A 47-yr-old man with hepatitis B virus associated liver cirrhosis was admitted to our hospital with diarrhea and generalized edema and diagnosed as protein-losing enteropathy due to intestinal lymphangiectasia by intestinal biopsy and 99mTc albumin scan. During hospitalization, he received subcutaneous octreotide therapy. After 2 weeks of octreotide therapy, follow-up albumin scan showed no albumin leakage, and the serum albumin level was sustained. We speculate that liver cirrhosis can be a cause of intestinal lymphangiectasia and administration of octreotide should be considered for patients with intestinal lymphangiectasia whose clinical and biochemical abnormalities do not respond to a low-fat diet.
Adolescent ; Adult ; Duodenum/pathology ; Female ; Hepatitis B/complications ; Hepatitis B Virus/metabolism ; Human ; Intestinal Diseases/*drug therapy/virology ; Jejunum/pathology ; Liver Cirrhosis/*drug therapy/virology ; Lymphangiectasis, Intestinal/*drug therapy/virology ; Male ; Middle Aged ; Octreotide/*pharmacology ; Protein-Losing Enteropathies/*drug therapy

<b>OBJECTIVEb>To analyze the development of liver damage and reactivation of hepatitis B virus (HBV) during the treatment of extremely severe burn injury in HBsAg positive patients, in order to provide reference for prevention and treatment of liver damage in patients with HBV infection after extremely severe burn.

<b>METHODSb>Medical records of 54 HBsAg positive patients after extremely severe burn injury admitted from January 2004 to December 2014 were retrospectively analyzed. Development of liver damage and HBV reactivation of these patients during the treatment were analyzed according to the classification of their gender, results of hepatitis B e antigen (HBeAg) and HBV DNA examinations on admission, and development of sepsis in the process of treatment. Data were processed with chi-square test.

<b>RESULTSb>(1) The incidence of liver damage in the process of treatment of these patients was 85.2% (46/54). Among all the patients, the proportion of liver damage was 35/38 in male, which was significantly higher than that in female (11/16, χ² = 4.867, P<0.05). Liver damage was found in all of 26 patients who were HBeAg positive on admission, 34 patients who were HBV DNA positive on admission, and 36 patients who developed sepsis in the process of treatment; the proportions were significantly higher than those in patients who were HBeAg negative on admission (20/28), patients who were HBV DNA negative on admission (12/20), and patients who did not develop sepsis in the process of treatment (10/18), with χ² values respectively 11.801, 18.384, and 20.574, P values below 0.01. (2) The incidence of HBV reactivation in these patients was 29.6% (16/54). Among all the patients, the proportion of HBV reactivation was 13/38 in male and 3/16 in female, with no statistically significant difference between them (χ² = 0.656, P>0.05). The proportions of HBV reactivation in patients who were HBeAg positive on admission, patients who were HBV DNA positive on admission, and patients who developed sepsis in the process of treatment were respectively 13/26, 16/34, and 15/36, and they were significantly higher than those in patients who were HBeAg negative on admission (3/28), patients who were HBV DNA negative on admission (0/20), and patients who did not develop sepsis in the process of treatment (1/18), with χ² values respectively 9.979, 18.615, and 5.873, P<0.05 or P<0.01.

<b>CONCLUSIONSb>Patients who are HBsAg positive, HBeAg positive, HBV DNA positive on admission, and develop sepsis in the process of treatment of extremely severe burn injury are more likely to develop liver damage and HBV reactivation. It is necessary to dynamically monitor the changes in HBV DNA and liver function, in order to identity the reactivation of virus.

Alanine Transaminase ; blood ; Burns ; complications ; drug therapy ; Chemical and Drug Induced Liver Injury ; DNA, Viral ; Female ; Hepatitis Antibodies ; blood ; Hepatitis B ; drug therapy ; epidemiology ; virology ; Hepatitis B Surface Antigens ; blood ; immunology ; Hepatitis B virus ; drug effects ; immunology ; isolation & purification ; Hepatitis B, Chronic ; blood ; pathology ; virology ; Humans ; Incidence ; Liver ; pathology ; Male ; Retrospective Studies

<b>OBJECTIVEb>To establish non-invasive predictors of antiviral therapy for chronic HBV carriers.

