Hepatitis: Korea

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.

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

This publication has no abstract.

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

This publication has no abstract.

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

This publication has no abstract.

Bae K, Choi J, Jang Y, Ahn S, Hur B. · Vaccine Research Institute, CrucellBerna Biotech Korea, Yongin, 449-903, Korea. · Arch Pharm Res. · Pubmed #19407962 No free full text.

Abstract: This review paper provides an overview of innovative technologies designed to produce bacterial, viral, recombinant subunit, and polysaccharide vaccines, as well as combination vaccines. Advances in this field are illustrated by vaccines against DTP (diphtheria-tetanus-pertussis), influenza, hepatitis B (HepB) and typhoid fever. In addition, technological trends regarding antigens, adjuvants, and preservatives in vaccines are discussed. The progress achieved in vaccine production technologies is especially important for improving the protection of vulnerable populations against infectious diseases. These at-risk groups include infants, the elderly and immunocompromized individuals, as well as people living in developing countries or emerging economies.

Kim DJ. · Department of Internal Medicine, Hallym University College of Medicine and Center for Liver and Digestive Diseases, Hallym University Medical Center, Chuncheon, Korea. · Korean J Gastroenterol. · Pubmed #19158465 links to  free full text

Abstract: Liver injury due to prescription and nonprescription medications is a growing medical, scientific and public health problem. Drug-induced liver injury (DILI) is the single most common reason for regulatory actions, including failure of approval, removal from the marketplace and restriction of prescription. Worldwide, the estimated annual incidence rate of DILI is 13.9-24.0 per 100,000 inhabitants. At the same time, there is increasing concern about the potential risk for hepatotoxicity from complementary and alternative medicines (CAM) including herbal products because they are unregulated and not standardized with regard to their contents. Determining hepatotoxicity remains a major challenge in clinical practice due to a lack of reliable markers. The RUCAM/CIOMS scale have been proposed to establish a causal relationship between offending drug and liver injury. The efforts of Drug-Induced Liver Injury Network (DILIN, USA) directed toward the development of an abridged instrument in evaluating suspected drug-induced hepatotoxicity were presented at the National Institute of Health (NIH) Workshop, titled Drug-induced liver injury: Standardization of nomenclature and causality assessment, December, 2008. The main contents of the presentations and discussions at the NIH workshop are introduced in this article. This fine-tuned operations of RUCAM/CIOMS scale would enable a more confident assessment of causality and facilitate the collection of bona fide cases of drug-induced hepatotoxicity in Korea. Several demanding tasks for the near future in Korea are also proposed at the end.

Yim HJ. · Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea. · Korean J Hepatol. · Pubmed #19119240 links to  free full text

Abstract: Hepatitis B virus (HBV) is a partially double stranded DNA virus with genetic diversity represented by eight genotypes (A to H). Natural course and response to treatment could be affected by HBV genotypes. HBV shows high rates of turn over in the absence of proof-reading ability. As a result, large amounts of quasispecies are produced naturally or antiviral-associated. HBV consists of four open reading frames, namely preS/S gene, precore/core gene, polymerase gene, and X gene. Mutations on preS gene can result in undetectable HBsAg even in case that HBV is replicating. Surface gene mutation leads to decreased binding affinity to anti-HBs, which is associated with a vaccine escape mutant. Precore mutation abolishes HBeAg whereas mutations on basal core promoter gene down-regulate the HBeAg production. Mutations on basal core promoter are associated with increased HBV replication and high incidence of progressive liver diseases such as liver cirrhosis and hepatocellular carcinoma. Mutations on polymerase genes are often induced by antiviral therapy. Emergence of antiviral-resistant mutation is the major cause of treatment failure. Furthermore, existence of prior antiviral-resistant mutations limits the options of subsequent antiviral agents. Therefore, judicious use of antivirals and selection of the most potent drug with the lowest resistance rate are of the utmost importance for the prevention of antiviral-associated mutants. Detailed knowledge and understanding of HBV genetic diversity and mutant would be critical to establish strategies for the diagnosis and management of HBV infection.

