Bile Duct Injury Due to Drug-Induced Liver Injury
AbstractPurpose of ReviewDrug-induced liver injury (DILI) can present with a variable clinical and pathological phenotype and can be classified using liver enzymes as hepatocellular, cholestatic, or a mixed pattern. The cholestatic pattern has been considered amongst the spectrum of direct liver damage at the microscopic level, but recently, bile duct injury, as a manifestation of DILI, has emerged as a distinct entity, and this review examines several examples of biliary tract abnormalities due to DILI from a clinical, radiologic, and pathologic perspective.Recent FindingsCase series and reports have emerged over the last...
Source: Current Hepatitis Reports - July 15, 2019 Category: Infectious Diseases Source Type: research

Management of Fatigue in Primary Biliary Cholangitis
AbstractPurpose of ReviewFatigue in primary biliary cholangitis patients is a frequently encountered and often debilitating symptom. With no currently approved drug therapies available to target fatigue as a symptom, managing these patients can be very challenging in a day-to-day clinical practise. We have critically appraised currently available evidence on various pharmacological agents trialled in the management of fatigue in PBC.Recent FindingsMost recently, a randomised controlled trial from Newcastle group using Rituximab in high fatigue patients has shown equivocal results for the improvement of fatigue, with a sign...
Source: Current Hepatitis Reports - May 23, 2019 Category: Infectious Diseases Source Type: research

Hepatitis C-Positive Organs for Liver and Kidney Transplantation —Emerging Data and Current Management Strategies
AbstractPurpose of ReviewWe aim to review the current guidelines and emerging data and compare the pros and cons for the use of HCV-positive organs.Recent FindingsSome recent data suggests that the use of HCV-positive livers and kidneys safely increases the organ pool, additionally reducing wait list time, healthcare costs, and mortality.SummaryDespite this therapeutic breakthrough, the demand for organs and waitlist mortality remains high. Every year, thousands of viable hepatitis C-positive organs are discarded. The emerging data regarding transplantation of HCV-positive organs is promising; however, further research is ...
Source: Current Hepatitis Reports - May 18, 2019 Category: Infectious Diseases Source Type: research

State of the Art HCV Treatment in Children
AbstractPurpose of ReviewHepatitis C infection is a global issue with an estimated 5 million children with active HCV infection worldwide. The advent of oral direct-acting antiviral (DAA) regimens has revolutionized treatment in adults with excellent efficacy and tolerability. There are limited data and few approved therapies in children. The aim of this review is to discuss the currently approved regimens for children and the recently reported results of clinical trials of DAA in children.Recent FindingsDAA regimens are currently approved only for children ≥ 12 years. For most children
Source: Current Hepatitis Reports - May 17, 2019 Category: Infectious Diseases Source Type: research

The Role of Hepatic and Splanchnic Lymphatic System in Portal Hypertension and Ascites
AbstractPurpose of ReviewThe lymphatic network plays a major role in maintaining tissue fluid homeostasis. Therefore, several pathological conditions associated with edema formation result in deficient lymphatic function. However, traditionally, the lymphatic system has been underestimated until recent years when it has been noticed the importance of this system in chronic liver disease. This review highlights the knowledge of lymphatic biology in the context of portal hypertension and liver cirrhosis.Recent FindingsAmong different roles of lymphatic system in liver disease, two remarkable ones are the contribution in asci...
Source: Current Hepatitis Reports - May 16, 2019 Category: Infectious Diseases Source Type: research

Portal Hypertension in NASH: Is It Different from Other Aetiologies?
AbstractPurpose of ReviewIn non-alcoholic fatty liver disease (NAFLD), an increased portal pressure is observed before signs of cirrhosis or even inflammation or fibrosis are histologically present. This review describes the differences between the mechanisms of cirrhotic portal hypertension (PHT) and PHT in non-cirrhotic NAFLD.Recent FindingsThe increased portal pressure in NAFLD is primarily a result of an increased intrahepatic vascular resistance. Vasodilation is decreased by endothelial dysfunction and the sensitivity to vasoconstrictors is increased. Furthermore, the activation of hepatic stellate cells and the prese...
Source: Current Hepatitis Reports - May 14, 2019 Category: Infectious Diseases Source Type: research

