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Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long‐term tenofovir or entecavir
Summary Background Suppression of hepatitis B virus (HBV) replication with nucelos(t)ide analogues should be considered for patients with chronic hepatitis D virus (HDV) infection and ongoing HBV replication. Aim To verify the clinical outcome after long‐term entecavir or tenofovir treatment in pati...
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| Published in: | Alimentary pharmacology & therapeutics 2019-04, Vol.49 (8), p.1071-1076 |
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| container_end_page | 1076 |
| container_issue | 8 |
| container_start_page | 1071 |
| container_title | Alimentary pharmacology & therapeutics |
| container_volume | 49 |
| creator | Brancaccio, Giuseppina Fasano, Massimo Grossi, Adriano Santantonio, Teresa Antonia Gaeta, Giovanni B. |
| description | Summary
Background
Suppression of hepatitis B virus (HBV) replication with nucelos(t)ide analogues should be considered for patients with chronic hepatitis D virus (HDV) infection and ongoing HBV replication.
Aim
To verify the clinical outcome after long‐term entecavir or tenofovir treatment in patients with advanced fibrosis/cirrhosis, ineligible to peg‐interferon therapy.
Methods
Patients were prospectively followed‐up at 3‐6 month intervals; measured outcomes were decompensation, hepatocellular carcinoma (HCC), liver transplant and liver related death. HBV monoinfected patients receiving the same treatment served as reference after 1:1 matching by age, gender, platelet count, albumin level, bilirubin and INR.
Results
56 HDV patients (48 with cirrhosis; median follow‐up 50 months) were enrolled; all achieved HBV DNA suppression. Death or liver transplant occurred in 19 patients, with a rate (n/1000 patient‐months) of 2.92 in HDV patients vs 0.38 in HBV monoinfected patients (P |
| doi_str_mv | 10.1111/apt.15188 |
| format | article |
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Background
Suppression of hepatitis B virus (HBV) replication with nucelos(t)ide analogues should be considered for patients with chronic hepatitis D virus (HDV) infection and ongoing HBV replication.
Aim
To verify the clinical outcome after long‐term entecavir or tenofovir treatment in patients with advanced fibrosis/cirrhosis, ineligible to peg‐interferon therapy.
Methods
Patients were prospectively followed‐up at 3‐6 month intervals; measured outcomes were decompensation, hepatocellular carcinoma (HCC), liver transplant and liver related death. HBV monoinfected patients receiving the same treatment served as reference after 1:1 matching by age, gender, platelet count, albumin level, bilirubin and INR.
Results
56 HDV patients (48 with cirrhosis; median follow‐up 50 months) were enrolled; all achieved HBV DNA suppression. Death or liver transplant occurred in 19 patients, with a rate (n/1000 patient‐months) of 2.92 in HDV patients vs 0.38 in HBV monoinfected patients (P < 0.001); similarly, decompensation occurred at a rate of 1.53 vs 0.13 (P = 0.015), respectively, and the rate of HCC was almost thrice in HDV cohort (3.12 vs 1.12; P = 0.02) Platelet count, Child‐Pugh score and marginally HDV infection were associated with HCC development.
Conclusion
Patients with HDV infection and advanced liver disease maintain an increased risk of severe clinical events as compared with HBV monoinfected patients, during prolonged HBV DNA suppression with potent NA.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.15188</identifier><identifier>PMID: 30793345</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adult ; Antiviral Agents - therapeutic use ; Bilirubin ; Carcinoma, Hepatocellular - epidemiology ; Chronic infection ; Cirrhosis ; Clinical outcomes ; Deoxyribonucleic acid ; DNA ; Female ; Fibrosis ; Follow-Up Studies ; Guanine - administration & dosage ; Guanine - analogs & derivatives ; Health risks ; Hepatitis ; Hepatitis B ; Hepatitis B - drug therapy ; Hepatitis B virus - drug effects ; Hepatitis D, Chronic - drug therapy ; Hepatocellular carcinoma ; Humans ; Infections ; Interferon ; Liver ; Liver cirrhosis ; Liver Cirrhosis - drug therapy ; Liver diseases ; Liver Neoplasms - epidemiology ; Liver transplantation ; Liver Transplantation - statistics & numerical data ; Male ; Middle Aged ; Patients ; Platelets ; Prospective Studies ; Replication ; Tenofovir ; Tenofovir - therapeutic use ; Treatment Outcome ; Viruses</subject><ispartof>Alimentary pharmacology & therapeutics, 2019-04, Vol.49 (8), p.1071-1076</ispartof><rights>2019 John Wiley & Sons Ltd</rights><rights>2019 John Wiley & Sons Ltd.</rights><rights>Copyright © 2019 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2838-113c8dffa487b9d51f528c932afba585de127c488e4145cd5be0d10b11c84e8e3</citedby><cites>FETCH-LOGICAL-c2838-113c8dffa487b9d51f528c932afba585de127c488e4145cd5be0d10b11c84e8e3</cites><orcidid>0000-0003-1573-6224 ; 0000-0001-5643-0139</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30793345$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brancaccio, Giuseppina</creatorcontrib><creatorcontrib>Fasano, Massimo</creatorcontrib><creatorcontrib>Grossi, Adriano</creatorcontrib><creatorcontrib>Santantonio, Teresa Antonia</creatorcontrib><creatorcontrib>Gaeta, Giovanni B.</creatorcontrib><title>Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long‐term tenofovir or entecavir</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Suppression of hepatitis B virus (HBV) replication with nucelos(t)ide analogues should be considered for patients with chronic hepatitis D virus (HDV) infection and ongoing HBV replication.
