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HBV Journal Review
HBV Journal Review
January 1, 2015, Vol 12, no 11
by Christine M. Kukka
Having Hepatitis B and a Family Member with Cancer Raises Cancer Risk Dramatically
Having a hepatitis B virus (HBV) infection and an immediate family member–especially a mother–with liver cancer significant increases one's cancer risk, according to a report published in a Chinese hepatology journal.
Researchers found liver cancer rates to be 59% higher in HBV-infected individuals with a family history of liver cancer, compared to uninfected individuals with no family history of cancer.
Chinese researchers followed 708 HBV-infected patients and 730 uninfected individuals in Qidong City to see how much a hepatitis B infection and/or having a family member with liver cancer increased participants' cancer risk.
Researchers regularly assessed participants' liver health and screened them for cancer twice a year over the 20-year study.
The incidence of liver cancer in those with HBV infection and liver cancer in their immediate family was 1,244 per 100,000 person years. In contrast, the incidence was 509 per 100,000 person years in individuals (infected and uninfected) without a family history of liver cancer.
Liver cancer rates remained high, but did not vary significantly if an individual had a sibling versus a father with cancer. However, having a mother with liver cancer further increased cancer risk in HBV-infected individuals.
Among participants with a family history of liver cancer, 56.52% were diagnosed with cancer before age 50.
At the end of the 20-year study, cancer rates were:
32.21% for those with hepatitis B and a family history of cancer
19.80% for those with hepatitis B but no family history of cancer
1.71% for those with a family cancer history but no hepatitis B infection
And 0.65% for those with neither a hepatitis B infection nor a family history of liver cancer.
Source: PMID:25496865
www.ncbi.nlm.nih.gov/pubmed/25496865
VA Tests Only 21.8% of Its Patients for Hepatitis B, Missing Many at Risk of Infection
Among 5.6 million U.S. veterans treated at Veterans Administration clinics during 2013, only 21.8% had been screened for hepatitis B during the prior 14 years, according to a report by VA researchers published in the December 2014 issue of the Annals of Internal Medicine.
National medical guidelines recommend HBV screening in anyone who has hepatitis C, HIV or a sexually-transmitted infection, signs of liver damage, is an injecting drug user, or is taking immune-suppressing medication that can weaken the immune system.
However, VA health providers screened only:
53.5% of injecting drug users
51.4% of veterans with sexually transmitted infections
70.7% of those with elevated alanine aminotransferase (ALT) levels, which indicate liver damage
83.5% of those with hepatitis C virus infection
And 89.7% of those with HIV infection.
People of Asian descent are also at high risk of hepatitis B, yet the VA screened only 26.6% of Asian-American patients for hepatitis B.
Researchers discovered that very few of the veterans were infected with HBV–0.84% overall tested positive for the hepatitis B surface antigen (HBsAg). However, that rate was three-times higher than what federal health officials predict to be the national average from its NHANES (National Health and Nutrition Examination Survey) data and the infection rate was twice what the U.S. Centers for Disease Control and Prevention predicts to be the national infection rate.
Among those screened by VA clinics, HBV infection was found in:
4.93% of Asian-American patients
1.53% of African-American patients
1.38% of injecting drug users
1.71% of patients with sexually transmitted infections
1.29% of patients with elevated ALT levels
And in 5.14% of HIV-infected veterans.
As expected, HBV infection was greatest in high-risk patients, underscoring the importance of screening veterans considered to be at risk of infection.
The VA's substandard screening rates, especially in veterans at high risk of infection, shows that teaching VA health officials about the importance of screening is needed.
"Complete screening in high-risk groups could identify substantial numbers of HBV-infected persons and patients eligible for vaccination who are at continued high risk of HBV infection," researchers wrote. "Such screening efforts are needed to accurately characterize and address the burden of HBV infection."
Source: http://annals.org/article.aspx?articleid=2023029
Research Shows Importance of HBV Screening Before Chemotherapy Begins
New research shows the critical need to screen cancer patients for hepatitis B before they receive immune-suppressing chemotherapy drugs.
Without preventive antiviral treatment to keep HBV replication in check, these patients risk life-threatening hepatitis B reactivation when treated with chemotherapy if they do not test positive for the hepatitis B surface antibody.
Researchers, writing in the journal Hepatogastroenterology, found that HBV reactivation occurred in 3.3% of patients in one study who were treated for lymphoma (blood cancers). Two of these patients died from liver failure following the chemotherapy-induced HBV flare. (1)
Even brain cancer drugs causes hepatitis B reactivation: A fifth case of hepatitis B reactivation was reported in a brain cancer patient treated with radiation and the chemotherapy drug called temozolomide.
Temozolomide, when combined with radiation, slows the growth of cancer cells. In this report from Rome, a man who appeared to have a resolved HBV infection was treated with chemotherapy, radiation and steroids for glioblastoma multiforme, a common and deadly brain tumor.
