Impact of tenofovir entecavir treatment on progression of chronic hepatitis B: A nationwide cohort study.

Background & Aims: Conflicting evidence exists on hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis B (CHB) receiving tenofovir entecavir. We assessed the impacts of the two drugs on the clinical trajectory of CHB at a population level.

Methods: We conducted a retrospective nationwide cohort study using data from Taiwan's National Health Insurance Research Database, including 55,885 patients with CHB who were treatment-naïve aged 30-75 years receiving tenofovir (n = 17,137) or entecavir (n = 38,748) monotherapy for ≥3 months between November 2009 and December 2020, and followed until December 2022.

Switching to tenofovir alafenamide in virally-suppressed chronic hepatitis B patients with renal/hepatic impairment: Phase 2 study sub-analysis from Taiwan.

Background/purpose: Tenofovir alafenamide (TAF) has demonstrated non-inferior efficacy to tenofovir disoproxil fumarate (TDF) with improved bone and renal safety across diverse populations, including those with mild renal or hepatic impairment. We evaluated TAF efficacy and safety in a subset of Taiwanese chronic hepatitis B (CHB) patients enrolled in a phase 2, multicentre study (NCT03180619) of patients with more advanced renal or hepatic impairment.

Methods: In a sub-analysis of virally-suppressed (hepatitis B virus DNA <20 IU/mL) adult Taiwanese CHB patients with renal (chronic kidney disease stage ≥1) or hepatic (Child-Turcotte-Pugh Class B or C) impairment, all participants received open-label TAF 25 mg once daily for 96 weeks.

Effects of Exercise Intervention in Subjects with Metabolic Dysfunction-Associated Steatotic Liver Disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent liver disorder globally, including in Asia-Pacific countries. In addition to contributing to severe liver disorders, MASLD increases the risk of various complications. Currently, resmetirom is the only U.

Hepatitis B surface antigen level identifies patients with inactive chronic hepatitis B from Asia with HCC risk below surveillance threshold.

Background: Chronic hepatitis B (CHB) is a major global health concern primarily due to hepatocellular carcinoma (HCC) development.

Objective: This study aimed to identify patients with inactive CHB with negligible HCC risk using hepatitis B surface antigen (HBsAg) levels, which is the key to define partial HBV cure.

Design: Data from 2674 patients with inactive CHB (non-cirrhotic, hepatitis B e antigen negative, normal alanine transaminase (ALT), HBV DNA <2000 IU/mL) in the ERADICATE-B and REVEAL-HBV cohorts were analysed.

Effects of Sofosbuvir/Velpatasvir Therapy on Extrahepatic Manifestations in Patients With Type 2 Diabetes and Chronic Hepatitis C: Insights From a Nationwide Hepatitis C Virus Registry in Taiwan.

This study examines the impact of hepatitis C virus (HCV) eradication through sofosbuvir/velpatasvir (SOF/VEL) treatment on glycated hemoglobin (HbA1c) levels in patients with chronic hepatitis C and type 2 diabetes mellitus (T2DM). Utilizing data from the Taiwan HCV Registry, a retrospective analysis was conducted on 2180 patients who met the inclusion criteria, 695 of whom had T2DM. HbA1c levels significantly decreased in the diabetes group from 7.

Long-term risk of depression and the impact of risk factors among chronic hepatitis C patients after successful antiviral therapy: A nationwide real-world Taiwanese cohort (T-COACH).

Background: Chronic hepatitis C virus (HCV) infection is associated with an increased risk of neuropsychiatric disorders, including depression. However, the impact of interferon (IFN)-based therapy, after achieving a sustained virologic response (SVR), on the long-term risk of depressive disorders remains unclear. Thus, we evaluated the incidence of new-onset depression and the impact of risk factors on patients with chronic hepatitis C following antiviral therapy.

Impact of Hepatitis C Virus Clearance on Cardiovascular Risk: A Real-World Experience From the Nationwide Taiwan Hepatitis C Virus Registry.