Paik SW. · Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Korean J Gastroenterol. · Pubmed #18604138 links to  free full text

Abstract: Hepatitis C virus (HCV) is a major cause of chronic hepatitis and hepatic fibrosis worldwide. Up to 85% of individuals infected with HCV develop chronic infection, which can progress to cirrhosis and hepatocellular carcinoma. The primary goal in the treatment of HCV infection is to reduce the mortality by preventing liver-related deaths associated with the development of hepatocellular carcinoma and decompensated cirrhosis. Pegylated interferons together with ribavirin are currently the standard of care for patients with chronic hepatitis. Here, I discuss the goals of treatment, indication and treatment of chronic hepatitis C.

Kwon JH, Bae SH. · Department of Internal Medicine, Kangnam St. Mary's Hospital, Seoul, Korea. · Korean J Gastroenterol. · Pubmed #18604137 links to  free full text

Abstract: The mortality due to chronic liver disease, including liver cirrhosis and hepatocellular carcinoma (HCC), ranks as one of the highest in Korea. The prevalence rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in the general Korean population are approximately 1 and 5%, respectively. Blood transfusion was the strongest risk factor for the transmission of HCV infection. Therefore, the evaluation of risk factors for HCV infection including blood transfusion, intravenous drug user, hemophilia, and hemodialysis, is important. The most prevalent HCV genotype is 1b followed by 2a. The annual incidence of HCC among HCV-related liver cirrhosis has been estimated at 5%, and approximately 12% of HCC is attributable to HCV and 68% to HBV in Korea. HCV infection is more closely associated with HCC in elderly patients than HBV-related HCC. Even though the prevalence of anti-HCV in Korea has been reduced and the risk of HCV transmission through blood transfusion has markedly decreased, public-health programs to prevent de novo infections should be developed. This review describes the HCV prevalence and risk factors among the general population, and the distribution of HCV genotypes as well as the clinical course of HCV in Korea.

Yim HJ. · Department of Internal Medicine, Korea University Medical College, Seoul, Korea. · Korean J Gastroenterol. · Pubmed #18604136 links to  free full text

Abstract: Substantial progress has been made in the treatment of chronic hepatitis B during the past decade. Nucleos(t)ide analogues are now widely used due to their convenience, less side effects, and considerable response rates. However, development of antiviral resistance is a major problem being considered as the most important factor for the treatment failure. Viral breakthrough associated with selection of antiviral-resistant hepatitis B virus (HBV) is usually followed by biochemical breakthrough, clinical deterioration, and even progressive liver failure. Therefore, appropriate management of antiviral resistance is critical for improving treatment outcomes. Strategies for the management of antiviral-resistant chronic HBV infection are described herein considering recently published guidelines. Lamivudine/telbivudine resistance can be managed by adding adefovir. Switching to adefovir or entecavir is also a viable option. However, careful follow-up of viral load is mandatory to detect any primary or secondary treatment failure in case of sequential monotherapy. Interferon or peg-interferon therapy can also be considered in case of young patients with compensated liver disease. For adefovir resistance, lamivudine can be added, but adding or switching to entecavir is a more reasonable option. Likewise, adding or switching to adefovir can be considered for entecavir resistance. Adding or switching to tenofovir needs to be considered upon availability. Experiences for clevudine resistance are still lacking, and need to be studied further upon the isolation of clinically resistant strains. To avoid emergence of resistant mutations, antiviral therapy should be initiated after careful balance of risk and benefit, and the most potent antiviral agent with the lowest resistance rate should be selected.

Cheong JY. · Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea. · Korean J Gastroenterol. · Pubmed #18604135 links to  free full text

Abstract: Chronic hepatitis B (CHB) is a serious health problem in Korea. The natural history of chronic HBV infection has been divided into 4 phases: immune tolerance, immune clearance, inactive HBsAg carrier state and reactivation. During the phases of immune tolerance and inactive HBsAg carrier state, no treatment is required. Patients in the immune clearance or reactivation phases are candidates for therapy. In the last years, treatment effects of CHB have considerably improved. Several agents are currently approved for the treatment of CHB: interferon alpha, pegylated interferon alpha, lamivudine, adefovir, entecavir, telbivudine and clevudine in Korea. The treatment recommendations from the 2004 Korean Association for the Study of the Liver guideline on the management of CHB have been updated to incorporate new therapeutic options. What is uncertain is which agent or combination of agents is most effective, how long therapy should last, and which criteria should be used to start, continue, switch or stop therapy. Issues for consideration include efficacy, safety and incidences of resistance, and method of administration of antiviral therapy in treatment-naive patients.