Doctors did not administer antivirals to counter any resurgence in HBV infection when they treated the brain cancer. In this case, within five months the patient began having symptoms of acute hepatitis B as the virus rebounded. The patient's immune system, weakened by temozolomide, could no longer keep the viral infection in check.
Doctors immediately started the 52-year-old male on the highly effective antiviral entecavir (Baraclude).
As soon as his viral load had dropped to nearly undetectable, doctor restarted the radiation and chemotherapy to treat his brain cancer.
"Up to now, only four other cases of HBV relapse during temozolomide therapy have been reported in literature," researchers wrote in the December 2014 edition of the European Review for Medical and Pharmacological Sciences. "These cases underline the need of HBV screening and antiviral prophylaxis before starting temozolomide (treatment) administration."(2)
All chemotherapy patients should be screened for HBV: An unrelated article in the November issue of Hepatology also concluded that all patients receiving chemotherapy, immunotherapy, hematopoietic stem cell transplantation, or solid organ transplantation should be screened for hepatitis B and that preventive antiviral treatment be used when infection is discovered.
This screening is important given that an estimated 70% of people with hepatitis B are unaware of their infections.
"There is good evidence to support routine screening of all patients for hepatitis B prior to undergoing chemotherapy or immunosuppressive treatment," the researchers write. "Use of prompt antiviral treatment appears to diminish the risk of severe or fatal reactivation of hepatitis B." (3)
A recent report published in the Journal of the American Medical Association found also found entecavir to be highly effective in keeping HBV in check in patients treated for cancer.
The Chinese researchers who authored the report followed 121 HBV-positive patients treated with one of these chemotherapy drugs: rituximab, cyclophosphamide, doxorubicin, vincristine and/or prednisone. They reported that entecavir was more effective than lamivudine (Epivir-HBV) to prevent HBV reactivation while causing fewer side effects(4).
Source 1: www.ncbi.nlm.nih.gov/pubmed/25513151
Source 2: www.ncbi.nlm.nih.gov/pubmed/25535132
Source 3: www.doctorslounge.com/index.php/news/pb/51398
Source 4: www.ncbi.nlm.nih.gov/pubmed/25514302
Younger Age and Low HBsAgLevels Benefit Patients Who Stop Antivirals
Can patients who lose the hepatitis B "e" antigen (HBeAg) and develop the "e" antibody stop taking the daily antiviral pill that stops HBV from replicating and keeps viral loads low?
A new study, published in the December issue of the Journal of Gastroenterology and Hepatology, suggests that only younger patients whose HBsAg levels are under 2,000 international units per milliliter (IU/mL) may be able to stop their daily antiviral regimen.
No patient wants to take antivirals all his or her life, and researchers are working hard to identify when a patient can stop antivirals without risking a relapse of HBV infection.
In this study, Taiwanese researchers followed 157 patients who stopped taking antivirals 12 months or more after they seroconverted (lost HBeAg and developed "e" antibodies.) These patients, treated with lamivudine (78), entecavir (68) and telbivudine (Tyzeka) (11), were then followed for five years after they stopped antiviral treatment.
After five years, 57.1% had relapsed and tested positive for HBeAg again.
Researchers found that patients who were younger than age 40 and had HBsAg levels below 2,000 IU/mL when they stopped taking antivirals had lower relapse rates.
In this study, there appeared to be no advantage gained by taking antivirals longer than 12 months to "consolidate" the seroconversion. Additionally, all three antivirals performed equally well, with no advantage gained by taking one antiviral over another.
Source: www.ncbi.nlm.nih.gov/pubmed/25532588
Doctors Debate Benefits of Interferon vs. Antiviral Treatment
Two teams of doctors summarized their preferences in treating HBeAg-positive and HBeAg-negative patients in the January 2015 issue of the journal Liver International.
How do I treat my HBeAg-negative patients? A team from Italy tackled how best to treat this difficult-to-cure phase of hepatitis B and halt viral replication and liver damage.
Two different treatment strategies are currently available: a short-term course of pegylated interferon or long-term antiviral treatment using either entecavir or tenofovir (Viread).
Young patients with mild-to-moderate stages of liver disease can benefit from a 48-week course of interferon, while antivirals may be preferred in older patients, those with severe liver damage or those who haven't responded to interferon or who do not want to endure its flu-like side effects, they wrote.
While antivirals are effective in halting viral replication and further liver damage, it remains unclear whether antivirals prevent liver cancer, they noted.
Also, patients may have to take antivirals for the rest of their lives, can risk development of drug resistance and must pay the high cost of these medications.
"On the other hand, interferon treatment may achieve a sustained viral response in nearly a quarter of patients, ultimately leading to HBsAg loss in almost 30-50%," they wrote.
