HBV Journal Review Part 2/2

StephenW

HBeAg Seroconversion from Interferon Is Sustained Years after Treatment Ends
Approximately 30% to 40% of patients with HBeAg-positive hepatitis B treated with pegylated interferon achieve HBeAg seroconversion within six months after treatment ends.

The “durability” of this seroconversion was studied in 85 HBeAg-positive patients who were treated with peginterferon alfa-2b 1.5 mug/kg/week for 32 weeks and lamivudine for 52 or 104 weeks and followed for about six years.

Twenty-five (29%) of all patients retained the “e” antibody and undetectable HBV DNA after five years. The rate of HBeAg seroconversion rose progressively from 37% at the end of treatment to 60% at 5 years.

Among those who responded by the end of treatment, 82% and 57% and sustained HBeAg seroconversion and virologic response at 5 years. Only two patients of the 85 patients had advanced fibrosis after five years.

Indicators of successful treatment included viral load status at Week 16 of treatment, whether they seroconverted and had undetectable HBV DNA at the end of treatment.

The addition or duration of lamivudine treatment had no impact on any long-term response, according to the report by Hong Kong researchers published in Hepatology.

Many Substance Abuse Treatment Centers Don't Offer Viral Hepatitis Screening
Fewer than half of all substance abuse treatment facilities surveyed nationwide reported that they conduct on-site infectious disease screening, according to a new study sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Rates of HIV, tuberculosis, sexually transmitted diseases, hepatitis B and C are high among drug users. This study was based on data from the 2007 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of all known facilities in the United States, both public and private, that provide substance abuse treatment.

The facilities that were most likely to provide infectious disease screening were operated by the federal government, followed by a state government. More than half of the approximately 1,100 treatment programs provided on-site screening for hepatitis B (62.1 percent), hepatitis C (64.1 percent), HIV (69.8 percent), sexually transmitted diseases (67.8 percent), or tuberculosis (93.3 percent).

Facilities that provided hospital inpatient treatment were more likely than facilities providing outpatient or non-hospital residential treatment to offer screening for hepatitis B. Where available, the most common types of on-site screening were for tuberculosis, (34.3 percent), and HIV (29.7 percent).

Operating-room Needlesticks and Sharps Injuries Rise Despite Efforts to Reduce Them
After passage of the Needlestick Safety and Prevention Act of 2000, hospitals' injury rates dropped 31.6% in nonsurgical areas but have increased 6.5% in surgical settings, according to a report in the April issue of the Journal of the American College of Surgeons.

Suture needles appear to be the major culprit, with most injuries occurring when the needles are used or passed between providers. This risk prevents HBV-infected providers from performing surgical practices and places surgeons and nurses at risk when patients are infected.

The results suggest surgical teams have been unresponsive to implementing occupational safety measures despite their high risk. The law required health care employers to provide safety-engineered needles and sharp instruments designed to reduce risk, and it applied equally across hospital settings.

The reason for the increase in operating room injuries is unclear since there have been a number of changes in surgery, including greater use of less risky laparoscopic techniques and more outpatient procedures.

But the surgical culture of resistance to change and the poorly safety-designed devices available for surgery until recently may be reasons that surgery hasn't kept up with other surgical settings in injury reduction.

In the operating room, just three devices account for most injuries: suture needles (43.4%), scalpel blades (17.1%), and disposable syringes (12.1%). Focusing on suture needles may present the greatest opportunity for improving operating room safety, researchers wrote.

Substituting blunt suture needles for sharp ones when suturing less-dense tissues could reduce the injury rate by 29.2%, researchers suggested, based on a prior study's finding of 59% reduced risk with blunt suture needles.

Longer Period of Interferon Treatment Needed for HBV Genotype D Patients
Treating patients who have HBeAg-negative hepatitis B, genotype D, with pegylated interferon for twice as long as is currently recommended produced vastly better results than treating them for just the currently-recommended 48 weeks, according to a report presented by Italian researchers at the 45th Annual Meeting of the European Association for the Study of the Liver, held in April in Vienna.

The findings are important because to date patients with genotype D have not responded well to interferon, and are often not considered candidates for this treatment.

While both groups had similar responses when their treatments ended, one year later 29% of 52 genotype D patients treated for 96 weeks had undetectable HBV DNA, compared to 12% of 51 genotype D patients treated for 48 weeks. Additionally, 6% of the longer-treated patients cleared HBsAg. Both groups had similar rates of normal ALT levels at the end of treatment.

Researchers Find Tenofovir Effective for Adefovir- and Lamivudine-Resistant HBV
Another round of research into how lamivudine- and adefovir-resistant patients fare when treated with tenofovir found the antiviral to be highly effective in those patient groups, according to a report released at the European Association for the Study of the Liver conference.

The majority of patients achieved undetectable HBV DNA at the following rates:

    * 75% of 141 patients with no mutations responded to tenofovir with undetectable viral load and normal ALT rates.
    * 83% of 12 patients with adefovir resistance responded to tenofovir.
    * 86% of 7 patients with lamivudine resistance mutations responded.
    * The number of HBeAg-positive patients experiencing HBeAg seroconversion increased after two years of tenofovir treatment.

Current Liver Transplant Allocation System Leaves Women at a Disadvantage
Women with end-stage liver disease in need of liver transplantation are less likely to get liver transplants and are more likely to die while awaiting transplants, according to a report presented at the European Association for the Study of the Liver conference.

The researchers suggest that the current transplant allocation system needs to be re-examined and refined to reduce gender disparities.

Women awaiting transplants tended to have lower serum creatinine (SCr) values, due to smaller size and muscle mass, despite worse renal (kidney) function when placed on the waiting list. As a result, they were not considered to be at high risk of death and were not placed at the top of the wait list. Consequently, they were significantly less likely to undergo transplantation and had higher death rates after three months on the list,

In earlier studies, 65% of cirrhotic women had increases in their transplant ranks when their SCr values were corrected for gender.



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