Richard Guan

A one year trial of Lamivudine for chronic hepatitis B

BACKGROUND AND METHODS In preliminary trials, lamivudine, an oral nucleoside analogue, has shown promise for the treatment of chronic hepatitis B. We conducted a one-year, double-blind trial of lamivudine in 358 Chinese patients with chronic hepatitis B. The patients were randomly assigned to receive 25 mg of lamivudine (142 patients), 100 mg of lamivudine (143), or placebo (73) orally once daily. The patients underwent liver biopsies before entering the study and after completing the assigned treatment regimen. The primary end point was a reduction of at least two points in the Knodell necroinflammatory score. RESULTS Hepatic necroinflammatory activity improved by two points or more in 56 percent of the patients receiving 100 mg of lamivudine, 49 percent of those receiving 25 mg of lamivudine, and 25 percent of those receiving placebo (P<0.001 and P=0.001, respectively, for the comparisons of lamivudine treatment with placebo). Necroinflammatory activity worsened in 7 percent of the patients receiving 100 mg of lamivudine, 8 percent of those receiving 25 mg, and 26 percent of those receiving placebo. The 100-mg dose of lamivudine was associated with a reduced progression of fibrosis (P=0.01 for the comparison with placebo) and with the highest rate of hepatitis B e antigen (HBeAg) seroconversion (loss of HBeAg, development of antibody to HBeAg, and undetectable HBV DNA) (16 percent), the greatest suppression of HBV DNA (98 percent reduction at week 52 as compared with the base-line value), and the highest rate of sustained normalization of alanine aminotransferase levels (72 percent). Ninety-six percent of the patients completed the study. The incidence of adverse events was similar in all groups, and there were few serious events. CONCLUSIONS In a one-year study, lamivudine was associated with substantial histologic improvement in many patients with chronic hepatitis B. A daily dose of 100 mg was more effective than a daily dose of 25 mg.

A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt

Background: The hepatitis C pandemic has been systematically studied and characterized in North America and Europe, but this important public health problem has not received equivalent attention in other regions.

Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2005 update

Background/Aims: A large amount of new data on the treatment of chronic hepatitis B has become available such that the 2003 consensus statement requires revision and update.

Four years of lamivudine treatment in Chinese patients with chronic hepatitis B

Background and Aims:  This study assessed the efficacy and safety of up to 4 years of lamivudine treatment and the clinical relevance of the emergence of YMDD‐variant hepatitis B virus (HBV).

Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection.

Co-chairs: GW McCaughan, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia M Omata, Tokyo University Hospital, Tokyo, Japan Faculty Members: D Amarapurkar, Bombay Hospital, Mumbai, India S Bowden, Victorian Infectious Diseases Reference Laboratories, Melbourne, Australia WC Chow, Singapore General Hospital, Singapore A Chutaputti, Pramongkutklao Hospital, Bangkok, Thailand G Dore, National Center in HIV Epidemiology and Clinical Research, Sydney, Australia E Gane, NZ Liver Transplant Unit, Auckland, New Zealand R Guan, Mount Elizabeth Medical Center, Singapore SS Hamid, The Aga Khan University, Karachi, Pakistan W Hardikar, Royal Children’s Hospital, Melbourne, Australia CK Hui, Queen Mary Hospital, University of Hong Kong, Hong Kong, China W Jafri, The Aga Khan University, Karachi, Pakistan J-D Jia, Beijing Friendship Hospital, Capital Medical University, Beijing, China M-Y Lai, National Taiwan University Hospital, Taiwan L Wei, Peking University Peoples Hospital, Beijing, China N Leung, The Chinese University of Hong Kong, Hong Kong, China T Piratvisuth, Prince of Songkla University, Hat Yai, Thailand S Sarin, GB Pant Hospital, Delhi, India J Sollano, University Santo Tomas Hospital, Manilla, Philippines R Tateishi, University of Tokyo Hospital, Tokyo Japan

Racial differences in Helicobacter pylori seroprevalence in Singapore: correlation with differences in peptic ulcer frequency.

