HEPATOLOGY WATCH^®

Editorial Board: Emmet B. Keeffe, MD (Chair); M. Eric Gershwin, MD; Ira S. Goldman, MD; John L. Gollan, MD, PhD; Kris V. Kowdley, MD; Paul Martin, MD; Marion G. Peters, MD

OCTOBER 2005

CHRONIC HEPATITIS C VIRUS (HCV) INFECTION

Association of daily cannabis smoking with fibrosis progression. Cannabinoid receptors have recently been demonstrated to regulate the progression of hepatic fibrosis in experimental models. These findings led Hezode and others to review cannabis use and clinical data from 270 consecutive patients with untreated chronic hepatitis C. Multivariate analysis identified daily cannabis use, Metavir activity grade ≥A2, age >40 years, genotype 3, excessive alcohol intake, and steatosis to be related to an increased fibrosis progression rate. Furthermore, severe fibrosis (stage ≥F3) was predicted by daily cannabis use. These data indicate that daily cannabis smoking is significantly associated with fibrosis progression in patients with chronic HCV infection. (Hezode C, et al. Hepatology 2005;42:63–71.)

Susceptibility to hepatitis A virus (HAV) infection. Shim and colleagues conducted a retrospective study of 1,193 patients diagnosed with HCV infection over a 1-year period to discern how often they underwent testing and vaccination for HAV. They found that anti-HAV testing was performed in only 53.6% of patients and that 49.5% of patients tested were susceptible (anti-HAV negative). Only 7.9% of patients received HAV vaccination and approximately half of vaccinated patients received only one dose of the vaccine. Three unvaccinated patients developed acute hepatitis A, with one dying of acute liver failure. These data highlight the need for public programs to increase awareness for guidelines concerning HAV testing and vaccination in patients with chronic hepatitis C. (Shim M, et al. Hepatology 2005;42:688–695.)

Role of liver biopsy. A survey of experts from Italy, about the role of liver biopsy in the management of patients with HCV infection, indicated a great divergence of opinion. This led the authors to call for an evidence-based evaluation of liver histology in chronic HCV infection. (Almasio PL, et al. J Hepatol 2005;43:381–387.)

CHRONIC HEPATITIS B VIRUS (HBV) INFECTION

Telbivudine trial. Previous preclinical and early clinical studies have demonstrated that telbivudine, an oral nucleoside, has activity against HBV. These findings led Lai and coworkers to conduct a multicenter, double-blind study in which 104 patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B were randomized to one of five treatment groups: telbivudine 400 or 600 mg/day, telbivudine 400 or 600 mg/day plus lamivudine 100 mg/day, and lamivudine 100 mg/day. At week 52, patients treated with telbivudine monotherapy exhibited a greater mean reduction in HBV DNA levels (P <0.05), clearance of HBV DNA (P <0.05), and normalization of alanine aminotransferase levels (P <0.05) than did patients receiving lamivudine monotherapy. Combination therapy did not improve the results achieved with telbivudine monotherapy. HBeAg seroconversion occurred in 31% and 22% of patients who received telbivudine and lamivudine monotherapy, respectively, and viral breakthrough occurred in 4.5% and 15.8% of patients who received telbivudine and lamivudine monotherapy, respectively. Patients with telbivudine resistance had the rtM204I mutation involving the YMDD motif. All treatments were well tolerated. (Lai C-L, et al. Gastroenterology 2005;129:528–536.)

WILSON'S DISEASE (WD)

Diagnostic value of quantitative hepatic copper determination. Ferenci and colleagues investigated the value of hepatic copper in the diagnosis of WD. The results of 114 baseline liver biopsies revealed that hepatic copper content is not a diagnostic gold standard, with values of <250 mg/g not excluding WD. Thus, accurate diagnosis requires a combination of clinical and biochemical tests. (Ferenci P, et al. Clin Gastroenterol Hepatol 2005;3:811–818.)

DRUG-INDUCED LIVER INJURY

Analysis over a 10-year-period. A cooperative network in Spain reviewed prospectively collected data concerning reported cases of drug-induced liver injury from April 1994 to August 2004. Among 461 submitted cases, amoxicillin-clavulanate was the agent most commonly responsible for drug-induced liver injury, having been administered to 12.8% of patients in the study. A hepatocellular pattern of liver injury was observed in 58% of cases and was associated with the poorest outcomes. The incidence of liver transplantation and/or death was 11.7% in patients with jaundice compared with 3.8% in non-jaundiced patients. Female gender, hepatocellular damage, and higher plasma bilirubin levels at baseline were associated with the development of acute liver failure. (Andrade RJ, et al. Gastroenterology 2005;129:512–521.)

PRIMARY BILIARY CIRRHOSIS (PBC)

Systematical review of randomized trials of colchicine. Gong and Gluud conducted a systematic review of ten randomized trials comparing colchicine with placebo and no intervention in patients with PBC. Colchicine treatments were not found to reduce mortality, the need for liver transplantation, liver complications, biochemical variables, or liver histology compared with placebo or no intervention. The authors concluded that there is insufficient evidence to support the use of colchicine in patients with PBC outside of a clinical trial. (Gong Y and Gluud C. Am J Gastroenterol 2005;100:1876–1885.)

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