KASL clinical practice guidelines: management of chronic hepatitis B

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doi:10.3350/cmh.2016.22.1.18

Cited by 155 publications

(101 citation statements)

References 536 publications

(644 reference statements)

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“…[27,28] The epidemiology of HBV infection and patient demographics of HBV-infected patients are significantly different from those of HCV-infected patients, but the outcomes and liver disease progression rates seem to be not so different. [29] However, due to the intrinsically different characteristics of HBV and HCV disease, head-to-head comparison is of moot value.…”

Section: Discussionmentioning

confidence: 99%

The clinical outcomes of chronic hepatitis C in South Korea

Jeong²,

Jang³

et al. 2016

Medicine

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This prospective cohort study aimed to elucidate the clinical outcome and its related factors of chronic hepatitis C in a hepatitis B-dominant Asian region.From January 2007 to October 2012, 382 patients with chronic hepatitis C without liver cirrhosis were prospectively enrolled at 6 university hospitals, and regularly followed until Apr 2014 to identify the development of liver cirrhosis, decompensated cirrhosis, hepatocellular carcinoma (HCC), and overall survival.During the median follow-up of 39.0 months (range 18.0–81.0 months), liver cirrhosis, hepatic decompensation, and HCC developed in 42 patients (11.0%), 4 patients (1.0%), and 12 patients (3.1%), respectively. The cumulative probability of development of cirrhosis at 3 years and at 5 years was 9.6% and 16.7%, respectively. That of HCC at 3 and 5 years was 1.6% and 4.5%, respectively. The 3-year and 5-year overall survival rate was 99.7% and 96.0%, respectively. Pegylated interferon-based antiviral therapy was undertaken in 237 patients (62.0%) with a sustained virologic response (SVR) rate of 74.3%. The factors related to the overall clinical outcomes were age ≥55 years (HR 2.924, P = 0.016), platelet counts <150 × 109/L (HR 3.195, P = 0.007), and the achievement of SVR (HR 0.254, P = 0.002).The clinical outcomes of this Korean chronic hepatitis C cohort were modest with minimal mortality, but significant disease progression occurred in the patients with old age, low platelet, and non-SVR after interferon-based antiviral treatment or no treatment, suggesting priority for direct acting antiviral therapy.

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Section: Discussionmentioning

confidence: 99%

The clinical outcomes of chronic hepatitis C in South Korea

Jeong²,

Jang³

et al. 2016

Medicine

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“…The diagnosis of HCC was done on the basis of American Association for the Study of Liver Diseases (AASLD) guidelines [19]. The indication for the initiation of antiviral treatment was based on Korean Association for the Study of the Liver (KASL) guideline: (i) HBV DNA ≥20,000 IU/mL and serum aminotransferase level (AST or ALT) ≥2 upper limit of normal (ULN) in patients who were HBeAg positive; (ii) HBV DNA ≥2,000 IU/mL and serum aminotransferase level ≥2 ULN in patients who were HBeAg negative; and (iii) HBV DNA ≥2,000 IU/mL and serum aminotransferase level above ULN in cirrhotic patients [20, 21]. This study was approved by the Institutional Review Board of Samsung Medical Center.…”

Section: Methodsmentioning

confidence: 99%

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma

et al. 2016

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ObjectivesThis study aimed to investigate the effect of oral antiviral treatment on the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radiofrequency (RF) ablation.MethodsBetween January 2003 and December 2010, 228 patients without a history of antiviral treatment were treated with RF ablation for a single HBV-related HCC. We divided the patients into two groups, patients who received (n=125) or did not receive antiviral treatment (n=103), based on whether oral antiviral treatment was administered after RF ablation. The median duration of antiviral treatment was 60.1 months. HCC recurrence and overall survival were compared in the two groups in the full cohort and the propensity score-matched cohort.ResultsIn the matched cohort, the probability of HCC recurrence at 5 years was 43.8% for the non-antiviral treatment group and 14.7% for the antiviral treatment group (p<0.001). The probability of overall survival at 5 years was 77.2% for the non-antiviral treatment group and 93.5% for the antiviral treatment group (p=0.002). Multivariable analysis showed that risk factors for HCC recurrence included large tumor size (hazard ratio (HR)=1.30, p=0.022), HBV DNA serum level (HR=1.11, p=0.005), and serum AFP level ≥20 ng/mL (HR=1.66, p=0.005). Overall survival was associated with larger tumor size (HR=1.86, p=0.001) and Child-Pugh Class B (HR=2.13, p=0.019). Oral antiviral treatment after RF ablation was significantly associated with a lower risk of tumor recurrence and death (HR=0.33, p<0.001, and HR=0.44, p=0.004).ConclusionUse of oral antiviral treatment after curative RF ablation was associated with favorable outcomes in terms of tumor recurrence and overall survival in patients with HBV-related HCC.

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“…Standard treatments include pegylated IFN-α and nucleos(t)ide analogues [91]. Several studies have demonstrated that hepatitis B virus (HBV) DNA suppression is associated with biochemical and histological responses.…”

Section: Clinical Evidence Of Reversibility According To Etiologymentioning

confidence: 99%

Reversal of liver cirrhosis: current evidence and expectations

Jung

Yim

2017

Korean J Intern Med

115

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In the past, liver cirrhosis was considered an irreversible phenomenon. However, many experimental data have provided evidence of the reversibility of liver fibrosis. Moreover, multiple clinical studies have also shown regression of fibrosis and reversal of cirrhosis on repeated biopsy samples. As various etiologies are associated with liver fibrosis via integrated signaling pathways, a comprehensive understanding of the pathobiology of hepatic fibrogenesis is critical for improving clinical outcomes. Hepatic stellate cells play a central role in hepatic fibrogenesis upon their activation from a quiescent state. Collagen and other extracellular material components from activated hepatic stellate cells are deposited on, and damage, the liver parenchyma and vascular structures. Hence, inactivation of hepatic stellate cells can lead to enhancement of fibrolytic activity and could be a potential target of antifibrotic therapy. In this regard, continued efforts have been made to develop better treatments for underlying liver diseases and antifibrotic agents in multiple clinical and therapeutic trials; the best results may be expected with the integration of such evidence. In this article, we present the underlying mechanisms of fibrosis, current experimental and clinical evidence of the reversibility of liver fibrosis/cirrhosis, and new agents with therapeutic potential for liver fibrosis.

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KASL clinical practice guidelines: management of chronic hepatitis B

Cited by 155 publications

References 536 publications

The clinical outcomes of chronic hepatitis C in South Korea

The clinical outcomes of chronic hepatitis C in South Korea

Effect of oral antiviral treatment on long-term outcomes of radiofrequency ablation therapy for hepatitis B virus-related hepatocellular carcinoma

Reversal of liver cirrhosis: current evidence and expectations

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