<b>METHODSb>Liver biopsies were performed in 139 chronic HBV carriers. Seventeen of them were histopathologically graded as G > or =2 or S > or =3, being considered in need of antiviral therapy. The other 122 subjects with grades G < 2 and S < 3 were not applicable for antiviral therapy. Independent predictors were analyzed using logistic regression (Backward). The covariates included age, gender, duration of HBV infection, family history of hepatitis B, HBeAg positivity, quantitive HBeAg, level of LN, PCIII, HA, CIV and gamma-globin, low white blood cell count, spleen measurement and HBV load. ROC curve was used to define the diagnostic critical value.

<b>RESULTSb>Logistic regression analysis showed that PCIII, but not other factors, was related to antiviral therapy in these HBV carriers (OR = 1.122). When the diagnostic critical value was 85.02 ng/ml, 100.79 ng/ml and 105.50 ng/ml, its sensitivity was 80.0%, 67.3% and 54.8%, respectively; its specificity was 52.0%, 70.6% and 84.2%, respectively. The area under ROC curve was 70.8%.

<b>CONCLUSIONb>PCIII might be a reference index for predicting antiviral therapy in chronic HBV carriers, but liver biopsy is still a non-substutiable reference index.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Carrier State ; drug therapy ; virology ; Child ; Female ; Hepatitis B ; Hepatitis B, Chronic ; drug therapy ; pathology ; virology ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

<b>OBJECTIVEb>To study histological changes of the livers in patients with chronic viral hepatitis B treated with bicyclol tablets.

<b>METHODSb>Thirty one patients with chronic viral hepatitis B were divided into two groups and were treated with bicyclol orally at doses of 150 mg daily or 75 mg daily for 36 weeds. The histological changes of the livers were observed before and after the treatment.

<b>RESULTSb>Compared with pre-treatment findings, there were significant differences in histological activity index in each group (P < 0.01, P < 0.05), there were also significant differences between the two groups (P < 0.05). Decreased inflammatory reaction was also seen (P < 0.05).

<b>CONCLUSIONb>Daily use of 150 mg and 75 mg bicyclol tablets are effective in improving liver histological changes in chronic hepatitis B patients. Bicyclol 150 mg daily was better.

Adult ; Antiviral Agents ; therapeutic use ; Biphenyl Compounds ; therapeutic use ; DNA, Viral ; blood ; genetics ; Female ; Hepatitis B Antibodies ; blood ; immunology ; Hepatitis B e Antigens ; immunology ; Hepatitis B virus ; drug effects ; genetics ; immunology ; Hepatitis B, Chronic ; blood ; drug therapy ; virology ; Humans ; Liver ; drug effects ; pathology ; virology ; Male ; Middle Aged ; Tablets ; Treatment Outcome ; Young Adult

BACKGROUND: Spontaneous delayed clearance of hepatitis B surface antigen (HBsAg) in patients with chronic HBV infection is a rare event. The aim of this study was to investigate the incidence of delayed clearance of serum HBsAg in chronic HBV infection and to determine the characteristics and clinical outcomes of HBsAg delayed clearance in Korean patients. METHODS: From April 1981 to June 2003, 4,061 patients who were positive for HBsAg were evaluated retrospectively. The following assessments were undertaken in 47 patients who had spontaneous delayed clearance: liver biochemistry, viral markers, alpha-fetoprotein levels, and radiographic examinations including ultrasonography every three to six months for 6-264 months (median 87.9 months). RESULTS: Twenty-four of 47 patients were asymptomatic carriers. The others included seven patients with chronic hepatitis, seven with liver cirrhosis and nine with hepatocellular carcinoma. The estimated annual incidence of HBsAg seroclearance was 0.4%. The time span from positive HBsAg to HBsAg seroclearance in the AHC, CH, LC, and HCC was 62.9, 141, 63, and 95.3 months during follow up. Twenty-four of 24 AHC remained normal, 5 of 7 CH remained as CH and 2 patients remained normal, 1 of 7 with LC developed HCC and 6 of the LC remained as LC, and 4 of 9 HCC patients died. CONCLUSION: The clinical course following delayed clearance of HBsAg had diverse outcomes from AHC to HCC. Therefore, these patients require close follow up for the possible development of hepatocellular carcinoma following HBsAg clearance.
Carrier State ; Female ; Hepatitis B Antibodies/blood ; Hepatitis B Surface Antigens/*blood/immunology ; Hepatitis B virus/*immunology ; Hepatitis B, Chronic/drug therapy/pathology/*virology ; Humans ; Incidence ; Korea ; Liver Cirrhosis/pathology/virology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Seroepidemiologic Studies ; Time Factors ; *Treatment Outcome

<b>OBJECTIVEb>To further verify the efficacy and safety of locally manufactured lamivudine on patients with chronic hepatitis B (CHB).

