Search Results (323)

Malnutrition in patients with gastrointestinal (GI) cancers can be the result of functional and/or anatomical changes in the alimentary tract, secondary to malignancy or oncologic therapies. Understanding the underlying mechanisms of malnutrition in these patients is imperative in providing appropriate interventions that can not only improve quality of life for these individuals, but also improve their tolerance of oncologic treatment and progression towards remission or cure. In this narrative review, we address common nutritional deficiencies associated with GI malignancies, including pancreatic, biliary, and hepatic cancers. Furthermore, we address common issues related to these deficiencies and causes of nutrition barriers as they relate to organ malfunction or surgical alterations of anatomy. Recommendations for counseling, dietary modifications, nutritional supplements, and pharmacologic interventions are provided based on individual barriers and the vital role of multidisciplinary care is highlighted. Additionally, we highlight novel techniques, such as the role of psychosocial care, prehabilitation, digital health, and machine learning, which can improve nutritional outcomes, provide patient-directed care, and improve risk stratification for this complex and multifaceted issue that faces patients diagnosed with GI cancers. Full article

Background: People who inject drugs (PWID) have a higher risk of contracting hepatitis C (HCV) than the general population, but these individuals are often poorly served by traditional healthcare systems. The elimination of HCV as a threat to public health relies on the treatment of this population. Novel care models designed with input from PWID may help to better align care to the needs of PWID. Methods: We designed and implemented a community-based, point-of-care testing program for HCV delivered by a syringe service program, combined with facilitated access to a healthcare provider, care navigation, and financial incentives. We collected participant demographics and drug use patterns, testing and treatment history, and communication preferences. Descriptive analyses include the number of people tested between 15 October 2021 and 1 February 2025, their seropositivity rate, and the number who completed pre-treatment laboratory tests, completed treatment and achieved cure by sustained virologic response (SVR12) by 1 August 2025. Results: The program engaged 464 unique individuals, of whom 98 (21.1%) had a known diagnosis of HCV. Of 389 unique individuals who underwent point of care (POC) HCV antibody (Ab) testing, including 31 with a known prior diagnosis of HCV, 97 (24.9%) had a positive result. Of 439 unique individuals who underwent POC HIV Ab testing, only 1 had a positive result. Of 164 individuals with either a positive POC HCV Ab test or a known HCV diagnosis, 66 completed pre-treatment laboratory tests, identifying 52 viremic participants. Of those, 35 started and completed treatment. Among those who completed treatment, 9 (25.7%) achieved SVR12, 3 (8.6) failed to achieve SVR12, and 23 (65.7%) had outstanding laboratory orders for SVR12 determination. Conclusions: An incentivized, community-based, point-of-care testing program with facilitated linkage to care successfully engaged a high-risk population in HCV and HIV testing and treatment. However, substantial attrition occurred at each step of the care cascade, particularly at SVR12 determination. Additional strategies are needed to optimize retention throughout the entire care cascade. Full article

Chronic hepatitis C virus (HCV) infection remains a major global health burden, responsible for substantial morbidity and mortality despite the advent of curative antiviral therapy. HCV induces hepatic injury and carcinogenesis through direct viral effects, persistent inflammation, oxidative stress, and metabolic disturbance. The introduction of direct-acting antivirals (DAAs) has revolutionized therapy, achieving sustained virologic response rates exceeding 95% and transforming HCV from a chronic, progressive disease into a curable infection. Nevertheless, viral eradication does not fully normalize hepatic or systemic risk. Patients with advanced fibrosis or cirrhosis continue to face an elevated incidence of hepatocellular carcinoma (HCC) and other complications, reinforcing the need for long-term monitoring. This review summarizes current knowledge of the molecular mechanisms underlying HCV-mediated carcinogenesis, the partial restoration of hepatic homeostasis following DAA-induced cure, and the clinical implications for surveillance and management in the post-HCV era. By integrating insights from molecular virology, immunopathogenesis, and clinical hepatology, the review highlights how persistent epigenetic and inflammatory footprints may sustain oncogenic potential even after viral clearance. A comprehensive understanding of these processes is essential for optimizing HCC prevention strategies, guiding surveillance policies, and advancing future therapeutic innovations aimed at complete hepatic recovery. Full article

