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A Prospective Study to Evaluate the Outcome of Hepatitis B Patients Presenting With Jaundice
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
Treatment regimen
SOF + R Peg-IFN + SOF + R SOF + DCV ± R Total
Patient group
Total
Chronic hepatitis C (no cirrhosis)
Compensated cirrhosis
Decompensated cirrhosis
4/4 (100%) 27/27 (100%) 46/48b (96%) 77/79 (98%)
8/9a (89%) 11/12a (92%) 28/30c (93%) 47/51 (92%)
5/8 (63%) – 18/22d (82%) 23/30 (77%)
17/21 (81%) 38/39 (97%) 92/100 (92%) 147/160 (92%)
One patient relapsed after treatment completion; , two patients discontinued treatment and one died during treatment. b Two patients discontinued treatment because of financial constraints. c Two patients died after treatment completion. d Four patients died during treatment; SOF, Sofosbuvir; R, Ribavirin; Peg-IFN, pegylated interferon; DCV, Daclatasvir. a
Figure 1. Flow chart of study population.
and 100 (63%) received sofosbuvir and daclatasvir, with (n = 49) or without (n = 51) ribavirin. On intention-to-treat basis, RVR, ETR and SVR12 in entire cohort were 146/160 (91.3%), 151/160 (94.4%) and 147/160 (91.9%), respectively. On per protocol analysis, the RVR, ETR and SVR12 rates were 139/149 (93.3%), 149/149 (100%) and 147/149 (98.7%), respectively. Seven patients died (CC 2, DC 5) during treatment; four (2 CHC, 2 DC) patients discontinued treatment; and two with CC relapsed (Table 1). Conclusions: Dual-DAA based regimens were safe and highly effective in treating genotype-3 HCV infection in CHC or CC patients in real-life setting (Figure 1).
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.039
7 A PROSPECTIVE STUDY TO EVALUATE THE OUTCOME OF HEPATITIS B PATIENTS PRESENTING WITH JAUNDICE Pathik Parikh 1,∗ , Aabha Nagral 1 , Nishtha Nagral 2 1 Apollo Hospitals, Mumbai City, India 2 BYL Nair, Mumbai City, India
E-mail address: [email protected] (P. Parikh). Background and Aim: Differentiating acute hepatitis B from reactivation of chronic hepatitis B (CHB) is essential as one group requires treatment while other just observation for spontaneous clearance. Methods: All patients presenting with jaundice over a 6 month period to the Kasturba Hospital of Infecious Disease (KHID), Mumbai between February and July 2015 with Hepatitis B surface antigen (HBsAg) positivity were included. Patients with previous knowledge of hepatitis B or cirrhosis, decompensation history, significant alcohol or recent intake of hepatotoxic drugs were excluded. These patients were followed up for six months for determining their outcome. Treatment was given to them if they had severe acute hepatitis B (AASLD guidelines) or proven to be reactivation of chronic hepatitis B. Results: Of 1835 patients presenting with jaundice, 65 patients were detected to be HBsAg positive. 51 patients completed the follow up of 6 months. 13 patients had AHB, while rest where chronic of which 13 had CHB with superimposed acute hepatitis A or E while rest were reactivation of CHB. Though median HBV load at presentation was higher in chronic hepatitis B it failed to be statistically significant between the groups (AUROC 0.6). Similarly, HBeAg and Anti HBe failed to differentiate the two entities. IgM Anti HBc was more commonly positive in AHB and the sample/cutoff ratio was significantly higher in AHB with a AUROC of 0.81. The cutoff of 11 reliably differentiates the two with a specificity of 100 and sensitivity of 57.1. Conclusion: Patients presenting with acute jaundice and features of acute viral hepatitis, 3.5% is caused by hepatitis B. Viral quantification, envelope antigen and antibody against envelope antigen may not help differentiate acute from chronic hepatitis B. A sample/cutoff ratio >11 for IgM Anti HBc can be used to identify patients with acute hepatitis B at presentation.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.040
Journal of Clinical and Experimental Hepatology July 2017 Vol. 7 No. S2
S17
VIRAL HEPATITIS
Table 1 Rates of Sustained Virological Response at 12 Weeks After Treatment Completion (SVR12) Among Patients With Different Disease Severities and Treatment Regimens.
