Andri Sanityoso

Genotype diversity of hepatitis C virus (HCV) in HCV-associated liver disease patients in Indonesia

Background: Hepatitis C virus (HCV) genotype distribution in Indonesia has been reported. However, the identification of HCV genotype was based on 5′‐UTR or NS5B sequence.

Hepatitis C virus genotype in blood donors and associated liver disease in Indonesia.

Objective: The aim of this study was to investigate the distribution of hepatitis C virus (HCV) genotype and the possible association between genotype and HCV-associated liver disease in Indonesia. Methods: 32 anti-HCV-positive asymptomatic carriers (AC), 55 chronic hepatitis (CH), 41 liver cirrhosis (LC), and 35 hepatocellular carcinoma (HCC) patients were included in this study. HCV genotyping was performed by phylogenetic analysis of the NS5B and 5′-UTR regions. Results: The HCV subtype 1b (36.5%), based on NS5B region, was the most prevalent, followed by subtypes 3k (15.4%), 2a (14.4%), 1a (12.5%) and 1c (12.5%), and 2e (4.8%). Subtypes 2f, 3a, 3b, and 4a were also found in some of the samples. HCV subtypes 3k (40.0%) and 1a (35.0%) were the two major subtypes in AC. HCV subtype 1b was not found in AC, but it was common in CH (31.3%), LC (50.0%), and HCC (57.1%). Conclusion: HCV subtype 1b was prevalent in samples of HCV-associated liver disease patients, including CH, LC and HCC. The percentage of subtype 1b was increased with the disease severity (AC < CH < LC < HCC).

Alpha-1-acid glycoprotein as potential biomarker for alpha-fetoprotein-low hepatocellular carcinoma

BackgroundThe outcome of patients with hepatocellular carcinoma (HCC) remains poor because of late diagnosis. We determined the performances of α -1-acid glycoprotein (AAG) and des-γ-carboxy prothrombin (DCP) for the diagnosis of HCC, especially for α-fetoprotein (AFP)-low HCC.MethodsOf the 220 patients included in this retrospective study, 124 had HCC, and 61 (49%) of these were AFP-low HCC (AFP ≤ 20 ng/mL). The remaining 96 patients, including 49 with chronic hepatitis B or C and 47 with cirrhosis, were considered as control. Plasma AAG was analyzed using high performance liquid chromatography (HPLC) and confirmed using Western blot technique.ResultsWhen all patients with HCC were evaluated, the area under receiver operating characteristic (ROC) curves for AAG (0.94, 95% CI: 0.91-0.97) and DCP (0.92, 95% CI: 0.88-0.95) were similar (P = 0.40). AAG had better area under ROC curve (0.96, 95% CI: 0.94-0.99) than DCP (0.87, 95% CI: 0.81-0.93) for AFP-low HCC (P < 0.05). At the specificity 95%, the sensitivity of AAG was higher in AFP-low HCC than in AFP-high HCC (82% and 62%, respectively). In contrast, higher sensitivity was obtained from DCP in discriminating HCC patients with low AFP than that in high AFP (57% and 90%, respectively).ConclusionOur cross-sectional study showed that AAG was better performance in diagnosing HCC patients with low AFP, while DCP did better in those with high AFP.

Serologic and Urine Diagnostic Tests to Detect Helicobacter pylori Infection in Functional Dyspepsia Patients

Background: Dyspepsia is a collection of symptoms in the forms of discomfort, pain, nausea, vomiting, bloating, and early satiety in the stomach. This condition can be caused by various problems; one of them is Helicobacter pylori infection. Dyspepsia without organic problem is known as functional dyspepsia. H. pylori examination is recommended in functional dyspepsia patients. Method: In this study, we performed a diagnostic test study in dyspepsia patients in Community Health Centre of Koja District, North Jakarta, from February to April 2015. Samples were obtained through consecutive sampling method; 74 patients were included. The data was gathered by distributing questionnaires to patients, performing urea breath test (UBT) examination, serologic test, and urine test using rapid urine test (RAPIRUN). Results: Prevalence of H. pylori infection by using UBT examination reached up to 36.5%; meanwhile serologic and RAPIRUN tests showed positive results in 32.4% and 24.3% patients, respectively. Serologic test has sensitivity of 74% (95% CI: 55-87%), specificity 91% (95% CI: 80-97%), positive predictive value (PPV) 83% (95% CI: 64-93%), and negative predictive value (NPV) 86% (95% CI: 74-93%). Meanwhile, RAPIRUN has sensitivity of 63% (95% CI: 44-78%), specificity 98% (95% CI: 89-100%), PPV 94% (95% CI: 74-99%), and NPV 82% (95% CI: 70-90%). Conclusion: Sensitivity of serologic and RAPIRUN tests are still inadequate to be alternative to UBT examination. However, they have high specificity. Further studies are required with larger sample size and consideration of factors which may influence the results of both tests.

