Siwaporn P. Chainuvati

Patterns of managing chronic hepatitis B treatment-related drug resistance: a survey of physicians in Mainland China, South Korea, Taiwan, and Thailand

PurposeThe emergence of antiviral resistance can negate the benefits of antiviral therapy in patients with chronic hepatitis B (CHB). This study aimed to assess how physicians in Asia manage suspected antiviral resistance.MethodsRandomly selected CHB-treating physicians in Mainland China, South Korea, Taiwan, and Thailand underwent a face-to-face interview. A standardized questionnaire was used to assess how physicians identify, monitor, and manage suspected resistance and its associated medical costs.ResultsWe interviewed 575 physicians from January to May 2008. Most physicians preferred a “prevention-of-antiviral resistance” strategy over a “rescue-once-resistance-develops” strategy. Physicians had encountered lamivudine resistance most frequently (96–100% of respondents), followed by the resistance to adefovir (18–58%) and entecavir (3–7%). While physicians in South Korea and Taiwan have access to resistance testing, physicians in Mainland China and Thailand have limited access to resistance testing but rely on HBV DNA and alanine aminotransferase (ALT) tests to identify resistance. Once resistance is suspected, 60% of the physicians in Mainland China, South Korea, and Thailand monitored these patients quarterly and the remaining 40% opted for monthly follow-up. In comparison, 70% of the Taiwanese physicians monitored these patients monthly. The average total direct medical costs, excluding antiviral costs, to manage a patient during the first year after suspected resistance is identified ranged from USD

ALT Course, Serum HBV DNA and Liver Stiffness Measurement for Therapeutic Decision in HBeAg‐Negative Chronic Hepatitis B

319 to USD

Alanine aminotransferase course, serum hepatitis B virus DNA, and liver stiffness measurement for therapeutic decisions in hepatitis B e antigen-negative chronic hepatitis B.

709.ConclusionsLimited access to HBV resistance tests causes physicians in Asia to manage suspected resistance by various HBV DNA assays and ALT tests. This raises concerns that resistance may not be detected early enough to be rescued efficiently.

Su1013 Influence of Insulin Resistance on Histological Features in Patients With Chronic Hepatitis B Infection

To evaluate the utility of the combination of alanine aminotransferase (ALT) course, hepatitis B virus (HBV) DNA level, and liver stiffness measurement (LSM) for determining significant liver disease in hepatitis B e antigen (HBeAg)‐negative patients.

Su1014 The Significance of Steatohepatitis in Chronic Hepatitis B Infection

To evaluate the utility of the combination of alanine aminotransferase (ALT) course, hepatitis B virus (HBV) DNA level, and liver stiffness measurement (LSM) for determining significant liver disease in hepatitis B e antigen (HBeAg)‐negative patients.

Erythrocyte sedimentation rate and C-reactive protein for the prediction of severity of acute pancreatitis.

Background/Aims: Insulin resistance (IR), the major feature of the metabolic syndrome, is common in patients with chronic hepatitis B (CHB) infection. The data on the influence of IR on histological features in CHB are limited. This study aimed to determine the association among IR, liver fibrosis, necroinflammation and steatosis in CHB patients. Methods: Consecutive naive CHB patients with serum HBV DNA levels >2000 IU/mL undergoing liver biopsies at Siriraj Hospital between December 2010 and June 2013 were prospectively included. Patients coinfected with other viruses or suffering from liver disease of other causes were excluded. Liver biopsy specimens were analyzed by a single experienced pathologist blinded to clinical data. IR was assessed by the Homeostasis Model for Assessment of Insulin Resistance (HOMA-IR) method. Results: A total of 251 patients (51% male) with a mean age of 46±11 years and a mean body mass index (BMI) of 23.7±4.2 kg/m2were recruited. Fifty-eight patients (23.5%) met the criteria of the metabolic syndrome according to the harmonizing criteria. HBeAg-negative patients constituted 72% of the cohort with a median viral load of 5.6 log10IU/mL (range 3.3-8.5). The most common genotype was C (67%), followed by B (30%) and other genotypes coinfected with B or C (3%). According to the METAVIR score, necroinflammation was moderate to severe in 47 patients (18.7%). Fibrosis was significant (F≥2) in 117 patients (46.6%) with 9 patients having cirrhosis. Macrovesicular steatosis alone was present in 4.5% of patients and a mixed pattern characterized by the presence of both macro-and microvesicular steatosis was found in 33%. The mean of HOMAIR was 2.44±1.97. HOMA-IR correlated significantly with BMI (r=0.41, p 2.0, IR was observed in 50% of patients. Patients with IR were male predominant (62% vs 41%, p=.002) andmore overweight (78% vs 29%, p 5% (50% vs 17%; OR=4.92; 95% CI 2.74-8.83). It is noteworthy that HOMA-IR showed a trend toward increasing value of the fibrosis stage (p=.058): 2.39±2.35 (F0-F1), 2.42±1.33 (F2), 2.40±1.06 (F3), 3.64±2.41 (F4). Conclusion: IR is associated with several histological findings which are at risk for progressive liver disease in CHB patients. Thus, measures aiming at reducing the IR might improve histological features in this population.

Association between HLA class II alleles and autoimmune hepatitis type 1 in Thai patients.

Background/Aims: Insulin resistance (IR), the major feature of the metabolic syndrome, is common in patients with chronic hepatitis B (CHB) infection. The data on the influence of IR on histological features in CHB are limited. This study aimed to determine the association among IR, liver fibrosis, necroinflammation and steatosis in CHB patients. Methods: Consecutive naive CHB patients with serum HBV DNA levels >2000 IU/mL undergoing liver biopsies at Siriraj Hospital between December 2010 and June 2013 were prospectively included. Patients coinfected with other viruses or suffering from liver disease of other causes were excluded. Liver biopsy specimens were analyzed by a single experienced pathologist blinded to clinical data. IR was assessed by the Homeostasis Model for Assessment of Insulin Resistance (HOMA-IR) method. Results: A total of 251 patients (51% male) with a mean age of 46±11 years and a mean body mass index (BMI) of 23.7±4.2 kg/m2were recruited. Fifty-eight patients (23.5%) met the criteria of the metabolic syndrome according to the harmonizing criteria. HBeAg-negative patients constituted 72% of the cohort with a median viral load of 5.6 log10IU/mL (range 3.3-8.5). The most common genotype was C (67%), followed by B (30%) and other genotypes coinfected with B or C (3%). According to the METAVIR score, necroinflammation was moderate to severe in 47 patients (18.7%). Fibrosis was significant (F≥2) in 117 patients (46.6%) with 9 patients having cirrhosis. Macrovesicular steatosis alone was present in 4.5% of patients and a mixed pattern characterized by the presence of both macro-and microvesicular steatosis was found in 33%. The mean of HOMAIR was 2.44±1.97. HOMA-IR correlated significantly with BMI (r=0.41, p 2.0, IR was observed in 50% of patients. Patients with IR were male predominant (62% vs 41%, p=.002) andmore overweight (78% vs 29%, p 5% (50% vs 17%; OR=4.92; 95% CI 2.74-8.83). It is noteworthy that HOMA-IR showed a trend toward increasing value of the fibrosis stage (p=.058): 2.39±2.35 (F0-F1), 2.42±1.33 (F2), 2.40±1.06 (F3), 3.64±2.41 (F4). Conclusion: IR is associated with several histological findings which are at risk for progressive liver disease in CHB patients. Thus, measures aiming at reducing the IR might improve histological features in this population.