Treatment regimen
SOF + R Peg-IFN + SOF + R SOF + DCV ± R Total
Patient group
Total
Chronic hepatitis C (no cirrhosis)
Compensated cirrhosis
Decompensated cirrhosis
4/4 (100%) 27/27 (100%) 46/48b (96%) 77/79 (98%)
8/9a (89%) 11/12a (92%) 28/30c (93%) 47/51 (92%)
5/8 (63%) – 18/22d (82%) 23/30 (77%)
17/21 (81%) 38/39 (97%) 92/100 (92%) 147/160 (92%)
One patient relapsed after treatment completion; , two patients discontinued treatment and one died during treatment. b Two patients discontinued treatment because of financial constraints. c Two patients died after treatment completion. d Four patients died during treatment; SOF, Sofosbuvir; R, Ribavirin; Peg-IFN, pegylated interferon; DCV, Daclatasvir. a
Figure 1. Flow chart of study population.
and 100 (63%) received sofosbuvir and daclatasvir, with (n = 49) or without (n = 51) ribavirin. On intention-to-treat basis, RVR, ETR and SVR12 in entire cohort were 146/160 (91.3%), 151/160 (94.4%) and 147/160 (91.9%), respectively. On per protocol analysis, the RVR, ETR and SVR12 rates were 139/149 (93.3%), 149/149 (100%) and 147/149 (98.7%), respectively. Seven patients died (CC 2, DC 5) during treatment; four (2 CHC, 2 DC) patients discontinued treatment; and two with CC relapsed (Table 1). Conclusions: Dual-DAA based regimens were safe and highly effective in treating genotype-3 HCV infection in CHC or CC patients in real-life setting (Figure 1).
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.039
7 A PROSPECTIVE STUDY TO EVALUATE THE OUTCOME OF HEPATITIS B PATIENTS PRESENTING WITH JAUNDICE Pathik Parikh 1,∗ , Aabha Nagral 1 , Nishtha Nagral 2 1 Apollo Hospitals, Mumbai City, India 2 BYL Nair, Mumbai City, India
E-mail address: [email protected] (P. Parikh). Background and Aim: Differentiating acute hepatitis B from reactivation of chronic hepatitis B (CHB) is essential as one group requires treatment while other just observation for spontaneous clearance. Methods: All patients presenting with jaundice over a 6 month period to the Kasturba Hospital of Infecious Disease (KHID), Mumbai between February and July 2015 with Hepatitis B surface antigen (HBsAg) positivity were included. Patients with previous knowledge of hepatitis B or cirrhosis, decompensation history, significant alcohol or recent intake of hepatotoxic drugs were excluded. These patients were followed up for six months for determining their outcome. Treatment was given to them if they had severe acute hepatitis B (AASLD guidelines) or proven to be reactivation of chronic hepatitis B. Results: Of 1835 patients presenting with jaundice, 65 patients were detected to be HBsAg positive. 51 patients completed the follow up of 6 months. 13 patients had AHB, while rest where chronic of which 13 had CHB with superimposed acute hepatitis A or E while rest were reactivation of CHB. Though median HBV load at presentation was higher in chronic hepatitis B it failed to be statistically significant between the groups (AUROC 0.6). Similarly, HBeAg and Anti HBe failed to differentiate the two entities. IgM Anti HBc was more commonly positive in AHB and the sample/cutoff ratio was significantly higher in AHB with a AUROC of 0.81. The cutoff of 11 reliably differentiates the two with a specificity of 100 and sensitivity of 57.1. Conclusion: Patients presenting with acute jaundice and features of acute viral hepatitis, 3.5% is caused by hepatitis B. Viral quantification, envelope antigen and antibody against envelope antigen may not help differentiate acute from chronic hepatitis B. A sample/cutoff ratio >11 for IgM Anti HBc can be used to identify patients with acute hepatitis B at presentation.
CONFLICTS OF INTEREST The authors have none to declare. http://dx.doi.org/10.1016/j.jceh.2017.05.040
Journal of Clinical and Experimental Hepatology July 2017 Vol. 7 No. S2
S17
VIRAL HEPATITIS
Table 1 Rates of Sustained Virological Response at 12 Weeks After Treatment Completion (SVR12) Among Patients With Different Disease Severities and Treatment Regimens.