HBV Journal Review
June 1, 2015, Vol 12, no 6
by Christine M. Kukka  PDF (download)
HBV Liver Cancer Requires Aggressive Treatment from the Start
Today, doctors use a one-size-fits-all approach to treating liver cancer no matter if it results from hepatitis B or C. However, a new study finds that liver cancer caused by the hepatitis B virus (HBV) requires an aggressive treatment plan.
These findings, presented at the American Society of Clinical Oncology meeting in May, may lead doctors to develop a more accelerated treatment plan for HBV-related liver cancer.
Researchers reached this conclusion after monitoring disease progression and survival rates in 815 liver cancer patients infected with either HBV or the hepatitis C virus (HCV) treated at their University of Texas M. D. Anderson Cancer Center between 1992 and 2011.
HBV (a DNA virus) and HCV (an RNA virus) infect the liver differently. The researchers found HBV patients developed liver cancer at a younger age and had a more aggressive cancer.
When compared to hepatitis C patients, HBV patients:
- Had higher levels of alpha-fetoprotein (AFP), found through a blood test, which indicates the presence of tumors
- Had liver cancer tumors that grew and spread more quickly
- Had larger tumors
- And often had portal thrombosis–a blockage of the vessel that delivers blood to the liver from the intestines.
However, hepatitis C patients with liver cancer had higher rates of cirrhosis, histories of alcohol and cigarette use and more diabetes than hepatitis B patients.
The average survival rate for hepatitis B patients was 9.3 months after liver cancer diagnosis, compared to 10.9-month survival for hepatitis C patients.
According to a related editorial published in the medical journal Oncology, about 700,000 patients are diagnosed with liver cancer each year worldwide; more than two-thirds of new cases result from HBV infection.
Knowing HBV-related liver cancer is more aggressive can lead to different or accelerated treatment plans when patients are first diagnosed, the study's experts suggest.
“This study provides more evidence that future clinical trials should stratify patients by hepatitis type to help identify better drugs and create personalized treatment modalities,” researcher Ahmed Kaseb explained.
Source: http://newswise.com/articles/variations-in
-liver-cancer-attributable-to-hepatitis-virus-variations
Experts: Treat Cirrhotic Patients, Even if Viral Load Is Low
Should "healthy" patients who have cirrhosis with low viral load and no signs of liver damage be treated? Absolutely, according to experts writing in the May issue of the medical journal Hepatology.
Today, there are no clear medical guidelines dictating whether patients with "compensated cirrhosis" should be treated. These patients have liver scarring and fibrosis, but not severe enough to impede their liver function. They can have low viral load (HBV DNA) and normal alanine transaminase (ALT) levels, which indicate no liver damage.
Despite those healthy signs, Korean researchers contend these patients remain at high risk of liver cancer and do require treatment.
They followed 385 untreated patients with seemingly benign cirrhosis (average age 51, 66% male) for nearly six years and discovered 9.6% developed liver cancer despite their low viral loads. Researchers determined the five-year risk of liver cancer in these patients was:
- 2.2% in patients with undetectable viral load
- 8% in patients with low viral load and normal ALT levels
- And 14% in patients with low viral load but elevated ALT levels.
During the six-year study's follow-up period, 126 patients had increases in their viral load exceeding 2,000 IU/mL; 77 of these patients were treated with antivirals.
- The patients treated with antivirals had liver cancer rates of 1.4%
- Untreated patients who continued to have low viral load had cancer rates of 8.8%.
- And untreated patients with viral load spikes had liver cancer rates of 13.3%.
"Compensated cirrhosis patients with detectable but low viral load were not at low risk for liver cancer, and (antiviral treatment) was associated with lower liver cancer risk, suggesting that prompt (antiviral treatment) should be considered for these patients," researchers wrote.
Source: www.ncbi.nlm.nih.gov/pubmed/25963803
?dopt=Abstract
Some Patients Can Safely Stop Antiviral After Four Years
German researchers followed 21 middle-aged patients who stopped treatment with the antiviral tenofovir (Viread) after four years and found that most did well, with two patients even losing the hepatitis B surface antigen (HBsAg).
All study participants had HBeAg-negative hepatitis B (testing negative for the hepatitis B "e" antigen). All maintained undetectable viral loads and normal ALT levels, indicating no liver damage, during their four years on tenofovir.
After stopping tenofovir, only three of the 21 patients had to restart tenofovir due to rising viral loads and liver damage.
The overall study involved 42 patients, 21 of whom were taken off tenofovir and 21 who continued on tenofovir and served as the control group. Both groups were similar in age and most were male.
According to the report presented at the 50th European Association for the Study of the Liver (EASL) conference, all patients in the stop-tenofovir group developed detectable levels of HBV DNA, but nearly all maintained low HBV DNA levels under 2,000 IU/mL. These patients also had moderate increases in their ALT levels, except for the three patients who were restarted on tenofovir.
What was significant is the stop-tenofovir group had notable declines in their HBsAg levels after stopping treatment. Two of the patients lost HBsAg completely, indicating they developed an "inactive" infection that posed little risk of liver damage.
