C.-S. Hsu

Interferon-based therapy reduces risk of stroke in chronic hepatitis C patients: a population-based cohort study in Taiwan

Hepatitis C virus (HCV) infection has been linked to an increased risk of insulin resistance and carotid atherosclerosis.

Impact of hepatitis B virus infection on metabolic profiles and modifying factors

Summary.  The metabolic syndrome may cause disease progression in patients with chronic hepatitis B (CHB). However, the interactions between hepatitis B virus (HBV) infection and metabolic factors remain unknown. We investigated the association of HBV infection with metabolic profiles in HBV‐infected and noninfected subjects. In addition, the impacts of serum HBV DNA level on metabolic profiles were studied. Initially, a case–control analysis of patients with and without chronic HBV infection was performed. The HBV group consisted of 322 patients with chronic HBV infection, and the control group consisted of 870 matched subjects without HBV infection. Fasting blood glucose, lipid profiles and adiponectin levels were compared. The results were then confirmed in a second retrospective cohort study in 122 CHB patients with serum HBV DNA levels and HOMA‐IR index values. In the case–control analysis, the HBV group had significantly higher serum adiponectin, but lower triglyceride (TG) and high‐density lipoprotein cholesterol (HDL) levels than the control group. These relationships already existed in subjects younger than 45 years of age and were modified by serum alanine aminotransferase (ALT) levels. In the retrospective cohort, serum HBV DNA levels were negatively proportional to TG levels, but not to other metabolic parameters. Moreover, this relationship was significant only in subjects with higher ALT levels. Compared with healthy adults, patients with chronic HBV infection have significantly higher serum adiponectin, but lower TG and HDL levels. These relationships are modified by ALT levels and already exist in middle‐age patients with chronic HBV infection, implying HBV may interact with host metabolism.

Increasing insulin resistance is associated with increased severity and prevalence of gastro‐oesophageal reflux disease

Aliment Pharmacol Ther 2011; 34: 994–1004

Viral load and alanine aminotransferase correlate with serologic response in chronic hepatitis B patients treated with entecavir

Although entecavir has been shown to have good efficacy and low resistance for the treatment of chronic hepatitis B (CHB), factors associated with a favorable response remain unknown.

Interferon-Based Therapy Decreases Risks of Hepatocellular Carcinoma and Complications of Cirrhosis in Chronic Hepatitis C Patients

Background Interferon-based therapy (IBT) has been the standard of care for hepatitis C virus (HCV) infection. However, conflicting results exist regarding the effects of IBT on risk of developing hepatocellular carcinoma (HCC) and cirrhosis-associated complications, and most included highly selected patients. Methods This 8-year cohort study was based on the Longitudinal Health Insurance Database 2000 (LHID 2000) consisting of 1,000,000 beneficiaries randomly selected from all Taiwan National Health Insurance enrollees in 2000 (>23.7 million). Patients with newly detected HCV infections (n = 11,264) were classified based on treatment and clinical outcomes. IBTs were defined as regimens that included interferon- alfa, pegylated interferon- alfa -2a, or pegylated interferon- alfa -2b for at least 3 months. The Cox proportional hazards models were used to estimate the hazard ratio (HR) and associated confidence interval (CI) of HCC and cirrhosis-associated complications for IBT. Results The 8-year incidence rate for HCC was 3.9% among patients who received IBT and 5.6% among those who did not. The HCC-free survival rate was significantly higher among patients receiving IBT during the 8-year period than their counterpart (adjusted HR, 0.50; 95% CI, 0.31–0.81; P = .004). Similarly, the event-free survival rates for esophageal variceal bleeding (adjusted HR, 0.45; 95% CI, 0.22–0.91; P = .026), hepatic encephalopathy (adjusted HR, 0.38; 95% CI, 0.21–0.69; P = .001), ascites (adjusted HR, 0.28; 95% CI, 0.14–0.57; P<.001), and cirrhosis (adjusted HR, 0.63; 95% CI, 0.44–0.91; P = .013) were significantly higher among patients who received IBT than those who did not, after adjustment for associated factors. Conclusion Treatment with interferon may reduce the 8-year risk of HCC and cirrhosis-associated complications in patients with chronic HCV infection.

Peginterferon alfa-2b or alfa-2a with ribavirin for hepatitis C.

n engl j med 361;18 nejm.org october 29, 2009 1808 ences in other baseline variables such as temperature and levels of plasma glucose, creatinine, bilirubin, aspartate aminotransferase, and alkaline phosphatase make the two populations different clinically. Since 20 patients recruited in Wang Pha did not have fever at admission, these patients may have had partial immunity to malaria (premunition); this may have affected the treatment response. The results reported are excellent, with fever clearance at day 2 and parasite clearance at day 2 to day 3. Is drug resistance really a problem?

Letter: HBV/HCV coinfection in the era of direct‐acting antivirals

SIRS, We read with great interest the study reported by Londono et al., which examined the clinical impact on HBV virological reactivation in 352 patients with HBV/HCV coinfection receiving direct-acting antivirals (DAAs). Although the HBV virological reactivation rates were high, among the six patients who presented HBV virological reactivation, none of these patients had an increase in ALT levels. Therefore, the authors concluded that the HBV virological reactivation has no clinical impact on HBsAg+ patients receiving DAAs therapy for HCV coinfection. Their results also echoed earlier studies from Taiwan that showed a high HBV virological reactivation rate (36.3%) but no significant hepatitis in patients receiving pegylated interferon treatment for HBV/HCV infection. However, some of their findings deserve further discussion. Because HBV/HCV-coinfected patient usually represents a dynamic, not a static process, depending on the order for infection and viral levels over time, the clinical impact of DAAs on HBV/HCV coinfected patients will be influenced by the dynamics of HBV/HCV infection over time. In this study, most patients were inactive HBV carrier with low viral loads or had undetectable baseline HBV-DNA levels before DAAs treatment. Therefore, their HBV infections were in a suppressed condition, either by viral interference or innate immunity. There would be no reactivation of HBV if it was suppressed by innate immunity. But reactivation may occur in those whose HBV was suppressed by viral interference. Furthermore, in patients who have both active HBV and HCV replications before DAA treatment, such as injection drug users, the risk of liver injuries imposed by the use of DAAs remains unclear and needs further examination. Moreover, as the loss of HBsAg is an important predictor for disease progression and therapeutic efficacy of Hepatitis B patients, and patients may have a high post-treatment HBsAg clearance rate (11.2%) after pegylated interferon treatment, whether HBV/HCV-coinfected patients receiving DAAs treatment have a satisfactory HBsAg clearance rate needs future studies.

Aerobic exercise and caloric reduction should be the key lifestyle modifications in obese patients with GERD: authors' reply

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