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Hepatitis B flare: the good, the bad and the ugly
Yun-Fan Liaw
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Received 22 Sep 2022, Accepted 05 Dec 2022, Accepted author version posted online: 07 Dec 2022
Download citation https://doi.org/10.1080/17474124.2022.2156338 CrossMark Logo CrossMark
Accepted author version
Abstract
Introduction
Hepatitis B flare, defined as an event of abrupt ALT elevation to >5x ULN, is a frequent episode during the natural course or during/after antiviral therapy of chronic HBV infection, in both HBeAg-positive and HBeAg-negative patients with chronic hepatitis B or liver cirrhosis.
Areas covered
the definition, the pathogenesis, clinical presentation and management of hepatitis B flares in publish literature were reviewed. Hepatitis B flares have been considered as results of the robust immune response of the patient to an upsurging HBV/HBV-antigen(s). “Host-dominating flares”, reflect effective immune response, may resolve with ALT normalization and decline of HBV/ antigen(s). Contradictorily, “virus-dominating flares”, reflect ineffective immune response, are usually followed by persistent/intermittent hepatitis and may even develop hepatic decompensation/failure.
Expert opinion
Not all hepatitis B flares require antiviral therapy, and close observation with combined HBsAg/ALT kinetics along the ascending ALT during hepatitis flare may differentiate hepatitis flares for an appropriate treatment/retreatment decision. More studies are needed to verify this proposal. Further immunologic studies using multiple samples during hepatitis B flare are important to clarify the precise underlying mechanisms as basis for further improvement in the management of hepatitis flare.
Keywords:
CHBETVHBV-LChepatic decompensationhost-dominating flareimmunopathogenesisTDFvirus dominating flare (5-10)
Disclaimer
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Article highlights
Hepatitis B flare may occur in various clinical settings, most frequent during immune active phases of chronic HBV infection and after cessation of antiviral therapy in Nuc treated patients.
Hepatitis B flares are considered results of robust immune response of the patient to upsurging HBV and its antigens.
Careful monitoring is required to detect clinical deterioration for timely treatment, and to differentiate two types of flare for treatment/retreatment decision.
Combined HBsAg/ALT kinetics may effectively differentiate “virus-dominating flare” from “host-dominating flare”.
Patients with “virus-dominating flare” require treatment whereas treatment may be held or may even not necessary in those with “host dominating flare”.
Funding
This paper was funded by Chang Gung Medical Research Fund (CMRPG1K0101-3, CMRPG1K0111-3)
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or mending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. |
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发表于 2022-12-9 03:43