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New Advances in Management of Hepatitis B Virus (HBV) Infection
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New Advances in Management of Hepatitis B Virus (HBV) Infection

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 10815

Special Issue Editors

Dr. Maryam Moini

E-Mail Website
Guest Editor
Department of Medicine, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
Interests: hepatitis; cirrhosis; liver fibrosis; chronic liver disease; liver transplant
Dr. Scott K. Fung

E-Mail Website
Guest Editor
Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, ON M5G 2CV, Canada
Interests: gastroenterology; liver disease; hepatitis; clinical trials; hepatitis B; hepatitis C; viral hepatitis

Special Issue Information

Dear Colleagues,

Chronic hepatitis B infection (HBV) is the leading cause of cirrhosis and hepatocellular carcinoma worldwide. The introduction of effective vaccination and improvement in preventive measures has led to a decreased incidence of the dis-ease, and effective antiviral treatment has resulted in reduced complications of hepatitis B related chronic liver disease and cirrhosis. However, the functional cure defined as hepatitis B surface antigen loss is rarely achieved with the currently approved antiviral medications, and long-term treatment is required to maintain viral suppression. The development of novel antiviral treatments has been shown promising results to achieve functional cure and could be a game-changer for patients with chronic hepatitis B infection. To achieve the goal of cure using new antiviral medications, new sensitive assays are required to detect a low level of viremia and HBs Ag level for monitoring response to treatment. 

The aim of this Special Issue is to provide original and review articles presenting new insights and advances in epidemiology, diagnosis, prognosis, treatment, and management of hepatitis B infection and related complications.

Dr. Maryam Moini
Dr. Scott K. Fung
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • epidemiology of chronic hepatitis B infection
  • predictors of disease progression in chronic hepatitis B infection
  • predictors of hepatocellular carcinoma in chronic hepatitis B infection
  • management of hepatocellular carcinoma in patients with chronic hepatitis B
  • ethnicity and diversity in chronic hepatitis B management
  • treatment of chronic hepatitis B infection in children
  • treatment endpoints for chronic hepatitis B
  • treatment of HBV/HIV coinfection
  • management of hepatitis B infection in immunosuppressed patients
  • novel treatments for chronic hepatitis B

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Published Papers (5 papers)