Prediction of Decompensation in Patients with Compensated Cirrhosis: Does Etiology Matter?
AbstractPurpose of ReviewTransition from compensated to decompensated cirrhosis, defined by overt clinical signs, represents a turning point in the clinical course of the disease. In fact, while compensated cirrhosis is a silent disease characterized by long survival, decompensated cirrhosis is associated with symptoms markedly reducing the quality of life and with a median survival of 2 –4 years. Therefore, identifying predictors of decompensation and investigating potential interventions for its prevention is a major objective. Mechanisms and incidence of decompensation, together with its predictors, are summa...
Source: Current Hepatitis Reports - May 10, 2019 Category: Infectious Diseases Source Type: research

Non-invasive Fibrosis Assessment of Patients with Hepatitis C: Application of Society Guidelines to Clinical Practice
AbstractPurpose of ReviewChronic hepatitis C (CHC) infection remains a significant global public health burden and is associated with significant morbidity and mortality due to complications of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). All oral direct-acting antivirals (DAAs) are associated with high rates of sustained virologic response (SVR). Pre-treatment assessment for liver fibrosis remains of high importance as it may impact treatment choice, treatment duration, and signal the presence of cirrhosis for which variceal screening and HCC surveillance are warranted.Recent FindingsNon-invasive fibrosis...
Source: Current Hepatitis Reports - May 9, 2019 Category: Infectious Diseases Source Type: research

Testing for Hepatitis C in Pregnancy: the Time Has Come for Routine Rather than Risk-Based
AbstractPurpose of ReviewThe purpose of this review is to discuss the reasons for HCV testing during pregnancy and to review what is known about antiviral treatment during pregnancy.Recent FindingsHepatitis C virus affects over 3 million persons in the USA and is one of the leading infectious causes of death. While HCV is most commonly transmitted via parenteral exposures, thus affecting people who inject drugs, it is also transmitted from mother-to-child. Due to an expanding opioid crisis, an increasing number of women of childbearing age are now infected, resulting in transmission to infants. Risk-based screening has nev...
Source: Current Hepatitis Reports - May 9, 2019 Category: Infectious Diseases Source Type: research

HCV Management in the Incarcerated Population: How Do We Deliver on This Important Front?
AbstractPurpose of ReviewIn this review, the peculiarities of infection and treatment of HCV in the prison population are detailed. In addition, the barriers to HCV treatment and possible solutions are highlighted.Recent FindingsSeveral previous experiences of HCV treatment in prisons have been successful. In this manuscript, we detail the most relevant.SummaryWe think that incarceration should be considered an opportunity to engage this population in health care. Therefore, we should encourage systematic screening of these patients and promote the access to treatment by supporting equity with the general population. Thus,...
Source: Current Hepatitis Reports - May 2, 2019 Category: Infectious Diseases Source Type: research

Hepatic Venous Pressure Gradient Response in Non-Selective Beta-Blocker Treatment —Is It Worth Measuring?
AbstractPurpose of ReviewTo review the evidence supporting the assessment of hepatic venous pressure gradient (HVPG) response to non-selective beta-blockers (NSBB).Recent FindingsHVPG response to NSBB reduces the risks of variceal bleeding, hepatic decompensation due to ascites and its complications, and, finally, mortality. In hemodynamic non-responders to NSBB, their effectiveness is suboptimal, although there is increasing evidence for non-hemodynamic effects. Carvedilol may be a good treatment option for patients with non-response to conventional NSBB, as it is more potent in decreasing HVPG. Furthermore, hemodynamic n...
Source: Current Hepatitis Reports - May 2, 2019 Category: Infectious Diseases Source Type: research

The Use of Grafts from HCV+ Patients in Transplantation: Are we There Yet?
AbstractUse of organs from donors previously or currently infected with hepatitis C virus is gaining interest in the transplantation realm.Purpose of ReviewHere we will outline the historical perspectives for discarding such organs, review the reasons for revitalized interest in their use, and highlight available data on the use of hepatitis C virus (HCV)-viremic grafts in transplantation. We will summarize arguments supporting and against such practices and offer our recommendations.Recent FindingsHCV can now be safely and effectively treated post transplantation with direct-acting antivirals (DAAs). Several reports are h...
Source: Current Hepatitis Reports - May 2, 2019 Category: Infectious Diseases Source Type: research