Aim
To verify the clinical outcome after long‐term entecavir or tenofovir treatment in patients with advanced fibrosis/cirrhosis, ineligible to peg‐interferon therapy.
Methods
Patients were prospectively followed‐up at 3‐6 month intervals; measured outcomes were decompensation, hepatocellular carcinoma (HCC), liver transplant and liver related death. HBV monoinfected patients receiving the same treatment served as reference after 1:1 matching by age, gender, platelet count, albumin level, bilirubin and INR.
Results
56 HDV patients (48 with cirrhosis; median follow‐up 50 months) were enrolled; all achieved HBV DNA suppression. Death or liver transplant occurred in 19 patients, with a rate (n/1000 patient‐months) of 2.92 in HDV patients vs 0.38 in HBV monoinfected patients (P < 0.001); similarly, decompensation occurred at a rate of 1.53 vs 0.13 (P = 0.015), respectively, and the rate of HCC was almost thrice in HDV cohort (3.12 vs 1.12; P = 0.02) Platelet count, Child‐Pugh score and marginally HDV infection were associated with HCC development.
Conclusion
Patients with HDV infection and advanced liver disease maintain an increased risk of severe clinical events as compared with HBV monoinfected patients, during prolonged HBV DNA suppression with potent NA.</description><subject>Adult</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Bilirubin</subject><subject>Carcinoma, Hepatocellular - epidemiology</subject><subject>Chronic infection</subject><subject>Cirrhosis</subject><subject>Clinical outcomes</subject><subject>Deoxyribonucleic acid</subject><subject>DNA</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Follow-Up Studies</subject><subject>Guanine - administration & dosage</subject><subject>Guanine - analogs & derivatives</subject><subject>Health risks</subject><subject>Hepatitis</subject><subject>Hepatitis B</subject><subject>Hepatitis B - drug therapy</subject><subject>Hepatitis B virus - drug effects</subject><subject>Hepatitis D, Chronic - drug therapy</subject><subject>Hepatocellular carcinoma</subject><subject>Humans</subject><subject>Infections</subject><subject>Interferon</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - drug therapy</subject><subject>Liver diseases</subject><subject>Liver Neoplasms - epidemiology</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Platelets</subject><subject>Prospective Studies</subject><subject>Replication</subject><subject>Tenofovir</subject><subject>Tenofovir - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Viruses</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kc1q3TAQRkVpaG6TLPoCRdBNC3GikSxbXia3PykEmkWyNrI8zlWwJVeSE7LrI3TZ5-uTVMlNSyl0NpoPzhwEHyGvgB1BnmM9pyOQoNQzsgJRyYIzUT0nK8arpuAKxC55GeMNY6yqGX9BdgWrGyFKuSI_1qN11uiR-iUZP2Gk1tFZJ4suRXpn04Zu8CEnG-n7Q2psCBsfc9CupzOGvKbM_kWd0lsblkgDzmNWJ-vd4SMd0KC9te6ajt5d__z2PWGYaL72g88n1AeaTWh0DvtkZ9BjxIOnd49cffxwuT4rzr98-rw-OS8MV0IVAMKofhh0qequ6SUMkivTCK6HTkslewRem1IpLKGUppcdsh5YB2BUiQrFHnm79c7Bf10wpnay0eA4aod-iS0HJWXZ1JXK6Jt_0Bu_BJd_13IhQEFdQZWpd1vKBB9jwKGdg510uG-BtQ91tbmu9rGuzL5-Mi7dhP0f8nc_GTjeAnd2xPv_m9qTi8ut8hfslqK6</recordid><startdate>201904</startdate><enddate>201904</enddate><creator>Brancaccio, Giuseppina</creator><creator>Fasano, Massimo</creator><creator>Grossi, Adriano</creator><creator>Santantonio, Teresa Antonia</creator><creator>Gaeta, Giovanni B.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1573-6224</orcidid><orcidid>https://orcid.org/0000-0001-5643-0139</orcidid></search><sort><creationdate>201904</creationdate><title>Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long‐term tenofovir or entecavir</title><author>Brancaccio, Giuseppina ; Fasano, Massimo ; Grossi, Adriano ; Santantonio, Teresa Antonia ; Gaeta, Giovanni B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2838-113c8dffa487b9d51f528c932afba585de127c488e4145cd5be0d10b11c84e8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Bilirubin</topic><topic>Carcinoma, Hepatocellular - epidemiology</topic><topic>Chronic infection</topic><topic>Cirrhosis</topic><topic>Clinical outcomes</topic><topic>Deoxyribonucleic acid</topic><topic>DNA</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Follow-Up Studies</topic><topic>Guanine - administration & dosage</topic><topic>Guanine - analogs & derivatives</topic><topic>Health