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HEPATOLOGY WATCH® |
Editorial Board:
Emmet B. Keeffe, MD (Chair); John L. Gollan, MD,
PhD; Kris V. Kowdley, MD; Paul Martin, MD;
Marion G. Peters, MD |
FEBRUARY 2005
NONALCOHOLIC FATTY LIVER DISEASE
(NAFLD)
NAFLD prevalence in the elderly,
progression rate, and association with metabolic syndrome. In a recent study, Nadya
Kagansky et al. evaluated 91 octogenarians (mean age, 85.56 ± 3.76 years) to
determine the prevalence and the clinical presentation of NAFLD in the
elderly. Among these patients, who had
been admitted to a geriatric hospital, 42 (46.2%) were diagnosed with
NAFLD. An association of NAFLD with the
metabolic syndrome or advanced liver disease was not observed in this older
patient population. These data indicate
that NAFLD is a common and relatively benign finding in the elderly. ♦ In
a second study, Leon Adams and colleagues examined sequential liver biopsies
obtained from 103 NAFLD patients. The
mean interval between biopsies was 3.2 ± 3.0 years (range, 0.7 to 21.3
years). Overall, the stage of fibrosis
slowly progressed in 37% of patients, remained stable in 34%, and regressed in
29%. Multivariate analysis identified diabetes and low initial fibrosis stage
to be associated with a higher rate of fibrosis progression. Changes in aminotransferase levels did not
parallel changes in fibrosis stage. ♦ An accompanying editorial by Vlad
Ratziu and Thierry Poynard discusses these results and reviews data from other
recently published studies. ♦ Additionally, Keith Tolman et al. reviewed
the spectrum of liver disease in patients with type 2 diabetes in the December
21, 2004, issue of Annals of Internal
Medicine. The article describes the metabolic effects of type 2 diabetes on
the liver, the hepatotoxicity of antiglycemic medications, and the treatment of
diabetes in patients with liver disease. (Kagansky N, et al. Liver Int 2004;24:588-594; Adams LA, et al. J Hepatol 2005;42:132-138; Ratziu V and Poynard T. J Hepatol 2005;42:12-14; and Tolman KG, et al. Ann Intern Med 2004;141:946-956)
ACUTE HEPATITIS B VIRUS (HBV)
INFECTION
Lamivudine for the treatment of
acute, severe hepatitis B. Hemda
Schmilovitz-Weiss and coworkers investigated the safety and efficacy of
lamivudine for the treatment of acute, severe HBV infection in a pilot study of
15 patients. All patients had severe
coagulopathy and high aminotransferase levels, and 5 patients had grade 1–4
hepatic encephalopathy. Therapy was
tolerated well by all patients, and 13 patients responded to lamivudine
treatment. Virologic response (undetectable serum HBV DNA) was associated with
improvement of coagulopathy, resolution of encephalopathy, and normalization of
liver enzyme levels. The results of this
small study suggest that lamivudine may prevent the progression of severe,
acute hepatitis B to fulminant liver failure with the potential need for
transplantation. Further large, prospective studies are warranted to confirm
this pilot experience.
(Schmilovitz-Weiss H, et al. Liver
Int 2004;24:547-551)
CHRONIC HEPATITIS C VIRUS (HCV)
INFECTION
Three clinically relevant trial
reports. Complaints of fatigue and
difficulties in concentration and memory in up to 50% of HCV patients led Karin
Weissenborn and colleagues to study 30 patients with HCV infection for central
nervous system involvement. Their
evaluations provided evidence of HCV-induced neurologic deficits. ♦ In a
second study, investigating the effects of estrogen exposure in women infected
with HCV, Vincent Di Martino and associates found the estimated rate of
fibrosis progression to be significantly higher in postmenopausal and
nulliparous women. Postmenopausal women
who were treated with hormone replacement therapy had a lower rate of fibrosis
progression than did untreated patients (P
= 0.02). Prior use of oral
contraceptives had no significant effect. ♦ Olav Dalgard et al. studied
the rate of sustained virologic response in HCV patients infected with genotype
2 and 3 virus who achieved a rapid virologic response (undetectable HCV RNA at
weeks 4 and 8 of treatment) after 14 weeks of therapy with peginterferon and
ribavirin. Among the 122 patients in this uncontrolled multicenter study, 95
(78%) achieved a rapid virologic response. Within this group, there was a high rate of sustained
virologic response (undetectable HCV RNA at 24 weeks after the end of
treatment): 90% (85 of 95 patients). ♦ An editorial by Amany Zekry and
others reviews current data concerning duration of antiviral therapy. They
conclude that recommendations to shorten the duration of antiviral treatment
for subgroups of patients must await the results of currently ongoing trials. (Weissenborn K, et al. J Hepatol 2004;41:845-851; Di Martino V, et al. Hepatology 2004;40:1426-1433; Dalgard O,
et al. Hepatology 2004;40:1260-1265;
and Zekry A, et al. Hepatology
2004;40:1249-1251)
CYSTIC
FIBROSIS
Concomitant liver disease. The development of focal biliary cirrhosis is associated with cystic
fibrosis. Thierry Lamireau and coworkers
performed a long-term cohort study to describe the prevalence of liver disease
in 241 patients with cystic fibrosis.
The prevalence of liver disease was observed to be 18%, 29%, and 41%
after 2, 5, and 12 years of follow-up, respectively. Cirrhosis occurred in 19 (7.8%) patients, at
a median age of 10 years. ♦ An accompanying editorial by Carla Colombo
and Pier Maria Battezzati provides a comprehensive review of the
pathophysiology of liver disease in cystic fibrosis. (Lamireau T, et al. J Hepatol 2004;41:920-925; and
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