<b>METHODSb>2200 patients with CHB were recruited and received lamivudine orally 100 mg once daily for 12 months. The efficacy assessments included virologic response rate (defined by the absence of serum HBV DNA, HBeAg loss and HBeAg/HBeAb seroconversion), percentage of patients with normalization of alanine aminotransferase (ALT). Meanwhile improvement of quality of life (QOL) measured by mos SF-36 QOL questionnaire and liver histology evaluation were conducted in some patients. The safety assessments included adverse events, serious adverse events and laboratory abnormalities. All 2200 patients received at least one dose of medication and were all included in the safety population.

<b>RESULTSb>Ninety seven percent of patients (2137/2200) recruited were HBV DNA positive by dot blot (sensitivity GRT or equal to 1.0 pg/ml) at baseline. At the end of 12 months treatment, HBV DNA was undetectable in 80% patients (1538/1920) with HBV DNA positive before treatment. Among the 79%(1744/2200) of the patients recruited had positive HBV DNA accompanied abnormal ALT levels at baseline, 72% patients became ALT normal. And among the 84% (1843/2200) of the patients recruited were HBV DNA and HBeAg positive, anti-HBe negative, 16% (269/1650) patients achieved HBeAg/HBeAb seroconversion after 12 months of lamivudine treatment. The HBeAg/HBeAb seroconversion rate was positive correlation to the ALT level before treatment. A total of 304 patients completed the health-related QOL questionnaire. After 12 months treatment, lamivudine improved both their physical and mental health, especially for their mental health. 133 evaluable, paired liver biopsies were obtained for histological assessment, among whom 115 patients had abnormal ALT levels at baseline. Compared with pre-treatment most of their liver injury got alleviated (51.9%) or no further deterioration (36%), only 12% worsening. During the 12 months treatment, 9% patients withdrew from the study and 17% patients showed at least one adverse event, mild or moderate. There were no obvious difference between this study and the previously reported lamivudine Phase II or III study with regard to the kinds, incidence and severity of adverse events.

<b>CONCLUSIONb>The efficacy and safety profile of the locally manufactured lamivudine 100 mg tablets are similar with those of the previously reported available lamivudine tablets imported in treating Chinese chronic hepatitis B patients.

Adolescent ; Adult ; Aged ; Antiviral Agents ; therapeutic use ; Child ; DNA, Viral ; blood ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; drug therapy ; psychology ; virology ; Humans ; Lamivudine ; adverse effects ; therapeutic use ; Liver ; pathology ; Middle Aged ; Quality of Life

<b>OBJECTIVEb>To study the correlation of HBV genotypes to the response to PEG-interferon alpha (PEG-IFN) in chronic hepatitis B (CHB) patients.

<b>METHODSb>Real-time fluorescent PCR was used for HBV genotyping in 48 CHB patients, and the therapeutic effects of PEG-IFN and hepatic pathological changes were observed.

<b>RESULTSb>No obvious differences were noted in ALT and HBV DNA levels or negative rate for HBeAg between patients with genotypes B and C (P>0.05). The sustained response rate was significantly higher in genotype B than in genotype C patients 48 weeks o after the therapy.

<b>CONCLUSIONb>HBV genotype is the main factor for predicting PEG-IFN therapy response in CHB patients, and the sustained response rate is significantly higher in genotype B than in genotype C patients.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; DNA, Viral ; blood ; Female ; Genotype ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; genetics ; immunology ; Hepatitis B, Chronic ; blood ; drug therapy ; virology ; Humans ; Interferon-alpha ; therapeutic use ; Liver ; drug effects ; pathology ; virology ; Male ; Middle Aged ; Polyethylene Glycols ; therapeutic use ; Recombinant Proteins ; Young Adult

<b>OBJECTIVEb>To evaluate the effect of antiviral agents on intrahepatic HBV DNA and histology in HBeAg-positive chronic hepatitis B patients.

<b>METHODSb>Thirty-five patients were treated with lamivudine, 16 with interferon alfa (INF-alpha), 24 with sequential Lamivudine and INF-alpha. The total duration of therapy was 12 months. Intrahepatic HBV DNA was measured quantitatively by real-time polymerase chain reaction.