risks</topic><topic>Hepatitis</topic><topic>Hepatitis B</topic><topic>Hepatitis B - drug therapy</topic><topic>Hepatitis B virus - drug effects</topic><topic>Hepatitis D, Chronic - drug therapy</topic><topic>Hepatocellular carcinoma</topic><topic>Humans</topic><topic>Infections</topic><topic>Interferon</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - drug therapy</topic><topic>Liver diseases</topic><topic>Liver Neoplasms - epidemiology</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - statistics & numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Platelets</topic><topic>Prospective Studies</topic><topic>Replication</topic><topic>Tenofovir</topic><topic>Tenofovir - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Viruses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brancaccio, Giuseppina</creatorcontrib><creatorcontrib>Fasano, Massimo</creatorcontrib><creatorcontrib>Grossi, Adriano</creatorcontrib><creatorcontrib>Santantonio, Teresa Antonia</creatorcontrib><creatorcontrib>Gaeta, Giovanni B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brancaccio, Giuseppina</au><au>Fasano, Massimo</au><au>Grossi, Adriano</au><au>Santantonio, Teresa Antonia</au><au>Gaeta, Giovanni B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long‐term tenofovir or entecavir</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2019-04</date><risdate>2019</risdate><volume>49</volume><issue>8</issue><spage>1071</spage><epage>1076</epage><pages>1071-1076</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Suppression of hepatitis B virus (HBV) replication with nucelos(t)ide analogues should be considered for patients with chronic hepatitis D virus (HDV) infection and ongoing HBV replication.
Aim
To verify the clinical outcome after long‐term entecavir or tenofovir treatment in patients with advanced fibrosis/cirrhosis, ineligible to peg‐interferon therapy.
Methods
Patients were prospectively followed‐up at 3‐6 month intervals; measured outcomes were decompensation, hepatocellular carcinoma (HCC), liver transplant and liver related death. HBV monoinfected patients receiving the same treatment served as reference after 1:1 matching by age, gender, platelet count, albumin level, bilirubin and INR.
Results
56 HDV patients (48 with cirrhosis; median follow‐up 50 months) were enrolled; all achieved HBV DNA suppression. Death or liver transplant occurred in 19 patients, with a rate (n/1000 patient‐months) of 2.92 in HDV patients vs 0.38 in HBV monoinfected patients (P < 0.001); similarly, decompensation occurred at a rate of 1.53 vs 0.13 (P = 0.015), respectively, and the rate of HCC was almost thrice in HDV cohort (3.12 vs 1.12; P = 0.02) Platelet count, Child‐Pugh score and marginally HDV infection were associated with HCC development.
Conclusion
Patients with HDV infection and advanced liver disease maintain an increased risk of severe clinical events as compared with HBV monoinfected patients, during prolonged HBV DNA suppression with potent NA.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30793345</pmid><doi>10.1111/apt.15188</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-1573-6224</orcidid><orcidid>https://orcid.org/0000-0001-5643-0139</orcidid></addata></record> |
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| subjects | Adult Antiviral Agents - therapeutic use Bilirubin Carcinoma, Hepatocellular - epidemiology Chronic infection Cirrhosis Clinical outcomes Deoxyribonucleic acid DNA Female Fibrosis Follow-Up Studies Guanine - administration & dosage Guanine - analogs & derivatives Health risks Hepatitis Hepatitis B Hepatitis B - drug therapy Hepatitis B virus - drug effects Hepatitis D, Chronic - drug therapy Hepatocellular carcinoma Humans Infections Interferon Liver Liver cirrhosis Liver Cirrhosis - drug therapy Liver diseases Liver Neoplasms - epidemiology Liver transplantation Liver Transplantation - statistics & numerical data Male Middle Aged Patients Platelets Prospective Studies Replication Tenofovir Tenofovir - therapeutic use Treatment Outcome Viruses |
| title | Clinical outcomes in patients with hepatitis D, cirrhosis and persistent hepatitis B virus replication, and receiving long‐term tenofovir or entecavir |
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