Hepatitis Monthly
Volume:17 Issue: 4, Apr 2017

Context: Quantitative hepatitis B surface antigen (qHBsAg) levels have been shown to assist the management of patients with chronic hepatitis B virus (HBV) infection and reflect the level of transcriptional activity of covalently closed circular DNA (cccDNA). It has been indicated the importance of co-operative use of qHBsAg and HBV-DNA for diagnosis and monitoring of CHB treatment.
Evidence Acquisition: In order to achieve a comprehensive approach in HBsAg quantification, an extensive search was done using relevant keywords in major medical libraries to collect, categorize, and summarize data in different sections.
A combination of qHBsAg The use of qHBsAg in chronic hepatitis B (CHB) patients may bring about important complementary information regarding HBV DNA during treatment and help predict the treatment outcome.

Dietary components predisposing to non-alcoholic fatty liver disease (NAFLD) have been conflicting to date. This study aimed to compare macro and micronutrients and food intake among non-lean and lean patients with NAFLD.
Adult people older than 18 years from seven postal districts of Shiraz, Iran, were selected using multistage cluster randomized sampling. Nutrition status was queried by a standard food frequency questionnaire and NAFLD was detected by sonography. The participants were divided into four groups: non lean-NAFLD (participants with NAFLD and BMI ≥ 25 kg/m2), lean-NAFLD (participants with NAFLD, BMI Of 478 participants, 204 (42.7%) were lean and 95 (19.9%) were diagnosed with NAFLD. The median age of interviewees was 42 years and male to female ratio was 0.7. Overall, starchy foods and potato intake was significantly different between the groups. In non-lean group, potato intake was higher among NAFLD compared to non-NAFLD (P = 0.02) individuals and in lean group, total starchy food intake was higher in those with NAFLD compared to the counterpart group (P = 0.02). Our study revealed that after adjusting for confounders, for each gram increase in carbohydrate intake, the chance of NAFLD increased by 1.99 times (95% CI: 1.982 - 1.997; P = 0.004). Also, for each gram increase in potato consumption, the risk of the disease increased by more than 2.5-fold (OR = 2.584; 95% CI: 1.281 - 5.213, P = 0.008). Moreover, NAFLD had an association with the intake of fat and the intake of polyunsaturated fatty acids (P = 0.01 and P = 0.02, respectively).
Besides studying NAFLD in obese patients, lean NAFLD patients should not be neglected and more studies should be conducted to assess their dietary intake. It seems greater attention should be given to fat and starches than before in order to prevent the rising trend of NAFLD in population.

Documentation of the effectiveness of sofosbuvir and ribavirin with or without pegylated interferon alfa for hepatitis C virus Genotype 3 (HCV GT3) is limited in a real world setting.
The present study aimed at examining the outcome of the above therapy in a real world setting.
Dual therapy of sofosbuvir and ribavirin was given for 24 weeks and triple therapy with additional pegylated interferon for 12 weeks. Patients received dual therapy when there was unwillingness to take interferon or interferon ineligibility.
In this analysis, 241 patients were included, of whom 175 were treated with dual and 66 with triple therapy. The mean age of the patients was 46.6 years, ranging from 20 to 72, and 136 (56.4%) were male. Clinical cirrhosis was present in 151 (62.7%) patients, and 98 (40.7%) had treatment experience. HCV RNA became negative in 225 (93.3%) patients at week 4 of the treatment. End of treatment virologic response was observed in 221 (91.7%) patients, and 199 (82.6%) had sustained virologic response 12 weeks post treatment (SVR12). Undetectable HCV RNA at week 4 was an independent parameter predicting SVR12 (P = 0.001). SVR12 was achieved in 143 (81.7%) patients treated with dual therapy and 56 (84.8%) with triple therapy (P = 0.567). Prior HCV treatment status and presence or absence of cirrhosis did not significantly affect the outcome between the 2 treatment groups.
Treatment of HCV GT3 infection with the sofosbuvir and ribavirin with or without PEG-IFNα achieved durable responses in a significant number of cases in a real world setting.

