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1.
Clin Gastroenterol Hepatol ; 7(8): 889-93, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19394445

RESUMO

BACKGROUND & AIMS: During the natural course of chronic hepatitis B virus infection, a small proportion of patients experience hepatitis B surface antigen (HBsAg) seroclearance. However, the long-term clinical outcomes of this process are not well established. METHODS: Thirty-five patients with chronic hepatitis B, followed between 1976 and 2008 at a community liver clinic, experienced HBsAg seroclearance. Ten patients were Caucasian and 25 were Asian. These patients continued to undergo surveillance for hepatocellular carcinoma that included test for alpha-fetoprotein levels and abdominal ultrasound examinations. The median follow-up time was 185 months (range, 27-400 months). RESULTS: During the initial visit to the clinic, the median age of the patients was 41 years (range, 1.5-72 years). Eighteen patients (51.4%) were hepatitis B e antigen (HBeAg) positive 25 (71.4%) were hepatitis B virus DNA positive, and 13 (37.1%) had cirrhosis. At the time of HBsAg loss, the median age was 54 years (range, 13-77 years) and all were hepatitis B e antigen- as well as hepatitis B virus DNA negative. During the long-term follow-up, 4 patients with cirrhosis developed hepatocellular carcinoma (HCC), which was discovered by ultrasound examination. Factors associated with development of HCC were low baseline levels of albumin (P = .04), family histories of HBsAg positivity (P = .01) and HCC (P = .04), and age of less than 50 years at the time of HBsAg clearance (P = .03). CONCLUSIONS: HCC can still develop after HBsAg seroclearance. Thus, surveillance should be continued after HBsAg loss in the same manner as for HBsAg positive patients.


Assuntos
Carcinoma Hepatocelular , Antígenos de Superfície da Hepatite B/sangue , Hepatite B Crônica/complicações , Abdome/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Adulto Jovem , alfa-Fetoproteínas/análise
2.
J Dig Dis ; 17(2): 113-21, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26749171

RESUMO

OBJECTIVE: Due to high sustained virological response (SVR) rates, sofosbuvir-based regimens are currently a mainstay for hepatitis C virus (HCV) therapies. The addition of pegylated interferon (PEG-IFN) and ribavirin impacts patients' quality of life during treatment. This study aimed to compare severe adverse events (SAEs) amongst therapeutic combinations for HCV in a community clinic setting. METHODS: From December 2013 to July 2014, 128 chronic HCV-infected patients were treated with sofosbuvir, ribavirin and weekly PEG-IFN for 12 weeks (cohort 1), 12 or 24 weeks of sofosbuvir and ribavirin (cohorts 2 and 3) or sofosbuvir plus simeprevir for 12 weeks (cohort 4). Adverse events were recorded from baseline to 12 or 24 weeks of treatment. RESULTS: SAEs appeared in 15.6-53.8% of ribavirin-inclusive treated patients compared to 4.8% of the ribavirin-free regimen. PEG-IFN, sofosbuvir plus ribavirin had the highest frequencies of fatigue, headache and rash compared to either 12 or 24 weeks of ribavirin and sofosbuvir. However, sofosbuvir and ribavirin regimens led to significant increases in dyspnea, need for ribavirin dose reductions and withdrawal from treatment due to SAEs. Anemia was also more frequent in ribavirin-inclusive combinations (P < 0.001). Conversely, sofosbuvir plus simeprevir reached similar SVR rates at week 12 post-treatment compared to all ribavirin-containing regimens, but with significantly fewer adverse events (P = 0.006). At week 12 post-treatment, cirrhotic patients experienced a higher virological relapse rate than non-cirrhotic patients (P = 0.019). CONCLUSIONS: Ribavirin-inclusive HCV therapies increased the frequencies of SAEs, had higher dropout rates and increased patient morbidity.


Assuntos
Antivirais/efeitos adversos , Hepatite C Crônica/tratamento farmacológico , Ribavirina/efeitos adversos , Sofosbuvir/efeitos adversos , Idoso , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Serviços de Saúde Comunitária , Esquema de Medicação , Quimioterapia Combinada , Feminino , Hepatite C Crônica/virologia , Humanos , Interferon-alfa/administração & dosagem , Interferon-alfa/efeitos adversos , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Ribavirina/administração & dosagem , Ribavirina/uso terapêutico , Sofosbuvir/administração & dosagem , Sofosbuvir/uso terapêutico , Resposta Viral Sustentada , Resultado do Tratamento
3.
Hepatol Int ; 9(4): 567-77, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26219830

RESUMO

BACKGROUND AND AIMS: The progression of HBsAg-positive chronic hepatitis is insidious and unpredictable. Identification of factors leading to either a benign or more serious clinical outcome may assist in decision making for antiviral therapy. METHODS: From 1989 to 1998, 130 untreated patients with chronic hepatitis were enrolled in a prospective study and followed every 3-6 months with liver and virologic tests, platelet counts and alpha-fetoprotein (AFP) measurements. RESULTS: During a mean follow-up of 107 ± 86 months, 16 (12.3 %) chronic hepatitis patients progressed to cirrhosis (annual rate 1.4 %), and 23 (17.7 %) reverted to being inactive carriers (annual rate 2.1 %). Compared to baseline values, chronic hepatitis patients who progressed to cirrhosis exhibited declines in mean platelet counts (225.7-195.2 mm(3), p = 0.008-0.04) during the first 4 years of follow-up, while those who reverted to being inactive carriers had substantial reductions in mean levels of AST (83.5-27.2 u/l, p < 0.001-0.002) and ALT (100.2-29.2 u/l, p < 0.001-0.007). In addition, during spontaneous alanine aminotransferase (ALT) flares, patients progressing to cirrhosis had concomitant elevations of AFP levels, while patients who became inactive carriers maintained normal AFP values during ALT flares (13.45 vs. 4.65 ng/ml, p = 0.001). These AFP differences during episodes of ALT flares were similarly observed when analyzed in two separate cohorts of cirrhosis and inactive carrier patients. CONCLUSION: Patients with chronic hepatitis who progressed to cirrhosis exhibited declines in platelet counts and had AFP elevations during ALT flares. To prevent progression, serial measurements of these parameters during the chronic hepatitis stage will assist in identifying patients requiring antiviral therapy.


Assuntos
Previsões , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Hepatite B Crônica/diagnóstico , Cirrose Hepática/etiologia , Adulto , DNA Viral/análise , Progressão da Doença , Feminino , Seguimentos , Vírus da Hepatite B/genética , Hepatite B Crônica/complicações , Hepatite B Crônica/virologia , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Masculino , Estudos Prospectivos , alfa-Fetoproteínas/metabolismo
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