Antiviral Agents ; Hepatitis B, Chronic ; Hepatitis C, Chronic ; Humans

The cytokine patterns secreted by T cells at the site of viral replication may influence the final outcome of HBV and HCV infection. The different cytokine profiles of T cells within the liver in chronic HBV (Th0/Th2 cytokine) and HCV (Th1 cytokine) infections illustrate a different behavior of the local immune response in these two infections. The predominance of Th1-type cytokine responses has been reported to play an important role in viral clearance of patients with both acute and chronic hepatitis B. In contrast, a combined Th1-and Th2-like responses were found in chronic hepatitis C, exhibiting a pattern like that of acute hepatitis C with chronic evolution. It suggests that different patterns of cytokine expressions between HBV and HCV infection involve the difference in chronicity in each infection.
Cytokines* ; Hepacivirus ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis, Chronic* ; Humans ; Liver ; T-Lymphocytes

Occult hepatitis B virus (HBV) infection is defined as the presence of HBV DNA in the liver (with or without detectable HBV DNA in serum) for individuals testing HBV surface antigen negative. Until recently, the clinical implication of occult HBV infection was unclear. Several studies suggest a high prevalence of occult HBV infection among patients with chronic liver disease. Occult HBV infection is a complex entity comprising many conditions and situations that may be widely different from the biological point of view and clinical consequences. Data regarding natural course and therapy in chronic hepatitis C patients with occult HBV are limited and based on small case numbers. These considerations imply the need for a critical re-evaluation of this field to define better strategies to diagnose and treat this infection.
Antigens, Surface ; DNA ; Hepatitis ; Hepatitis B ; Hepatitis B virus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Liver ; Liver Diseases ; Prevalence

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the most common causes of chronic liver disease worldwide. The host immune pressure against hepatitis viruses during the chronic infection has led to mutations in their coding genes, which could play a pivotal role in the clinical outcomes of chronic patients. Our recent molecular epidemiologic studies regarding the HBV precore/core (preC/C) regions and HCV nonstructural 5B (NS5B) protein suggest the presence of distinct CD4 T cell immune pressure against HBV and HCV in Korean chronic patients. However, induced HBV and HCV mutations seem to exert an opposite effect on Korean chronic hepatitis B (CHB) and chronic hepatitis C (CHC) patients, respectively. On the basis of two of our recent papers, we focused in this review on the relationships between the mutation patterns of HBV preC/C and HCV NS5B, which were presumed to be caused by distinct CD4 T cell pressure in the Korean population and their effect on the clinical outcomes and liver disease progression of CHB and CHC patients.
Clinical Coding ; Epidemiologic Studies ; Hepacivirus* ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis C* ; Hepatitis C, Chronic ; Hepatitis Viruses ; Hepatitis* ; Humans ; Liver Diseases

BACKGROUND: The Elecsys hepatitis B surface antigen (HBsAg) II quantitative assay is a newly introduced electrochemiluminescence immunoassay incorporating an initial 1:400 onboard dilution and a simple algorithm to determine HBsAg levels in serum. We evaluated the performance of the Elecsys HBsAg II assay and determined the impact of its initial onboard dilution on laboratory efficiency. METHODS: HBsAg levels were determined using both Roche Elecsys and Abbott Architect HBsAg assays. Linearity and precision of the Elecsys HBsAg II assay and its correlation with the Architect HBsAg assay were evaluated. In particular, precision was verified at Samsung Medical Center, Severance Hospital, Seoul St. Mary's Hospital in Seoul, using the same pooled serum controls. The efficiency of the dilution algorithm for both methods was verified using data from 1,848 clinical samples. RESULTS: The Elecsys HBsAg II assay showed a good linearity from 0.1 to 48,000.0 IU/mL and a good correlation (r=0.9998) between expected and measured values. Precision analyses performed at Samsung Medical Center, Severance Hospital, Seoul St. Mary's Hospital showed excellent performance with coefficients of variation between 1.28% and 6.82%. The values of the Elecsys HBsAg II and Architect HBsAg assays were well correlated (n=506, r=0.987, P<0.001) and also reliably determined in hepatitis C virus- and hepatitis B virus-co-infected patient sera (n=27). In terms of efficiency, 64.0% of samples provided a final HBsAg result on the first run without the need for further dilution, when using the 1:400 onboard pre-dilution protocol of the Elecsys HBsAg II assay. CONCLUSIONS: Given the excellent precision and correlation with the Architect assay, the Elecsys HBsAg II assay showed a potential advantage for laboratory efficiency by significantly reducing the need for retesting samples with high HBsAg levels.
Hepatitis B ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis C ; Humans ; Immunoassay ; Seoul

