Update in Drug Development for Chronic HBV/HDV Infection
AbstractPurpose of ReviewChronic hepatitis D is the most severe form of viral hepatitis. Currently, no drug has been approved for its treatment and pegylated interferon alpha remains the only recommended therapy, with dismal efficiency and important side effects. This review summarizes the recent advances in drug development for chronic hepatitis D.Recent FindingsA better knowledge of virology of hepatitis D virus has led to the development of several drugs targeting different steps of the viral life cycle. Among them, bulevirtide (a viral entry inhibitor, formerly denominated as Myrcludex B), lonafarnib (a viral assembly ...
Source: Current Hepatitis Reports - November 26, 2019 Category: Infectious Diseases Source Type: research
Spectrum of Drug Induced Liver Injury Caused by Anabolic Androgenic Steroids Abuse
AbstractPurpose of ReviewPotent anabolic androgenic steroids (AAS) are often illegally present in commercially available body building supplements (BBS) and may cause drug induced liver injury (DILI) with different phenotypes.Recent FindingsAAS induced DILI typically presents with a prolonged cholestatic liver injury with pruritus and a typical enzyme pattern of elevated transaminases that rapidly fall as alkaline phosphatase slowly increases. Liver biopsy reveals bland cholestasis that usually does not have chronic sequalae. Pathophysiology is unknown and genetic variants in genes associated with cholestatic syndromes wer...
Source: Current Hepatitis Reports - November 25, 2019 Category: Infectious Diseases Source Type: research
Medical Approach for Weight Loss in Nonalcoholic Fatty Liver Disease
AbstractPurpose of ReviewNonalcoholic fatty liver disease (NAFLD) has reached epidemic proportions due to obesity in the modern world. Although treatments are in development, weight loss remains the most definitive and impactful approach to treating this disease and with it the other multisystemic complications of obesity. In this review, we summarize the current medical therapies for weight loss in NAFLD, including patient evaluation, counseling, and incorporation of medications for obesity.Recent FindingsDespite need for weight loss as treatment for NAFLD, few achieve successful weight loss. Weight loss medications lead ...
Source: Current Hepatitis Reports - November 20, 2019 Category: Infectious Diseases Source Type: research
NAFLD in Women: Unique Pathways, Biomarkers, and Therapeutic Opportunities
AbstractPurpose of reviewIn this review article, we evaluate sex differences in the natural history of NAFLD and highlight distinct risk profiles of women with NAFLD, as well as unique treatment considerations and research gaps.Summary of FindingsReproductive factors, such as menopausal status, should be considered when evaluating NAFLD risk in women, as well as additional reproductive risk factors such as age at menarche, presence of polycystic ovary syndrome, and gestational diabetes. Women do appear to have lower risk for hepatocellular carcinoma from NASH, as well as lower mortality from NASH cirrhosis than men, althou...
Source: Current Hepatitis Reports - November 17, 2019 Category: Infectious Diseases Source Type: research
Extrahepatic Malignancies in Nonalcoholic Fatty Liver Disease
AbstractPurpose of ReviewMalignancy is the second most common cause of death in individuals with nonalcoholic fatty liver disease (NAFLD). Understanding unique characteristics of malignancy risk beyond hepatocellular carcinoma in NAFLD has significant implications in counseling and personalized preventative measures in this high-risk population. Herein, we systematically review the literature reporting extra-hepatic malignancies in NAFLD and discuss the key biological mechanisms underpinning the association between excess adiposity and cancer risk.Recent FindingsSeveral studies have shown significant associations between N...
Source: Current Hepatitis Reports - November 14, 2019 Category: Infectious Diseases Source Type: research
HIV-Associated NAFLD: Disease Burden and Management
AbstractPurpose of ReviewHighly potent anti-retroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) has led to dramatic improvements in quality of life and lifespan in persons living with HIV (PLWH). PLWH, however, are suffering from other comorbid conditions, including non-alcoholic fatty liver disease (NAFLD). This review summarizes the epidemiology and pathophysiology of NAFLD in PLWH and explores unique diagnostic and treatment considerations in this population.Recent FindingsThough it is well established that there is a high prevalence of NAFLD in PLWH, the mechanisms underlying NAFLD in this ...
Source: Current Hepatitis Reports - November 14, 2019 Category: Infectious Diseases Source Type: research
Quantification of Liver Fat in NAFLD: Available Modalities and Clinical Significance
AbstractPurpose of ReviewTo review the available modalities for quantification of liver fat in nonalcoholic fatty liver disease (NAFLD) and their clinical significance.Recent FindingsUltrasonography remains the first line imaging used to diagnose NAFLD as it is widely available and relatively inexpensive. Controlled attenuation parameter can be used as a screening tool for fatty liver as it is reasonably accurate and provides simultaneous estimation of hepatic fibrosis. Magnetic resonance imaging proton density fat fraction and magnetic resonance spectroscopy are the most accurate noninvasive modalities for quantification ...
