HOME | LOG IN | SIGN UP

Final results of a prospective treatment program for chronic viral Hepatitis B and C: Health Services Development Program (HSDP)

Thwin Maung Aye, Seng Gee Lim, Myat Oo Aung, Kieron Lim, Yin Mei Lim, Guan Huei Lee, How Cheng Low, Yock Young Dan

Abstract


Background and Aims: Chronic Hepatitis B (CHB) and C (CHC) lead to chronic liver disease and complications if left untreated. A Health Services Development Program (HSDP) was approved by the Ministry of Health to evaluate the effectiveness of treatment and the outcomes of CHB and CHC.

Methods: Eighty-three CHB and twenty-one CHC patients were included. Inclusion criteria were HBVDNA>105 copies/ml, abnormal Liver Function Tests (LFTs), cirrhosis and positive HCVRNA. Daily Lamivudine with/without Adefovir rescue therapy and pegylated interferon with ribavirin were prescribed. Exclusion criteria were hepatocellular carcinoma, renal failure, CHB/CHC/HIV co-infection. Outcomes measured were: proportion of patients who i) normalize LFTs, ii) achieve sustained virological remission, iii) improve Child-Pugh (CP) score, iv) develop liver related complications and v) die.

Results: CHB: Thirty-one patients (37%) had baseline cirrhosis. The mean therapy duration was 67.5 months. At the end of study, 100% had undetectable HBVDNA and 98% had LFTs normalization. The majority (87%) had stable C-P score, of whom 11.42% had improvement of score >2 points. Lamivudine resistance developed in 59.5% requiring add-on Adefovir therapy. Eleven patients (13%) developed end stage liver disease complications. CHC: There were 21 patients (genotype1=62%). Eight patients (38%) had baseline cirrhosis. LFTs improved in 18 patients (86%). The overall end-of-treatment response and SVR were 95% and 86% while SVR for genotype 1 and 2/3 were 92% and 75% respectively. No major liver related complications or mortality were noted.

Conclusion: It was a successful program with excellent outcomes of disease complication free in 87% of  CHB patients.


Keywords


Hepatitis treatment; lamivudine; adefovir; clinical outcomes; liver cirrhosis; HCC

Full Text:

References


Helen S. Te, MD, Donald M. Jensen, MD. Epidemiology of hepatitis B and C viruses: A global overview. Clin Liver Dis. Volume 14, Issue 1 (February 2010).

Imperial JC. Natural history of chronic hepatitis B and C. J Gastroenterol Hepatol 1999;14 Suppl:S1-5.

Benvegnu L, Gios M, Boccato S, Alberti A. Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications. Gut 2004;53:744-749.

Liaw YF, Sung JJY, Chow WC, Farrell G, Lee CZ, Yuen H, et al. Effects of Lamivudine on Disease Progression and Development of Liver Cancer in Advanced Chronic Hepatitis. In: American Association for Study of Liver Disease; 2003; Boston; 2003. p. 262A (Abstract 220).

Kim WR, Gross JB Jr, Poterucha JJ, Locke GR 3rd, Dickson ER. Outcome of hospital care of liver disease associated with hepatitis C in the United States. Hepatology 2001;33:201-206.

Li SC, Ong SC, Lim SG, Yeoh KG, Kwong SKS, Lee V, et al. A Cost Comparison of Management of Chronic Hepatitis B and its Associated Complications in Hong Kong and Singapore. J Clin Gastroenterol 2004;in press.

AS Lok and BJ McMahon. Chronic hepatitis B: update 2009. Hepatology 50(3): 661-662. September 2009.

Patrick Marcellin, Geoffrey Dusheiko, Fabien Zoulim, Rafael Esteban, Stefanos Hadziyannis, Pietro Lampertico, et al. EASL Clinical Practice Guidelines: Management of chronic hepatitis B. Journal of Hepatology 50 (2009) 227–242.

Yun-Fan Liaw, M.D., Dong Jin Suh, M.D., Masao Omata, M.D. 2008 APASL guidelines for HBV management.

Chien RN. On-treatment monitoring of chronic hepatitis B virus infection: an Asian-Pacific perspective. J Gastroenterol Hepatol. 2010 May;25(5):852-7. Review.

Yuen MF, Seto WK, Chow DH, Tsui K, Wong DK, Ngai VW, et al. Long-term lamivudine therapy reduces the risk of long-term complications of chronic hepatitis B infection even in patients without advanced disease.

Eun JR, Lee HJ, Kim TN, Lee KS. Risk assessment for the development of hepatocellular carcinoma: according to on-treatment viral response during long-term lamivudine therapy in hepatitis B virus related liver disease. J Hepatol.2010 Jul;53(1):118-25.

Lim SG, Aung MO, Mak B, Sutedja D, Lee YM, Lee GH, et al. Clinical outcomes of Lamivudine-adefovir therapy in chronic hepatitis B cirrhosis. J Clin Gastroenterol. 2011 Oct;45(9):818-23.

Elefsiniotis I, Buti M, Jardi R, Vezli E, Esteban R. Clinical outcome of lamivudine-resistant chronic hepatitis B patients with compensated cirrhosis under adefovir salvage treatment. Importance of HCC surveillance. Eur J Intern Med. 2009 Sep; 20(5): 478-81.

Yu ML, Chuang WL. Treatment of chronic hepatitis C in Asia: when East meets West. J Gastroenterol Hepatol. 2009 Mar;24(3):336-45.

Thomas DL, Thio CL, Martin MP, Qi Y, Ge D, O'Huigin C, et al. Genetic variation in IL28B and spontaneous clearance of hepatitis C virus. Nature. 2009 Oct 8;461(7265):798-801.

Shah SR, Patel K, Marcellin P, Foster GR, Manns M, Kottilil S, et al. Steatosis is an independent predictor of relapse following rapid virologic response in patients with HCV genotype 3. Clinical Gastroenterology And Hepatology: 2011 Aug; Vol. 9 (8), pp. 688-93.

Restivo L, Zampino R, Guerrera B, Ruggiero L, Adinolfi LE. Steatosis is the predictor of relapse in HCV genotype 3- but not 2-infected patients treated with 12 weeks of pegylated interferon-α-2a plus ribavirin and RVR. Journal Of Viral Hepatitis 2012 May; Vol. 19 (5), pp. 346-52.

Andriulli A, Mangia A, Iacobellis A, Ippolito A, Leandro G, Zeuzem S. Meta-analysis: the outcome of anti-viral therapy in HCV genotype 2 and genotype 3 infected patients with chronic hepatitis. Alimentary Pharmacology & Therapeutics 2008 Aug 15; Vol. 28 (4), pp. 397-404.




DOI: http://dx.doi.org/10.18103/mra.v0i3.127

Refbacks

  • There are currently no refbacks.