The aim of this study was to determine, first, whether racial differences exist in the seroprevalence of Helicobacter pylori infection in Singapore, and second, whether these differences correlate with racial differences in peptic ulcer frequency. A commercial serological test for immunoglobulin (Ig)G antibody to H. pylori which was 90% sensitive and 83% specific in our population was used to screen 403 adult blood donors of Chinese, Malay and Indian origin, aged between 15–60 years. Serum specimens from 84 paediatric patients admitted to the Paediatrics Department, National University of Singapore, with non‐gastroenterological illnesses were also tested. In all three races, seroprevalence of H. pylori increased with age. Indians have the highest prevalence of infection followed by Chinese and Malays. Peptic ulcer prevalences are known to be highest in Chinese, followed by Indians and Malays. The Malays have the lowest prevalence of H. pylori and peptic ulcer among the three races in Singapore. Indians have a higher prevalence of H. pylori antibodies but a lower frequency of peptic ulcer than the Chinese. Racial differences in peptic ulcer frequency between Chinese and Indians are not explained by the prevalence of H. pylori infection; other environmental or genetic factors may be involved.

Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection

Aims : To determine: (i) the prevalence of histological gastritis and peptic ulcer; and (ii) the clinical features of peptic ulcer, in patients with end‐stage renal failure.

Chronic hepatitis B: treatment alert

Abstract: Chronic hepatitis B (CHB) is a serious global health concern, particularly in the Asia‐Pacific region. New information on the clinical management of CHB is emerging rapidly, requiring that physicians be alerted to updated treatment recommendations. The ACT‐HBV Asia‐Pacific Steering Committee members, composed of experts in hepatitis B from throughout the Asia‐Pacific region, reviewed and discussed new clinical data as reported in the literature or presented at recent international congresses, and recommended that physicians be alerted to updated treatment recommendations. Hepatitis B e antigen (HBeAg)‐positive patients with HBV DNA levels of ≥20 000 IU/ml (≥105 copies/ml) and elevated alanine aminotransferase levels should be considered for treatment. It is suggested that HBV DNA≥2000 IU/ml (≥104 copies/ml) is the more appropriate threshold for the treatment of HBeAg‐negative patients. Lamivudine, adefovir dipivoxil, interferon α‐2b, thymosin α‐1, and, most recently, entecavir, and pegylated interferon α‐2a are licensed for the management of CHB. The treatment recommendations from the 2005 Asian‐Pacific Consensus Statement on the Management of Chronic Hepatitis B have been updated to incorporate these new therapeutic options. A summary of treatment recommendations for special patient populations is also included.

Study on the comparative immunogenicity of a recombinant DNA hepatitis B vaccine containing pre‐S components of the HBV coat protein with non pre‐S containing vaccines

Abstract A new recombinant hepatitis B vaccine (SCI‐B‐VAC), derived from Chinese hamster ovary (CHO) cells and consisting of both the major S protein and the minor pre‐S1 and pre‐S2 proteins of the viral coat were compared with two yeast‐derived vaccines containing only S proteins (B‐Hepavac II and Engerix‐B) for immunogenicity in human volunteers in a randomized controlled study. Two hundred and ninety‐five healthy subjects completed the 12 month follow up. There was no difference in the mean age and sex distribution among the three study groups. Seroconversion rates for all the three groups were similar at months 6, 9 and 12. However, hepatitis B surface antibody (anti‐HBs) geometric mean titres (GMT) were significantly higher with 10 μg SCI‐B‐VAC and 20 μg Engerix‐B than with 10 μg B‐Hepavac‐II at months 6, 9 and 12. SCI‐B‐VAC at month 6 also showed a significantly higher anti‐HBs GMT than Engerix‐B (295 vs 143 miu/mL, P < 0.02).

Racial differences in peptic ulcer frequency in Singapore

Several hospital series of peptic ulcer patients have suggested that ulcer prevalence may be different in the different races in Singapore. However, such studies may be biased because different races use hospital services differently and also because hospital catchment populations are difficult to define. In the present study the racial composition of a consecutive series of 1248 peptic ulcer patients seen in two medical units of a general hospital was compared to that of 2023 general medical patients attending the same units. For both sexes, the racial structure of the gastric ulcer as well as the duodenal ulcer patients was significantly different from that of the general medical group. There was an excess of Chinese patients of both sexes with gastric ulcer and duodenal ulcer. In contrast, the numbers of male Malay gastric ulcer, male Malay duodenal ulcer, female Malay duodenal ulcer as well as Indian gastric ulcer patients of both sexes were fewer than expected. These results cannot be accounted for by racial differences in either health‐seeking behaviour or analgesic and tobacco usage. These observations confirm the probable occurrence of racial differences in peptic ulcer frequency in Singapore.