<b>RESULTSb>There was significant change in all parameters of the groups of patients at the end of treatment (P < 0.05). The patients treated with sequential treatment had slightly higher HBeAg seroconversion rate (38.1%) than that of the other patients (P=0.1352). The baseline levels of intrahepatic HBV DNA in the patients with HBeAg seroconversion or undetectable serum HBV DNA were significantly lower than that of the other patients (P < 0.05).

<b>CONCLUSIONb>Antiviral agents could effectively inhibit intrahepatic HBV DNA and improve hepatic histology. The patients with low baseline intrahepatic HBV DNA level may achieve better antiviral efficacy. Sequential treatment might produce high HBeAg seroconversion rate.

Adolescent ; Adult ; Antiviral Agents ; pharmacology ; therapeutic use ; DNA, Viral ; blood ; metabolism ; Drug Therapy, Combination ; Female ; Hepatitis B e Antigens ; immunology ; metabolism ; Hepatitis B, Chronic ; drug therapy ; immunology ; pathology ; virology ; Humans ; Interferon-alpha ; pharmacology ; therapeutic use ; Lamivudine ; pharmacology ; therapeutic use ; Liver ; drug effects ; metabolism ; pathology ; virology ; Male ; Middle Aged ; Time Factors

BACKGROUND/AIMS: Occult HBV infection can persist following HBsAg loss and be transmitted, but the virological features are not well defined. METHODS: Here we investigated 25 Korean patients who lost HBsAg during follow up, either spontaneously or subsequent to therapy. RESULTS: Whereas subtype adr (genotype C) was found in 96% of HBsAg positive patients, 75 % of patients who lost HBsAg spontaneously were seemed to be infected with the ayw subtype with sequence similar to genotype D. Mutations in the major hydrophilic region (MHR) of HBsAg were found in 7 patients who lost HBsAg spontaneously. The mutations include T123S, M125I/N, C139R, D144E, V177A, L192F, and W196L, some of which have not been reported before. Functional analysis via transfection experiments indicate that the C139R and D144E mutations drastically reduced HBsAg antigenicity, while the Y225del mutation found in one interferon-treated patient impaired HBsAg secretion. CONCLUSIONS: Lack of detectable HBsAg in patient serum could be explained by low level of ccc DNA in liver tissue, low antigenicity of the surface protein, or its secretion defect.
Adult ; Aged ; Amino Acid Sequence ; Antiviral Agents/therapeutic use ; DNA, Circular/*analysis ; Female ; Genotype ; Hep G2 Cells ; Hepatitis B/drug therapy/*pathology/virology ; Hepatitis B Surface Antigens/blood/*genetics/metabolism ; Hepatitis B virus/genetics/*metabolism ; Humans ; Liver/virology ; Male ; Middle Aged ; Molecular Sequence Data ; Mutation ; Remission, Spontaneous ; Republic of Korea ; Serotyping

<b>OBJECTIVEb>To explore the dynamics of hepatitis B virus covalently closed circular DNA (cccDNA) and optimal duration of treatment after serum virology response.

<b>METHODSb>HBV cccDNA in liver biopsies and the serum HBV DNA were quantified by real time PCR, the serum makers were detected by enzyme-linked immunosorbent assay.

<b>RESULTSb>(1) The cccDNA in biopsy samples continued to decrease after serum virology responded. (2) The longer the treatment after serum virology response, the lower the cccDNA level in liver tissue. (3) Anti-HBe positive patients had lower cccDNA in liver tissue than anti-HBe negative patients. (4) cccDNA in liver tissue was undetectable in 12 out of the 18 case anti-HBe(+) patients. Serum virology response lasted 35 months and anti-HBe(+) lasted 30 months.

<b>CONCLUSIONb>After serum virology responded, the longer the treatment, the lower the liver cccDNA. The cccDNA is undetectable in about 2/3 of the patients if the serum virological clearance lasts more than 35 months and anti-HBe lasts more than 30 months.

Adult ; Aged ; Antiviral Agents ; therapeutic use ; Biopsy ; DNA, Circular ; analysis ; DNA, Viral ; analysis ; blood ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; genetics ; Hepatitis B, Chronic ; blood ; drug therapy ; virology ; Humans ; Liver ; pathology ; virology ; Male ; Middle Aged ; Polymerase Chain Reaction ; methods ; Time Factors ; Viral Load ; Young Adult