Higher Alanine Aminotransferase Values Research Articles

Patients with Non-Alcoholic Fatty Liver Disease and Alcohol Dehydrogenase 1B/Aldehyde Dehydrogenase 2 Mutant Gene Have Higher Values of Serum Alanine Transaminase.

Patients with non-alcoholic fatty liver disease (NAFLD) share similar pathophysiologies to those of patients with alcohol liver disease. Alcoholic metabolic enzyme-related genes (alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2)) may be associated with pathophysiology in NAFLD patients. In this study, the association between ADH1B/ALDH2 gene polymorphism and serum metabolic factors, body statures, and hepatic steatosis/fibrosis status was evaluated in patients with NAFLD. Using biochemistry data, abdominal ultrasonography, fibrosis evaluation (Kpa), and steatosis evaluation (CAP), ADH1B gene SNP rs1229984 and ALDH2 gene SNP rs671 polymorphism were analyzed in sixty-six patients from 1 January 2022 to 31 December 2022. The percentage of the mutant type (GA + AA) was 87.9% (58/66) in the ADH1B allele and 45.5% (30/66) in the ALDH2 allele. Patients with the mutant-type ADH1B/ALDH2 allele had higher values of alanine aminotransferase (ALT) than the wild type (β = 0.273, p = 0.04). No association was observed between body mass index, serum metabolic factors (sugar and lipid profile), CAP, kPa, and ADH1B/ALDH2. A high proportion of the mutant-type ADH1B allele (87.9%) and ALDH2 allele (45.5%) was observed in patients with NAFLD. No association was observed between ADH1B/ALDH2 allele, BMI, and hepatic steatosis/fibrosis. Patients with the mutant-type ADH1B/ALDH2 allele had higher values of ALT than those with the wild type.

A Danish population-based case series of patients with liver cirrhosis and coronavirus disease 2019

Objectives Coronavirus disease 2019 (COVID-19) is an ongoing major health emergency, but its occurrence and clinical impact on patients withliver cirrhosis is unknown. Therefore, we conducted a population-based study of 2.6 million Danish citizens investigating the occurrence and impact of COVID-19 in patients with liver cirrhosis. Materials and methods A prospective population-based cohort study was conducted in the Capital Region of Denmark and Region Zealand in the study period between 1 March 2020 up until 31 May 2020, with the only eligibility criteria being a reverse-transcriptase polymerase chain reaction for presence of viral genomic material confirming COVID-19. The patients were subsequently stratified according to presence of pre-existing liver cirrhosis. Results Among 575,935 individuals tested, 1713 patients had a diagnosis of cirrhosis. COVID-19 occurredsignificantly lessamongpatients with cirrhosis (n = 15; 0.9%, p < .01) compared with the population without cirrhosis (n = 10,593; 1.8%). However, a large proportion (n = 6;40.0%) required a COVID-19 related hospitalization which was correlated with higher values of alanine aminotransferase (p < .01) and lactate dehydrogenase (p = .04). In addition, one-in-three (n = 2; 13.3%) required intensive therapy. Four patients died (26.7%) and mortality was associated with higher MELD scores, co-existing type 2 diabetes, and bacterial superinfections. Conclusion In conclusion, patientswith cirrhosis may have a lower risk of COVID-19; but a higher risk of complications hereto and mortality.

The clinical significance of quantitative HBSAG in patients with HBEAG negative chronic hepatitis B

Background: The quantification of HBsAg provides different and complementary information that helps in determination of the different phases of chronic hepatitis B viral infection, evaluation and follow-up of liver disease progression as well as in treatment individualization.Aim: To evaluate the clinical significance of quantitative HBsAg (qHBsAg) in patients with HBeAg negative chronic hepatitis (CHB) and its correlation with the serum levels of alanine aminotransferase (ALT), quantitative HBV DNA and liver fibrosis.Subjects and Methods: The study included 53 treatment naïve patients with HBeAg negative chronic hepatitis B. All patients underwent complete laboratory and serology testing, quantification of HBV DNA and HBs antigen. The liver stiffness was measured with elastography. Patients’ demographic characteristics, viral and biochemical markers were recorded at one point of time.Results: Correlation analysis between the qHBsAg and ALT showed an significant, positive correlation between the parameters for R=0.42 and p&lt;0.05; there was statistically non-significant positive correlation for R=0.25 and p&gt;0.05 between qHBsAg and HBV DNA. There was a positive correlation between qHBsAg and liver fibrosis for R=0.08 and p&gt;0.05. The serum levels of HBsAg had greater impact on the serum levels of ALT compared to that of HBV DNA for R=0.15 and p&gt;0.05.Conclusion: Patients with higher ALT values and higher liver fibrosis score have higher qHBsAg; qHBsAg can reflect the serum HBV DNA levels.