Background and Objectives: Patients who undergo hepatitis virus testing may remain unaware of their results in the absence of clinician feedback, particularly from non-specialists. To address this issue, we introduced patient-directed test result reports and evaluated their effectiveness in promoting physician responses among non-specialists. Materials and Methods: Distribution of hepatitis virus test result reports began on 22 August 2022 at the National Hospital Organization Disaster Medical Center in Japan. The study included all patients who underwent hepatitis testing, excluding those whose tests were ordered by gastroenterologists or screening physicians. The numbers of tests performed and reports distributed were obtained from electronic medical records. Results: Between August 2022 and August 2025, 30,700 patients underwent hepatitis B surface antigen (HBsAg) and/or hepatitis C virus antibody (HCV-Ab) testing, and 11,797 individuals received test result reports. In the most recent one-year period (September 2024–August 2025), the report distribution rate was 49.7%, unaffected by test positivity. Compared with the year before report implementation, the referral rates to gastroenterologists increased significantly for both HBsAg-positive (11.4% to 34.5%) and HCV-Ab-positive cases (7.7% to 25.2%; p < 0.01). Documentation of test results and confirmation of clinical cure or ongoing treatment by the ordering physician both improved. Cases without physician response decreased markedly (from 61.4% to 23.6% in HBsAg-positive patients and from 59.3% to 24.5% in HCV-Ab-positive patients; p < 0.01 for both). Conclusions: Distribution of dedicated hepatitis virus test result reports improved awareness among non-specialist physicians and contributed to better management of test-positive patients. Full article

Background and Objectives: Hepatitis C virus (HCV) remains a significant cause of chronic liver disease worldwide. While direct-acting antivirals achieve high cure rates, the interplay between viral load, gender, and routine laboratory parameters remains unclear. This study aimed to investigate hematological, biochemical, and coagulation profiles, as well as derived non-invasive indices, in HCV-infected patients, stratified by gender and viremia levels. Materials and Methods: This retrospective study included 367 patients with HCV infection (223 males and 144 females). Patients were divided into four groups: high viremia males (hiVM), high viremia females (hiVF), low viremia males (loVM), and low viremia females (loVF), using 800,000 IU/mL as the threshold. Routine hematological, biochemical, and coagulation tests were conducted, and derived indices (FIB-4, APRI, AST/ALT ratio, PLR, NLR, SII, AISI, PNI, HALP, PAR, NAR) were calculated. Results: Significant gender- and viremia-specific differences were observed. hiVM showed higher erythrocyte indices and altered coagulation parameters, whereas hiVF had increased lymphocyte counts and AST/ALT ratio elevation. loVM displayed reduced hemoglobin and hematocrit, along with worse coagulation results. Biochemical analysis revealed gender differences in GGT, bilirubin, and albumin levels. Among derived indices, FIB-4 and APRI were higher in loVM, while SII and PLR were elevated in loVF. At the second visit after 17±4 weeks, when patients had no detectable HCV DNA in the peripheral blood, most indices improved significantly across groups. Conclusions: HCV infection affects laboratory profiles depending on gender and viremia levels. Non-invasive indices from routine tests offer valuable insights into inflammatory and nutritional status. Using these indices alongside traditional markers may aid hypothesis generation or clinical assessment and help prioritize further assessment for HCV patients. Full article

