Hepatitis: Asia

Sungkanuparph S, Anekthananon T, Hiransuthikul N, Bowonwatanuwong C, Supparatpinyo K, Mootsikapun P, Chetchotisakd P, Kiertiburanakul S, Tansuphaswadikul S, Buppanharun W, Manosuthi W, Techasathit W, Ratanasuwan W, Tantisiriwat W, Suwanagool S, Leechawengwongs M, Ruxrungtham K, Anonymous00067. · Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand. · J Med Assoc Thai. · Pubmed #19133532 No free full text.

Abstract: BACKGROUND: More than 100,000 patients have been treated, since the implementation of the National Universal Coverage for antiretroviral therapy (ART) in Thailand Although there are several comprehensive guidelines available internationally, there is a need to have guidelines that can be implemented in Thailand. MATERIAL AND METHOD: The guidelines were developed by a panel of 17 members who are the experts on HIV research and/or HIV patient care and appointed without incentive by the Thai AIDS Society (TAS). The recommendations were based on evidences from the published studies and availability of antiretroviral agents. Published studies that are relevant and applicable to Thailand in particular have been taken into consideration. RESULTS: The recommendations include: when to start ART; what to start; how to monitor the therapy; adverse effects and its management; diagnosis of treatment failure; and antiretroviral treatment options in patients with treatment failure. ART in special circumstances, i.e., patients with co-infection of tuberculosis or hepatitis B virus, is also included Appropriate level of CD4+ T-cell count to start ART among Thai patients has been considered carefully. The authors recommend to start ART at CD4+ T-cell count < 200 cells/mm3. CONCLUSION: ART should be initiated in adults and adolescents HIV-1 infected patients with a history of HIV-related illness or AIDS or with a CD4+ T-cell count <200 cells/mm3. For treatment-naive patients, the preferred initial therapy is a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. CD4' T-cell count and viral load should be monitored for at least twice and once a year, respectively. Proper management of antiretroviral-related toxicity and enhancement of adherence are crucial for the long-term success of ART.

Parsad D, Gupta S, Anonymous00015. · Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. · Indian J Dermatol Venereol Leprol. · Pubmed #18688102 links to  free full text

Abstract: Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. PHYSICIAN'S QUALIFICATIONS: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on) under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. FACILITY: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. INDICATIONS FOR VITILIGO SURGERY: Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. PREOPERATIVE COUNSELING AND INFORMED CONSENT: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure, about the possible future progression of disease and whether more procedures will be needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures and one-to-one discussions. The need for concomitant medical therapy should be emphasized and the patient should understand that proper results take time (a few months to a year). Preoperative laboratory studies include hemogram including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time), and blood chemistry profile. Screening for antibodies for hepatitis B surface antigen and HIV is recommended depending on individual requirements. ANESTHESIA: Lignocaine (2%) with or without adrenaline is generally used for anesthesia; infiltration and nerve block anesthesia are adequate in most cases. General anesthesia may be needed in patients with extensive lesions. POSTOPERATIVE CARE: Proper postoperative immobilization and care are very important to obtain satisfactory results.

Ishibashi H, Komori A, Shimoda S, Gershwin ME. · Clinical Research Center, National Hospital Organization (NHO), Nagasaki Medical Center, and Department of Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. · Semin Liver Dis. · Pubmed #17520519 No free full text.

Abstract: The principle of therapy for chronic inflammatory liver diseases is the removal of causal agents. For autoimmune liver diseases, however, total removal of causal agents and immune cells is impossible. Therefore, autoimmune liver diseases are presently treated by suppression of the immune response. Autoimmune hepatitis is characteristically responsive to corticosteroids, often used in combination with azathioprine to obtain a steroid-sparing effect. For primary biliary cirrhosis, ursodeoxycholic acid is safe and is the first choice for treatment. Treatment of this autoimmune liver disease should also address various symptoms and complications arising from any associated autoimmune diseases, particularly cholestasis and cirrhosis-related complications. For primary sclerosing cholangitis there are no established immunomodulatory therapies, but medical, endoscopic, and surgical treatments are applicable to this disease. Liver transplantation becomes indicated during the eventual end stages of each of these immune-mediated liver diseases.