"Interestingly, response rates to interferon may further increase with more careful patient selection based on age, ALT and HBV DNA levels at baseline and by applying early on-treatment stopping rules based on HBV DNA and HBsAg kinetics," they concluded. (1)
How do I treat HBeAg-positive patients? A team of Greek researchers compared interferon and antiviral treatment for these patients with high viral loads.
Interferon has a limited duration of treatment (about 48 weeks) with a chance of permanent results, they noted.
However, these benefits are limited to approximately 30% of HBeAg-positive patients, and are accompanied by weekly injections and side effects, they wrote.
Candidates who will benefit from interferon must be carefully selected and monitored. New research shows that if patients haven't responded after 12 weeks of interferon treatment, it should be stopped in these non-responders.
The antivirals entecavir and tenofovir will quickly tamp down viral load with a low risk of drug resistance, researchers pointed out, but these too have their drawbacks. Patients may need to take them for many years, and there may be safety concerns in young patients who want to have children.
"Since there will always be safety concerns and family planning issues with long-term therapy, (antivirals) should be used carefully particularly in young HBeAg-positive patients with minimal-mild liver disease," they added. (2)
Source 1: www.ncbi.nlm.nih.gov/pubmed/25529095
Source 2: www.ncbi.nlm.nih.gov/pubmed/25529094
New Study Finds Fibroscan Accuracy on Par with Liver Biopsies
Historically, an invasive liver biopsy has been the only accurate tool to measure liver damage in hepatitis B patients. But biopsies, which withdraw a sliver of liver tissue through a needle, aren't perfect. They are invasive and they may miss a more diseased area of the liver and produce a faulty diagnosis.
Recently, doctors have pinned their hopes on a new instrument (Fibroscan), a type of ultrasound that measures how quickly vibration waves pass through a liver. The more damaged or "stiff" a liver is, the quicker the vibration waves pass through the organ. The test is painless, takes only a few minutes and produces an immediate diagnosis.
Now, a recent report published in the December issue of the journal of Clinical Gastroenterology and Hepatology, confirms that Fibroscan is as reliable as a liver biopsy.
The U.S. study compared the accuracy of the Fibroscan results in more than 700 hepatitis B and C patients who also underwent a liver biopsy at several medical centers across the country.
"...We confirmed that (Fibroscan) provides an accurate assessment of liver fibrosis in patients with chronic viral hepatitis," they reported. Their findings showed similar levels of accuracy to similar studies performed in Europe and Asia.
Source: www.ncbi.nlm.nih.gov/pubmed/25528010
Mild Kidney Problems and Bone Loss Linked to Antivirals
A study of 60 patients who switched from a combination of lamivudine plus adefovir to only tenofovir found the antivirals produced moderate bone-mineral loss and kidney problems.
Italian researchers monitored patients who switched to tenofovir every three months to see what impact the antivirals had on their kidney function. An impaired kidney (renal) function contributes to bone loss, or vitamin D deficiency.
According to their report published in the December issue of the Journal of Antimicrobial Chemotherapy, kidney function faltered up to six months after switching to tenofovir, and a total of 92.6% of patients had vitamin D deficiency, which resulted from kidney problems.
There had been reduced bone mineral density in 52.7% of patients at baseline (probably resulting from the lamivudine-adefovir treatment), which increased to 77.8% after six months of tenofovir treatment. The patients were given vitamin D supplements to offset that impact.
"In conclusion, patients exposed to lamivudine plus adefovir showed relevant osteorenal (bone loss and kidney) damage," the researchers wrote. The switch to tenofovir slightly worsened their condition, but it stabilized after six months, they found. "The reduced bone mineral density at baseline did not worsen under tenofovir treatment," they concluded.
Source: www.ncbi.nlm.nih.gov/pubmed/25525197
Hepatitis B Vaccine Effectiveness Challenged
How effective is hepatitis B immunization? A study of 100 people who received all three of the required vaccine doses at a Laguna Beach, Calif., clinic found the percentage of people who generated an adequate number of protective hepatitis B antibodies was far below what the vaccine's manufacturer promised.
The study, published in the January 2015 issue of the Biological Research for Nursing, followed 100, predominantly white men, average age 39, who received all three doses.
The participants were tested for hepatitis B surface antibodies, to see how many were adequately protected against hepatitis B as a result of the vaccination.
Only 78.6% of the participants, who were healthy and had no immune-suppressing infection such as HIV, generated an adequate level of surface antibodies.
"The manufacturer-published rates of seroconversion are 90-100%, depending upon the population," the researchers wrote. "These findings highlight a need for further study to validate or reveal deficits in current vaccine protocols for individuals who are vaccinated against hepatitis B, including health care workers, the immune-compromised and other high-risk populations."
Source: www.ncbi.nlm.nih.gov/pubmed/25504950
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发表于 2015-1-5 11:24