Jeong SH. · Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. · Korean J Gastroenterol. · Pubmed #18604134 links to  free full text

Abstract: One of the major cause of recent acute viral hepatitis in Korean adults is hepatitis A virus (HAV) infection. Most of hepatitis A cases are young adults in their twenties or thirties, and the severity of the disease is related to the age of patients. The seroprevalence of HAV among the adolescents and young adults in their teens and twenties is about 10%, which suggests that a growing number of young adults are susceptible to HAV infection. Development of more adult cases with severe presentation is expected in the near future, and some preliminary data suggest the incidence rate of hepatitis A in Korea might be higher than 20/100,000 population. This clinical features and the epidemiological shift of HAV urge to promote childhood vaccination and consider catch-up vaccination for adolescents and young adults. More extensive evaluation on the nationwide epidemiology of HAV infection, cost-benefit analysis of HAV vaccination, and setting-up of guidelines for HAV vaccination are urgently warranted.

Yoon SK. · Department of Internal Medicine and WHO Collaborating Center for Reference and Research on Viral Hepatitis, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. · Intervirology. · Pubmed #18544946 No free full text.

Abstract: Hepatocellular carcinoma (HCC) is one of the most devastating malignancies in the world and is the third most common cause of cancer-related death in Korea. Because most HCC are accompanied by chronic liver disease that results from hepatitis B or C viruses, prognosis is still poor even after surgical resection of the tumor. Moreover, diagnosis of advanced HCC still leads to an extremely bleak prognosis. Earlier detection of HCC, therefore, could improve patient survival. Accordingly, the development of tumor markers that can detect HCC at even earlier stages is essential. The functions of tumor markers include prediction of prognosis or therapeutic response as well as diagnosis or screening of cancer. Possible candidate tumor markers may be quantitative alterations in DNA-, RNA- or protein-based molecules in tumorous conditions assessed by various technologies, e.g. serological assays, microarrays, mass spectrometry and proteomics. However, validation and clinical implementation is needed after the discovery of novel genes. An ideal tumor marker for HCC would be sensitive and specific enabling to differentiate it at an early stage from premalignant lesions like dysplastic nodules. In addition, the marker should be easily measurable, reproducible and minimally invasive. Although it is important to identify new biomarkers for HCC, the validation and cost-effectiveness of those markers as diagnostic or prognostic tools need confirmation in large-scale studies in clinical practice.

Yeon JE. · Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea. · Intervirology. · Pubmed #18544942 No free full text.

Abstract: Early detection of antiviral resistant mutants is of clinical importance in patients receiving antiviral treatment. The ideal assay is sensitive, specific, accurate, reproducible and easy to perform, attains a high throughput and is able to detect mixed and novel mutations. Advantages and disadvantages of sequencing, line probe assay, DNA chip technology, peptide nucleic acid cramping, fluorescent biprobe hybridization and a new technique based on matrix-assisted laser desorption/ionization time-of-flight mass-spectrometric analysis will be discussed.

Park SH. · Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea. · Korean J Hepatol. · Pubmed #18367854 links to  free full text

