M.L. González-Diéguez

Long-term outcome in Caucasian patients with chronic hepatitis B virus infection after HBsAg seroclearance.

The natural course after hepatitis B surface antigen (HBsAg) seroclearance in Caucasian patients with chronic hepatitis B virus (HBV) infection is not well‐defined. To investigate the clinical characteristics and outcome in a series of European Caucasian patients with chronic HBV infection according to HBsAg response over time.

Adherence to a Semiannual Surveillance Program for Hepatocellular Carcinoma in Patients With Liver Cirrhosis

Background: Patient adherence to screening for hepatocellular carcinoma (HCC) is not well known. Our aims were to analyze the adherence to a surveillance program in a prospective cohort of cirrhotic patients and to examine its association with HCC stage at diagnosis. Materials and Methods: A total of 770 patients with cirrhosis were examined semiannually by ultrasound and alpha-fetoprotein at a tertiary center. We collected data on 17 variables at baseline. Suboptimal adherence was defined as failure to complete 2 consecutive screening rounds. Results: Over a median follow-up period of 42.0 months (interquartile range: 60.0), 125 patients (16.2%) had suboptimal adherence. Active or previous intravenous drug use [hazard ratio (HR), 5.33; 95% confidence interval (CI), 3.07-9.23], active alcohol consumption (HR, 3.03; 95% CI, 2.03-4.51), absence of liver decompensation before the inclusion in the program (HR, 1.65; 95% CI, 1.07-2.55) and aspartate transaminase/alanine transaminase ratio ≥1.6 (HR, 1.82; 95% CI, 1.23-2.70) were independent predictors of suboptimal adherence. Compared with those with optimal adherence, patients with suboptimal adherence had a more advanced HCC stage at diagnosis (P=0.015), they were less frequently treated with curative intention (P=0.078) and survived less (median: 14.2 mo; IQR: 36.0 vs. 22.7 mo; IQR: 47.4; P=0.160), although these differences were not significant. Conclusions: The adherence to the process of HCC surveillance can be considered as adequate among cirrhotic patients. Active alcohol consumption and a history of intravenous drug use are the strongest predictors of suboptimal adherence. These patients have a more advanced HCC stage at diagnosis and tend to be less frequently treated with curative intention.

Prevalence and epidemiology of hepatitis D among patients with chronic hepatitis B virus infection: a report from Northern Spain

Background The incidence of hepatitis delta virus (HDV) infection has decreased during the last decades. However, an increasing trend has been reported recently. Patients and methods We carried out a case–control study to analyze changes in its prevalence in 1215 chronic hepatitis B virus (HBV) patients, diagnosed consecutively in a tertiary center, between 1983 and 2012. According to the year of diagnosis, patients were distributed into two groups: A [1983–1997 (n=786)] and B [1998–2012 (n=429)]. Results The prevalence of anti-HDV was 8.2% (9.4% in group A and 6.1% in group B) (P=0.04). Multivariate regression revealed that intravenous drug use [odds ratio (OR) 261.0; 95% confidence interval (CI), 28.7–2368.5; P<0.001], blood transfusion (OR 28.0; 95% CI, 2.7–295.9; P=0.03), anti-HIV(+) (OR 4.8; 95% CI, 1.6–14.5; P=0.004), and high alanine aminotransferase (OR 14.4; 95% CI, 3.4–60.6; P<0.001) were associated independently with the presence of anti-HDV in group A, whereas in group B, it was associated with immigration (OR 20.0; 95% CI, 4.7–84.9; P<0.001), intravenous drug use (OR 683.5; 95% CI, 52.7–8855.7; P<0.001), promiscuous sexual activity (OR 22.6; 95% CI, 2.2–228.5; P=0.008), and high alanine aminotransferase (OR 3.4; 95% CI, 1.1–10.0; P=0.02). Conclusion Although a significant decrease in the prevalence of HDV infection has been observed, it is still above 5%. Immigration and sexual transmission have emerged as new risk factors for HDV infection.

Incidence and risk factors associated with hepatocellular carcinoma surveillance failure: Hepatocellular carcinoma surveillance

Surveillance for hepatocellular carcinoma (HCC) intends to detect tumors at an early stage to improve survival. The study aims were to assess the frequency and risk factors associated with HCC surveillance failure.