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Research

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16 pages, 1636 KiB  
Article
A New Assessment of Two Transferase-Based Liver Enzymes in Low- and High-Fibrosis Patients Chronically Infected with Hepatitis B Virus: A Meta-Analysis and Pilot Study
by Marina Manea, Ion Mărunțelu and Ileana Constantinescu
J. Clin. Med. 2024, 13(13), 3903; https://doi.org/10.3390/jcm13133903 - 3 Jul 2024
Viewed by 847
Abstract
Background: The detection of fibrosis remains a necessity for the evaluation of hepatitis B virus (HBV)-infected patients, but the most accurate technique is invasive. Current studies aim to develop a novel noninvasive biomarker for fibrosis assessment, but no-one has found the ideal candidate. [...] Read more.
Background: The detection of fibrosis remains a necessity for the evaluation of hepatitis B virus (HBV)-infected patients, but the most accurate technique is invasive. Current studies aim to develop a novel noninvasive biomarker for fibrosis assessment, but no-one has found the ideal candidate. This study is a meta-analysis combined with a pilot study to investigate the connection between two transferase compounds and the levels of fibrosis. Methods: We studied data from PUBMED, Web of Science, and Scopus, retrieving 28,896 articles. Following PRISMA guidelines, we finally analyzed full-text articles written in English. The excluded items were duplicates, non-article entries, and irrelevant papers. We assessed the variations in alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels between patients with high and low levels of fibrosis. Joanna Briggs Institute tools were used to assess article quality. We used R 4.2.2 for statistics. The pilot study included 14 randomly chosen patients with different fibrosis levels. Results: We found significant differences in ALT and GGT levels between patients with high and low fibrosis. The GGT/ALT ratio correlated with the levels of fibrosis and the fibrosis-4 (FIB-4) score. Conclusions: This meta-analysis assessed ALT and GGT levels in chronic HBV patients with fibrosis. The pilot study identified the first association between fibrosis and the GGT/ALT ratio in a Romanian cohort of chronic patients. This brings new ideas for future research. Full article
(This article belongs to the Special Issue New Advances in Management of Hepatitis B Virus (HBV) Infection)
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11 pages, 820 KiB  
Article
The Use of Tenofovir Disoproxil Fumarate in the Management of eAg-Negative Chronic Hepatitis B Infection
by Nishita Jagarlamudi, Melissa Reyes, Scott Fung and Florence Wong
J. Clin. Med. 2024, 13(7), 1864; https://doi.org/10.3390/jcm13071864 - 24 Mar 2024
Viewed by 1033
Abstract
Background/Objectives: Currently, there are insufficient data to recommend the treatment of patients with hepatitis B e antigen (HBeAg)-negative chronic infection who have normal ALT and low HBV DNA, since the prognosis is generally regarded as favorable. The aim of this pilot study was [...] Read more.
Background/Objectives: Currently, there are insufficient data to recommend the treatment of patients with hepatitis B e antigen (HBeAg)-negative chronic infection who have normal ALT and low HBV DNA, since the prognosis is generally regarded as favorable. The aim of this pilot study was to determine whether the use of tenofovir disoproxil fumarate (TDF) 300 mg/day for 3 years was able to achieve functional cure (HBsAg loss) and HBsAg seroconversion in HBeAb-positive individuals. Methods: Fifty patients not on antiviral therapy (40% men, mean age 48.9 ± 10.9 years, 84% Asians) with minimal fibrosis were enrolled. Results: TDF reduced HBV DNA significantly to undetectable levels after 6 months. Overall, 48.3% of inactive carriers (baseline HBV DNA < 2000 IU/mL) remained HBV DNA negative 6 months after treatment withdrawal, which was significantly higher than the 5.6% in those who were not inactive carriers (baseline HBV DNA ≥ 2000 IU/mL) (p = 0.003). The HBsAg levels did not drop throughout the study period with no difference between inactive carriers versus those who were not. Five inactive carriers achieved functional cure, but none of these were amongst those who were not inactive carriers. No renal dysfunction or ALT flare on treatment withdrawal was observed. Conclusions: TDF could potentially be used to induce functional cure in patients who are inactive carriers with normal ALT, low HBV DNA and without advanced fibrosis. Full article
(This article belongs to the Special Issue New Advances in Management of Hepatitis B Virus (HBV) Infection)
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16 pages, 700 KiB  
Article
Hepatitis B Virus Genotype Influence on Virological and Enzymatic Measures over Time—A Retrospective Longitudinal Cohort Study
by Alexa Keeshan, Carolina Fernandes da Silva, Alicia Vachon, Elizabeth Giles, Carla Osiowy, Carla Coffin and Curtis L. Cooper
J. Clin. Med. 2023, 12(21), 6807; https://doi.org/10.3390/jcm12216807 - 27 Oct 2023
Cited by 1 | Viewed by 1218
Abstract
HBV is a hepatotropic virus with multiple genotypes. It is uncertain if specific genotype(s) influence virological measures and/or liver markers over time. It is unclear whether nucleos(t)ide analogue therapy response is influenced by genotype. In this retrospective longitudinal study, we utilized data from [...] Read more.
HBV is a hepatotropic virus with multiple genotypes. It is uncertain if specific genotype(s) influence virological measures and/or liver markers over time. It is unclear whether nucleos(t)ide analogue therapy response is influenced by genotype. In this retrospective longitudinal study, we utilized data from The Ottawa Hospital Viral Hepatitis Program (TOHVHP) to evaluate the role of HBV genotype on viral load, liver enzymatic levels, fibrosis progression, and parenchymal inflammation and steatosis over time. HBV DNA, ALT, and AST levels, as well as transient elastography scores for fibrosis (E) and inflammation/steatosis (CAP), were modeled using mixed-effects linear regression. Interaction terms between HBV genotype and time were included to investigate if there was a difference in trends between genotypes. A total of 393 HBV patients infected with genotypes A-E were included. The mean age was 44.4 years, and 56% were male. Asian (50.5%), Black (29.1%), and White (6.4%) patients were well-represented. By multivariate analysis, we found no evidence that the trajectories of these commonly measured viral or liver measures varied over time by HBV genotype in those receiving HBV nucleos(t)ides and in those not on antiviral therapy. Full article
(This article belongs to the Special Issue New Advances in Management of Hepatitis B Virus (HBV) Infection)
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Review