Yuen MF, Lai CL. · Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. · Expert Opin Pharmacother. · Pubmed #17059379 No free full text.

Abstract: The natural history of chronic hepatitis B should be clearly defined before appropriate recommendations for treatment can be advocated. In patients who acquire the disease in early life, the complications of chronic hepatitis B continue to occur as a result of prolonged insidious damage to the liver, even in the low viraemic phase. Treatment that ends with hepatitis B e antigen seroconversion with hepatitis B virus DNA levels just below 10(5) copies/ml may not be sufficient. Patients with mild elevation of alanine aminotransferase levels are already at considerable risk of developing complications. Treatment strategy should aim at maximal and prolonged viral suppression to the lowest possible hepatitis B virus DNA levels. Nucleotide/nucleoside analogues will become the mainstay of treatment. Future treatment strategic plans should target maximising antiviral potency and minimising the chance of drug resistance.

Park JW, Anonymous00069. · Korean Liver Cancer Study Group, Korea. · Korean J Hepatol. · Pubmed #15218342 links to  free full text

Abstract: BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is the 3rd most common cancer. The annual incidence is over 10,000 cases in Korea. While hepatitis B virus is major cause of Korean HCC, the impact of alcoholic liver disease is a rising trend. The 5-year survival rate of HCC is only 9.6%, mainly due late diagnosis, tumor biology and underlying chronic liver diseases. Because almost eighty percent of HCC is diagnosed in late, not early stages, a nationwide surveillance program to screen high risk groups (HBV or HCV carriers or liver cirrhosis, over 40 years old) was launched last year and a practice guideline, with special emphasis on advanced stage HCC was formulated. METHODS: Forty-five experts from KLCSG and the National Cancer Center participated in a special committee to develop a practice guideline for HCC. Based on scientific evidence, the consensus was made for diagnosis and treatment strategy after considering the medico-social situation in Korea. RESULTS: Required and optional tests and clinical (non-invasive) diagnosis criteria for HCC are identified. The first decision, based on both Child-Pugh score and modified UICC tumor staging, is to determine operability. The second decision, to determine resectability, is based on localization of the tumor and residual liver function. Chemoembolization or local ablation therapy is allowed for resectable tumors in certain conditions, such as at borderline risk or non-invasively diagnosed. Unresectable tumors are classified into either a group with inadequate residual liver functions or the another group with extensive or macrovascular invasion or distant metastases. Indications of liver transplantation, chemoembolization, local ablation, radiation therapy and chemotherapy for unresectable HCC are presented. CONCLUSIONS: This guideline is expected to be useful for clinical management of, and research for HCC patients.

Liaw YF, Leung N, Guan R, Lau GK, Merican I, Anonymous00265. · Liver Research Unit, Chang Gung University, Taipei, Taiwan. · J Gastroenterol Hepatol. · Pubmed #12603522 No free full text.

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John TJ. · Department of Peediatrics, Christian Medical College and Hospital, Vellore 632 004, India. · Indian Pediatr. · Pubmed #10740304 No free full text.

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Kim DG. · Division of Gatroenterology and Hepatology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea. · Korean J Gastroenterol. · Pubmed #19077518 links to  free full text

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Kim HJ. · Department of Internal Medicine, Chungang University College of Medicine, Seoul, Korea. · Korean J Hepatol. · Pubmed #18159146 links to  free full text

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Miyamura T. · National Institute of Infectious Diseases, 1-23-1 Toyama Shinjuku-ku, Tokyo 162-8640, Japan. · Adv Drug Deliv Rev. · Pubmed #17889399 No free full text.