The treatment of chronic viral hepatitis is aimed to prevent the progression to cirrhosis and hepatocellular carcinoma, eventually increasing the survival of the patients through biochemical, virological, and histological improvement. Recently, international and domestic consensus on management guidelines for chronic viral hepatitis B and C have been announced and recommended. Interferon-alpha, lamivudine, or adefovir dipivoxil, approved by FDA, can be used in the treatment of chronic hepatitis B according to the patient and virus characteristics, while the internationally standardized antiviral regimen for chronic hepatitis C is a combination therapy of pegylated interferon-alpha and ribavirin. Among these antiviral agents, adefovir dipivoxil, a nucleoside analogue of adenosine monophosphate, is known to be effective in treatment of chronic hepatitis B with the lamivudine-resistant YMDD mutant. The antiviral treatment of chronic viral hepatitis can be individualized to get the maximal treatment effect in a cost-effective manner through taking consideration of the patient status, side effects of antiviral agents, administration route, insurance criteria, and the patient' motivation toward medical treatment.
Adenosine Monophosphate ; Antiviral Agents ; Carcinoma, Hepatocellular ; Consensus ; Fibrosis ; Hepatitis ; Hepatitis B ; Hepatitis B, Chronic* ; Hepatitis C, Chronic ; Hepatitis, Chronic* ; Humans ; Insurance ; Interferon-alpha ; Lamivudine ; Motivation ; Ribavirin

<b>OBJECTIVEb>To compare the abilities of transient elastography (TE) versus real-time tissue elastography (RTE) for assessing liver fibrosis in patients with chronic liver disease.

<b>METHODSb>Ninetytwo patients with chronic liver disease were enrolled in the study, and included 77 cases of chronic hepatitis B, 4 cases of chronic hepatitis C, 4 cases of autoimmune liver disease, 2 cases of primary biliary cirrhosis, I case of abnormal bile duct development, and 4 cases of unknown etiology.All patients were assessed by both TE and RTE in a single day.The correlation coefficient of liver fibrosis level and the receiver operating characteristic (ROC) curve of S more than 2 and =4 of TE and RTE were determined.The values were compared using findings fiom pathological analysis as reference.

<b>RESULTSb>The correlation coefficient of liver fibrosis level was significantly higher for TE (r =0.755, 95% CI:0.651-0.831, P =0.000) than for RTE (r=0.481, 95% CI:0.306-0.624, P =0.000) (Z=3.07, P =0.002).The areas under the ROC curves for S more than 2 and =4 were 0.903 and 0.740 for TE and 0.915 and 0.786 for RTE, respectively, indicating that the performance of TE was superior to that of RTE.

<b>CONCLUSIONb>TE was superior to RTE for assessment of liver fibrosis.

