Patterns of managing chronic hepatitis B treatment-related drug resistance: a survey of physicians in Mainland China, South Korea, Taiwan, and Thailand

Chainuvati, Siwaporn; Cheng, Jun; Hou, Jin; Hsu, Chao‐Wei; Jia, Ji Dong; Komolmit, Piyawat; Kwon, So Young; Lee, Chang Hong; Li, Hong; Liu, Ying; Liu, Chun‐Jen; Neo, Boon Leong; Peng, Cheng Yuan; Tanwandee, Tawesak; Wongcharatrawee, Suchat; Wu, Jaw Ching; Yu, Ming; Zhang, Xin Xin

doi:10.1007/s12072-009-9139-9

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…15 Hence, most of the participants used ALT in combination with HBV DNA to identify the resistance while in the study from Singapore study, HBV DNA was used most commonly for this purpose. 23 In a drug resistance management survey among physicians in China, South Korea, Taiwan and Thailand 23 add-on ADV therapy approach was commonly used in case of LAM resistance while in present study maximum participant switched the patient to ETV therapy (31.8%) followed by TDF therapy (22.3%). In a study from Taiwan, 40% participants switched patients to ETV in case of ADV resistance 23 which is comparable to our study (30.7%).…”

Section: Discussionmentioning

confidence: 69%

Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan

Hafeez¹,

Butt²,

Ahmed³

2018

Journal of Clinical and Experimental Hepatology

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Background: In Pakistan, approximately 4.5 million people are afflicted with chronic hepatitis B (CHB). The compliance with hepatitis B virus (HBV) management guidelines is still unknown. This was the first study from Pakistan in which the knowledge and practices of treating physicians were compared with three standardized guidelines (Asia Pacific Association for the Study of the Liver (APASL) 2012/European Association for the Study of the Liver (EASL) 2012/American Association for the Study of Liver Diseases (AASLD) 2009). Methods: A crosssectional study was conducted during 2014-2015 at four tertiary care teaching hospitals of Karachi, Pakistan. The study participants were internists, gastroenterologist, senior residents who were involved in the management of CHB patients. All participants were offered to fill the study questionnaire. Results: A total of 179 physicians (103 residents, 76 consultants) participated. Mean age of participant was 35 AE 9.3 years. Approximately one-third of them followed AASLD (27.3%) and EASL (24.0%) guidelines. Entecavir, tenofovir or Peg IFN 1 2a were considered as first line therapy by 43%, 38.5% and 30.2% respectively. However, 17.9% preferred entecavir with tenofovir for rescue therapy, 25.7% and 23.5% preferred tenofovir or entecavir as both first line and rescue therapy respectively. Serum HBV DNA, alanine transaminase levels were used to monitor during oral antivirals therapy by 45.3%. hepatocellular carcinoma screening was considered for all HBV cases by 51.4% using ultrasound (55.3%) and alfa fetoprotein (52.5%) every 6 months. Overall 40.2% participants had poor knowledge about indication of liver biopsy, treatment initiation and antiviral prophylaxis. Significant association was found between grades of knowledge and gender, age group, designation and specialty (P < 0.05). Younger physicians, consultants (age 25-40 years) and those who were practicing gastroenterology/hepatology were more likely to have higher knowledge scores in compliance with the guidelines as compared to others. Conclusion: Our study highlighted the gaps in knowledge and practices in managing CHB patients according to guidelines. Efforts to improve knowledge, refresher courses and appropriate coordination between gastroenterologists and internal medicine physicians could enable management and follow-up of patients with CHB effectively.

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Section: Discussionmentioning

confidence: 69%

Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan

Hafeez¹,

Butt²,

Ahmed³

2018

Journal of Clinical and Experimental Hepatology

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“…These findings were in contrast to the two previous reports of Chinese cohorts[ 36 , 46 ] which showed that any mutations were not found within both regions. This findings may partially provide a likely explanation for why relapse after antiviral therapy is so prevalent in Korean patients[ 48 ] and also suggest that these patients should be treated with newer NAs, such as tenofovir (TDF), which is very potent and has a high genetic barrier to antiviral resistance.…”