The Long-term Efficacy of Sodium Glucose Co-transporter 2 Inhibitor in Patients with Non-alcoholic Fatty Liver Disease.

Objective Sodium glucose co-transporter 2 inhibitor (SGLT-2i), recommended for patients with type 2 diabetes, has been reported to improve the liver function test results in non-alcoholic fatty liver disease (NAFLD). However, the long-term effects of SGLT-2i on the liver function and body weight in NAFLD patients have not been fully elucidated. In this study, we investigated the long-term effects of SGLT-2i in NAFLD patients. Methods Twenty-two diabetic patients with NAFLD were enrolled in this study. We assessed the body weight, liver enzyme levels, metabolism, and glucose levels at 12 months (22 cases) and 24 months (15 cases) after the initiation of SGLT-2i. The changes in controlled attenuation parameter (CAP) and liver stiffness in 20 of the 22 patients were evaluated using transient elastography (TE) and acoustic radiation force impulse (ARFI) elastography before the initiation of treatment and 1 year later. Results Body weight and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly decreased at 12 and 24 months after SGLT-2i treatment. The decrease in the levels of ALT at 12 and 24 months was significantly correlated with the level of ALT at the initiation of SGLT-2i (r=0.813, p=0.001 and r=0.867, p=0.0001, respectively). SGLT-2i also reduced the CAP and velocity of shear wave (Vs) values at 12 months (CAP 315.1±43.4 db/mL→293.1±27.2 db/mL, p=0.027; Vs 1.87±0.8 m/s→ 1.48±0.6 m/s, p=0.011). Conclusion SGLT-2i treatment improved the liver function test results and reduced the body weight in NAFLD patients over a period of 12-24 months. This improvement was greater in patients with higher ALT values at baseline than in those with lower values.

Single and simultaneous effects of acrylamide and ethanol on bone microstructure of mice after one remodeling cycle

BackgroundThis study aimed to examine femoral bone microstructure of mice after single and simultaneous administration to acrylamide and ethanol since both substances are often consumed separately and/or together by humans. Interactive effects of these toxins were analysed after one remodeling cycle.MethodsTwenty clinically healthy adult mice were randomly divided into four groups following 2 weeks administration of toxins: A group - mice were fed with acrylamide (40 mg/kg bw); E group - mice were ethanol-fed (15% ethanol); AE group - mice were simultaneously fed with both toxins, and a C group – control (without acrylamide and/or ethanol supplementation). Generally, 2D and 3D imaging methods were used to determine cortical and trabecular bone tissues microstructure. Biochemical analyses of plasma parameters were also realized using commercially available ELISA tests and spectrophotometrically.ResultsSingle and simultaneous exposure to acrylamide and ethanol affected only cortical bone microstructure. No significant changes in trabecular bone morphometry were detected among all groups. In mice from the A group, increased endocortical remodeling associated with a higher level of serum calcium and vasoconstriction of primary osteon’s vascular canals (POVC) were identified. On the contrary, increased cortical porosity consistent with a decreased relative bone volume, bone mineral density (BMD) and lower levels of alkaline phosphatase (ALP), glutathione (GSH), calcium in plasma and also with vasodilation of POVC were observed in the E group. In the AE group, the highest density of secondary osteons associated with a lower BMD and decreased levels of ALP, GSH were documented. The parameters of POVC and Haversian canals approximated to the C group. In addition, single and simultaneous exposure to both toxins caused liver disease consistent with a higher values of alanine aminotransferase (ALT), aspartate aminotransferase (AST) in plasma of all experimental groups.ConclusionsSingle administration to acrylamide and ethanol had negative effects on cortical bone structure of mice after one remodeling cycle. However, we identified possible antagonistic impact of these toxins on the structure of the cortical bone.