Hepatitis C virus (HCV) infection is associated with an increased risk of cardiovascular disease (CVD); however, the impact of interferon (IFN)-based therapy on cardiovascular outcomes remains unclear. This nationwide cohort study included 7411 patients with HCV from The Taiwanese Chronic Hepatitis C Cohort registry who received IFN-based therapy between 2003 and 2014. Patients were categorized into sustained virological response (SVR) (n = 5785) and non-SVR (n = 1676) groups.

Evolution of qHBsAg levels in HBV/HCV co-infected patients with low serum HBV DNA: Comparison between treated versus untreated.

Background And Aims: Patients with chronic hepatitis B virus (HBV) infection and low serum HBV DNA level (<2000 IU/mL) are not indicated for anti-HBV therapy. Fortunately, anti-HBV therapy is recommended if co-infected with hepatitis C virus (HCV) by World Health Organization recently. Whether specific anti-viral therapy could facilitate the decline or the loss of hepatitis B surface antigen (HBsAg) in this clinical setting was investigated in the co-infected patients.

Sequential combination with ropeginterferon alfa-2b and anti-PD-1 treatment as adjuvant therapy in HBV-related HCC: a phase 1 dose escalation trial.

Background/purpose: Post-operative recurrence is a major clinical challenge with hepatocellular carcinoma (HCC). While currently unapproved, anti-programmed cell death 1 (PD-1) and anti-vascular endothelial growth factor combination adjuvant therapy showed promise. We initiated a phase I trial using sequential treatment with ropeginterferon alfa-2b (ropeg), a novel interferon-based antiviral and antitumor agent, followed by anti-PD-1 therapeutic antibody nivolumab as an adjuvant therapy for hepatitis B virus (HBV)-related HCC.

Automated Whole-Liver Fat Quantification with Magnetic Resonance Imaging-Derived Proton Density Fat Fraction Map: A Prospective Study in Taiwan.

Background/aims: Magnetic resonance imaging (MRI) with a proton density fat fraction (PDFF) sequence is the most accurate, noninvasive method for assessing hepatic steatosis. However, manual measurement on the PDFF map is time-consuming. This study aimed to validate automated whole-liver fat quantification for assessing hepatic steatosis with MRI-PDFF.

Higher level of HBsAg associated with delayed development of HCC in immune-tolerant patients.

Background And Aims: Active viral replication in patients with chronic HBV infection is a major risk factor for HCC. However, the HCC risk in highly viremic patients, such as immune-tolerant patients, remains unclear. This study aimed to investigate the relationship between viral factors and HCC risk in patients with chronic HBV infection, focusing on immune-tolerant patients.

Posttreatment FIB-4 score change predicts hepatocellular carcinoma in chronic hepatitis C patients: Findings from the Taiwan hepatitis C registry program.

Purpose: This study investigated whether Fibrosis-4 (FIB-4) score and its change can serve as predictors of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C (CHC) infection receiving direct-acting antivirals (DAAs).

Methods: This study identified 9679 patients who completed DAA treatment and achieved sustained virologic response (SVR) from the Taiwan Nationwide Real-World HCV Registry Program, and their risk of HCC was analyzed.

Results: Multivariable Cox regression analyses identified diabetes mellitus (DM), alpha-fetoprotein (AFP) level, and FIB-4 score as independent predictors of HCC in both Model 1 (baseline) and Model 2 (SVR).

The Asian Pacific association for the study of the liver clinical practice guidelines for the diagnosis and management of metabolic dysfunction-associated fatty liver disease.

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment.

Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral-Induced Cure of Hepatitis C Virus Infection.

Background: Data regarding the risk of incident type 2 diabetes (T2D) and prediabetes among patients with hepatitis C virus (HCV) achieving direct-acting antivirals (DAAs)-induced sustained virologic response (SVR) remains limited.

Methods: A total of 1079 patients, including 589 with normoglycemia and 490 with prediabetes, who underwent biannual fasting glucose and glycosylated haemoglobin (HbA1c) assessment for a median post-SVR follow-up of 5.5 years, were enrolled.