Background/Objectives: Phosphatidylinositol (PI) species are bioactive lipids implicated in liver fibrogenesis. Hepatitis C virus (HCV) relies on host lipid metabolism for infection. The relationship between serum PI profiles, chronic HCV, and liver injury remains incompletely defined. Methods: Fourteen PI species were quantified by direct flow injection–tandem mass spectrometry (FIA–MS/MS; triple quadrupole) in serum from 178 patients with chronic HCV at three time points: before treatment and at weeks 4 and 12 after starting direct-acting antiviral (DAA) therapy. Results: At baseline, PI 34:1, 36:1, and 36:3 were higher in patients with ultrasound-diagnosed cirrhosis than in those without, whereas PI 38:4, 40:5, and 40:6 were lower. In non-cirrhotic patients, PI 36:3, 36:4, 38:3, 38:4, and 38:5 increased, while PI 40:5 and 40:6 declined at weeks 4 and 12 after therapy start. In cirrhosis, viral cure was not associated with changes in PI species. By the end of therapy, cirrhotic patients showed higher PI 36:3 and lower PI 38:4 than non-cirrhotic patients. Genotype 3a was associated with lower PI 38:3, 38:4, and 38:5; the reduction in PI 38:4 persisted to the end of therapy. Across time points, most PI species did not correlate with routine markers of liver injury or inflammation. Conclusions: HCV cure remodels the serum PI profile in non-cirrhotic patients. These findings suggest that altered PI profiles are primarily linked to HCV infection, supporting a role for PI lipids in viral propagation. Full article

Hepatitis B virus (HBV) represents a significant global health challenge, affecting over 254 million individuals and contributing to 1.1 million deaths from liver-related complications in 2022. The World Health Organization has set ambitious targets to reduce HBV infections and mortality by 2030. However, only a small proportion (13%) of infected individuals receives timely diagnosis and treatment. HBV elimination efforts necessitate substantial improvements in HBV diagnosis, particularly in identifying early-stage infections, occult HBV infections (OBI), and breakthrough cases. The hepatitis B surface antigen (HBsAg) is a key biomarker in HBV diagnosis, serving as a reliable indicator of infection status and treatment response. Conventional HBsAg assays, with a lower limit of detection (LoD) between 0.03 and 250 IU/mL, often fail to detect OBI and HBV reactivation. In contrast, ultrasensitive HBsAg assays, with an LoD as low as 0.005 IU/mL, can improve the identification of low concentration levels of HBsAg, facilitating earlier diagnosis, monitoring of therapeutic response, and assessment for functional cure. Research confirms the superiority of ultrasensitive assays in detecting HBV in cases missed by conventional assays, detecting NAT-yield samples, and enabling earlier detection of HBV reactivation. This review examines the challenges in HBV diagnostics and the clinical utility of ultrasensitive HBsAg assays in improving progress toward global HBV elimination. Full article

Direct-acting antivirals (DAAs) have transformed hepatitis C virus (HCV) management, offering high cure rates, favorable safety, and simplified regimens. Management in immunosuppressed patients remains challenging due to drug–drug interactions (DDIs). The objective of this review is to summarize clinical outcomes, safety, and pharmacologic considerations of DAA therapy in immunosuppressed patients, including solid organ transplant recipients and those on biological agents. We reviewed clinical studies, pharmacologic databases, and guidelines to characterize DAA classes, mechanisms, and relevant DDIs in immunosuppressed HCV patients. In transplant recipients, DAAs achieved sustained virological response (SVR) > 90% with minimal graft rejection. Safety profiles were favorable, and immunosuppressant dose adjustments were rarely needed. DDIs, particularly with calcineurin inhibitors (tacrolimus, cyclosporine), require careful monitoring due to variable trough-level effects. Evidence also supports the efficacy and safety of DAAs in patients on biological agents, without compromising SVR. Pharmacokinetic data indicate DAAs maintain antiviral activity across HCV genotypes in the presence of immunosuppressants, though mTOR inhibitors may alter efficacy in certain HCV genotypes. DAAs are highly effective and safe in immunosuppressed patients, achieving high SVR rates and potential graft survival benefits. Prospective studies are needed to assess DAA therapy in patients receiving biological agents and to optimize co-administration strategies with immunosuppressive agents. Full article

