Saturday, January 28, 2023

Hepatitis B And Fatty Liver

How Do Doctors Treat The Complications Of Hepatitis B

Liver cancer: the global impact

If chronic hepatitis B leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, minor medical procedures, and surgery. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order blood tests and an ultrasound or another type of imaging test to check for liver cancer.

If chronic hepatitis B leads to liver failure or liver cancer, you may need a liver transplant.

Assessment Of Circulating Memory B And T Cells

The proportion of memory B and T cells in PBMC at baseline and post vaccination was assessed using flow cytometry. Approximately, 5×105 PBMC were stained for memory B-cell markers using anti-CD19, anti-CD45, and anti-CD27. Memory T cells were identified using anti-CD3, anti-CD4, anti-CD8, anti-CD56, anti-CD45RA, and anti-CCR7 using multi-parameter flow cytometry Catalog and lot numbers of the antibodies used can be found in Supplementary Table . Prior to staining, cells were stained with fixable viability dye FVS 510. Antibodies were used at dilutions recommended by the vendor. Appropriate isotype and compensation controls were used and a minimum of 100,000 events was acquired. Data were analyzed using FACS DIVA and Flowjo v11 .

Patient Characteristics And Overall Alt Distribution

In total, our study included 3,705 CHB patients: 533 with NAFLD and 3,172 without NAFLD . The majority of patients were Asian . Compared to patients with CHB only, CHB patients with NAFLD were older , more likely male and had significantly higher rates of comorbidities .

Table 1.

Demographic and clinical characteristics of patients with CHB with or without NAFLD

Table 2.

Laboratory characteristics in patients with CHB with or without NAFLD

Fig. 1.

Flowchart of patients included in the study.

The distribution of HBeAg positivity was similar in both groups . Compared to CHB patients without NAFLD, CHB patients with NAFLD had a similar proportion of patients with low HBV DNA but higher proportion of patients with elevated ALT . Additional analysis was also performed using an alternative cutoff for ULN as suggested by Prati et al. and EASL as shown in Table 2. In addition, patients with CHB and NAFLD were slightly more likely to have advanced fibrosis though the proportion of patients with advanced fibrosis was low in both groups .

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What Are The Symptoms Of Liver Disease

At the beginning of the spectrum of liver disease, it can be asymptomatic, says Lindenmeyer. Take hepatitis C, for example, she says: The majority of people who have hepatitis C have no idea, because they dont have symptoms, she says. This is why we recommend screening for hepatitis C for the baby boomer cohort, or everyone born between 1945 and 1965.

Early symptoms of cirrhosis may include feeling tired or weak, loss of appetite, weight loss, nausea and vomiting, and pain in the upper right side of your abdomen. With more advanced liver disease, as well as liver failure, symptoms include fluid accumulation in the abdomen or legs, yellowing of the skin or eyes, fatigue, mental confusion, and bleeding in the gastrointestinal tract, says Lindenmeyer.

How Is Fibrosis Scored

Liver Failure: It

There are several scoring systems for evaluating chronic hepatitis, and they all include 2 components: inflammatory activity and degree of fibrosis. Commonly used scoring systems are the Knodell score/Histological Activity Index , the METAVIR score, and the Ishak score . The Knodell system has 4 stages of fibrosis and the Ishak system has 6 stages of fibrosis. The METAVIR scoring system has 5 stages of fibrosis, from F0 to F4, as depicted below:

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Development Of Hepatocellular Carcinoma In Patients With Concomitant Disease

Hepatitis B infection can cause HCC with or without presence of liver cirrhosis. Similarly, NAFLD patients with steatohepatitis may develop HCC in the absence of liver cirrhosis . There are conflicting data regarding risk of developing HCC in patients with concomitant disease. In a study from Hong Kong by Chan et al., CHB patients with histologically confirmed NAFLD were found to have 7.3-fold increased risk of developing HCC over a follow-up period of over 7 years . In another study by Choi et al. with a median duration of follow-up of 10 years, CHB patients with biopsy proven NASH were significantly associated with higher risk of HCC . On the contrary, in a study by Lim et al. with a median follow-up of 111 months, hepatic steatosis was not associated with higher risk of HCC formation among the patients with CHB .