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15 pages, 288 KiB  
Review
Non-Invasive Assessment of Liver Fibrosis in Hepatitis B Patients
by Chinmay Bera, Nashla Hamdan-Perez and Keyur Patel
J. Clin. Med. 2024, 13(4), 1046; https://doi.org/10.3390/jcm13041046 - 12 Feb 2024
Cited by 3 | Viewed by 2934
Abstract
The aim of this review is to provide updated information on the clinical use of non-invasive serum and imaging-based tests for fibrosis assessment in chronic hepatitis B (CHB) virus infection. In recent years, non-invasive tests (NIT) have been increasingly used to determine eligibility [...] Read more.
The aim of this review is to provide updated information on the clinical use of non-invasive serum and imaging-based tests for fibrosis assessment in chronic hepatitis B (CHB) virus infection. In recent years, non-invasive tests (NIT) have been increasingly used to determine eligibility for treatment. Liver biopsy is still considered the gold standard for assessing inflammatory activity and fibrosis staging, but it is an invasive procedure with inherent limitations. Simple serum markers such as APRI and FIB-4 are limited by indeterminate results but remain useful initial tests for fibrosis severity if imaging elastography is not available. Point-of-care US-based elastography techniques, such as vibration-controlled transient elastography or 2D shear wave elastography, are increasingly available and have better accuracy than simple serum tests for advanced fibrosis or cirrhosis, although stiffness cut-offs are variable based on E-antigen status and inflammatory activity. Current NITs have poor diagnostic performance for following changes in fibrosis with antiviral therapy. However, NITs may have greater clinical utility for determining prognosis in patients with CHB that have advanced disease, especially for the development of hepatocellular carcinoma and/or liver decompensation. Algorithms combining serum and imaging NITs appear promising for advanced fibrosis and prognostic risk stratification. Full article
(This article belongs to the Special Issue New Advances in Management of Hepatitis B Virus (HBV) Infection)
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14 pages, 3224 KiB  
Review
Hepatitis B Virus Reactivation with Immunosuppression: A Hidden Threat?
by Sama Anvari and Keith Tsoi
J. Clin. Med. 2024, 13(2), 393; https://doi.org/10.3390/jcm13020393 - 11 Jan 2024
Cited by 3 | Viewed by 4076
Abstract
Hepatitis B virus (HBV) reactivation in the setting of immunosuppressive therapy is an increasingly recognized and preventable cause of elevated liver enzymes and clinical hepatitis in treated patients. However, not all immunosuppressive therapies confer the same risk. The purpose of this article was [...] Read more.
Hepatitis B virus (HBV) reactivation in the setting of immunosuppressive therapy is an increasingly recognized and preventable cause of elevated liver enzymes and clinical hepatitis in treated patients. However, not all immunosuppressive therapies confer the same risk. The purpose of this article was to review the literature on risks of HBV reactivation associated with immunosuppressive agents and propose a management algorithm. We searched Google Scholar, PubMed, and MEDLINE for studies related to hepatitis B reactivation and various immunosuppressive agents. The risk of HBV reactivation was found to differ by agent and depending on whether a patient had chronic HBV (HBsAg+) or past HBV (HBsAg−, anti-HBc+). The highest risk of reactivation (>10%) was associated with anti-CD20 agents and hematopoietic stem cell transplants. Multiple societies recommend HBV-specific anti-viral prophylaxis for patients with positive HBsAg prior to the initiation of immunosuppressive therapy, while the guidance for HBsAg− patients is more variable. Clinicians should check HBV status prior to beginning an immune-suppressive therapy. Patients with positive HBsAg should be initiated on antiviral prophylaxis in the majority of cases, whereas HBsAg− individuals should be evaluated on a case-by-case basis. Further research is required to determine the optimum duration of therapy. Full article
(This article belongs to the Special Issue New Advances in Management of Hepatitis B Virus (HBV) Infection)
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