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Highest Rated Articles

Alter MJ, Seeff LB, Bacon BR, Thomas DL, Rigsby MO, Di Bisceglie AM. Testing for Hepatitis C Virus Infection Should Be Routine for Persons at Increased Risk for Infection. Ann Intern Med. 2004;141:715-7.

This is a position paper by national experts from the Centers for Disease Control and Prevention (CDC), National Institutes of Health, American Association for the Study of Liver Diseases, Veterans Health Administration, and American Liver Foundation. They analyze the 1998 recommendations from the CDC that testing be routinely offered to persons most likely to be infected with hepatitis C virus (HCV), and those of the U.S. Preventive Services Task Force (2004) that found insufficient evidence to recommend for or against routine screening for HCV infection in high-risk asymptomatic adults.

These experts quote accepted data that show that chronic HCV affects close to 3 million Americans and is the most common cause for liver disease morbidity and mortality in the United States. They also note that there are many benefits to be gained from identifying people with chronic hepatitis C, including providing counseling and immunization, seeking medical evaluation, implementing lifestyle modifications that may improve disease outcome, and proceeding with antiviral therapy if recommended.

This paper very appropriately concludes that "It is imperative that medical and public health professionals use the available evidence and the collective judgment of experts to continue the best practice of screening persons for risk factors, offering testing to those at increased risk, and providing infected persons with appropriate counseling, medical evaluation, and treatment."

Di Martino V, Lebray P, Myers RP, Pannier E, Paradis V, Charlotte F, Moussalli J, Thabut D, Buffet C, Poynard T. . Progression of liver fibrosis in women infected with hepatitis C: Long-term benefit of estrogen exposure. Hepatology. 2004;40:1426-33.

Women affected with chronic hepatitis C have a slower disease progression to cirrhosis and liver cancer than men. Di Martino and colleagues conducted a retrospective study in 157 women (average age, 48 ± 1 years) with a mean duration of hepatitis C virus (HCV) infection at the time of liver biopsy of 18 ± 1 years. Data were collected on exposure to estrogen: time between menarche and menopause, number of pregnancies, use of birth control pills, and use of hormonal replacement therapy. Multivariate regression analysis of the data showed that a history of pregnancy and the use of hormonal replacement therapy after menopause were independently associated with a lower estimated rate of fibrosis progression. Conversely, menopause was associated with more rapid progression of fibrosis and a higher fibrosis stage at the time of liver biopsy.

The authors conclude that estrogens may have a protective effect on liver fibrosis progression in women chronically infected with HCV, but the potential benefit of using hormonal replacement therapy in this setting needs to be balanced against other health risks.

Pockros PJ, Shiffman ML, PROACTIVE Study Group, et al. Epoetin alfa improves quality of life in anemic HCV-infected patients receiving combination therapy. Hepatology. 2004;40:1450-8.

A recent publication by the PROACTIVE group (Gastroenterology 2004) showed that patients being treated with peginterferon and ribavirin for chronic hepatitis C who received epoetin alfa experienced a significant increase in health-related quality of life (HRQL) when compared with patients who received placebo. This paper by Pockros et al from the PROACTIVE group expands on these data by comparing the HRQL of anemic hepatitis C virus (HCV)-infected patients receiving antiviral therapy with that of the general population as well as that of patients with other chronic illnesses using the short form 36 and LASA questionnaires (SF-36). Mean SF-36 scores of anemic HCV-infected patients receiving antiviral therapy were significantly lower than those of the general population or cohorts of chronically ill individuals. These patients then received epoetin alfa and experienced significant improvements in HRQL (previously published). Further analysis in this paper showed a direct correlation between the increase in hemoglobin levels with epoetin alfa and the improvement in SF-36 and LASA scores.

This paper adds to a growing body of knowledge supporting the use of erythropoetin analogs for the management of anemia and anemia-related decrease in quality of life in patients with chronic hepatitis C undergoing pegylated interferon and ribavirin therapy.

van Bommel F, Wunsche T, Mauss S, Reinke P, Bergk A, Schurmann D, Wiedenmann B, Berg T. Comparison of adefovir and tenofovir in the treatment of lamivudine-resistant hepatitis B virus infection. Hepatology. 2004;40:1421-1425.

Van Bommel and colleagues compare adefovir dipivoxil (recently FDA-approved for the treatment of chronic hepatitis B virus infection; HBV) and tenofovir disoproxil fumarate (approved for the treatment of human immunodeficiency virus infection) in 53 lamivudine-resistant chronic HBV-infected patients. Tenofovir therapy was faster in reducing HBV DNA levels, achieved a statistically greater HBV DNA suppression from week 12 through week 48 of therapy, and normalized ALT levels more rapidly than adefovir therapy. No major clinical side effects were reported with either drug.

While the number of patients in this study is small, its results are very provocative, suggesting that tenofovir may be a better choice than adefovir for patients with chronic hepatitis B.

Lu CY, Chiang BL, Chi WK, et al. Waning immunity to plasma-derived hepatitis B vaccine and the need for boosters 15 years after neonatal vaccination. Hepatology. 2004;40:1415-20.