In conclusion, the interaction between CHB and NAFLD remains complicated and there are still unanswered questions to be addressed about their relationship. As we step into the era of promising therapies for NAFLD/NASH, it would be interesting to find out how the interplay between these two conditions evolve.

How Can I Pay For My Medication

Private health insurance or drug plansIf you have private health insurance or a drug plan at work, you may be able to have the medication paid through your plan. Please consult your private health insurance or drug plan provider to see if your drug is covered.

Publicly funded drug plansEach province and territory has their own rules. Some provincial drug plans provide coverage for individuals 65 and older, or those on social assistance. Some provinces provide special support to low-income individuals. Please call your Provincial Ministry or Department of Health to get more information about the terms of the publicly funded drug plan in your province.

Quebec public drug programIn Quebec, everyone must be covered by prescription drug insurance either through private or publicly funded plans.

Each provincial and territorial government offers a drug benefit plan for eligible groups. Some are income-based universal programs. Most have specific programs for population groups that may require more enhanced coverage for high drug costs. These groups include seniors, recipients of social assistance, and individuals with diseases or conditions that are associated with high drug costs. For more details, please contact your provincial or territorial health care ministry, or click on the appropriate link below.


Available Patient Assistance Program for Hepatitis B treatment VEMLIDY

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Incidence Of Cirrhosis Hcc And Hbsag Seroclearance In The Overall Chb Cohort

In the overall FL-CHB cohort, a lower cumulative 10-year incidence for cirrhosis and HCC and a higher cumulative 10-year incidence of HBsAg seroclearance was observed compared with non-FL CHB patients .

Cumulative 10-year incidence of cirrhosis , hepatocellular carcinoma , and hepatitis B surface antigen seroclearance in the overall chronic hepatitis B cohort. Number at risk values are presented as the number of patients at risk at the given time points .

When stratified by antiviral treatment status, within the unmatched, untreated CHB cohort, both the FL-CHB and non-FL CHB groups had low and similar rates of cirrhosis and HCC development, but the FL-CHB group had a significantly higher 10-year cumulative incidence of HBsAg seroclearance . Within the unmatched, treated cohort, compared to the FL-CHB group, the non-FL CHB group had a higher 10-year cumulative incidence for cirrhosis and HCC , but there was no difference in the rates of seroclearance .

Cumulative 10-year incidence of cirrhosis, hepatocellular carcinoma , and hepatitis B surface antigen seroclearance in the overall chronic hepatitis B cohort, by antiviral treatment status. Number at risk values are presented as the number of patients at risk at the given time points .

Diminished Hbv Seromarkers In Patients With Chb Plus Nafld: Necessarily Favourable

Liver Disorders: Hepatitis B | Steven-Huy Han, MD, UCLA | UCLA Digestive Diseases

The European Association for the Study of the Liver guideline in 2017 listed long-term suppression of HBV-DNA as the main endpoint for CHB treatment, with hepatitis B surface antigen seroclearance as an optimal endpoint. Most patients receiving antiviral treatment can achieve HBV-DNA suppression. However, the annual incidence of serological clearance of HBsAg is estimated to be less than 3%, which is most commonly observed in patients treated with interferons and nucleoside analogues . Notably, in recent clinical studies, both obesity and hepatic steatosis appear to be positively associated with HBsAg seroclearance and HBV-DNA suppression .

Research type
SMD 74.12 Machado et al
  • Abbreviations: BMI, body mass index CHB, chronic hepatitis B HBeAg, hepatitis B e-antigen HBsAg, hepatitis B surface antigen HBV, Hepatitis B virus HR, hazard ratio NAFLD, non-alcoholic fatty liver disease OR, odds ratio RR, relative risk SMD, standardized mean difference.
  • a HBeAg-seronegative patients with CHB.
  • b Calculated based on data from the original article .
  • c Pooled from seven studies.

