Optimal management of chronic hepatitis B patients receiving nucleos(t)ide analogues

Buti, María; Roade, Luisa; Riveiro‐Barciela, Mar; Esteban, Rafael

doi:10.1111/liv.14367

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…However, some reports indicate that TDF might lead to a higher incidence of AKI compared to ETV in CHB patients [28,29]. As AKI is common in ACLF [30], renal injury associated with TDF use has raised some concerns [31]. However, in this single-center study, we found that the use of TDF did not increase the risk of AKI within one month of treatment.…”

Section: Discussioncontrasting

confidence: 57%

The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment

Zhang

Lin

Wang

et al. 2020

BioMed Research International

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Aims. Tenofovir (TDF) is an antiviral drug with potential risk of kidney injury. The study is aimed at comparing the incidence of acute kidney injury (AKI) between TDF and entecavir (ETV) treatment in hepatitis B virus- (HBV-) related acute on chronic liver failure (ACLF). Methods. Treatment-naive patients with HBV-related ACLF were included. Propensity score matching was used to balance the baseline characteristics between ETV and TDF groups. The risk of AKI and the efficacy of TDF and ETV were compared. Results. A total of 95 cases with HBV-related ACLF were included in this study, with 74.74% of male and a mean age of 47.01±14.71 years. The antiviral therapy was initiated within 2 days after admission, with 39 cases on the TDF group and 56 on the ETV group. Patients in the TDF group had higher AST, hemoglobin, and serum sodium levels and lower MELD-Na score. After propensity matching, 39 cases of TDF and 39 of ETV were included in the final analysis. No difference was found in the changes of creatinine and cystatin C from baseline to 4 weeks after treatment between ETV and TDF groups. AKI was developed in 1 (2.56%) patient in the ETV group and 2 (5.13%) in the TDF group within one month (P=0.556). Survival analysis revealed no significant difference in the 6-month mortality between the two groups (P=0.813). Cox analysis showed that the type of antiviral drug or the development of AKI was not an independent risk factor for the outcomes. Conclusions. Compared to ETV, TDF did not increase the risk of AKI nor the mortality in patients with HBV-related ACLF in the short time.

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Section: Discussioncontrasting

confidence: 57%

The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment

Zhang

Lin

Wang

et al. 2020

BioMed Research International

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“…HBV infection remains a global health concern due to its high incidence and mortality rates. According to the estimates made by the World Health Organization (WHO) in 2016, there were ~292 million individuals infected with HBV worldwide (7). There is sufficient evidence to indicate that CHB is a major cause of liver failure and hepatocellular carcinoma (8,9).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of tenofovir alafenamide fumarate in nucleoside analogue treatment-naïve patients with chronic hepatitis B

Chen¹,

Wei

Jin

et al. 2021

Exp Ther Med

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Tenofovir alafenamide fumarate (TAF) is a first-line drug for the antiviral treatment of patients with chronic hepatitis B (CHB) in China. In the present study, the efficacy and renal safety of TAF were evaluated in treatment-naive patients with CHB. Patients with CHB who had not been previously treated with nucleoside analogues (NAs) were recruited before TAF treatment was initiated. Changes in the levels of hepatitis B virus (HBV) DNA, hepatitis B e antigen (HBeAg) and hepatitis B surface antigen (HBsAg) were analyzed at 24 and 48 weeks using immunoassays. In addition, liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were analyzed using transient elastography, while alanine aminotransferase (ALT), triglyceride (TG), total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) levels, calcium (Ca) and inorganic phosphorus (IP) levels were measured using biochemistry assay. In addition, the estimated glomerular filtration rate (eGFR) was calculated. After 48 weeks, the ALT normalization rate was 95.24% (40/42), the complete virological response (HBV DNA <20 IU/ml) rate was 69.05% (29/42) and the HBeAg seroconversion rate was 8.57% (3/35). The levels of HBV DNA and HBsAg were significantly decreased from the baseline at 5.49±1.95 to 1.26±0.66 log 10 IU/ml and from 3.59±0.81 to 3.32±0.55 log 10 IU/ml after 48 weeks of treatment, respectively. Compared with that in the baseline measurements, LSM at 48 weeks was significantly decreased from 13.00±8.15 to 8.66±4.45 kPa. No significant differences were observed in the TG, TC, LDL-C, CAP, eGFR, Ca and IP measurements. According to the baseline ALT levels, patients were divided into group A [ALT ≤1 x upper limit of normal (ULN); ULN=50 U/l; n=21], group B (1 x ULN < ALT <2 x ULN; n=22) and group C (ALT ≥2 x ULN; n=18). A significant decrease in HBsAg levels was observed in group B (3.63±0.68 vs. 3.53±0.63 log 10 IU/ml) and group C (4.15±0.57 vs. 3.66±0.48 log 10 IU/ml) at 24 weeks compared with the baseline. In conclusion, TAF was found to be effective and safe in NA treatment-naive patients with CHB. Moreover, the higher the ALT levels, the more prominent the curative effect from TAF treatment. Therefore, NA treatment-naive CHB patients could benefit from TAF treatment in real world.