Autoimmune Diseases ; Elasticity Imaging Techniques ; Hepatitis B, Chronic ; diagnostic imaging ; Hepatitis C, Chronic ; diagnostic imaging ; Humans ; Liver Cirrhosis, Biliary ; diagnostic imaging ; ROC Curve

BACKGROUND/AIMS: There are no pathognomonic features of autoimmune hepatitis (AIH). Its diagnosis requires the exclusion of various other conditions. The aim of this study was to validate indirectly the International Autoimmune Hepatitis Group (IAHG) scoring system in diagnosing AIH. METHODS: Twenty-six patients with Type 1 AIH and female patients with chronic hepatitis B (n=34), chronic hepatitis C (n=25), or toxic hepatitis (n=13) were evaluated according to 9 categories of pretreatment minimum required parameters proposed by IAHG. Aggregate scores of AIH to those of non-AIH groups, which were assessed before and after extracting the proportions of etiologic factors, were also compared and evaluated. RESULTS: While aggregate scores of non-AIH groups, before extracting the proportions of etiologic factors, were 5.2+/-1.8, 5.6+/-1.1, and 7.4+/-1.2 in that order, those of AIH groups were 12.8+/-1.7. These were significantly higher than those of non-AIH groups (p<0.01). All patients in AIH groups and only 1 patient in a non-AIH group showed aggregate scores of more than 10. Aggregate scores after extracting the proportions of etiologic factors were more than 4 in all, except 2, patients. These should have been consistent with 10 if there were no etiologic factors in non-AIH groups. CONCLUSION: The IAHG scoring system might have a relatively excessive importance to the scores of categories excluding distinct etiologies from AIH. It might be difficult to differentiate AIH from chronic liver diseases of indistinct cause based on the IAHG scoring system.
Adult ; Aged ; Autoimmune Diseases/*classification/diagnosis ; English Abstract ; Female ; Hepatitis/*classification/diagnosis/immunology ; Hepatitis B, Chronic/classification/diagnosis ; Hepatitis C, Chronic/classification/diagnosis ; Hepatitis, Toxic/classification/diagnosis ; Human ; Korea ; Male ; Middle Aged

Chronic hepatitis B virus (HBV) infection remains a global health burden. Timely and effective antiviral therapy is beneficial for patients with HBV infection. With existing antiviral drugs, including nucleos(t)ide analogs and interferon-alfa, patients can achieve viral suppression with improved prognosis. However, the rate of hepatitis B surface antigen loss is low. To achieve a functional cure and even complete cure in chronic hepatitis B patients, new antivirals need to be developed. In this review, we summarized the advantages and disadvantages of existing antiviral drugs and focused on new antivirals including direct-acting antiviral drugs and immunotherapeutic approaches.
Antiviral Agents/therapeutic use* ; Hepatitis B/drug therapy* ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B, Chronic/drug therapy* ; Hepatitis C, Chronic/drug therapy* ; Humans

BACKGROUND/AIMS: Metabolic syndrome, comprising diabetes, hypertension, central obesity, and dyslipidemia, is increasingly prevalent worldwide. We aimed to study the relationship between metabolic syndrome and the risk of liver fibrosis in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). METHODS: In total, 954 patients (CHB, 850; CHC, 104 patients) with liver biopsy were included in the retrospective analysis. Extensive clinical and histological data were available. Metabolic syndrome was defined using the International Diabetes Federation definition of metabolic syndrome, 2006 criteria. Histological lesions were evaluated according to the histology activity index system. RESULTS: Metabolic syndrome was present in 6% of patients and significantly more prevalent in patients with CHC than in patients with CHB (5% vs 13%, p<0.001). Patients with metabolic syndrome were older among patients with CHB and patients with CHC, and, as expected, were mainly overweight or obese. Fibrosis was significantly more severe in patients with metabolic syndrome than in those without, regardless of whether they had CHB and CHC (CHB, 3.3+/-2.1 vs 2.4+/-1.3, p=0.025; CHC, 2.6+/-1.5 vs 1.3+/-0.7, p=0.006). Liver fibrosis (stages 3 to 4) was independently associated with increased age, higher transaminase level and metabolic syndrome (odds ratio, 2.421; p=0.017). CONCLUSIONS: Metabolic syndrome is associated independently with severe fibrosis in patients with chronic viral hepatitis B and C.
Biopsy ; Dyslipidemias ; Fibrosis ; Hepatitis ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Humans ; Hypertension ; Liver ; Liver Cirrhosis ; Obesity, Abdominal ; Overweight ; Retrospective Studies