Patient Selection in Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Refractory Ascites and Associated Conditions
AbstractPurpose of ReviewThis review summarizes the key developments and latest evidence for transjugular intrahepatic portosystemic shunt (TIPS) for the indications of refractory ascites and related conditions, as well as factors that should be taken into consideration with regard to patient selection.Recent FindingsRecent evidence from randomized controlled studies has suggested that the early institution of TIPS in well-selected patients with refractory ascites may confer a survival benefit. Increasing evidence is also mounting on the potential role of TIPS in improving and reversing hepatorenal syndrome.SummaryTIPS has...
Source: Current Hepatitis Reports - May 2, 2019 Category: Infectious Diseases Source Type: research

Acute HCV Treatment: What Should We Do in the DAA Era?
AbstractPurpose of ReviewAcute hepatitis C infection is a growing concern in the USA, especially in light of the opioid epidemic. Prior treatment data consisted of trials in patients receiving interferon-based regimens. There is now emerging evidence regarding the safety and efficacy of direct-acting antivirals for the treatment of acute hepatitis C. This review summarizes the current evidence on the treatment of acute HCV in the DAA era.Recent FindingsCertain populations, such as people who inject drugs, or HIV-positive men who have sex with men, may benefit from early treatment of acute HCV. As compared with chronic hepa...
Source: Current Hepatitis Reports - May 2, 2019 Category: Infectious Diseases Source Type: research

Novel Targets and Drug Development in Portal Hypertension
AbstractPurpose of the ReviewThis review aims to introduce animal models of portal hypertension in which targets and drugs can be tested and presents current advances in the field of preclinical and early clinical settings.Recent FindingsThe interest in this field has risen in recent years and many promising targets and potential drugs have been tested in preclinical and early clinical studies. Most of these targets are intrahepatic and aim to decrease hepatic stellate cell activity, as this cell type mediates both fibrosis and portal hypertension.SummaryLiver cirrhosis with portal hypertension is a global health burden du...
Source: Current Hepatitis Reports - April 30, 2019 Category: Infectious Diseases Source Type: research

HVPG Measurements as a Surrogate of Clinical Events in Cirrhosis: Experience from Clinical Trials
AbstractPurpose of ReviewUpdate current knowledge of the use of hepatic venous pressure gradient (HVPG) as a predictor of clinical events and of efficacy of therapy for portal hypertension.Recent FindingsHVPG is a good predictor of clinical events. Decrease in HVPG during therapy is accompanied by a decreased incidence of complications from portal hypertension and improved survival.SummaryHVPG measurements are a valuable tool in the management of portal hypertension in cirrhosis. In addition of detecting and grading the severity of portal hypertension, HVPG measurements provide robust prognostic information on the risk of ...
Source: Current Hepatitis Reports - April 30, 2019 Category: Infectious Diseases Source Type: research

HCV Exposure in the Health Care Arena. Is there a Role for Post-exposure Prophylaxis?
AbstractPurpose of ReviewHealthcare workers are a vulnerable population for exposure to a variety of bloodborne pathogens including hepatitis C (HCV). With the development of novel efficacious treatments for chronic HCV, the role of post-exposure prophylaxis (PEP) has been suggested instead of the current approach to monitor for the development of infection.Recent FindingsThe lack of robust studies that HCV PEP lowers transmission risk as well as the significant financial cost limits enthusiasm for routine use of HCV PEP at this time.SummaryWe support stringent monitoring protocols with prompt referral for evaluation and t...
Source: Current Hepatitis Reports - April 27, 2019 Category: Infectious Diseases Source Type: research

The Use of Biologics in Patients with Inflammatory Bowel Disease and Primary Sclerosing Cholangitis
AbstractPurpose of ReviewBiologics are well established in the treatment of many immuno-inflammatory diseases including inflammatory bowel disease (IBD). However, although primary sclerosing cholangitis (PSC) is closely associated with IBD, the role of biologics in PSC remains uncertain. Many new biologics are becoming available to treat IBD, and this review aims to use the experience of biologics in PSC so far to guide more effective evaluation of emerging therapies in the future.Recent FindingsAntibodies to TNF- α were the first biologics used in IBD, and retrospective analysis suggests that they may have some bene...
Source: Current Hepatitis Reports - March 7, 2019 Category: Infectious Diseases Source Type: research

Future Pharmacological Therapies of Portal Hypertension
AbstractPurpose of ReviewTo provide an overview of recent pharmacological treatments for portal hypertension evaluated in early clinical trials, with particular emphasis on the pathophysiological basis of their use.Recent FindingsIn patients with compensated cirrhosis, even small decreases in portal pressure (as small as 1  mmHg) are associated with a lower probability of decompensation. In patients with decompensated cirrhosis, portal pressure “response” to non-selective beta-blocker (NSBB) therapy is associated with a lower mortality. When present, significant portal hypertension persists even after the ...
Source: Current Hepatitis Reports - February 19, 2019 Category: Infectious Diseases Source Type: research