Stimulatory effect of dietary clove, Eugenia caryophyllata, bud extract on growth performance, nutrient utilization, antioxidant capacity, and tolerance of African catfish, Clarias gariepinus (B.), to Aeromonas hydrophila infection

The occurrence of pathogenic bacteria, Aeromonas hydrophila, in farm‐raised fish requires urgent attention. Continuous and indiscriminate use of antibiotics as growth promoters and disease control agents in aquaculture have been discouraged because of the risk of development of antibiotic‐resistant bacterial strains. There is steady interest in the use of botanicals, such as clove, Eugenia caryophyllata, buds extract (ECBE), as alternatives. Hence, the present study evaluated the effect of dietary ECBE supplementation on the growth performance, physiological, antioxidant, and immunity biomarkers of African catfish, Clarias gariepinus. Fish (11.7 ± 0.5 g) were fed diets containing 0.0 (control), 5.0, 10.0, or 15.0 g ECBE/kg diet up to apparent satiation twice daily for 12 weeks. After the feeding trial, fish from each treatment were challenged with A. hydrophila infection by intraperitoneal injection and kept under observation for 14 days to record any abnormal clinical signs and daily mortality. The results demonstrated that fish performance and feed intake were significantly enhanced with increasing ECBE levels, and its optimum level is 15 g/kg diet. Further, the dietary ECBE increased significantly the intestinal villi length/width and absorption area in a dose‐dependent manner. There are significant progressive increases in the values of red blood cells, hemoglobin, hematocrit, white blood cells, platelets, lymphocytes, and heterocytes, while monocytes, eosinophil, and basophils decreased significantly due to dietary ECBE in a dose‐dependent manner. Highest glucose, cholesterol, total protein, globulin, and albumin‐globulin ratios, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), urea, and creatinine values were found in fish fed 15 g ECBE/kg diets, while lowest values were recorded in fish fed the control diet. Despite the high AST and ALT values, no visible lesions or damage were observed in the liver cells of fish fed ECBE‐enriched diets. In addition, the inclusion of ECBE in fish diets enhanced the antioxidant and immunity capacity. Fish mortality after the bacterial challenge was higher in fish fed the control diet (82.3%) than those fed ECBE‐enriched diets. The lowest fish mortality was observed in fish fed the 15 ECBE/kg diet (4.7%) [Correction added on 16 November 2018: this section has been revised for clarity.].

Regional variation of alanine aminotransferase serum levels in the People's Republic of China.

The regional variation of the blood concentration of alanine aminotransferase (ALT), a sensitive predictor of liver damage, was studied in the People's Republic of China with reference to its potential association with environmental variables and geographic location. The research results presented are based on 121,977 blood samples from healthy adults in 93 cities in the country using correlation analysis, ridge regression estimation and trend surface analysis that were applied to explore if there was any tendency of spatial variation. A regression formula using a simulation equation under the condition of known local geographic factors was used. Statistical significance was set at P<0.05. A positive correlation between ALT concentration altitude and sunshine hours and a negative correlation between ALT concentration and temperature, humidity and precipitation were found. With respect to geographical location, there was a negative correlation between ALT concentration and longitude. Higher ALT values were found in western China compared to eastern regions, dividing the country into three different regions with respect to serum ALT levels.

Hepatitis‐Viral

Hepatitis‐Viral

Hepatic Inflammation May Influence Liver Stiffness Measurements by Transient Elastography in Children and Young Adults.

