Time to decompensated cirrhosis and hepatocellular carcinoma after an HBV or HCV notification: A population-based study

Alavi, Maryam; Law, Matthew; Grebely, Jason; Amin, Janaki; Hajarizadeh, Behzad; George, Jacob; Dore, Gregory J.

doi:10.1016/j.jhep.2016.06.025

Cited by 30 publications

(43 citation statements)

References 36 publications

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“…Moreover, the Netherlands is a low HBV endemic country with no nationwide screening program and subsequent unawareness among both patients and physicians. A long observed lag time between HBV infection and HBV diagnosis was recently described in an Australian study, demonstrating a median duration between HBV diagnosis and DC of 0.8 (IQR 0‐3.5) years in 2001‐2002, increasing to 7.3 (0.8‐11.9) years in 2011‐2012. In addition, in that study, 64% had a late diagnosis of HBV (ie, <2 years between HBV diagnosis and DC or HCC) in 2001‐2002, which decreased to 31% in 2011‐2012.…”

Section: Discussionsupporting

confidence: 89%

“…In the combined cohorts, those with liver-related mortality were aged older (median 44 [IQR 40-53] vs 37 [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] years, P < 0.0001), were more often male (46 [90%] vs 1558 [77%], P = 0.03), and had higher vs 43 , P < 0.0001) at baseline, compared to those without liver-related mortality. Moreover, they had higher incidences of HCV coinfection (8 [ In coinfected subjects, no difference in baseline HIV RNA was observed in those with liver-related mortality vs those with other causes of mortality, while significantly lower baseline CD4 counts (212 [130-420] vs 347 , P = 0.05) were observed in those with liver-related mortality.…”

Section: Frequencies Of Liver Disease and Mortality In The Study Pomentioning

confidence: 99%

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Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono‐infection

Lieveld

Smit

Richter

et al. 2018

Liver International

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Background & Aims HIV/hepatitis B virus (HBV) coinfected subjects are thought to have faster progression to end‐stage liver disease (ESLD) than HBV mono‐infected subjects. We assessed whether this remains in the current cART‐era. Methods Data from subjects with follow‐up completion post‐2003 were compared between HIV/HBV coinfected subjects in the Dutch HIV Monitoring database and HBV mono‐infected subjects from two centres. The primary outcomes of composite ESLD included portal hypertension, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver‐related mortality. Outcomes were analysed using time‐dependent cause‐specific Cox regression models adjusted for follow‐up time and relevant covariates. Subset‐analyses were done in subjects with follow‐up pre‐2003. Results In the 1336 co‐ vs 742 mono‐infected subjects, coinfected subjects had no increased probability for ESLD compared to mono‐infected subjects (cHR 0.7 (95% CI 0.4‐1.1), but had increased probabilities for all‐cause (cHR 7.4 [4.9‐11.1]) and liver‐related mortality (cHR 3.4 [1.6‐7.5]). In the current combined cohort, treatment with tenofovir or entecavir was inversely associated with ESLD, all‐cause and liver‐related mortality (cHR 0.4 [95% CI 0.3‐0.7], cHR 0.003 [0.001‐0.01]), cHR 0.007 [0.001‐0.05]). Other predictors for ESLD were older age, being of Sub‐Sahara African descent, increased alanine aminotransferase levels and hepatitis C virus coinfection. While the probability for all‐cause mortality was increased in coinfected subjects, this rate decreased compared to pre‐2003 (HR 40.2 (95% CI: 8.7‐186.2). Conclusions HIV/HBV coinfected patients no longer seem to be at increased risk for progression to ESLD compared to HBV mono‐infected patients, likely due to widespread use of highly effective cART with dual HBV and HIV activity.