Portal Hypertension after Liver Transplantation —Causes and Management
AbstractPurpose of ReviewWhile portal hypertension (PHT) treatment strategies for patients with advanced chronic liver disease (ACLD) are well established, studies on the management of PHT after orthotopic liver transplantation (OLT) are limited. This is due to the heterogeneous causes of portal hypertension in the OLT setting.Recent FindingsSpecific recommendations for the management of non-alcoholic steatohepatitis (NASH), including medical and surgical therapeutic options, and hepatitis C virus (HCV) infection after OLT, are available with most of them applying to transplanted patients. Important concepts to prevent and...
Source: Current Hepatitis Reports - February 13, 2019 Category: Infectious Diseases Source Type: research

Future Medical Treatment of PSC
AbstractPurpose of ReviewPrimary sclerosing cholangitis (PSC) is a chronic cholestatic disorder characterized by inflammation of intrahepatic and/or extrahepatic bile ducts leading to stricturing, biliary fibrosis, cirrhosis, and liver failure. PSC is highly associated with inflammatory bowel diseases (IBD) and bears significant risk for cholangiocellular and colorectal cancer. To date, no medical treatment has been proven in randomized controlled trials to improve transplant-free and overall patient survival. However, numerous innovative therapeutic concepts are currently tested in phase 2 to phase 3 clinical trials. Base...
Source: Current Hepatitis Reports - February 13, 2019 Category: Infectious Diseases Source Type: research

Obscure Gastrointestinal Bleeding in Cirrhosis: Work-up and Management
AbstractPurpose of ReviewObscure gastrointestinal bleeding (OGIB) in patients with cirrhosis can be a diagnostic and therapeutic challenge. Recent advances in the approach and management of this group of patients can help to identify the source of bleeding. While the work-up of patients with cirrhosis and OGIB is the same as with patients without cirrhosis, clinicians must be aware that there are conditions exclusive for patients with portal hypertension that can potentially cause OGIB.Recent FindingsNew endoscopic and imaging techniques are capable to identify sources of OGIB. Balloon-assisted enteroscopy (BAE) allows dir...
Source: Current Hepatitis Reports - February 12, 2019 Category: Infectious Diseases Source Type: research

TIPS Indications and Contraindications —Pushing the Limits: Is Earlier Better?
AbstractPurpose of ReviewTo describe the main indications and contraindications of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with portal hypertension (PH).Recent FindingsAn adequate selection of patients helps to identify those who may benefit from TIPS in terms of survival. In patients with acute variceal bleeding and factors of poor prognosis, a pre-emptive use of TIPS is associated with significant reductions in treatment failure and mortality. Similarly, TIPS has shown to improve survival in a highly selected group of patients with cirrhosis and refractory ascites.SummaryPH is a clinica...
Source: Current Hepatitis Reports - February 8, 2019 Category: Infectious Diseases Source Type: research

The Role of Fibrates in Primary Biliary Cholangitis
AbstractPurpose of ReviewUrsodeoxycholic acid (UDCA) is recognized worldwide as the standard of care of primary biliary cholangitis (PBC). Obeticholic acid and fibrates have recently shown the potential to further improve the biochemical markers of PBC. The purpose of this review is to discuss more specifically the role of fibrates in PBC.Recent FindingsThe BEZURSO trial (Phase 3 Study of Bezafibrate in Combination With Ursodeoxycholic Acid in Primary Biliary Cholangitis) is the first ever placebo-controlled trial of a fibrate in PBC. In this 24-month study, second-line use of bezafibrate in addition to continued UDCA resu...
Source: Current Hepatitis Reports - February 7, 2019 Category: Infectious Diseases Source Type: research

Predicting Future Complications of Cirrhosis
AbstractPurpose of ReviewDecompensated cirrhosis and liver failure result in high mortality risk. Identifying the severity of illness and risk of poor outcomes is important for improved clinical decision making. This review serves to examine the currently in practice and developing tools for prognosticating patients with cirrhosis.Recent FindingsThe Child –Turcotte–Pugh (CTP) score and Model for End-Stage Liver Disease (MELD) score are the most used prognostic tools for cirrhotic patients. More recently, however, are newly developing biochemical models and imaging tools that strive to improve upon the MELD scor...
Source: Current Hepatitis Reports - February 6, 2019 Category: Infectious Diseases Source Type: research