In contrast, none of the 21 control group patients who continued on tenofovir had any declines in their HBsAg levels.
While it remains unclear exactly when patients can be safely taken off antivirals, this study found that nearly all patients taken off tenofovir after four years of undetectable viral load and no liver damage remained healthy and did not need additional treatment.
Source: www.firstwordpharma.com/node/1279476
#axzz3bC1YUS2C
Tenofovir Safe and Effective in Pregnant Women with Drug Resistance
Tenofovir also proved very effective in lowering viral load and preventing infection of newborns in 48 pregnant women with HBV who had developed resistance to the antiviral drug lamivudine (Epivir-HBV) prior to their pregnancies.
According to the study presented at the EASL, the earlier in the pregnancy that tenofovir was started, the more effective it was in lowering viral load by the time delivery occurred. Infants are at high risk of becoming infected at birth if their mothers have high levels of HBV DNA in their blood and body fluids.
On average, tenofovir lowered the women's viral load five-fold. Researchers in China reported they began administering tenofovir between week 24 and 28 of the pregnancies. Other recent studies have shown that treating pregnant women even earlier in their pregnancies is safe and very effective in lowering viral load.
All newborns were immunized and received HBIG–hepatitis B antibodies–at birth to protect against infection. When tested 12 months after birth, none were found to be infected.
Source: www.firstwordpharma.com/node/1279605
#axzz3bC1YUS2C
Researchers Discover Why Children Become Chronically Infected
Researchers may finally have discovered why newborns and young children are prone to developing chronic hepatitis B infections, while adults usually clear the virus quickly after a brief (acute) infection.
British researchers report that HBV can sneak into the liver and infect cells during early childhood because special suppressor cells designed to protect young livers against inflammation basically shut down immune cells to keep them from attacking and inflaming the HBV-infected liver.
For years, researchers have tried to understand why a young immune system failed to attack an HBV infection of the liver. Because the immune system never responded, HBV was able to reproduce rapidly in the liver. This is called the "immune tolerant" stage of hepatitis B.
Researchers, writing in the May issue of Nature Medicine, suggests that suppressor cells in the liver switch off the immune cells that would normally attack the infection as a way to protect the young liver from inflammation and damage.
“If we could boost the immune system and counteract the liver’s suppressive effect, then the infection could potentially be cleared after a large ‘burst’ of immune activity," researchers suggested. "This might cause short-term damage to the liver, but would prevent the long-term damage from scarring and liver cancers that we see in chronic (hepatitis B) patients.”
In their study, researchers compared blood and liver tissue samples from hepatitis B patients and healthy participants. They found patients in the immune tolerant phase of infection had high levels of granulocytic myeloid-derived suppressor cells (gMDSCs) in their liver. These cells suppress the immune system's fighter T cells by cutting off their food supply.
The suppressor cells subdued both the T cells that would normally target HBV-infected liver cells as well as the T cells that cause inflammation as they eradicate the infected liver cells. Females in the study tended to have higher levels of gMDSCs.
Source: www.nature.com/nm/journal/vaop/ncurrent/full/
nm.3856.html
Expert Recommends Treatment for Mental Confusion from Cirrhosis
Some patients with cirrhosis develop confusion, poor memory, and sleep problems and have trouble driving because their damaged livers cannot screen toxins from their blood that impair brain function.
Hepatitis expert Dr. Robert Gish, writing in the online journal Scribd, recommends a thorough mental and physical exam to diagnosis this affliction, called hepatic encephalopathy.
Diet: Dr. Gish recommends a diet with adequate protein to avoid loss of muscle mass.
Zinc levels should also be measured because low zinc worsens encephalopathy symptoms. Patients with zinc deficiencies should take between 50 to 200 mg per day.
Treatments: Encephalopathy is treated with the antibiotic pill rifaximin (Xifaxan) at a dose of 550 mg daily. This antibiotic was originally developed for diarrhea. Flagyl (Metronidazole) is another antibiotic that helps patients with encephalopathy.
Probiotic supplements: Also recommended are probiotic supplements, which help repopulate the gut with natural bacteria to help it digest food and lower ammonia production. A recent study found probiotics alone (without antibiotics) was effective in preventing development of encephalopathy in 160 cirrhotic patients over a period of nine months.
Probiotics, in capsules, work by enhancing production of certain microorganisms that decrease ammonia production. The study found that twice as many untreated patients developed encephalopathy than did patients taking probiotic supplements.
Do not take Neo-Fradin, Neo-Rx (Neomycin): Another antibiotic, Neomycin, also changes the chemistry and bacteria in the intestine to lower ammonia levels, but it should never be used, Dr. Gish advises. "If this medication is prescribed for more than six months, hearing tests should be performed since there may be a risk of hearing loss. Hearing tests are critical if a patient is using Lasix (Furosemide) along with Neomycin," he writes.