Source: Current Hepatitis Reports - November 10, 2019 Category: Infectious Diseases Source Type: research
Evidence-Based Approach to Stopping Oral Antiviral Therapy in Chronic HBV
AbstractPurpose of ReviewTo review the evidence for stopping antiviral therapy with nucleos(t)ide analogues (NA) in patients with chronic hepatitis B.Recent FindingsHBsAg loss is usually stable even without anti-HBs seroconversion after stopping NA therapy. About 50% of HBeAg-positive patients who have achieved anti-HBe seroconversion and have stopped NA therapy remain in virological remission. Consolidation therapy increases the response rate. In HBeAg-negative hepatitis, stable virological remission is documented in 30% after NA discontinuation. Interestingly, some studies document unexpectedly high long-term HBsAg loss ...
Source: Current Hepatitis Reports - November 10, 2019 Category: Infectious Diseases Source Type: research
Should We Screen High-Risk Populations for NAFLD?
AbstractPurpose of reviewNonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide and yet remains largely underdiagnosed. However, whether a systematic screening in high-risk population for NAFLD should be performed remains debated.Recent findingsOver the past decade, a better knowledge of the natural history and epidemiology of NAFLD has identified high-risk population for NAFLD including obese and type 2 diabetes patients. Moreover, the presence of advanced fibrosis has been identified as the major determinant of overall and liver-related mortality. Moreover, several non-in...
Source: Current Hepatitis Reports - November 7, 2019 Category: Infectious Diseases Source Type: research
NAFLD Histology: a Critical Review and Comparison of Scoring Systems
AbstractPurpose of ReviewDespite the emergence of non-invasive tests, liver biopsy remains the gold standard for the diagnosis of non-alcoholic fatty liver disease (NAFLD). This review will provide an overview of the histology of adult NAFLD with a focus on current scoring systems, histologic features that predict clinical outcomes, and areas in need of improvement.Recent FindingsStudies during the last two decades have established the histologic features used to categorize NAFLD into non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), described histologic scoring systems that measure disease activit...
Source: Current Hepatitis Reports - November 3, 2019 Category: Infectious Diseases Source Type: research
Future Therapies for Functional Cure of Chronic HBV: Review of Investigational Drugs in Phase 1 and 2 Development
AbstractPurpose of ReviewTreating patients with chronic hepatitis B (CHB) infection with long-term oral antiviral therapy or pegylated interferon is the current standard of care (SOC). However, functional cure, defined as sustained hepatitis B surface antigen (HBsAg) seroclearance that is associated with favorable clinical outcomes, is a rarely achieved treatment endpoint with the SOC.Recent FindingsRemarkable advances in CHB therapy have been made in the recent years. This review was aimed to describe the different new treatment agents that are in the clinical phase of development. These include two main groups of agents ...
Source: Current Hepatitis Reports - October 31, 2019 Category: Infectious Diseases Source Type: research
Screening Indications and Treatments for Cholangiocarcinoma
AbstractPurpose of ReviewThe goal of this review paper is to provide a comprehensive overview of cholangiocarcinoma (CCA) including its classification, epidemiology, risk factors, surveillance, diagnosis, and treatment.Recent FindingsGuidelines recommend CCA surveillance in PSC patients with MRI/MRCP or ultrasound and CA 19-9 every 6 –12 months. Fluorescience in situ hybridization and next-generation sequencing improve the poor sensitivity of biliary brushings. Surgical resection with negative margins gives the best chance of survival, and liver transplantation is an option for patients with very early intrahepatic CCA a...
Source: Current Hepatitis Reports - October 30, 2019 Category: Infectious Diseases Source Type: research
Liquid Biopsy for Hepatocellular Carcinoma
AbstractPurpose of ReviewClinically available biomarkers for hepatocellular carcinoma (HCC) early diagnosis and prognostication have limited utility. Further lack of routine biopsy in hepatocellular carcinoma limits the availability of molecular information to guide drug development. Recent studies investigating liquid biopsy using circulating tumor cells (CTCs) and cell-free deoxyribonucleic acid (cfDNA) have yielded promising data that could address both of these limitations.Recent FindingsFor early HCC diagnosis, CTCs have modest sensitivity but high specificity. CfDNA methylation scores have shown high sensitivity and ...
Source: Current Hepatitis Reports - October 28, 2019 Category: Infectious Diseases Source Type: research
Downstaging and Expanded Criteria Hepatocellular Carcinoma Liver Transplantation
AbstractPurpose of ReviewLiver transplantation (LT) has been utilized in the last two decades for the treatment of selected patients with hepatocellular carcinoma (HCC). Currently, in most jurisdictions worldwide, only tumor size and number determine transplant candidacy, which may not sufficiently predict tumor behavior. Both tumor downstaging and expanding transplant criteria play an important role in expanding access to LT for HCC patients.Recent FindingsNew downstaging protocols are emerging that incorporate response to locoregional therapies (LRT) among those that initially present beyond the accepted Milan criteria. ...
Source: Current Hepatitis Reports - October 21, 2019 Category: Infectious Diseases Source Type: research
Harms of Hepatocellular Carcinoma Surveillance
AbstractPurpose of ReviewHepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is associated with decreased mortality by enabling early tumor detection. However, the benefits of any cancer screening program must be considered in light of potential physical, financial, and psychological harms, as well as the risk of overdiagnosis. Herein, we summarize the potential harms of HCC surveillance.Recent FindingsTo date, two retrospective studies have addressed physical harms of HCC surveillance. Based on these data, 15% to 28% of patients undergoing HCC surveillance experience physical harm including additional c...
Source: Current Hepatitis Reports - October 14, 2019 Category: Infectious Diseases Source Type: research
