Current practice of chronic hepatitis B treatment in Southern Italy

Stroffolini, Tommaso; Spadaro, A.; Marco, Vito Di; Scifo, G.; Russello, Maurizio; Montalto, Giuseppe; Bertino, Gaetano; Surace, L.; Caroleo, Benedetto; Portelli, V.; Madonia, Salvatore; Sapienza, Mauro; Cosco, Lucio; Frugiuele, P.; Galdieri, Antonio; Brandolino, N.; Siciliano, R.; Bruno, Savino; Almasio, Piero Luigi

doi:10.1016/j.ejim.2012.03.018

Cited by 13 publications

(20 citation statements)

References 9 publications

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“…Chronic HBV or HCV infections are well known to induce a chronic proinflammatory hepatic and systemic state associated with immunosuppressive and immunomodulatory effects [33, 34, 63–65]. …”

Section: Hepatocarcinogenesismentioning

confidence: 99%

Hepatocellular Carcinoma: Novel Molecular Targets in Carcinogenesis for Future Therapies

Bertino

Demma

Ardiri

et al. 2014

BioMed Research International

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Background Hepatocellular carcinoma is one of the most common and lethal malignant tumors worldwide. Over the past 15 years, the incidence of HCC has more than doubled. Due to late diagnosis and/or advanced underlying liver cirrhosis, only limited treatment options with marginal clinical benefit are available in up to 70% of patients. During the last decades, no effective conventional cytotoxic systemic therapy was available contributing to the dismal prognosis in patients with HCC. A better knowledge of molecular hepatocarcinogenesis provides today the opportunity for targeted therapy. Materials and Methods A search of the literature was made using cancer literature, the PubMed, Scopus, and Web of Science (WOS) database for the following keywords: “hepatocellular carcinoma,” “molecular hepatocarcinogenesis,” “targeted therapy,” and “immunotherapy.” Discussion and Conclusion. Treatment decisions are complex and dependent upon tumor staging, presence of portal hypertension, and the underlying degree of liver dysfunction. The knowledge of molecular hepatocarcinogenesis broadened the horizon for patients with advanced HCC. During the last years, several molecular targeted agents have been evaluated in clinical trials in advanced HCC. In the future, new therapeutic options will be represented by a blend of immunotherapy-like vaccines and T-cell modulators, supplemented by molecularly targeted inhibitors of tumor signaling pathways.

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Section: Hepatocarcinogenesismentioning

confidence: 99%

Hepatocellular Carcinoma: Novel Molecular Targets in Carcinogenesis for Future Therapies

Bertino

Demma

Ardiri

et al. 2014

BioMed Research International

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“…Endpoint secondari sono stati nella nostra valutazione l'eventuale normalizzazione delle ALT (controllo mensile), l'eventuale sieroconversione ad antiHBs (valutazione a 6 mesi), l'eventuale comparsa di breakthrough virologico (> 1 Log cp/ ml), l'eventuale modificazione della stiffness epatica con Fibroscan® (controllo a 6 mesi), l' eventuale tollerabilità del trattamento (controllo mensile di azotemia, creatinina, valutazione del filtrato glomerulare con controllo di creatinina-clearance, fosforemia, dosaggio di CPK ed emogasanalisi arteriosa). HBV-DNA è stato valutato in PCR a 1, 3 e 6 mesi dall'inizio della terapia [10]. L'indicazione al trattamento a lungo termine con un analogo a elevata efficacia e ottimo profilo di resistenza come tenofovir all' esame basale lieve epatomegalia, con ecostruttura epatica lievemente disomogenea e iperecogena, come da epatopatia steatosica, ma con vasi (vena porta e vene sovraepatiche) normali e non segni di scompenso (non segni di cirrosi, non versamento endoperitoneale e milza normale); gli altri quattro pazienti presentavano al basale un esame ecografico assolutamente normale.…”

Section: Pazienti Metodi E Risultatiunclassified

“…In nessun paziente abbiamo evidenziato fino ad ora la perdita di HBsAg e la conseguente sieroconversione ad antiHBs, endpoint ideale che però si verifica solo raramente con i farmaci attualmente a nostra disposizione [10].…”

Section: Punti Chiaveunclassified

[Use of tenofovir monotherapy in a cohort of prisoners confined in the prisons of the Molise region and affected by mild HBV-related chronic hepatitis]

