Prevalence of HCV infection has decreased in both the BD and HD population. However it remains high in IVDU population. GT-1 remains the most common in the HD population; however, GT-3 infection is now more common among the BD population in Singapore. IL28B - CC is the predominant variant among the HCV - infected individuals in Singapore.

AIMTo evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis.METHODSWe used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality.RESULTSWe identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years (range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients (71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death (OR = 5.39, 95%CI: 1.85-15.71).CONCLUSIONSevere hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.

Background and aim: Conventional hepatitis C treatment using pegylated interferon (PEG-IFN) and ribavirin is associated with significant side effects. IL28B polymorphism can predict response to treatment, with CC genotype having a better response. ITPA gene deficiency protects against clinically significant anaemia induced by treatment. The purpose of this study was to determine IL28B polymorphism and ITPA variation among hepatitis C genotype 1 patients who have undergone therapy with PEG-IFN and ribavirin and their association with sustained viral response (SVR). Methods: All hepatitis C genotype 1 patients who had been treated with PEG-IFN and ribavirin over the past 10 years were identified by available medical records and were contacted by letter of invitation to participate in the study. Blood samples for IL28B and ITPA genotyping were obtained. Medical records were reviewed for verification of treatment response, development of anaemia and if treatment reduction was required during the treatment. Results: A total of 61 patients with hepatitis C genotype 1 were treated with PEG-IFN and ribavirin, of whom 42 agreed to participate in the study. Mean age was 45.6±12.9 years at time of treatment, and 83.3% of patients were males. Thirty-three (78.6%) had IL28B CC genotype, of whom 25 (75.8%) obtained SVR compared with only 3 of 9 (33.3%) non C/C genotype patients who achieved SVR (P=0.041). Eleven (26.1%) patients had ITPA AC genotype, and 30 (71.4%) had CC genotype. There was no statistically significant difference between ITPA AC and CC genotypes in predicting clinically significant anaemia (45.5% vs 63.3%, P=0.302). Even among patients who developed anaemia, 70.8% still managed to achieve SVR. Treatment reduction also had no impact on SVR. Conclusion: Hepatitis C genotype 1 patients should be informed of the response rate for treatment with PEG-IFN and ribavirin in a population with favourable IL28B genotype before consideration of newer therapeutic options.

Alpha-fetoprotein (AFP) is the most established biomarker for surveillance of hepatocellular carcinoma (HCC) in at-risk individuals. However, its sensitivity and specificity are not very satisfactory. 1 Protein induced by vitamin K absence or antagonist-II (PIVKA-II) is a newer biomarker for HCC but without a widely established cut-off. 2,3 Recent data suggested that the cut-off may be different for HCC due to chronic hepatitis C (CHC) and chronic hepatitis B (CHB) infection. 4 Two different reference intervals (RIs), Japan and European Union (EU), are provided in the assay kit (Architect PIVKA-II, Abbott Laboratories, Chicago, US). 5 In Singapore, CHB is the most prevalent association with HCC. 6 Hence, we studied the distribution of PIVKA-II to determine which RI was more applicable to our Singapore patients. We also examined for significant associations between HCC and PIVKA-II alone, AFP alone, and the combination of both PIVKA-II and AFP.Study subjects had blood drawn on the day of their 6-monthly HCC surveillance ultrasound for up to a maximum of 3 visits. PIVKA-II, AFP (Abbott Laboratories, Chicago, US) and AFP (Roche Elecsys; Roche Diagnostics, Basel, Switzerland) were assayed at the same time. Ultrasound and blood results were reviewed by a clinician. Suspicious lesions were investigated and HCC was diagnosed in accordance with international guidelines. Patient consent was obtained. SingHealth Centralised Institutional Review Board approved the study (reference CIRB 2017/2577).Six hundred and ten patients in our HCC surveillance programme, who were without HCC for the prior 12 months, were enrolled. Majority were males (60.7%). Median age was 62 years (interquartile range [IQR] 55-69). Most had CHB (89.5%), of which 59.6% were on antiviral treatment with good control of the disease in 98.8%. Baseline median levels of alanine transaminase and aspartate transaminase of the cohort were 22U/L (IQR 17.0-32.0) and 25U/L (IQR 22.0-32.0), respectively. Median follow-up was 12.2 months, with 632 patient-years. About half (54.4%) had the second and 19.2% the third visit blood specimens taken.

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