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“…Fourth, antiviral treatment has been demonstrated to prevent cirrhosis, liver failure and HCC [6]. One third of the patients in our cohort were under antiviral treatment at the end of follow-up.…”

Section: Plos Onementioning

confidence: 92%

“…Clinical manifestations of chronic HBV infection are broad, ranging from minimal inflammatory activity and fibrosis to active hepatitis with progressive fibrosis, cirrhosis, decompensated liver disease and/or HCC. Sustained HBV replication and liver injury are well-known risk factors for the development of HCC and treatment with nucleos(t)ide analogues does not eliminate the risk of HCC [6]. Thus, new antiviral strategies targeting different steps of the viral life cycle and the host immune response are currently being pursued, with the aim to reach HBV cure [7].…”

Section: Introductionmentioning

confidence: 99%

Demographics and outcomes of hepatitis B and D: A 10-year retrospective analysis in a Swiss tertiary referral center

et al. 2021

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Background Hepatitis B virus (HBV) is a major global health challenge with approximately 250–350 million chronically infected individuals. An improved understanding of the demographic features and outcomes of chronic HBV infection and hepatitis D virus (HDV) infection in low-endemic areas may improve prevention, early identification and management both at individual and community levels. Here, we retrospectively analyzed the demographic and clinical characteristics, treatment rates and outcomes of adult patients with chronic HBV infection with or without HDV coinfection examined at Lausanne University Hospital, Switzerland over a 10-year period. Methods We analyzed the medical records of all adult patients with chronic HBV and HDV infection examined in our center between 2007 and 2016. Liver-related outcome was defined as the occurrence of cirrhosis, hepatocellular carcinoma, liver transplantation or liver-related death. Analyses were performed using logistic regression and results were reported as odds ratio (OR) and 95% confidence interval (CI). Results Of 672 consecutive patients, 421 (62.6%) were male, median age was 36 years (interquartile range, 28–46 years), and 233 (34.7%) were of African origin. The prevalence of HDV coinfection was 7.1% and the proportion of anti-HDV-positive patients with detectable HDV RNA was 70.0%. In multivariate analysis, HDV coinfection was the strongest predictor for liver-related outcome (OR 6.06, 95% CI 2.93–12.54, p<0.001), followed by HBeAg positivity (OR 2.47, 95% CI 1.30–4.69, p = 0.006), age (OR per 10-year increase 2.03, 95% CI 1.63–2.52, p<0.001) and sex (OR for female 0.39, 95% CI 0.22–0.71, p = 0.002). The predictive accuracy of the multivariate model was high (receiver operator characteristic area under the curve 0.81). Conclusion This retrospective study underscores the importance of migration in the epidemiology of chronic hepatitis B in low-endemic areas. HDV coinfection, HBeAg positivity and age predicted liver-related outcomes while female sex had a protective effect.

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Optimal management of chronic hepatitis B patients receiving nucleos(t)ide analogues

Cited by 15 publications

References 33 publications

The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment

The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment

Efficacy and safety of tenofovir alafenamide fumarate in nucleoside analogue treatment-naïve patients with chronic hepatitis B

Demographics and outcomes of hepatitis B and D: A 10-year retrospective analysis in a Swiss tertiary referral center

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