Non-alcoholic fatty liver disease (NAFLD) is a major worldwide public health problem with no effective treatment options. Green coffee bean extract (GCBE) is a rich source of bioactive phytochemicals with a variety of biochemical and physiological effects.
The aim of this study was to investigate the effects of GCBE on the management of patients with NAFLD.
44 patients with NAFLD were enrolled in a parallel, double-blind, placebo-controlled clinical trial. The participants were administered either GCBE or placebo (1 gram/day) for 8 weeks. They also were advised to follow a standard energy-balanced diet and physical activity. Liver ultrasonography, anthropometric variables, and biochemical parameters were compared at pre- and post-intervention.
GCBE significantly improved the levels of aspartate aminotransferase (AST), triglyceride (TG), total cholesterol, free fatty acids (FFAs), fasting blood sugar (FBS), homeostasis model assessment insulin resistance (HOMA-IR) index, high-sensitivity C-reactive protein (hs-CRP), and total antioxidant capacity (TAC) compared to the placebo group. On the other hand, there were no significant differences between the two groups in body weight, HDL-cholesterol, LDL-cholesterol, LDL-C to HDL-C ratio, insulin, degree of steatosis, aspartate transaminase (AST), alkaline phosphatase (ALP), and tumor necrosis factor-alpha (TNF-α).
GCBE supplementation may benefit patients with NAFLD. These beneficial effects may be due to the possible ability of GCBE to improve insulin sensitivity and its anti-inflammatory and antioxidant properties.

The presence of the hepatitis C virus (HCV) in cells of extrahepatic organs like peripheral blood mononuclear cells (PBMCs) have important implications for transmission, disease progression, and effective treatment of HCV-infected patients. The impact of host genetics such as polymorphisms near Interferon lambda 3 (IFNL3) on clearance of HCV RNA from buffy coat (BC) following successful clearance of HCV from plasma using Pegylated-IFN (PegIFN) and Ribavirin (RBV) treatment was evaluated in our study.
For detection of residual HCV RNA in BC samples, blood samples of 69 patients with sustained virologic response (SVR) after treatment with PegIFN and RBV were evaluated. Polymorphisms near IFNL3 gene including rs12979860 and rs8099917 were assessed using PCR-RFLP method.
The most prevalent rs12979860 and rs8099917 genotypes were CT (49.3%) and TT (62.3%), respectively. Nine (13.04%, 95%CI: 7.01% - 22.96%) patients had HCV RNA in their BC samples. The favorable genotypes of the 2 polymorphisms (rs12979860 CC and rs8099917 TT) were more frequently observed in patients with undetectable HCV RNA in their BC samples than those with HCV RNA in their BC samples (rs12979860 CC, 45% vs. 22.2%, P = 0.016 and rs8099917 TT, 66.7% vs. 33.3%, P = 0.01).
The polymorphisms of IFNL3 could play a crucial role not only in spontaneous clearance of HCV and SVR rate after PegIFN and RBV therapy, but also in the clearance of HCV from BC after PegIFN and RBV therapy.

Chronic hepatitis B virus (HBV) infection is a significant, worldwide burden due to it’s high prevalence, and risk of complications, including cirrhosis and hepatocellular carcinoma (HCC). Current literature suggests that African patients with chronic hepatitis B are at higher risk for hepatocellular carcinoma. The exact mechanism for the explanation for this observation is contentious and may be due to higher rates of chronicity, and/or exposure to hepatotoxins including aflatoxin. We sought to report the clinical characteristics of African born immigrants with chronic hepatitis B referred to a liver clinic in New York City. A total of 111 patients were enrolled. 19 patients (17%) had cirrhosis, and 14 patients (13%) had HCC at initial presentation. During the course of follow up, 13 patients (12%) died of complications of HBV, all of them related to HCC. Our case series revealed that a significant proportion of these patients manifested advanced complications of HBV such as cirrhosis or HCC.

The polymorphism rs58542926 C > T (E167K) in the gene of transmembrane 6 superfamily member 2 (TM6SF2) has been identified as a determinant of hepatic steatosis and fibrosis in patients with non-alcoholic fatty liver disease. Only limited data have been published on this subject in chronic hepatitis C (CHC).
This study aimed to evaluate the effect of TM6SF2 rs58542926 polymorphism on the risk of liver steatosis and fibrosis in Chilean patients with CHC infection.
A total of 153 biopsied CHC patients were genotyped for TM6SF2 rs58542926 using PCR-RFLP methodology. The risk of fatty liver was assessed by comparing absence ( TM6SF2 rs58542926 genotype CC was found in 138 (90.2%) patients, whereas genotypes CT was found in 15 (9.8 %). No association was observed between rs58542926 genotype and risk of steatosis (OR 0.62, 95% CI 0.17 - 2.22, P = 0.459) or fibrosis (OR 1.07, 95% CI 0.29 - 3.87, P = 0.923).
TM6SF2 rs58542926 polymorphism is not associated with the risk of liver steatosis or fibrosis in Chilean patients with CHC.