Section: Discussionmentioning

confidence: 99%

Naturally occurring mutations in the reverse transcriptase region of hepatitis B virus polymerase from treatment-naïve Korean patients infected with genotype C2

Kim¹,

Lee²,

Kim³

et al. 2017

WJG

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AIMTo report naturally occurring mutations in the reverse transcriptase region (RT) of hepatitis B virus (HBV) polymerase from treatment naïve Korean chronic patients infected with genotype C2.METHODSHere, full-length HBV reverse transcriptase RT sequences were amplified and sequenced from 131 treatment naïve Korean patients chronically infected with hepatitis B genotype C2. The patients had two distinct clinical statuses: 59 patients with chronic hepatitis (CH) and 72 patients with hepatocellular carcinoma (HCC). The deduced amino acids (AAs) at 42 previously reported potential nucleos(t)ide analog resistance (NAr) mutation positions in the RT region were analyzed.RESULTSPotential NAr mutations involving 24 positions were found in 79 of the 131 patients (60.3%). Notably, AA substitutions at 2 positions (rt184 and rt204) involved in primary drug resistance and at 2 positions (rt80 and rt180) that functioned as secondary/compensatory mutations were detected in 10 patients (1 CH patient and 9 HCC patients) and 7 patients (1 CH and 6 HCC patients), respectively. The overall mutation frequencies in the HCC patients (3.17%, 96/3024 mutations) were significantly higher than the frequencies in the CH patients (2.09%, 52/2478 mutations) (P = 0.003). In addition, a total of 3 NAr positions, rt80, rt139 and rt204 were found to be significantly related to HCC from treatment naïve Korean patients.CONCLUSIONOur data showed that naturally occurring NAr mutations in South Korea might contribute to liver disease progression (particularly HCC generation) in chronic patients with genotype C2 infections.

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“…Currently, there are two types of therapy for chronic hepatitis B: interferon therapy and NA therapy. NAs are widely used in Asian counties also in Thailand[ 25 ]. There are eight known genotypes of hepatitis B (A-H) variably present in different geographical location and ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Nucleos(t)ide analogues treatment outcome in genotype B and C chronic hepatitis B

Aung

Leowattana

Tangpukdee

et al. 2010

NAJMS

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Background:Hepatitis B genotypes influence the course and severity of the disease.Aim:To compare the treatment outcome of chronic hepatitis B genotype B and C patients after treating with nucleos(t)ide analogues for six months.Patients and Methods:Forty chronic hepatitis B patients attending the liver clinic of Hospital for Tropical diseases, Bangkok, were studied in retrospective cohort design. Six genotype B patients (15%) and thirty-four genotype C patients (85%) were treated. Serum hepatitis B viral load, serum alanine amino transferase level, HBeAg status and alpha-feto protein level were measured at the time of starting nucleos(t) analogues therapy, and six months later. Besides, achievement of undetectable viral load was assessed in patients with normal serum alanine amino transferase compared to patients with high serum alanine amino transferase level.Results:After six months of nucleos (t) analogues treatment, achievement of undetectable hepatitis B viral load was higher in genotype B patients (66.7%) than in genotype C patients (42.4%) (Relative Risk=1.57, 0.79-3.14). Biochemical remission, HBeAg seroconversion and tumor marker levels between the two groups were not significantly different. Moreover, achievement of undetectable hepatitis B viral load was significantly higher in normal alanine amino transferase level (75%) than in patients with high serum alanine amino transferase level (33.3%) on nucleos(t)ide analogue treatment (Relative Risk=2.25, 1.20- 4.20).Conclusion:Chronic hepatitis B treatment outcome between genotype B and C were not significantly different. Patients with normalized serum alanine amino transferase level tend to achieve undetectable viral load after nucleoside analogues treatment.

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Patterns of managing chronic hepatitis B treatment-related drug resistance: a survey of physicians in Mainland China, South Korea, Taiwan, and Thailand

Cited by 9 publications

References 20 publications

Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan

Management of Chronic Hepatitis B: Knowledge and Practices of Physicians in Pakistan

Naturally occurring mutations in the reverse transcriptase region of hepatitis B virus polymerase from treatment-naïve Korean patients infected with genotype C2

Nucleos(t)ide analogues treatment outcome in genotype B and C chronic hepatitis B

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