No abstract available.
Adult ; *Fatty Liver/diagnosis/etiology/pathology ; Humans ; Male

HCV-related decompensated liver cirrhosis is a life-threatening illness with an average 5-year survival rate of 50%. Because these patients have higher risk of morbidity and mortality including development of hepatocellular carcinoma, the benefits of eradicating the virus may be greater than in those with less-advanced disease. Recently, direct-acting antiviral agents (DAAs) are replacing interferon-based regimens that have serious adverse events and low tolerability in the treatment of HCV infection. Many clinical trials using combination of several DAAs with or without ribavirin are now actively on-going in HCV-related decompensated cirrhosis, and encouraging data are beginning to appear. In this review, recent advances in the treatment of HCV-related decompensated cirrhosis are introduced with special focus on new DAAs.
Antiviral Agents/*therapeutic use ; Drug Therapy, Combination ; Hepatitis C/complications/*drug therapy/pathology ; Humans ; Interferon-alpha/therapeutic use ; Liver Cirrhosis/*complications/pathology ; Practice Guidelines as Topic ; Republic of Korea ; Ribavirin/therapeutic use

Acquiring a sustained virological response (SVR) in patients with cirrhosis or advanced hepatic fibrosis reduces liver disease-related mortality and the incidence of hepatocellular carcinoma. However, the SVR rate of the current standard of care, which is combination therapy with peg-interferon-alpha and ribavirin, is significantly lower, and treatment-related complications occur more frequently in patients with cirrhosis. Thus, antiviral treatment should be individualized in this population. This review highlights the issues associated with anti-hepatitis C virus treatment in patients with compensated and decompensated cirrhosis.
Carcinoma, Hepatocellular ; Fibrosis ; Hepatitis C* ; Humans ; Incidence ; Liver ; Liver Cirrhosis* ; Mortality ; Ribavirin ; Standard of Care

Hepatitis B virus (HBV) infection during pregnancy brings up unique management challenges. Varying aspects of care must be considered, including the effects of pregnancy on the course of HBV infection, effects of HBV infection on maternal and fetal health, treatment of HBV during and after pregnancy, and prevention of perinatal infection. For those with chronic HBV infection, the course of disease is usually unchanged during pregnancy. However, flares have been reported shortly after delivery. Women with high HBV DNA titer have an increased likelihood of perinatal transmission and may contribute to the failure of current passive-active immunoprophylaxis at birth. The aim of the present review is to provide a tool that may help physicians to manage correctly HBV infection in pregnancy.
Breast Feeding ; Cesarean Section ; DNA ; Female ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Parturition ; Pregnancy

Although the classical gold standard for diagnosing and staging non-alcoholic fatty liver disease (NAFLD) and assessing fibrosis is liver biopsy, the procedure has several drawbacks, such as sample error, subjectivity in interpretation, high cost, and a small but real risk of complications.In an attempt to replace liver biopsy and to subcategorize patients with NAFLD into different prognoses, many non-invasive methods using various biomarkers, scoring systems, and imaging methods, such as elastography, have been attempted in the last decade. This article summarizes non-invasive diagnostic tests for the diagnosis of NAFLD/Nonalcoholic steatohepatitis, as well as the limitations and merits of liver biopsy.
Biomarkers ; Biopsy ; Diagnosis* ; Diagnostic Tests, Routine ; Elasticity Imaging Techniques ; Fatty Liver* ; Fibrosis ; Humans ; Liver ; Prognosis