Abstract: Nonalcoholic fatty liver disease (NAFLD) is characterized by a wide spectrum of liver damage spanning steatosis, nonalcoholic steatohepatitis (NASH), cryptogenic liver cirrhosis, and even to hepatocellular carcinoma. Investigations in the last few years have focused on NASH, a relatively aggressive form of liver disease, due largely to the explosion of information provided by clinical and basic science studies related to the widespread presence of risk factors, such as obesity, type II diabetes mellitus, and dyslipidemia. This is especially important given that obesity and type II diabetes mellitus have recently reached epidemic proportions in Korea. The pathogenesis of NASH is multifactorial, with insulin resistance and increased fatty acid possibly being important factors in the accumulation of hepatocellular fat, and oxidant stress, lipid peroxidation, mitochondrial dysfunction, and dysregulation of variable cytokines possibly being important causes of hepatocellular injury in steatotic liver. Because not all steatotic livers progress to NASH, some other environmental factors or a combination of genetic factors are thought to be required for progression to NASH and fibrosis. Lifestyle modifications continue to be the cornerstone therapy in NAFLD, but some insulin-sensitizing drugs might be more effective in treating NASH. Many pilot trials for antioxidants and lipid-lowering and hepatic protective agents have yielded promising initial results in improving liver enzymes or features of liver histology. However, the efficacy of these agents remains questionable. Despite recent gains in understanding NASH, several issues related to its natural history, pathogenesis, and treatment remain unresolved.

Park NH, Chung YH. · Department of Internal Medicine, University of Ulsan College of Medicine, Biomedical Research Center, Ulsan University Hospital, Ulsan, Korea. · Korean J Hepatol. · Pubmed #17898549 links to  free full text

Abstract: Hepatocellular carcinoma (HCC) is one of the most common malignant diseases in the world. The hepatitis B virus (HBV) replicates non-cytopathically in hepatocytes, and most of the liver injury associated with this infection reflects the immune response. Epidemiological studies have clearly demonstrated that a chronic HBV infection is a major etiological factor in the development of HCC. The pathogenesis of HBV-associated HCC has been studied extensively, and the molecular changes during the malignant transformation have been identified. The main carcinogenic mechanism of HBV-associated HCC is related to the long term-inflammatory changes caused by a chronic hepatitis B infection, which might involve the integration of the HBV. Integration of the HBV DNA into the host genome occurs at the early steps of clonal tumorous expansion. The hepatitis B x protein (HBx) is a multifunctional regulatory protein that communicates directly or indirectly with a variety of host targets, and mediates many opposing cellular functions, including its function in cell cycle regulation, transcriptional regulation, signaling, encoding of the cytoskeleton and cell adhesion molecules, as well as oncogenes and tumor suppressor genes. Continued study of the mechanisms of hepatocarcinogenesis will refine our current understanding of the molecular and cellular basis for neoplastic transformations in the liver. This review summarizes the current knowledge of the mechanisms involved in HBV-associated hepatocarcinogenesis.

Choi IG, Yu YG. · Division of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Anam-dong, Seongbuk-gu, Seoul 136-713, Korea. · Infect Disord Drug Targets. · Pubmed #17897061 No free full text.

Abstract: Human hepatitis B virus (HBV) causes chronic hepatitis disease which is a major public health problem worldwide. HBV has 4 genes encoding viral DNA polymerase, protein X and two structural proteins, the surface and core proteins. HBV DNA polymerase has been a primary target for the development of anti-HBV agents due to its enzymatic nature, and several nucleoside derivatives that inhibit HBV polymerase are currently used as anti-HBV therapeutics. On the other hand, accumulating information on the capsid assembly and the maturation process of HBV particles provides additional approaches for the development of anti-HBV agents. Proper interaction between core proteins is required for assembly of the nucleocapsid, and the specificity of the interactions between the capsid and surface proteins is essential for the maturation of active HBV in infected cells. In this article, the assembly process of active HBV particles and approaches to utilize the interactions of HBV structural proteins as target site for the development of anti-HBV agents are reviewed. In particular, novel approaches to target the assembly process and the interaction between HBV structural proteins are introduced.

Waasdorp CE, Kim JY. · U.S. Army, 121st Combat Support Hospital, Seoul, South Korea. · Wilderness Environ Med. · Pubmed #17896850 No free full text.

Abstract: Families are traveling with their children in increasing frequency. Travel to Asia offers children many opportunities to learn about new cultures and history. It also offers the potential for exposure to numerous infectious agents not commonly encountered in the United States. Families must begin to prepare for travel to Asia weeks before departure. Children should be up to date on routine vaccinations. Appropriate education should be given on arthropod avoidance and malaria prophylaxis. Additional education and possible prophylaxis should be completed for other infectious agents frequently encountered in Asia. With appropriate pretrip immunizations and prophylaxis, children can travel to Asia with minimal risk of acquiring infection. This article provides general advice to assist providers with pretravel preparation and education of families traveling with children to Asia.