Source: www.scribd.com/doc/265482027/
Hepatic-Encephalopathy
Antivirals Increase Survival After Liver Cancer Treatment
Starting hepatitis B patients who have had liver tumors removed on antivirals increases their survival, especially when patients are treated in the early stages of liver cancer, according to a report published in the Chinese Journal of Cancer.
Researchers followed 224 liver cancer patients who had liver tumors successfully removed using chemoembolization. This method injects chemotherapy directly into a tumor, which starves it by blocking its blood supply.
About half of the patients were treated with antivirals and the other half, the control group, were not. Overall, the group treated with antivirals survived for about 16 months after surgery, compared to a 9.6-month survival rate among untreated patients.
However, survival increased markedly in antiviral-treated patients who were in the early stages of liver cancer. Those who had tumors removed while in the early stages survived for another 62 months with the help of antivirals, compared to a 26.2-month survival rate for untreated, early-stage patients.
In patients with advanced stages of liver cancer, antivirals did not extend survival.
Source: http://7thspace.com/headlines/508704/
impact of oral antihepatitis b therapy on the survival
of patients with hepatocellular carcinoma initially treated
with chemoembolization.html
HBV Patients with Diabetes Have a Higher Risk of Liver Cancer
A new study from Taiwan finds hepatitis B patients who have diabetes or who develop diabetes during their infection are at higher risk of liver cancer.
According to the report, published in the May issue of the journal Alimentary Pharmacology & Therapeutics, researchers compared liver cancer rates in 2,099 hepatitis B patients who had new diabetes diagnoses against 2,080 hepatitis B patients without diabetes.
A higher proportion of patients with diabetes developed liver cancer (3.29%) compared with patients without diabetes (2.02%); researchers reported. Patients with recent diabetes diagnoses also had slightly higher rates of liver cancer.
Diabetic patients often had other health issues, including cirrhosis and obesity.
Because hepatitis B patients with diabetes are at higher risk of cancer, doctors should do everything they can to prevent diabetes development in these patients, and/or carefully monitor patients who develop diabetes while in their care, researchers concluded.
Source: www.healio.com/hepatology/oncology/news
/online /%7B6d308de1-614c-4423-b586-20f01a0e73e6%7D
/diabetes-increases-risk-for-hcc-in-adults-with-hbv
Long-term Antiviral Use Increases Hip Fracture Rates Slightly
To find out if long-term antiviral treatment is safe, Hong Kong researchers compared the health of 46,454 untreated hepatitis B patients against 4,046 patients who were treated with antivirals for five years to see if long-term treatment caused bone loss or kidney problems.
The comprehensive study, reported in the May issue of the journal Hepatology, looked for kidney disease and failure and hip, vertebral and other bone fractures in the participants.
Researchers noted a slight increase in hip fractures among treated hepatitis B patients, but no other bone fractures.
They concluded that antiviral treatment, "...does not increase the risk of renal (kidney) and bone events in general. (Antivirals) may increase the risk of hip fracture, but the overall event rate is low."
Source: www.ncbi.nlm.nih.gov/pubmed/25973979
Second Vaccine Series May Be Needed for Children with Celiac Disease
People with celiac disease–the inability to digest gluten–may require a heptitis B vaccine booster according to a study presented at the 33rd Annual Meeting of the European Society of Paediatric Infectious Diseases.
Researchers monitored 72 children with severe allergies to gluten who received the full three vaccine doses, but who still had hepatitis B antibodies below the recommended 10 mUI/mL, which is needed to protect against infection.
Researchers administered an additional vaccine dose to the children and measured their antibodies six months later. About 85% of the children who received the booster achieved a protective level of antibodies, however the remaining 15% were "non-responders."
Researchers recommended administering a second round of the three-shot vaccine in all children with celiac disease who do not respond to the initial round of immunization shots.
Source: www.firstwordpharma.com/node/1284715
#axzz3bC1YUS2C
Researchers Find HBV B Strain in Cuba Did Not Come from Africa
Because hepatitis B viral strains or genotypes developed over thousands of years in specific regions of the world, their presence in a new location can tell the story of human migrations.
For example, today in West Africa HBV genotype E is the dominant hepatitis B strain. So, scientists expected to find HBV genotype E in Caribbean islands settled by Africans who were brought there during the Transatlantic Slave Trade.
But two studies, one in Haiti and the latest one in Cuba, both failed to find HBV genotype E among the descendants of African slaves who have chronic hepatitis B.
In the May issue of the medical journal PlosS one, researchers examined the HBV genotypes of 172 Cubans. Instead of finding HBV genotype E, which they expected to find, they instead discovered the dominant HBV genotype was A, which originates in Asia and Europe.
The finding is similar to a study in Haiti which also found an absence of genotype E. This means that HBV genotype E was probably introduced to West Africa after the slave trade of the 1700s and 1800s stopped. Similarly, HBV genotype A was probably introduced to Cuba after the slave trade ended.
Source: www.bioportfolio.com/resources/pmarticle/1239701
/Genetic-Diversity-of-the-Hepatitis-B-Virus-Strains-in-Cuba-Absence-of.html
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发表于 2015-6-4 15:05