BACKGROUND/AIMS: Despite great progress, antiviral treatment for chronic hepatitis C in patients with prior hepatocellular carcinoma (HCC) has been rarely investigated. We evaluated the efficacy and safety of antiviral therapy following treatment for hepatitis C-related HCC. METHODS: Thirteen patients (age 34 to 60 years) who were treated with peginterferon plus ribavirin after treatment for HCC were reviewed. RESULTS: There were 6 patients with genotype 1 and 7 patients with genotype 2. All patients showed advanced fibrosis (> or =F3) but belonged to the Child-Pugh class A. Treatment was stopped in 2 patients because of recurrent HCC and in 1 patient due to a lack of early virologic response. Seven patients achieved sustained virologic response and three patients relapsed. The sustained virologic response rate was 54% overall, 17% in genotype 1, and 86% in genotype 2. No significant adverse events were reported. CONCLUSIONS: Antiviral therapy should not be excluded in patients who were previously treated with HCC with genotype 2 chronic hepatitis C, in which an efficacious antiviral treatment for chronic hepatitis C was feasible. Additional study is needed to prove the validity of antiviral therapy in patients with genotype 1 hepatitis C-related HCC.
Carcinoma, Hepatocellular ; Fibrosis ; Genotype ; Hepatitis ; Hepatitis C, Chronic ; Humans ; Ribavirin

BACKGROUND/AIMS: We investigated the effect of low dose corticosteroid therapy on HBV reactivation in patients with chronic HBV infection. METHODS: From August 1998 to March 2007, the HBsAg-positive patients who received oral or intravenous corticosteroid therapy for more than 1 week at Samsung Medical Center were included in this retrospective study. We included those patients who received anticancer chemotherapy or organ transplantation, or concurrent antiviral therapy or other immunosuppressive agents. HBV reactivation was defined as a 10-fold increase in the HBV DNA levels compared with baseline. RESULTS: A total of 16 patients were included. They were 45.4+/-16.7 years of age, and the male:female ratio was 14:2. Their combined diseases included bronchial asthma, allergic urticaria, allergic rhinitis, etc. The corticosteroid doses were converted to prednisolone equivalent doses and these varied from 2.5 mg to 50 mg per day. Eleven patients used less than 20 mg of prednisolone per day. The mean medication duration was 60.1 days (range: 7-364 days). Among the patients, only one patient showed HBV reactivation. This ankylosing spondylitis patient was a 31-year old man who took prednisolone 5 mg/day for 364 days. He displayed HBeAg-positivity before corticosteroid treatment. There was no aggravation of the levels of ALT, albumin, bilirubin, and PT between the pre-and post-medication in this patient. CONCLUSIONS: The short term use of low dose corticosteroid is not likely to be related with HBV reactivation in those patients with chronic HBV infection, yet long term use may lead to viral reactivation. Further large scaled, prospective studies on this subject are needed.
Asthma ; Bilirubin ; DNA ; Hepatitis B e Antigens ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Immunosuppressive Agents ; Organ Transplantation ; Prednisolone ; Retrospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Spondylitis, Ankylosing ; Transplants ; Urticaria