Lee HK, Park SJ, Yi BH, Yeon EK, Kim JH, Hong HS. · Department of Radiology, Soonchunhyang University, Bucheon Hospital, 1174 Jung-Dong Wonmi-Gu, Bucheon-Shi Kyungki-Do, South Korea. · Abdom Imaging. · Pubmed #17694406 No free full text.

Abstract: There are many causative diseases to produced portal vein thrombosis (PVT) with the most common being liver cirrhosis with hepatocellular carcinoma. Visualization of abnormalities associated with PVT is crucial to diagnosis and appropriate intervention. Dynamic contrast enhanced CT is the best means of diagnosis of PVT and evaluation of various causative diseases. The findings of PVT of the dynamic CT are filling defect partially or totally occluding the vessel lumen and rim enhancement of the vessel wall. Signs and symptoms of PVT may be subtle or nonspecific and overshadowed by the underlying illness. Radiologists should be aware of the clinical situations that predispose a patient to portal or mesenteric vein thrombosis.

Kim TY, Sohn JH. · Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea. · Korean J Gastroenterol. · Pubmed #17641552 links to  free full text

Abstract: Clinical management of chronic hepatitis B is rapidly evolving after the recent development of new antiviral drugs. These agents have been shown to be effective in improving virological, biochemical, and histological features in high proportion of the patients with chronic hepatitis B. However, these drugs can not eliminate hepatitis B virus (HBV) directly. It can only suppress HBV replication. Furthermore, the emergence of drug resistant HBV has become problematic according to the long-term use of oral antiviral drugs. Therefore, physicians should be careful in selecting whom to treat, when to start treatment, how long to treat, how to monitor patients before, during and after the treatment, which drug to choose, and how to manage patients with drug resistance. This review will focus on the monitoring and treatment strategy for chronic hepatitis B and drug resistant hepatitis B, quoting some clinical data of recently introduced or promising future drugs.

Song HU, Hwang SG. · Department of Internal Medicine, College of Medicine, Pochon CHA University, Seongnam, Korea. · Korean J Gastroenterol. · Pubmed #17464165 links to  free full text

Abstract: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors and has the third highest mortality rate among malignancies in South Korea. Despite the continuing efforts for the early detection of HCC, the mortality rate and prognosis have not been improved yet. Its clinical behavior is quite different from other cancers. High recurrence rate after curative treatment might be the reason for poor prognosis. Several methods including chemoprevention, blocking the development of HCC, have been under investigations. The vaccine for hepatitis, in the form of primary prevention, is considered to be the most effective one inhibiting the development of liver disease. Furthermore, keeping away from hepatotoxic agents is another way for preventing liver cell injuries. Secondary prevention is to stop the development of HCC in chronic liver diseases. Since the level of DNA in hepatitis B virus (HBV) hepatitis patients is closely related with the development of HCC, it is helpful to lower the DNA level using anti-viral agents. In addition, IFN, one of the anti-viral agents, can inhibit HCV hepatitis from tumorigenesis. Cyclo-oxygenase (COX)-2 inhibitors are also alleged to have a function in interrupting the development of HCC. Tertiary prevention means the prevention of recurrence of HCC after successful treatment. Because of high recurrence rate, the prevention of recurrence should be one of the important factors affecting the prognosis of HCC. Up to now, COX inhibitors, retinoic acids, vitamin K2, glycyrrhizin epigallocatechin-3-gallate (EGCG), and ginseng had been reported to be effective for the chemoprevention of HCC. Further studies are required for an advancement in the prevention of HCC.

