Background & Aims Data from Europe and North America have been published regarding the risk of developing hepatocellular carcinoma (HCC) after treatment with direct antiviral agents (DAA). We proposed to evaluate cumulative incidence and associated risk factors for de novo HCC. Methods This was a prospective multicentre cohort study from Latin America including 1400 F1‐F4‐treated patients with DAAs (F3‐F4 n = 1017). Cox proportional regression models (hazard ratios, HR and 95% CI) were used to evaluate independent associated variables with HCC. Further adjustment with competing risk regression and propensity score matching was carried out. Results During a median follow‐up of 16 months (IQR 8.9‐23.4 months) since DAAs initiation, overall cumulative incidence of HCC was 0.02 (CI 0.01; 0.03) at 12 months and 0.04 (CI 0.03; 0.06) at 24 months. Cumulative incidence of HCC in cirrhotic patients (n = 784) was 0.03 (CI 0.02‐0.05) at 12 months and 0.06 (CI 0.04‐0.08) at 24 months of follow‐up. Failure to achieve SVR was independently associated with de novo HCC with a HR of 4.9 (CI 1.44; 17.32), after adjusting for diabetes mellitus, previous interferon non‐responder, Child‐Pugh and clinically significant portal hypertension. SVR presented an overall relative risk reduction for de novo HCC of 73% (CI 15%‐91%), 17 patients were needed to be treated to prevent one case of de novo HCC in this cohort. Conclusions Achieving SVR with DAA regimens was associated with a significant risk reduction in HCC. However, this risk remained high in patients with advanced fibrosis, thus demanding continuous surveillance strategies in this population.

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<p>A infecção pelo vírus da hepatite B (HBV) é um dos mais sérios problemas de saúde pública no mundo. Estima-se que existam, aproximadamente, 350 milhões de portadores crônicos desse vírus distribuídos em várias regiões do mundo. O HBV é um vírus envelopado pertencente à família Hepadnaviridaee cujo material genético é armazenado sobre a forma de DNA dupla fita. É transmitido, principalmente, pelas vias parenteral e sexual.O curso natural da hepatite B pode ser dividido em três fases: imunotolerante, imunoativa e não replicativa. O vírus secreta três tipos de antígenos (AgHBs, AgHBc e AgHBe) que, juntamente, com seus respectivos anticorpos, ajudam no diagnóstico da doença e na identificação de suas fases. As respostas imunes humoral e celular estão envolvidas na eliminação do vírus e na cura da infecção aguda. Embora não seja um vírus citopático, os mecanismos de defesa desencadeados produzem agressão ao fígado e, como consequência, lesões hepáticasnecroinflamatórias. Diversas síndromes extra-hepáticas são associadas com a infecção crônica pelo HBV e contribuem, significantemente, para a morbidade e mortalidade. As principais síndromes são a poliarterite nodosa e a glomerulonefrite. Objetivo: o objetivo deste trabalho foi reunir informações sobre a hepatite B. Metodologia: para isso, foi realizada uma revisão bibliográfica com as palavras chaves: hepatite B, diagnóstico, imunologia e manifestações extra-hepáticas; na base de dados do Portal de Periódicos da CAPES e Pub Med, em artigos publicados no período de 2006 a 2011 e selecionados os artigos mais relevantes. Alguns artigos, publicados antes de 2006, também foram acrescidos na revisão por se mostrarem pertinentes. Resultados: foram selecionados vinte e cinco (25) artigos, os quais foram usados nesta revisão. Conclusão: apesar de toda a gama de informações sobre a hepatite B, ainda se faz importante que novos estudos sejam realizados para que se possa entender melhor os complexos mecanismos imunopatogênicos da infecção. </p>

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HDV infection still remains a serious public health problem in Amazonia. There are few data regarding the biomolecular aspects of HBV/HDV co-infection in this region. We studied 92 patients HBsAg(+) /anti-HDV IgG(+) followed at the Hepatitis Referral Centers of Porto Velho (RO), Rio Branco and Cruzeiro do Sul (AC), Brazil, from March 2006 to March 2007 for whom the HDV and/or the HBV genotype could be determined. The HDV genotype could be determined in 90 patients, while the HBV genotypes could be positively determined in 74. HBV subgenotype F2 is the most prevalent (40.2%), followed by the subgenotypes A1 (15.2%) and D3 (8.7%), while 16.4% were other subgenotypes or genotypes, 4.3% were discordant and 15.2% were unamplifiable. Surprisingly, HDV genotype 3 (HDV-3) was found in all of the HBV/HDV-infected patients that could be genotyped for HDV, confirming that HDV-3 can associate with non-F HBV genotypes. However, a HDV-3 mutant was found in 29.3% of patients and was more frequently associated with non-F HBV genotypes (P < 0.001) than were nonmutant strains, suggesting that the mutation may facilitate association of HDV-3 with non-F HBV genotypes.

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Introduction and Objectives Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. Patients We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. Results Overall, 4.6%(CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1(CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001). Conclusions SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.