BACKGROUND/AIMS: The notion that acute hepatitis A superimposed on chronic hepatitis B infection leads to a worse outcome than acute hepatitis A alone remains controversial. The aim of this study was to determine the influence of the presence of hepatitis B surface antigen (HBsAg) on the severity of acute hepatitis A. METHODS: We retrospectively analyzed 449 patients hospitalized for acute hepatitis A from January 2000 to February 2010 and compared clinical outcomes based on the presence of HBsAg. RESULTS: Of the 449 patients, 30 patients were in the HBsAg-positive group and 419 in the HBsAg-negative group. The HBsAg-positive group was older than the HBsAg-negative group (36.1+/-8.3 vs 31.8+/-8.5 years, p=0.004); however, other baseline characteristics were similar between the 2 groups. Mean peak values of prothrombin time, serum total bilirubin, and serum creatinine at admission were significantly higher in the HBsAg-positive group. When comparing clinical outcomes between the 2 groups, gastrointestinal bleeding, acute renal failure, and acute liver failure were more frequently observed in the HBsAg-positive group. In particular, the incidence of acute liver failure was approximately 9-fold higher in the HBsAg-positive group than in the HBsAg-negative group (23.3% vs 3.3%; odds ratio [OR], 8.80; p<0.001). Multivariate analysis showed that HBsAg (OR, 7.43; 95% confidence interval [CI], 2.56 to 21.57) and age (OR, 1.07; 95% CI, 1.02 to 1.13) were independent risk factors for the occurrence of acute liver failure. CONCLUSIONS: In patients with chronic hepatitis B infection, acute hepatitis A is associated with more severe clinical outcomes, including acute liver failure, compared with patients with acute hepatitis A alone.
Acute Kidney Injury ; Bilirubin ; Creatinine ; Hemorrhage ; Hepatitis ; Hepatitis A ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic ; Humans ; Incidence ; Liver ; Liver Failure, Acute ; Multivariate Analysis ; Odds Ratio ; Prothrombin Time ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Adefovir (ADV) is the preferred drug for treating lamivudine (LAM)-resistant hepatitis B. However, not all patients who face virologic breakthrough during LAM treatment respond to ADV. The aim of this study was to determine the factors associated with efficacy of ADV in LAM-resistant hepatitis B patients. METHODS: The medical records of 231 patients who received ADV due to LAM-resistance were reviewed. Efficacy was assessed by the initial virologic response (IVR), defined as hepatitis B virus (HBV) DNA not being undetectable by real-time PCR at 6 months of ADV treatment. RESULTS: Seventy patients (30%) achieved IVR. While 'add-on' modality, hepatitis B e antigen (HBeAg) negativity, and low baseline HBV DNA levels were associated with IVR in univariate analysis, multivariate analysis revealed HBeAg status and the DNA level to be the significant factors. The probability of IVR achievement increased sharply per each log10 copies/mL decrement in the baseline viral load, which was 133 times in patients who had HBV DNA <10(5) copies/mL compared with those who had > or =10(8) copies/mL. CONCLUSIONS: Factors associated with the IVR were HBeAg negativity and a low baseline viral load. Therefore, when virologic breakthrough with genotypic resistance emerges during LAM therapy, ADV treatment should be considered immediately before further increases in viral load. Additional long-term follow-up data are warranted.
Achievement ; Adenine ; DNA ; Drug Resistance, Viral ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Lamivudine ; Lipopolysaccharides ; Medical Records ; Multivariate Analysis ; Organophosphonates ; Real-Time Polymerase Chain Reaction ; Viral Load

BACKGROUND/AIMS: We compared the accuracy and usefulness of clinical diagnostic criteria for hepatocellular carcinoma in a hepatitis B virus (HBV)-endemic area. METHODS: We reviewed the medical records of 355 patients who had undergone liver resection or biopsy at our institution between January 2008 and December 2009. These patients were reevaluated using four noninvasive diagnostic criteria for hepatocellular carcinoma proposed by the European Association for the Study of the Liver (EASL), the American Association for the Study of Liver Diseases (AASLD), the Korean Liver Cancer Study Group and the National Cancer Center (KLCSG/NCC), and National Comprehensive Cancer Network (NCCN) guidelines. RESULTS: The overall sensitivity was highest using the KLCSG/NCC criteria (79.8%), followed by the AASLD (51.5%), EASL (38.4%), and NCCN (10.1%; P<0.001) criteria, whereas the specificity (84.5-98.3%) and positive predictive value (96.2-98.3%) were similar for all of the criteria. The KLCSG/NCC criteria had an acceptable false-positive rate and the highest sensitivity among all of the patients, including those positive for HBsAg, those without liver cancer, and those with a tumor of at least 2 cm. CONCLUSIONS: The KLCSG/NCC and AASLD criteria exhibited the highest sensitivity, and all four guidelines had a high specificity among all of the patients. Based on the sensitivity and false-positive rate, the KLCSG/NCC criteria was the most useful in the majority of patients. Inclusion of HBV infection in the clinical diagnostic criteria for hepatocellular carcinoma would be reasonable and may lead to an improvement in the sensitivity, with acceptable false-positive rates, in HBV-endemic areas.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/*diagnosis/etiology/pathology ; Female ; Hepatitis B/complications/*diagnosis/epidemiology ; Hepatitis B Surface Antigens/blood ; Hepatitis C/diagnosis/epidemiology ; Humans ; Liver/pathology ; Liver Neoplasms/*diagnosis/etiology/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Practice Guidelines as Topic ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Young Adult ; alpha-Fetoproteins/analysis