Chronic hepatitis B poses a serious threat to human health and life, and early diagnosis is essential to improving patient cure rates. Hepatitis B virus (HBV) and Alpha-fetoprotein (AFP) are two key biomarkers for diagnosing chronic hepatitis B. In this study, we propose a silicon nanowire array field effect transistor (SiNW-array FET) biosensor that enables highly sensitive, real-time, and low-cost joint detection of both HBV and AFP. The SiNW-array FET is fabricated using traditional micro-nano fabrication techniques such as self-limiting oxidation and anisotropic etching, and its morphology and electrical properties were tested. The results show that the diameters of the fabricated silicon nanowires (SiNWs) are uniform and the SiNW-array FET exhibits a strong output signal and high signal-to-noise ratio. Through specific chemical modification on the surface of SiNWs, the SiNW-array FET is highly sensitive and specific to HBV-DNA fragments and AFP, with ultralow detection limits of 0.1 fM (HBV-DNA) and 0.1 fg/mL (AFP). The detection curve of the SiNW-array FET exhibits good linearity within the HBV-DNA concentration range of 0.1 fM to 100 pM and AFP concentration range of 0.1 fg/mL to 1000 pg/mL. More importantly, the device could also detect HBV-DNA successfully in serum samples, laying a solid foundation for the highly sensitive clinical detection of chronic hepatitis B. Full article

Background: Functional cure of chronic hepatitis B (CHB) can be achieved with appropriate antiviral treatment. However, few studies have evaluated the added benefits of achieving functional cure. We aimed to conduct a quantitative analysis of the health-related quality of life (HRQoL) of CHB patients who achieved functional cure to provide evidence for economic analysis. Methods: We conducted a cross-sectional study in five provinces in China in 2021. The study population was recruited in hospitals and divided into three groups: functional cure, antiviral treatment, and healthy control group. Data were collected through face-to-face interviews using the Short Form-36 version 2. Results: 497 participants (163 with functional cure, 192 with antiviral treatment, and 142 with healthy control) were used in this study. The eight scale scores (physical function, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health) and two summary scores (physical composite and mental composite) in the functional cure and healthy control groups were similar. Compared to the healthy control group, the general health scores in the functional cure group were worse with −0.052 (95% CI: −0.094, −0.010), and the antiviral treatment group had significantly worse scores with −0.127 (95% CI: −0.170, −0.083). The antiviral treatment group had lower vitality scores (β = −0.048, 95% CI: −0.089 to −0.007) and MCS scores (β = −0.023, 95% CI: −0.042, −0.003, p = 0.022) compared to the healthy control. The mental composite summary scores of all groups were >50 (p > 0.05). Conclusions: Health-related quality of life decreases with CHB disease progression. The results indicate that functional cure is associated with HRQoL levels comparable to those of the healthy population, both on the physical and psychological aspect, reinforcing the clinical value of this therapeutic goal. Full article

Chronic hepatitis B (CHB) remains a major global health challenge, largely due to the persistence of covalently closed circular DNA (cccDNA) and impaired host immunity. Interferon-α (IFN-α), a key antiviral cytokine, not only directly restricts HBV replication but also orchestrates innate and adaptive immune responses. This review summarizes current advances in IFN-α-mediated immune regulation, highlighting its effects across diverse immune cell populations. Evidence indicates that IFN-α can reprogram immune responses to promote viral clearance, although clinical efficacy is limited by modest response rates and adverse effects. Recent progress in cytokine engineering, subtype research, and rational combination strategies—including nucleo(s/t)ide analogs, RNA interference therapeutics, antisense oligonucleotides, therapeutic vaccines, and beyond—has expanded opportunities to improve treatment outcomes. While challenges remain, these advances lay the foundation for optimizing IFN-α–based interventions and highlight IFN-α as a key driver for innovative therapies aimed at achieving a functional cure of chronic hepatitis B. Full article