Song HJ, Kim TH, Song JH, Oh HJ, Ryu KH, Yeom HJ, Kim SE, Jung HK, Shim KN, Jung SA, Yoo K, Moon IH, Chung KW. · Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea. · J Korean Med Sci. · Pubmed #17449927 links to  free full text

Abstract: Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic liver disease (CLD), but this has been deemed unnecessary in Korea since the immunity against HAV was almost universal in adults. However, this practice has never been reevaluated with respect to the changing incidence of adult acute hepatitis A. We retrospectively reviewed the medical records of 278 patients with acute hepatitis A diagnosed from January 1995 to November 2005 and prospectively tested 419 consecutive CLD patients from July to December 2005 for the presence of IgG anti-HAV. The number of patients with acute hepatitis A has markedly increased recently, and the proportion of adult patients older than 30 yr has been growing from 15.2% during 1995-1999, to 28.4% during 2000-2005 (p=0.019). Among 419 CLD patients, the seroprevalences of IgG anti-HAV were 23.1% for those between 26 and 30 yr, 64% between 31 and 35 yr, and 85.0% between 36 and 40 yr. These data demonstrate that immunity against HAV is no more universal in adult and substantial proportion of adult CLD patients are now at risk of HAV infection in Korea. Therefore, further study on seeking proper strategy of active immunization against HAV is warranted in these populations.

Ryu SH, Chung YH. · Division of Gastroenterology, Department of Internal Medicine, University of Inje College of Medicine, Seoul Paik Hospital, Seoul, Korea. · Korean J Hepatol. · Pubmed #17237626 links to  free full text

Abstract: Adefovir dipivoxil (ADV) is effective in the treatment of chronic hepatitis patients with wild type and lamivudine-resistant hepatitis B virus. The occurrence of viral resistance to long-term adefovir therapy is rare, the cumulative rates of resistance were 0%, 3%, 11%, 18%, and 28% at 1, 2, 3, 4, and 5 years of therapy, respectively. The emergence of adefovir resistant mutant in patients with lamivudine resistance is more common than in treatment-naive patients. Two major mutations of adefovir resistance are rtN236T and rtA181V/T. Other mutations in the HBV polymerase (rtP237H, rtN238T/D, rtV84M, rtS85A, rtV214A, rtQ215S) reduce sensitivity to adefovir, but the significance of these mutations is unclear. The adefovir mutations slightly decrease adefovir susceptibility in vitro, suggesting mild clinical course after the occurrence of adefovir resistance. However, some patients show viral rebound and hepatic decompensation. Lamivudine, entecavir, and tenofovir are used currently for salvage therapy in patients with adefovir resistance. To reduce adefovir resistance, combination therapy with adefovir and lamivudine in patients with lamivudine resistance may be a treatment option.

Lee YS. · University of Ulsan, Asan Medical Center, Division of Gastroenterology, Seoul, Korea. · Korean J Hepatol. · Pubmed #16998286 links to  free full text

Abstract: Autoimmune hepatitis (AIH) is an unresolved, predominantly periportal hepatitis that is usually displays hypergammaglobulinemia, and tissue autoantibodies, and this malady is responsive to immunosuppressive therapy. Our understanding about this clinical entity has been greatly expanded since the first description by Waldenstrom 50 years ago. The codified diagnostic criteria of AIH prepared by International Autoimmune Hepatitis Group are still valid, but new attempts are being made to overcome the shortcomings of this scoring system. Immunosuppressive therapies using prednisone and azathioprine are currently the mainstay for the treatment of AIH, but there are still many practical questions to be solved.

Park YN, Roncalli M. · Department of Pathology, Center for Chronic Metabolic Disease, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea. · J Hepatol. · Pubmed #16982109 No free full text.

Abstract: Large cell change (LCC) is a noncommittal term used today to indicate liver cell dysplasia of the large cell type. Dysplasia was deleted from the original definition because not enough evidence has been collected over time to support premalignancy. LCC is a microscopically well-defined lesion, usually found in cirrhosis, whose origin, natural history, and fate are still debated. Different morphologic, phenotypic, molecular and clinical studies have been performed to address the issue of the dysplastic versus reactive nature of this lesion. The aim of this review is to critically evaluate the contributions to the topic and to underline that the heterogeneity of the lesion is an important issue to be taken into account for our biological understanding of it. While LCC has important morphologic analogies in experimental liver carcinogenesis, no comparable lesions are known in solid non-liver parenchymal human tissues that morphologically feature dysplasia, but in which it is uncertain whether the lesions are reactive or preneoplastic. The debate over the lesion may be useful in learning the actual limits of morphology and how additional information can be gained by looking inside the cells.