Patriarchi¹,

Nicola²,

Grassi³

et al. 2015

CMI

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109dette popolazioni fragili, quali tossicodipendenti, senza fissa dimora (SFD) e detenuti.Giovani, sovrappeso, fumatori, affetti da almeno una patologia cronica: è questo il quadro dei detenuti delle carceri italiane scattato dall'Agenzia Regionale di Sanità (ARS) Toscana attraverso un'indagine condotta nel 2014 in 6 regioni (Toscana, Lazio, Umbria, Veneto, Liguria, Campania-ASL Salerno), finanziata dal Centro di Controllo delle Malattie (CCM) del Ministero della Salute e pubblicato nell'aprile 2015 [1]. In tutto sono stati presi in esame 15.751 detenuti, per il 96,5% uomini e per il 60% appartenenti alla fascia di età compresa tra 30 e 49 anni (l' età media è 39,6 anni). La nazionalità straniera costituisce il 46,3% del campione (i nordafricani sono il gruppo etnico più rappresentato, seguito dagli est europei).Il 67,5% dei detenuti in esame è risultato affetto da almeno una condizione patologica, anche non grave. Dalla ricerca emerge, in particolare, l'importanza che ricoprono, IntroduzIoneNel mondo, l'Organizzazione Mondiale della Sanità (OMS) ha stabilito che circa 240 milioni di persone sono portatori cronici dell'antigene di superficie dell'epatite B (HBsAg + ). In Italia fortunatamente l'epidemiologia dell'epatite B ha subìto profondi cambiamenti grazie al miglioramento delle nostre condizioni socio-economiche e sanitarie, prevalentemente dovute all'introduzione della vaccinazione obbligatoria contro l'epatite B dal 1991. Ciò ha comportato una progressiva riduzione dell'incidenza dei casi di epatite acuta B che, per i nuovi casi, riguarda quasi esclusivamente soggetti adulti nei quali la trasmissione dell'infezione da HBV si verifica per lo più per via sessuale. L'infezione cronica da HBV rappresenta un problema sanitario tutt'altro che risolto in Italia, incrementato dall'aumento della immigrazione da aree in cui la circolazione del virus è ancora endemica e anche dalle cosid-

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“…Overall, 469 studies were identified, of which 454 were captured by the search strategy and 15 by hand searching. The inclusion criteria were fulfilled in 25 studies , from which data were extracted and analysed. The studies flow is shown in Figure .…”

Section: Studies Flowmentioning

confidence: 99%

Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

Papatheodoridis

Tsochatzis

Hardtke

et al. 2014

Liver International

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Background & Aims: Despite the availability of effective therapies for hepatitis B (HBV) and C virus (HCV), only a minority of these patients receive treatment. We systematically reviewed published data on barriers to management for chronic HBV/HCV patients in Europe. Methods: Literature search to identify studies including adult patients with chronic HBV/HCV infection from European countries and data on barriers to treatment. Results: Twenty-five studies including 6253 chronic HBV and 19 014 HCV patients were identified, of which only two were from Eastern Europe. The mean rate of no treatment in HBV patients was 42% being higher in North-Western European countries than Italy (56% vs. 39%, P < 0.001). Immigrants represented the most common barrier to HBV treatment. The mean rate of no treatment in HCV RNA-positive patients was 57%, being highest in Romania (89%), intermediate in France (79%) and lower though still high in other European countries (52%, P < 0.001). The predominant barriers to HCV treatment were lack of financial resources in Romania and direct/indirect limitations of interferon-alfa and/or parenteral drug and alcohol abuse in other countries. The mean rate of no treatment was highest in HCV RNA-positive parenteral drug users (72%) and intermediate in those with HCV-HIV co-infection (64%). Conclusions: A substantial proportion of diagnosed chronic HBV and the majority of diagnosed HCV patients remain untreated. The rates and most importantly the reasons of barriers to treatment in chronic HBV/HCV patients vary widely among European countries supporting the need for country-specific national strategies, resource allocation and implementation of global management policies.Hepatitis B (HBV) and C viruses (HCV) are leading causes of chronic liver disease worldwide and responsible for 1.2-1.5 million deaths annually (1, 2). In particular in Europe, according to the estimations of the European Region of the World Health Organization, there are approximately 14 and 9 million people chronically infected with HBV and HCV and around 36 000 and 86 000 related deaths each year, respectively, with the number of deaths reported to be increasing (3).Over the last 15 years, the efficacy of the therapeutic options for chronic HBV and HCV infections has dramatically improved. Practically all chronic HBV infection can now achieve at least on-therapy virological remission which is associated with improved liver histology and often even reversion of pre-existing histological cirrhosis, reduction in need for liver transplantation and eventually improved survival (4, 5). In patients with chronic HCV infection, sustained virological response, which is equivalent to viral eradication and has been shown to improve survival (6, 7), can be currently achieved in the majority of cases without contraindication for interferon-alfa-based therapies (8, 9), while emerging and future treatment options are expected to further improve the sustained virological response rates to over 90-95% extending the treatment indications ...

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Current practice of chronic hepatitis B treatment in Southern Italy

Cited by 13 publications

References 9 publications

Hepatocellular Carcinoma: Novel Molecular Targets in Carcinogenesis for Future Therapies

Hepatocellular Carcinoma: Novel Molecular Targets in Carcinogenesis for Future Therapies

[Use of tenofovir monotherapy in a cohort of prisoners confined in the prisons of the Molise region and affected by mild HBV-related chronic hepatitis]

Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review

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