Chronic hepatitis B virus (HBV) infection remains a major global health challenge, substantially contributing to liver-related morbidity and mortality. Background/Objectives: Developing therapeutic strategies that overcome immune tolerance and achieve functional cures is an urgent priority. Methods: In this study, we report a therapeutic vaccine comprising hepatitis B surface antigen (HBsAg) formulated with the dual adjuvant system CpG 1018S and QS-21. The immunogenicity and therapeutic efficacy of this vaccine were systematically evaluated in an rAAV8-HBV1.3-established chronic HBV mouse model. Results: The vaccine elicited a robust Th1-skewed immune response, characterized by elevated anti-HBs IgG2b titers and an increased IgG2b/IgG1 ratio. Notably, immunized mice showed markedly reduced circulating HBsAg levels. Mechanistically, the CpG 1018S and QS-21 adjuvant system enhanced dendritic cell activation, maturation, and antigen presentation, expanded HBV-specific CD4⁺ and CD8⁺ T cell populations, and attenuated the expression of the exhaustion markers TIM-3 and TIGIT. Additionally, immunized mice exhibited restored T cell polyfunctionality, with an increased secretion of effector cytokines, including TNF-α and IL-21. These responses collectively contributed to the reversal of T cell exhaustion and breakdown of immune tolerance, facilitating sustained viral suppression. Conclusions: Our findings demonstrate that the CpG 1018S/QS-21-adjuvanted vaccine induces potent humoral and cellular immunity against chronic HBV infection and represents a promising candidate for clinical chronic HBV (CHB) treatment. Full article

New York State and New York City (NYC) developed hepatitis C (HCV) elimination plans to reduce premature deaths and new infections. NYC Health + Hospitals (NYC H + H), the municipal healthcare system for NYC serving over a million individuals annually, designed electronic health record (EHR) tools that collaboratively facilitated screening, linkage, and tracking of patients diagnosed with HCV through to cure. This study reviews the impact of this group of EHR tools by comparing data on HCV testing, linkage, and cure for 12 months before tools were released and a second 12-month period coinciding with the release of tools. Indicators related to HCV screening, diagnoses, treatment initiation, and cure were assessed. All indicators reviewed improved following the implementation of EHR tools. The proportion of individuals screened increased from 34% pre-intervention to 46% during the implementation phase; the number of individuals on direct-acting antivirals increased by 11%; and the number of individuals reaching cure increased by 37%. Efforts to collaboratively develop custom interlinking EHR tools to establish a systematic process proved impactful. Integrating the needs and functions of different care settings and the structure of the local epidemic allowed for the successful development and implementation of impactful resources. Full article

Chronic hepatitis B virus (HBV) infection remains a major global health burden, affecting millions and contributing significantly to liver-related morbidity and mortality. While substantial progress has been made in elucidating the virology and natural history of HBV, the management of chronic hepatitis B (CHB) continues to present clinical challenges. The development of potent nucleos(t)ide analogs and pegylated interferon has improved viral suppression and delayed disease progression, yet a definitive cure remains elusive due to the persistence of covalently closed circular DNA (cccDNA). Recent research has focused on novel antiviral agents, immunomodulatory therapies, and combination strategies aimed at achieving a functional cure. This review summarizes current therapeutic approaches, recent advancements, and emerging directions in CHB management. Full article

Cancer is a leading cause of cancer-related death. Liver metastases develop in over one-third of patients and are associated with worse prognosis. The evolution in the field of interventional oncology/radiology over the past two decades has expanded image-guided locoregional therapies for colorectal liver metastases (CLM). Historically, hepatic resection was considered the only possible cure for selected patients with CLM. Current evidence supports thermal ablation (TA) as another locally curative treatment modality for small CLM that can be ablated with adequate margins. Other non-thermal ablative treatment options include Yttrium-90 (⁹⁰Y) radiation segmentectomy (RS), irreversible electroporation (IRE), and histotripsy, with an evolving role in the treatment of CLM. More extensive disease that is not amenable to resection or ablation can be treated with intra-arterial therapies (⁹⁰Y trans-arterial radioembolization (TARE) and trans-arterial chemoembolization (TACE)). This comprehensive review describes the evolution of interventional oncology treatments for CLM and examines the appropriate indications for each treatment modality. Full article