Liver Involvement after a Fontan Procedure for Congenital Heart Disease
AbstractPurpose of ReviewPatients with congenital heart disease are living longer into adulthood. As these patients age, we see extracardiac complications of Fontan circulation. Liver dysfunction is almost universal in patients who have had a Fontan surgery. This paper seeks to describe the current understanding of the pathophysiology, diagnosis, and management of Fontan-associated liver dysfunction (FALD).Recent FindingsIn this era of noninvasive markers for liver diseases, unfortunately, these markers have been found to be less sensitive in patients with FALD. There have been small, mostly single center, reports about th...
Source: Current Hepatitis Reports - February 6, 2019 Category: Infectious Diseases Source Type: research

Multidrug-Resistant Bacterial Infection in Patients with Cirrhosis. A Review
AbstractPurpose of ReviewThe burden of multidrug resistance has become one of the world ’s most urgent public health problems. Patients with infection caused by multidrug-resistant organisms (MDROs) have an increased risk for worse outcomes and death.Recent FindingsCirrhotic patients, mostly decompensated, are prone to developing infections caused by MDROs, particularly because they are in close contact with healthcare settings. During the last two decades, the first-line therapies recommended to treat infections in cirrhotic patients have become progressively less effective. Early identification of patients at high ...
Source: Current Hepatitis Reports - February 6, 2019 Category: Infectious Diseases Source Type: research

Non-invasive Measurement of Portal Pressure
AbstractPurpose of ReviewTo provide an updated overview of the existing and emerging non-invasive diagnostic methods to assess portal hypertension.Recent FindingsData on liver stiffness measurement confirmed that it is a mainstay for assessing the risk of clinically significant portal hypertension in patients with advanced chronic liver disease of any etiology. The Baveno criteria for identifying patients who can safely spare endoscopy have been validated in NASH and cholestatic liver disease. New expanded criteria and other simple non-invasive algorithms including MELD score or spleen stiffness have been proposed and can ...
Source: Current Hepatitis Reports - February 2, 2019 Category: Infectious Diseases Source Type: research

Overcoming Alcohol Addiction in Patients with Alcohol-Related Liver Disease
AbstractPurpose of ReviewThis review provides a brief overview of key concepts in addiction medicine and provides tips and tricks as it pertains to treating patients with alcohol addiction in the setting of advanced alcohol-related liver disease (ALD).Recent FindingsUnderstanding the brain disease model of addiction by both providers and patients is a vital springboard for establishing a therapeutic relationship. Despite a paucity of high-quality evidence, psychosocial treatments have withstood the test of time and still form the foundation of alcohol use disorder (AUD) treatment in advanced ALD. Despite the inescapable li...
Source: Current Hepatitis Reports - January 31, 2019 Category: Infectious Diseases Source Type: research

Prevention and Management of Hepatitis B in Healthcare Professionals
AbstractPurpose of ReviewTo review the epidemiology of hepatitis B virus (HBV) transmission in the healthcare setting and outline best practices in the prevention and management of chronic HBV in healthcare professionals.Recent FindingsHepatitis B virus (HBV) infection remains a global public health burden and chronically infects an estimated 257 million persons worldwide. HBV represents one of the most important occupational risks for healthcare workers (HCWs) due to efficient transmission through percutaneous exposure of HBV-infected blood and blood-contaminated body fluids. Although the incidence of HCW-patient transmis...
Source: Current Hepatitis Reports - January 28, 2019 Category: Infectious Diseases Source Type: research

Cirrhosis and Autoimmune Liver Disease
AbstractPurpose of ReviewAutoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) constitute the most frequently observed forms of autoimmune liver diseases. Each of these autoimmune liver diseases might present with cirrhosis at diagnosis, and a significant proportion of patients develop cirrhosis during follow-up. This manuscript provides a review that addresses how to monitor and manage patients with cirrhosis secondary to autoimmune liver diseases.Recent FindingsFor patients with PBC, the farnesoid X receptor (FXR) agonist, obeticholic acid (OCA), is the first approved dru...
Source: Current Hepatitis Reports - January 28, 2019 Category: Infectious Diseases Source Type: research