Questions remain as to what is the appropriate follow-up for individuals vaccinated against hepatitis B virus (HBV). Lu and colleagues describe serum markers and immune response to HBV before and after booster injections in two cohorts of children born during the Taiwanese nationwide HBV vaccination program started in 1984. All children had received 4 doses of plasma-derived vaccine 15 years prior to follow-up.

One cohort consisted of high-risk children born to HBV-infected (and virus replicating) mothers. In these children, anti-HBs was undetectable in 23 of 77 children at age 15, and 21 of them had a serologic response to the booster. The response was greater in those with greater pre-booster titers and those anti-HBc positive before the booster.

The other cohort was representative of the general population. Only 15 of these individuals had a 15-year follow-up, and only one of these failed to respond to the second booster.

While this study showed loss of immune titers against HBsAg 15 years after vaccination, it did not prove a greater risk for these patients to acquire hepatitis B; and therefore, its applicability to a Western population with much less prevalence of HBV than that of Taiwan is less clear. Nonetheless, based on these data, one might consider re-testing young adults at high risk and consider a booster dose of anti-HBV vaccine for those with undetectable titers.

American Journal of Gastroenterology
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	Lawitz EJ, Hepburn MJ, Casey TJ. A Pilot Study of Interleukin-11 in Subjects with Chronic Hepatitis C and Advanced Liver Disease Nonresponsive to Antiviral Therapy. Am J Gastroenterol. 2004;99:2359-64.
European Journal of Gastroenterology & Hepatology
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	Abergel A, Darcha C, Chevallier M; French Multicentre Study Group. Histological response in patients treated by interferon plus ribavirin for hepatitis C virus-related severe fibrosis. Eur J Gastroenterol Hepatol. 2004;16:1219-27.
	Berenguer M, Prieto M, Palau A, et al. Recurrent hepatitis C genotype 1b following liver transplantation: treatment with combination interferon-ribavirin therapy. Eur J Gastroenterol Hepatol. 2004;16:1207-12.
Gastroenterology
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	Zeuzem S, Diago M, Gane E, Reddy KR, Pockros P, Prati D, Shiffman M, Farci P, Gitlin N, O'Brien CB, Lamour F, Lardelli P; PEGASYS Study NR16071 Investigator Group. Peginterferon alfa-2a (40 kilodaltons) and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels. Gastroenterology. 2004;127:1724-32.
	Hinrichsen H, Benhamou Y, Wedemeyer H, et al. Short-term antiviral efficacy of BILN 2061, a hepatitis C virus serine protease inhibitor, in hepatitis C genotype 1 patients. Gastroenterology. 2004;127:1347-55.
	Davila JA, Morgan RO, Shaib Y, McGlynn KA, El-Serag HB. Hepatitis C infection and the increasing incidence of hepatocellular carcinoma: A population-based study. Gastroenterology. 2004;127:1372-80.
	Heathcote EJ. Prevention of hepatitis C virus-related hepatocellular carcinoma. Gastroenterology. 2004;127(5 Suppl 1):S294-302.
	Dolganiuc A, Oak S, Kodys K, et al. Hepatitis C core and nonstructural 3 proteins trigger toll-like receptor 2-mediated pathways and inflammatory activation. Gastroenterology. 2004;127:1513-24.
	Liang TJ, Heller T. Pathogenesis of hepatitis C-associated hepatocellular carcinoma. Gastroenterology. 2004;127(5 Suppl 1):S62-71.
Hepatology
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	Piasecki BA, Lewis JD, Reddy KR, et al.. Influence of alcohol use, race, and viral coinfections on spontaneous HCV clearance in a US veteran population. Hepatology. 2004;40:892-9.
	Bantel H, Lugering A, Heidemann J, et al.. Detection of apoptotic caspase activation in sera from patients with chronic HCV infection is associated with fibrotic liver injury. Hepatology. 2004;40:1078-87.
	Kronenberger B, Herrmann E, Micol F, von Wagner M, Zeuzem S. Viral kinetics during antiviral therapy in patients with chronic hepatitis C and persistently normal ALT levels. Hepatology. 2004;40:1442-9.
	Klenerman P, Semmo N, Ward S. Cellular immune responses against HCV: T cells take a diversion in the liver. Hepatology. 2004;40:1459-61.
	Schwarzinger M, Dewedar S, Rekacewicz C, et al. Chronic hepatitis C virus infection: Does it really impact health-related quality of life? A study in rural Egypt. Hepatology. 2004;40:1434-41.
Liver Transplantation
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	Shimoda M, Ghobrial RM, Carmody IC, et al. Predictors of survival after liver transplantation for HCC associated HCV. Liver Transpl. 2004;10:1478-86.
	Gruener NH, Jung MC, Ulsenheimer A, et al. Analysis of a successful HCV-specific CD8+ T cell response in patients with recurrent HCV-infection after orthotopic liver transplantation. Liver Transpl. 2004;10:1487-96.