有急性感染率达0.6 ％ 100,000 。亚裔美国人可能在出生时有较高的感染引起的慢性感染，但大多数新感染发生在美国的非裔美国人社区。

在美国，被黑意味着你有一个3.9倍，与白人相比，被感染乙肝的机会。根据这项研究，刊登在八月号的临床胃肠病学和肝病学杂志，非裔美国人往往被感染HBV基因型A（ 84％），这与4 - 5倍的增长在肝癌比其他基因型。

更糟的是，非裔美国人和来自非洲的移民已执行的为数不多的B型肝炎研究发现，肝癌的发生在这些人群中，比其他族群有年轻化。

相反，在亚裔美国人基因型B和C是最普遍的。这些基因型出现应不小于剧毒比HBV基因型A.

此外，非裔美国人可能会使他们发展为慢性乙型肝炎暴露后，其他族群不面对病毒的遗传危险因素。然而，很少有医生屏幕非洲裔美国人的B型肝炎患者

非洲裔美国患者的长期随访研究发现，干扰素治疗的患者， “......更有可能回应疗法，”研究人员写道。 “值得注意的是，所有非洲裔应答，不仅清除了乙肝的”e“抗原（检测不到） HBV DNA ......但全部清除，乙肝表面抗原，乙肝病毒治疗的一种比较罕见的里程碑（通常情况下）发生（只）7.8 ％的患者治疗。 “

不幸的是，这是一个小的研究并没有额外的研究非裔美国人的非凡的能力，据报道，清除感染乙肝干扰素治疗后，已多次来验证这些结果。

在这一人群中，很少有临床试验研究抗病毒药物的有效性。

与亚裔美国人，很少有非裔美国人人有资格治疗没有收到它。从一个城市的医疗中心，其中包括患者的一项小规模研究发现，只有7％的主要是非洲裔和拉美裔人口接受治疗。

列举的研究缺乏医疗保险，规定和持续使用毒品和酒精为获得治疗不佳的可能原因未能按时服药。并不奇怪，肝移植也远低于在非裔美国人比白人。

资料来源： www.ncbi.nlm.nih.gov/pubmed/23811241

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