Surgical Issues in NASH: Bariatric Surgery and Liver Transplantation
AbstractPurpose of ReviewThe rising prevalence of obesity in general and non-alcoholic steatohepatitis (NASH) specifically as an indication for liver transplantation has occurred in parallel with an increase in the consideration and performance of bariatric surgery before and after liver transplantation. We review the impact and relative merits of bariatric surgery before, during, and after liver transplantation.Recent FindingsThe sleeve gastrectomy approach has several practical advantages over other forms of weight loss surgery and has been shown to improve metabolic parameters. Bariatric surgical procedures inevitably a...
Source: Current Hepatitis Reports - November 21, 2018 Category: Infectious Diseases Source Type: research

Correction: The Role of Anticoagulation in Treating Portal Hypertension
The article The Role of Anticoagulation in Treating Portal Hypertension, written by Laura Turco, Filippo Schepis and Erica Villa, was originally published electronically on the publisher ’s internet portal (currently SpringerLink) on 18 June 2018 without open access. (Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - November 16, 2018 Category: Infectious Diseases Source Type: research

Update in the Management of Chronic Hepatitis B in Pregnancy
AbstractPurpose of ReviewVertical transmission accounts for almost half of the chronic hepatitis B infections worldwide. Therefore, management of HBV in pregnancy presents a unique opportunity for intervention, so that vertical transmission and overall HBV could be reduced. There is limited data on outcomes of acute HBV. There were several observational and prospective studies on effects of chronic HBV during pregnancy, modes of mother to child transmission (MTCT), role of obstetric interventions, indications for antiviral therapy during pregnancy which demonstrated variable findings. Our purpose is to summarize and update...
Source: Current Hepatitis Reports - November 8, 2018 Category: Infectious Diseases Source Type: research

Small Esophageal Varices in Patients with Cirrhosis —Should We Treat Them?
AbstractPurpose of ReviewThe natural history and classification systems of small varices ( ≤ 5 mm in diameter) in cirrhotic patients with portal hypertension are summarized. Studies that assessed the course of and therapeutic intervention for small varices are discussed.Recent FindingsCurrent non-invasive methods show suboptimal sensitivity to detect small varices in patients with cirrhosis. Next to etiological therapy, hepatic venous pressure gradient (HVPG)-guided non-selective betablocker or carvedilol treatment has shown to impact on natural history of small varices.SummaryThe main therapeutic focus in c...
Source: Current Hepatitis Reports - November 7, 2018 Category: Infectious Diseases Source Type: research

Long-term Outcomes in Patients with HBV Treated with Antiviral Agents
AbstractᅟChronic hepatitis B (CHB) infection is one of the main causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC) worldwide. Long-term treatment with the most potent nucleos(t)ide analogues (NUCs), i.e., entecavir (ETV), tenofovir disoproxil fumarate (TDF), and the recently approved tenofovir alafenamide (TAF) are able to achieve and maintain virological suppression, and therefore are the first-line recommended therapies for all CHB patients.Purpose of ReviewTo assess the long-term outcome in CHB patients treated with NUCs.Recent FindingsThese NUCs are highly effective in suppressing viral re...
Source: Current Hepatitis Reports - November 5, 2018 Category: Infectious Diseases Source Type: research

Pathogenesis of NASH: the Impact of Multiple Pathways
AbstractPurpose of reviewAdvancing our understanding of the mechanisms that underlie NASH pathogenesis.Recent findingsRecent findings on NASH pathogenesis have expanded our understanding of its complexity including (1) there are multiple parallel hits that lead to NASH; (2) the microbiota play an important role in pathogenesis, with bacterial species recently shown to accurately differentiate between NAFL and NASH patients; (3) the main drivers of liver cell injury are lipotoxicity caused by free fatty acids (FFAs) and their derivatives combined with mitochondrial dysfunction; (4) decreased endoplasmic reticulum (ER) effic...
Source: Current Hepatitis Reports - October 31, 2018 Category: Infectious Diseases Source Type: research

Current State of Immunotherapy for HCC —Supporting Data and Toxicity Management
AbstractPurpose of ReviewAfter having tyrosine kinase inhibitor as only available one drug class to treat advanced hepatocellular carcinoma (HCC) for more than a decade, immunotherapy agents are now approved for second-line therapy and are currently being compared head-to-head with sorafenib for first-line treatment. It is becoming increasingly important for hepatologists to become aware of agents in development, potential adverse events, and suggested treatment monitoring.Recent FindingsNivolumab and pembrolizumab have both shown promising phase II data in the second-line setting for HCC and phase III data in both the fir...
Source: Current Hepatitis Reports - October 28, 2018 Category: Infectious Diseases Source Type: research