Administration of Methotrexate in Rheumatoid Arthritis Patients with Chronic Hepatitis B

Aim: To identify if methotrexate (MTX) may be given to chronic hepatitis B patients and to evaluate the necessity of antiviral prophylaxis administration. Method: Literature search procedure to answer this clinical problem was performed by exploring the literature online using PubMed, Highwire Stanford University, NUS Library, and MD Consult search engines. With this searching method, we found 20 articles in English. From those 20 articles, there were two articles relevant based on the title and abstract (studies by Tamori et al and Mori). Results: From 45 patients without HbsAg from Tamori et al study, only one from 3 patients receiving disease-modifying antirheumatoid drug /DMARD (including MTX) experienced reactivation. Those three patients did not receive anti-TNF-α therapy. Study by Mori concluded that DMARD was relatively safe to be given to most RA patients with the history of HBV infection, although they were not given anti HBV prophylaxis therapy. Conclusion: MTX is not recommended for patient in this case because it is contraindicated to be given in HBV infected patient with any given Child Pugh score. If MTX is still given, it is recommended to give antiviral prophylaxis therapy.

Prevention of Hepatitis B Virus Transmission in Pregnancy

Chronic hepatitis B virus infection is a serious health problem in many countries, particularly in developing countries. In Asia-Pacific region, vertical transmission from mother to child is the main endemicity factor of hepatitis B virus (HBV) infection. Almost 50% cases of hepatitis B virus infection happen during perinatal and neonatal period, including vertical transmission from mother to child during pregnancy. World Health Organization (WHO), World Gastroenterology Organization (WGO) and many countries have recommended immunoprophylaxis by the administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIg) to prevent transmission from mother to child. However, there are approximately 10-15% babies born from mother with hepatitis B infected by HBV through intrauterine transmission. Incidence of intrauterine transmission is accounted for around 43-50% if DNA of HBV in the mother is more than 107 copies/mL, although passive and active immunization to the baby has been administered. Therefore, administering antiviral drugs in pregnant women with chronic hepatitis B accompanied by immunoprophylaxis is effective in preventing hepatitis B infection transmission during pregnancy, particularly in decreasing the number of virus and administering active or even passive immunization to neonates. Keywords: hepatitis B, pregnancy, prevention, transmission

Combination Therapy of Sorafenib and Transarterial Chemoembolization in Management of Hepatoma

Incidence of hepatocellular carcinoma (HCC) continues to increase in developing countries and rank 5th in male and 7th in female. Main cause being reported is chronic hepatitis B in Asian region. Treatment of choice for HCC is liver resection, however it is oftenly not possible to be performed as the disease has entered advanced stage. Due to the less choice of treatment in HCC, one of the several other alternatives has been considered is transarterial chemoembolization (TACE) which is applied in patients who cannot undergo resection or ablation therapy, failure of therapy. However limitation of TACE is very high recurrence rate of HCC. Sorafenib is an anti-angiogenic medicine approved as first systemic drug in HCC therapy. Several studies stated the benefits of combination therapy of TACE and Sorafenib administration to prevent HCC recurrence. Success rate of this combination therapy reaches control disease rate of 100% based on response evaluation criteria in solid tumors (RECIST) from European Association for the Study of the Liver (EASL). Keywords: TACE, sorafenib, liver cancer, HCC

Non-invasive Markers for Diagnosis of Liver Cirrhosis in Chronic Hepatitis B

Background: Indonesia is an endemic country for hepatitis B viral infection. Thus, early diagnosis of cirrhosis is important to be established with regard to prompt treatment and to determine the patients’ prognosis. Liver biopsy which is a gold standard in diagnosing liver cirrhosis has several limitations, such as expensive and invasive. The objective of this study was to identify the accuracy of non-invasive markers: aspartate/alanine transaminase ratio (AAR), age-platelet index (API), aspartate transaminase to platelet ratio index (APRI), spleen to platelet ratio index (SPRI), and age-spleen-platelet ratio index (ASPRI) in predicting cirrhosis in chronic hepatitis B patients. Methods: A diagnostic study was performed in Division of Hepatology and Hepatology Outpatient Clinic, Depatment of Internal Medicine, Cipto Mangunkusumo Hospital between January 2009 and July 2010, with the participation of 71 chronic hepatitis B patients who had undergone liver biopsy consecutively. Stage of fibrosis was determined based on the METAVIR scoring system. Five non-invasive markers: AAR, API, APRI, SPRI, and ASPRI were compared with liver biopsy Results. Statistical analysis was performed by using T-test and Spearman correlation test using SPSS version 13. Results: API, APRI, SPRI, and ASPRI had significant correlation with the incidence of liver cirrhosis in hepatitis B infection (p < 0.05). However, AAR had no correlation with the incidence of cirrhosis. Using the cut-off point of 1.19, APRI was the best marker with area under curve (AUC) 0.91, sensitivity 83.3%, and specificity 89.2%. Conclusion: Non-invasive markers were suitable in predicting cirrhosis and have the potential to decrease the number of liver biopsy in chronic hepatitis B patients. Keywords: non-invasive markers, chronic hepatitis B, liver cirrhosis