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How Is Fatty Liver Disease Diagnosed

Because there are often no symptoms, it is not easy to find fatty liver disease. Your doctor may suspect that you have it if you get abnormal results on liver tests that you had for other reasons. To make a diagnosis, your doctor will use:

  • Your medical history
  • A physical exam
  • Various tests, including blood and imaging tests, and sometimes a biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver . He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as:

  • An enlarged liver
  • Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver function tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

If I Have Hepatitis B And Feel Healthy Do I Need To Keep Going To My Doctor

Chronic hepatitis B is a silent disease because often no symptoms appear until your liver is severely damaged. Although many people with chronic hepatitis B have an inactive disease and will remain healthy, about one in four will have an active disease that may lead to cirrhosis, liver failure, and liver cancer.

Because hepatitis B has no symptoms until your liver is badly damaged, a blood test is the only way for your doctor to find out if your hepatitis B is active or inactive, and to offer treatment, if needed. To help your doctor monitor how your disease behaves over time, you will need lifelong repeat blood tests every six to 12 months. Some tests, such as HBV DNA may need to be done more frequently . No treatment is required while the virus is inactive, but you should continue to get regular blood tests from your doctor to monitor your liver disease.

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Subgroup And Sensitivity Analyses

The results of the subgroup analyses and sensitivity analyses are shown in Table âTable2.2. When the analysis was stratified by study quality, study design and adjustment for cholesterol level or diabetes in the models, there was a significant difference between subgroups .2). For example, HBV infection was significantly associated with the risk of NAFLD in cohort and cross-sectional studies , but not in case-control studies .2). According to the sensitivity analyses, despite excluded the study using MRS, the results of the relationship between HBV infection and NAFLD remained stable . Additionally, the overall results remained consistent when the pooling model was changed .

Imaging Modalities For Detection Of Nash

Hep C in baby boomers unrelated to risky behaviour, researchers say ...

Different imaging modalities have been tried and tested for the diagnosis of steatohepatitis. Studies using transient elastography such as Fibroscan and magnetic resonance technology to assess NASH have shown a wide range of AUROCS, with the optimal cut-off being affected by the degree of fibrosis. In a study by Imajo et al., magnetic resonance imaging had a higher capability of diagnosing NASH as compared to transient elastography , with AUROC 0.91 vs. 0.82 . Recently, Naganawa et al. studied the role of non-contrast enhanced CT in the diagnosis of NASH and found that in patients without fibrosis, it has high sensitivity and specificity in diagnosing NASH, with an AUROC value of 0.93-0.94. For patients with high hyaluronic acid and hepatic fibrosis, however, the sensitivity and specificity was significantly reduced . Eddowes et al. evaluated the role of multiparametric MRI to differentiate simple steatosis from NASH. The results were suboptimal with AUROC for SS at 0.69 and AUROC for NASH at 0.74 . All these studies have shown promising results but have limitations, especially in the presence of variable amount of hepatic fibrosis. Liver biopsy remains the gold standard for diagnosing NASH .

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Do All Patients With Liver Disease Need To Have Fibrosis Testing

Fibrosis testing is relevant for the clinical care of patients with chronic liver disease, including hepatitis B, hepatitis C , non-alcoholic fatty liver disease , co-infections, primary biliary cirrhosis, primary sclerosing cholangitis, and other chronic metabolic diseases of the liver.

  • Knowing the severity of fibrosis can help with prognosis and understanding the degree of liver damage.
  • More rapid development of fibrosis and more advanced stages of fibrosis are more predictive of cirrhosis, and therefore liver-related illnesses and mortality.
  • The severity of liver disease is a factor in determining the urgency for HCV treatment and HBV treatment.
  • Understanding the fibrosis stage impacts clinical care decisions. Patients with advanced fibrosis or cirrhosis need more frequent follow up visits and labs, avoidance of some medications, and surveillance for hepatocellular carcinoma and gastroesophageal varices.