LI-RADS v2018: a Primer and Update for Clinicians
AbstractPurpose of ReviewTo familiarize readers with recent updates and additions to the Liver Imaging and Reporting Data System (LI-RADS) v2018 for hepatocellular carcinoma surveillance, diagnosis, and treatment response assessment.Recent FindingsUS surveillance, diagnosis, and treatment response assessment algorithms are now incorporated into LI-RADS v2018. Updates to the diagnostic algorithm for CT and MRI include clarification of the LI-RADS appropriate population, revision of LR-5 criteria to match with those advocated by the American Association for Study of Liver Disease, new specific criteria for the LR-M category,...
Source: Current Hepatitis Reports - October 24, 2018 Category: Infectious Diseases Source Type: research

Implications of Circulating Hepatitis B Virus RNA Levels in Assessment of Response to Antiviral Therapy
AbstractPurpose of ReviewTreatment of chronic hepatitis B infection with nucleos(t)ide analogues induces a significant inhibition of HBV DNA titer. However, reduction of viral DNA load is not an ideal marker to predict sustainable antiviral effect. Circulating HBV RNA has been, recently, explored as a novel biomarker for monitoring viral persistence and the progression of liver disease. This review aims to discuss the characteristics of circulating HBV RNA and to evaluate its applications in hepatitis B infection management.Recent FindingsHBV RNA is readily detectable in the blood of infected patients. Circulating viral RN...
Source: Current Hepatitis Reports - October 18, 2018 Category: Infectious Diseases Source Type: research

Hepatitis B Reactivation in the DAA Era: Minding the Gap Between the Black Box and Clinical Practice
AbstractPurpose of ReviewThe US Food and Drug Administration recently issued a black box warning regarding the risk of hepatitis B virus (HBV) reactivation with direct-acting antiviral (DAA) treatment in hepatitis C virus (HCV)-coinfected individuals. The warning included all HBV infection, active and resolved, which, along with the lack of consensus among the gastroenterology and hepatology guidelines, have left clinicians unsure on how to proceed. Recent data have filled some knowledge gaps regarding the true risk of HBV reactivation in HCV treatment. The clinical data pertaining to the risk of reactivation in active and...
Source: Current Hepatitis Reports - October 17, 2018 Category: Infectious Diseases Source Type: research

Update on Pediatric Fatty Liver Disease
AbstractPurpose of ReviewNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the USA, affecting over 7 million children. In this article, we provide an update on pediatric NAFLD by briefly reviewing the recent publications in diagnosis, screening, therapy, and follow-up.Recent FindingsNAFLD remains a diagnosis of exclusion and liver biopsy is the most accurate test to assess severity of the disease in children. There is a growing collection of studies testing noninvasive tests for hepatic steatosis and fibrosis, several of which have become available in more recent years, such as fibrosis ...
Source: Current Hepatitis Reports - October 17, 2018 Category: Infectious Diseases Source Type: research

Management of Combined Hepatocellular Carcinoma-Cholangiocarcinoma
AbstractPurpose of ReviewTo review the recent consensus on the nomenclature, clinical features, diagnosis, and treatment of combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA).Recent FindingscHCC-CCA is a primary liver carcinoma with varying degrees of hepatocytic and cholangiocytic cytology and architecture within the same tumor. The diagnosis of cHCC-CCA can only be established based on histologic examination. Surgical resection should be considered in patients with resectable tumors who do not have underlying liver disease or clinically significant portal hypertension. While treatment by liver transplantatio...
Source: Current Hepatitis Reports - October 17, 2018 Category: Infectious Diseases Source Type: research

Stereotactic Ablative Radiotherapy (SABR/SBRT) for Hepatocellular Carcinoma
AbstractPurpose of ReviewLiver-directed SABR (stereotactic ablative body radiotherapy) is emerging as an effective local therapy option for HCC (hepatocellular carcinoma). This review summarizes recent clinical progresses and proposes future directions.Recent FindingsSABR is an effective and safe, non-invasive local therapy option for HCC in the primary and salvage treatment settings, as well as a bridge to liver transplantation in selected patients. Randomized trials comparing SABR with other locoregional modalities are currently ongoing.SummaryResearch efforts are being made toward better predicting normal tissue toxicit...
Source: Current Hepatitis Reports - October 16, 2018 Category: Infectious Diseases Source Type: research