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Shobokshi OA, Serebour FE, Skakni L. · Ministry of Health and Central Laboratory, Riyadh Medical Complex, Riyadh, Saudi Arabia. · Ann Saudi Med. · Pubmed #17337941 No free full text.

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Miyakawa Y, Yoshizawa H. · Miyakawa Memorial Research Foundation, Minami-Aoyama 2-19-8, Minato-Ku, Tokyo 107-0062, Japan. · Hepatol Res. · Pubmed #17092770 No free full text.

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Tazuma S. · Department of General Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. · Hepatol Res. · Pubmed #17035081 No free full text.

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Abe M, Akbar SM, Onji M. · Third Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan. · Hepatol Res. · Pubmed #16890177 No free full text.

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Ahn BM. · Department of Internal Medicine, Laboratory of Disease Specific Dietary Supplements, Bupyeong Serim Hospital, Incheon, Korea. · Korean J Hepatol. · Pubmed #16565601 links to  free full text

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Gafter U. · Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel. · Nephron Clin Pract. · Pubmed #16534236 No free full text.

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Kurosaki M, Izumi N. · Division of Gastroenterology and Hepatology, Musashino Red Cross Hospital, 1-26-1 Kyonan-cho, Musashino-shi, Tokyo 180-8610, Japan. · Hepatol Res. · Pubmed #16303326 No free full text.

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Nakamura H. · Division of Hepatobiliary and Pancreatic Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. · Hepatol Res. · Pubmed #16290223 No free full text.

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Kaito M. · Department of Gastroenterology and Hepatology, Institute of Clinical Medicine and Biomedical Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan. · Hepatol Res. · Pubmed #15967711 No free full text.

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Yokosuka O. · Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ward, Chiba City, Chiba 260-8670, Japan. · Hepatol Res. · Pubmed #15869903 No free full text.

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Yokosuka O. · Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ward, Chiba City, Chiba 260-8670, Japan. · Hepatol Res. · Pubmed #15862782 No free full text.

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Kakumu S. · Gastroenterology Division, Department of Internal Medicine, Aichi Medical University School of Medicine, 21 Karimata, Yazako, Nagakute-cho, Aichi-gun, Aichi-ken 480-1195, Japan. · Hepatol Res. · Pubmed #15857808 No free full text.

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Chen Z. · Institute of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China. · Zhejiang Da Xue Xue Bao Yi Xue Ban. · Pubmed #15812879 No free full text.

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Zheng SS. · Department of Hepatobiliary-pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicne, Hangzhou 310003, China · Zhonghua Gan Zang Bing Za Zhi. · Pubmed #15779156 No free full text.

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Jiang L, Jiang LS, Cheng NS, Yan LN. · Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. · World J Gastroenterol. · Pubmed #19468999 links to  free full text

Abstract: Prophylactic strategies against hepatitis B virus (HBV) recurrence after liver transplantation (LT) are essential for patients with HBV-related disease. Before LT, lamivudine (LAM) was proposed to be down-graded from first- to second-line therapy. In contrast, adefovir dipivoxil (ADV) has been approved not only as first-line therapy but also as rescue therapy for patients with LAM resistance. Furthermore, combination of ADV and LAM may result in lower risk of ADV resistance than ADV monotherapy. Other new drugs such as entecavir, telbivudine and tenofovir, are probably candidates for the treatment of hepatitis-B-surface-antigen-positive patients awaiting LT. After LT, low-dose intramuscular hepatitis B immunoglobulin (HBIG), in combination with LAM, has been regarded as the most cost-effective regimen for the prevention of post-transplant HBV recurrence in recipients without pretransplant LAM resistance and rapidly accepted in many transplant centers. With the introduction of new antiviral drugs, new hepatitis B vaccine and its new adjuvants, post-transplant HBIG-free therapeutic regimens with new oral antiviral drug combinations or active HBV vaccination combined with adjuvants will be promising, particularly in those patients with low risk of HBV recurrence.