Possible Mechanistic Role Of Nafld In Hbv Infection

Although we cannot derive a causative relationship between NAFLD and diminished HBV seromarkers from observational studies in patients with CHB, their mere association is still a notable clinical phenomenon. Two animal models have been established that successfully mimic the NAFLD-related suppression in HBV seromarkers,, although the underlying mechanism remains unexplored. Four primary speculations exist concerning the possible pathways and mechanisms .

Figure 1

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How Children Are Affected By Nonalcoholic Fatty Liver Disease

  • NAFLD has become the most common form of childhood liver disease in the U.S., more than doubling over the past 20 years, partly because of the increase in childhood obesity. Studies estimate that 5% to 10% of children have NAFLD.
  • Prevalence of NAFLD in children by race/ethnicity: children of Hispanic/Latino ethnicity Asian children White children children of Black/African American race .

What Is Fatty Liver Disease

Alcoholic Liver Disease, Animation

Fatty liver disease means you have extra fat in your liver. You might hear your doctor call it hepatic steatosis.

Heavy drinking makes you more likely to get it. Over time, too much alcohol leads to a buildup of fat inside your liver cells. This makes it harder for your liver to work.

But you can get fatty liver disease even if you donât drink a lot of alcohol.

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Lifestyle Modifications For Nafld

Although there have been many breakthroughs in understanding epidemiology and pathophysiology of NAFLD, weight loss remains the cornerstone treatment for NAFLD . The AASLD suggests a weight loss goal of 35% of total body weight for improvement in steatosis. In addition, 710% weight reduction is required to improve fibrosis and other histological features of NASH . Weight loss can lead to remission of NAFLD in patients with a BMI < 25%. .

Generally, low calorie diets are recommended for patients with NAFLD/NASH . Nguyen, V. and George, J. recommend a hypo-caloric diet , with the aim of achieving 57% reduction in baseline weight over a year for NAFLD management this resulted in histological improvement of steatosis and steatohepatitis .

Intake of simple carbohydrates is associated with NASH development. Fructose, being a simple carbohydrate, is associated with increased hepatic fibrosis due to its rapid metabolism in the liver, leading to a decrease in hepatic ATP level and hepatic oxidative damage . Polyunsaturated fatty acids such as n-3 PUFA have been reported to reduce systemic inflammation and oxidation . The WELCOME study demonstrated a mild reduction in liver fat, with omega-3 fatty acids used at a dose of 4 g/day for 15 to 18 months, but did not result in an improvement in fibrosis scores .

The Typical Treatments Does Hepatitis Cause A Fatty Liver

The primary treatment for fatty liver disease is surgery. This involves removing or dissolving the fatty liver cell. Surgery can be used for treating both severe and moderate cases. But the downside to surgery is that it can leave you with scarring that could impede your progress in losing weight and even your ability to stand up.

A more common way to diagnose fatty liver disease is through the use of liver function tests called a CT scan and an MRI. These tests will show whether or not your liver is functioning to its fullest capacity. If it shows signs of inflammation then your doctor may want to prescribe medication that will reduce inflammation. If there is fluid buildup in your abdomen, then your doctor may use a procedure called a liposuction to remove some of the fluid and reduce the swelling in the abdominal area.

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The diagnosis of fatty liver is a little more tricky. A biopsy of your liver from the abdominal area will reveal inflammation, but it might not be fatty liver. It could be something else like hepatitis B or C, or even HIV if it is contained in its early stages. If the biopsy indicates the presence of fatty liver, then your doctor will conduct a trial of anti viral medication to make sure that the hepatitis does not develop into cirrhosis of the liver which would be very serious.

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