Non-invasive Fibrosis Testing in Patients with Chronic Hepatitis B
AbstractPurpose of ReviewSummarizing the available evidence and advantages and disadvantages of the use of non-invasive tests for the management of patients with chronic hepatitis B virus (HBV) infection, including before and during antiviral therapy.Recent FindingsStaging of liver fibrosis and early detection of compensated cirrhosis are critical in the treatment decisions and surveillance of HBV patients. Non-invasive assessment of liver fibrosis has been one of the major advances in hepatology over the past decade, relying either on the dosage of serum biomarkers or on the measurement of liver stiffness, using either ul...
Source: Current Hepatitis Reports - October 15, 2018 Category: Infectious Diseases Source Type: research

Impact of Chronic Hepatitis B Infection on Patient-Reported Outcomes
AbstractPurpose of ReviewHepatitis B virus (HBV) infects a large number of people worldwide causing tremendous clinical burden related to decompensated cirrhosis and hepatocellular carcinoma (HCC). Although clinical consequences of HBV are well described, the impact of chronic HBV infection on patient-reported outcomes (PROs) is not well described.Recent FindingsMostly asymptomatic, some HBV patients do have some impairment of their health-related quality of life. In general, the use of interferon-based regimens for HBV has been associated with negative impact on both physical function and psychological function of the tre...
Source: Current Hepatitis Reports - October 15, 2018 Category: Infectious Diseases Source Type: research

Prevention and Management of HBV Infection in Patients with Chronic Kidney Disease Requiring Renal Transplantation
AbstractPurpose of the ReviewThis review addresses clinical challenges of hepatitis B virus (HBV) infection in patients with chronic kidney disease and renal transplant recipients.Recent FindingsProphylactic antiviral therapy with nucleos(t)ide analogues is key to prevent HBV reactivation in renal transplant recipients. In addition, attaining adequate immunity following vaccination against HBV may permit transplantation of renal grafts from donors with evidence of prior HBV infection. The role of nucleos(t)ide analogues for treatment of recurrent or de novo HBV infection in renal transplant recipients is well established a...
Source: Current Hepatitis Reports - October 13, 2018 Category: Infectious Diseases Source Type: research

Indications and Best Practices for Intra-arterial Therapies to Treat Hepatocellular Carcinoma
AbstractPurpose of ReviewThe purpose of this review is to re-evaluate the role of intra-arterial therapies for hepatocellular carcinoma (HCC) recommended by contemporary staging systems.Recent FindingsCurrently, intra-arterial therapies are recommended by the Barcelona Clinic Liver Cancer (BCLC) staging system only for patients with BCLC B HCC in the form of trans-arterial chemoembolization. Recently, randomized controlled trials in patients with BCLC C HCC without metastatic disease have suggested a potential role for trans-arterial radioembolization (TARE) with fewer adverse events and better quality of life compared to ...
Source: Current Hepatitis Reports - October 10, 2018 Category: Infectious Diseases Source Type: research

New Advances in Hepatitis B Vaccination for Adults
AbstractPurpose of ReviewThe mainstay of elimination of hepatitis B virus is through primary prevention by vaccination recommended by the World Health Organization. This review seeks to update readers on the performance of the current second-generation vaccine and the challenges including primary and secondary vaccine failure, as well as compliance and coverage.Recent FindingsPrimary vaccine failure in children may be overcome by HBIG and antiviral therapy in high-risk pregnancies, while in adults, a number of strategies to address this include intradermal delivery, double-dose vaccination, improved adjuvants, and a third-...
Source: Current Hepatitis Reports - October 8, 2018 Category: Infectious Diseases Source Type: research

Portal Cavernoma Cholangiopathy
AbstractPurpose of ReviewPortal cavernoma cholangiopathy is a rare condition, a proper recognition of which is critical. Solid data on this condition are scarce. This review aims at updating current knowledge on its definition, manifestations, diagnosis, and management.Recent FindingsA consensus has been reached to prefer the denomination portal cavernoma cholangiopathy for the bile duct irregularities associated with portal cavernoma. Such irregularities are characterized by stenosis with or without dilatation and are mostly related to the impinging on bile duct lumen by portoportal collaterals. While bile duct irregulari...
Source: Current Hepatitis Reports - October 5, 2018 Category: Infectious Diseases Source Type: research