Tratamiento del paciente con hepatitis crónica por el virus de la hepatitis B

La hepatitis cronica por virus de la hepatitis B es aun un problema importante de salud publica, agravado por el creciente fenomeno de la inmigracion procedente de zonas con elevada prevalencia de infeccion por este virus. Durante los ultimos anos se ha producido un avance notable en los metodos diagnosticos, el conocimiento de la historia natural de la enfermedad y las opciones terapeuticas, incluido el trasplante hepatico, lo que se ha traducido en una mejoria en la supervivencia de los pacientes. Todo ello ha ido acompanado de un incremento en la complejidad de la toma de decisiones. Actualmente hay 6 tratamientos aprobados para la hepatitis B, incluidas 2 formulaciones de interferon, el estandar y el pegilado, y 4 analogos de nocleotidos/nucleosidos, lamivudina, adefovir, entecavir y telbivudina, y 2 mas que se utilizan en pacientes coninfectados con el virus de la inmunodeficiencia humana, tenofovir y emtricitabina. Sin embargo, ninguno de los tratamientos actuales es capaz de erradicar el virus, por lo que con frecuencia es preciso recurrir a tratamientos prolongados, con el consiguiente riesgo de generar variantes del virus resistentes. Por ello y por la heterogeneidad de la historia natural de la enfermedad, aun no se han establecido con claridad las indicaciones de tratamiento y en que parametros deben basarse, cual es el farmaco o la combinacion de farmacos ideal o que criterios deben seguirse para continuar, modificar o interrumpir el tratamiento. Por tanto, a pesar de los enormes progresos realizados, aun persisten numerosas incognitas que hacen que el tratamiento clinico de estos pacientes constituya un autentico reto.

Cuantificación del antígeno de superficie del virus de la hepatitis B en la caracterización y seguimiento

The recent availability of commercial techniques for the quantification of the hepatitis B surface antigen (HBsAg) has revived interest in this antigen. In recent years, the antigens potential as a biomarker of the natural history of the disease and its response to antiviral treatment has been assessed. HBsAg serum values reflect the transcriptional activity of cccDNA; reading these values could therefore complement the reading of hepatitis B virus (HBV) DNA in the categorization of the various phases of chronic HBV infection. During its natural history, HBsAg values progressively decrease from the immune-tolerant phase to the inactive carrier phase. For patients who are HBeAg-negative, the combined reading of HBV DNA and HBsAg can be useful for differentiating inactive carriers from patients with chronic HBeAg-negative hepatitis, for stratifying the risk of developing hepatocarcinoma and for predicting HBsAg clearance.

1018 USEFULNESS OF GD-EOB-DTPA CONTRAST ENHANCED MRI IN THE DIAGNOSIS OF HEPATOCELLULAR CARCINOMA (HCC). APPLICABILITY IN LIVER CIRRHOSIS

Thirteen lesions were characterized as focal nodular hyperplasia (FNH) and presented a characteristic ’map-like’ pattern of glutamine synthetase (GS). MR imaging signs of diffuse intratumoural fat deposition was present in 78% of L-FABP-negative HCA compared to 17% of inflammatory HCA (P =0.001). Steatosis within the nontumoural liver was present in 17% of inflammatory HCA compared to none of the L-FABP-negative HCA (P =0.001). A characterisric ’atoll’ sign was only seen in the inflammatory group (P =0.027). Presence of a typical vaguely defined type of scar was seen in 5 out of 7 b-catenin positive HCA (P =0.003). GS positivity in HCA and FNH lesions showed presence of a scar in 14 out of 18 GS positive lesions (P ≤0.001). No specific MR imaging features were identified for the unclassified group of HCA Conclusions: L-FABP-negative HCA, inflammatory HCA and b-catenin positive HCA were associated with specific MR patterns. Intratumoural fat deposition and presence of an ’atoll’ sign and/or a typical vagely defines scar can help to distinguish between these subtypes. Since b-catenin positive HCA are considered premalignant, resection or closer follow-up on MR imaging may be preferred in these cases.