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Section: Discussionsupporting

confidence: 89%

Section: Frequencies Of Liver Disease and Mortality In The Study Pomentioning

confidence: 99%

Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono‐infection

Lieveld

Smit

Richter

et al. 2018

Liver International

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“…Late notification increases the risk of decompensated cirrhosis and hepatocellular carcinoma. 421 Further, there is cultural resistance in migrant populations to accepting dietary and health advice from health service providers. 422 The price of drug treatment and medical services that are not supported by the Pharmaceutical Benefits Scheme represents another barrier to tackling the burden of liver disease-eg, new obesity drugs such as naltrexone-bupropion.…”

Section: The Lancet Gastroenterology and Hepatology Commissionmentioning

confidence: 99%

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Sarin

Kumar

Eslam

et al. 2020

The Lancet Gastroenterology & Hepatology

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389

303

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The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region. 168 www.thelancet.com/gastrohep Vol 5 February 2020The Lancet Gastroenterology & Hepatology Commission accounted for 108 276 (8·2%) of the total liver-related deaths in the region in 2015, compared with 929 (1·2%) of 72 437 in the USA and 4032 (0·3%) of 197 179 in Europe. Deaths in the Asia-Pacific region represented three-quarters of the global total number of deaths due to acute viral hepatitis. In 2015, the region accounted for three-quarters of the global total number of deaths related to acute HBV, almost two-thirds of those due to acute hepatitis A infection, and almost 80% of those due to acute hepatitis E infection. Of all deaths du...

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“…Both nonbleeding and bleeding oesophageal varices episodes were identified via the presence of discharge diagnoses codes (using International Classification of Disease (ICD10); see Table S1) in the same data source. These codes have been used extensively in previous research by ourselves and others . Note that discharge diagnoses are entered for day‐cases as well as for inpatient admissions.…”

Section: Methodsmentioning

confidence: 99%

Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005‐2016: a national database linkage study

McDonald

Barclay

Hutchinson

et al. 2019

Aliment Pharmacol Ther

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Summary Background Primary measures for preventing morbidity and mortality associated with bleeding gastroesophageal varices in cirrhotic patients include endoscopic screening. Aim To identify factors associated with (a) screening and (b) first hospital admission for variceal bleeding among cirrhotic hepatitis C virus (HCV) patients attending specialist care in Scotland. Methods The Scottish Hepatitis C Clinical Database was linked to national hospitalisation and deaths records to identify all chronic HCV patients diagnosed with compensated cirrhosis in 2005‐2016 (n = 2741). The adjusted odds of being screened by calendar year period were estimated using logistic regression, and the adjusted hazard ratio (HR) of a first variceal bleed using Cox regression. Results About 34% were screened within the period starting 12 months before and ending 12 months after cirrhosis diagnosis. The proportion screened was stable in 2005‐2010 at 42%, declining to 37% in 2011‐2013 and 26% in 2014‐2016. Odds of screening were decreased for age‐groups <40 (OR = 0.61, 95% CI: 0.48‐0.77) and 60+ years (OR = 0.67, 95% CI: 0.48‐0.94), history of antiviral therapy (OR = 0.70, 95% CI: 0.55‐0.89), and cirrhosis diagnosis in 2014‐2015, compared with 2008‐2010 (OR = 0.67, 95% CI: 0.52‐0.86). Compared with 2008‐2010, there was no evidence for an increased/decreased relative risk of a first variceal bleed in any other period, but viral clearance was associated with a lower risk (HR = 0.56, 95% CI: 0.32‐0.97). Conclusions Overall screening uptake following cirrhosis diagnosis was low, and the decline in recent years is of concern. The stable bleeding risk over time may be attributable both to ongoing prevention initiatives and to changing diagnostic procedures creating a patient pool with milder disease in more recent years.

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Time to decompensated cirrhosis and hepatocellular carcinoma after an HBV or HCV notification: A population-based study

Cited by 30 publications

References 36 publications

Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono‐infection

Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono‐infection

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

Uptake of endoscopic screening for gastroesophageal varices and factors associated with variceal bleeding in patients with chronic hepatitis C infection and compensated cirrhosis, 2005‐2016: a national database linkage study

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