High-normal and abnormal alanine transaminase levels linked to increased risk of hepatoma following treatment for chronic hepatitis C.

Background/purpose: The risk of hepatocellular carcinoma (HCC) is increased in patients with chronic hepatitis C (CHC) and elevated alanine transaminase (ALT) levels. The association between HCC and ALT levels after interferon (IFN) or direct-acting antivirals (DAA) therapy is unclear.

Methods: Patients with CHC receiving antiviral therapy were included in two large-scale cohorts in Taiwan (T-COACH and TACR).

Direct-acting antiviral therapy for patients with hepatitis C virus-related hepatocellular carcinoma: A nationwide cohort study.

Background/aims: The survival benefit of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection in patients with hepatocellular carcinoma (HCC), particularly in Barcelona Clinic Liver Cancer (BCLC) stages B/C, remains largely uncertain. We aimed to explore the impact of DAA therapy on overall survival (OS) in HCC patients using a nationwide cohort study.

Methods: We utilized the nationwide Taiwan Association for the Study of the Liver (TASL) HCV Registry (TACR) database to include all adults receiving a DAA therapy for HCV, excluding those with other viral infections, liver transplantation, non-HCC malignancies, and terminal-staged HCC.

Long-term serum ferritin dynamics in patients receiving antiviral treatment for hepatitis C virus infection.

Background: Limited data exists regarding the long-term serum ferritin dynamics following sustained virologic response (SVR) and factors associated with trends in changes among patients undergoing treatment for hepatitis C virus (HCV).

Methods: Serum ferritin levels were assessed biannually in 1538 participants undergoing direct-acting antivirals (DAAs) or peginterferon plus ribavirin (PR) with a median of follow-up of 5.0 years after off-treatment week 12.

Real-world efficacy and safety of universal 8-week glecaprevir/pibrentasvir in patients with chronic hepatitis C with early chronic kidney disease or pre-end-stage renal disease: Insights from a nationwide hepatisis C virus registry in Taiwan.

An 8-week regimen of glecaprevir/pibrentasvir is recommended for treatment-naïve patients with chronic hepatitis C (CHC). In alignment with the Taiwanese government's objective to eliminate hepatitis C by 2025, this study aimed to provide real-world evidence on the use of this regimen in treatment-naïve patients with chronic kidney disease (CKD) by using data from the Taiwan Association for the Study of the Liver HCV Registry (TACR). CKD was defined by an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.

Metabolic dysfunction-associated steatotic liver disease is associated with increased risks of heart failure.

Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD), defined by steatotic liver disease (SLD) and cardiometabolic factors, is increasing in prevalence, but its association with heart failure (HF) is unclear.

Methods And Results: Patients with SLD without a history of HF from 2006 to 2021 were retrospectively included and were classified into MASLD and non-MASLD groups that were followed longitudinally. The primary outcome was the new development of HF, which was sub-classified by echocardiography.

All-cause and cause-specific mortality in patients with chronic hepatitis B and concurrent steatotic liver disease.

Background & Aims: Steatotic liver disease (SLD) is prevalent among patients with chronic hepatitis B (CHB). However, the effects of metabolic dysfunction-associated SLD (MASLD) on the long-term survival of such patients remain unknown. Accordingly, this study investigated the mortality risks in patients with CHB and concurrent SLD.

Addition of neutrophil-to-lymphocyte ratio to Pre-DAA FIB-4 does not increase prediction value for de novo liver complications in hepatitis C.

Background And Aims: Direct-acting antiviral agents (DAAs) achieve high sustained virologic response (SVR) in chronic hepatitis C patients; yet a proportion of patients still experience de novo liver complications after SVR. Identification of risk factors is clinically important. FIB-4 index is a useful noninvasive tool to assess fibrosis, while neutrophil-to-lymphocyte ratio (NLR) is a biomarker for systemic inflammation.