Transient elastography (TE) measures liver stiffness to assess fibrosis. Studies in adults have shown that inflammation increases stiffness, leading to an overestimation of fibrosis. We investigated the contribution of inflammation to liver stiffness measurements (LSMs) in children/young adults. This was a cohort analysis of children/young adults who underwent TE within 1 year of liver biopsy. Alanine aminotransferase (ALT) was obtained within 30 days of the biopsy and LSM. Fibrosis was assessed by METAVIR stage and inflammation by ALT and Ishak score. Data were stratified into METAVIR F0-F2 versus F3-F4. Change between ALT and LSM over time was also assessed. A total of 154 patients (50% male patients) ages 3 weeks to 24 years (18% <3 years) were studied. Diagnoses included autoimmune (N = 38, 25%), viral (N = 25, 16%), cholestasis (N = 17, 11%), fatty liver (N = 9, 6%), biliary atresia (N = 8, 5%), metabolic (N = 5, 3%), allograft rejection (N = 4, 3%), and other (N = 48, 31%). Thirty-four percent of patients had F3-F4. In patients with F0-F2, the proportion of those with LSM >8.6 kPa increased with increasing ALT (P = 0.002). In patients with F3-F4, there was no association between ALT and LSM (P = 0.17). A correlation between change in ALT and LSM was observed in patients with no/minimal fibrosis and inflammatory liver diseases (r = 0.33). In children with no/minimal hepatic fibrosis and inflammatory liver disease, high ALT values are associated with LSM in the range typical of advanced fibrosis. However, with more advanced fibrosis, inflammation does not appear to contribute to LSM. Caution must be taken when interpreting LSM for assessing fibrosis severity in the setting of inflammation.

Influence of mistletoe (Viscum album) leaf meal on growth performance, carcass characteristics and biochemical profile of broiler chickens

The quest for alternatives to antibiotics has resulted in the discovery of prebiotics. The search for the alterative antibiotics is on-going. Therefore, this study was carried out to investigate possible prebiotic potentials inherent in mistletoe (Viscum album) leaf meal with the aim of developing prebiotics as an alternative to antibiotics thus optimizing animal performance, carcass characteristics and a healthy blood profile as indicators of systemic conditions. Five experimental diets were formulated and mistletoe leaf meal (AMLM) was incorporated into the diets at different concentrations (0% with 0.05% antibiotics (positive control), 2.5%, 5.0%, 7.5% without antibiotics (negative control)). The values of body weight were not significantly different across the treatments. Live weight, bled weight, wings, drumsticks, thighs, breasts and heads were not significantly different across the treatments. Aspartate aminotransferase, globulin and creatinine contents were not significantly different across the treatments. Meanwhile, birds on AMLM-supplemented diets obtained significantly (p < 0.05) higher values of alanine aminotransferase than those on negative control diet (3.75 IU/l). Urea anood glucose contents followed a similar patotern. The AMLM could be used as alternative antibiotics in broiler production, although further studies are required to ascertain this.

Sex‐dependent expression of cytoprotective elements in the kidney in response to a hepatotoxic dose of acetaminophen

Acetaminophen (APAP) overdose can cause liver and kidney necrosis. Male mice are known to be more susceptible to APAP hepatotoxicity than females, suggesting that gender‐related genotypic traits play a role in APAP toxicity. Gender‐related differences in susceptibility to APAP nephrotoxicity in mice are also well documented and attributed to differential renal expression of CYP2E1. Recent studies in our laboratory investigated the role of the transcription factor nuclear factor erythroid 2‐related factor 2 (Nrf2), the efflux transporter multidrug resistance‐associated protein 4 (Mrp4), and the drug metabolizing enzyme flavin‐containing mono‐oxygenase 3 (Fmo3) in sex‐dependent susceptibility to APAP‐induced hepatotoxicity in mice. However, the expression and potential role of Nrf2, Fmo3, and Mrp4 in the responsiveness of male and female mouse kidneys to toxic doses of APAP has not been investigated. In the current study, we examined gene expression and protein levels of Nrf2, Mrp4, and Fmo3 in the kidneys of APAP (400 mg/kg) and vehicle treated male and female mice. Plasma alanine aminotransferase (ALT) and blood urea nitrogen (BUN) levels were measured to assess liver and renal damage. Confirmation of tissue damage was made by histopathological analysis. Immunoblots and qRT‐PCR analysis revealed that basal renal Fmo3 gene and protein expression is significantly greater in male than female mice, while Mrp4 expression is higher in females. No differences in basal Nrf2 gene and protein expression were observed among genders. High plasma ALT values and histopathological analysis indicated the presence of hepatotoxicity in both males and females receiving APAP. Renal damage was not evident, as BUN values were within the normal range for both genders and the kidney histology was normal. In response to APAP treatment, no changes in renal expression of Mrp4 or Fmo3 were observed in either gender, consistent with the absence of renal pathology. However, renal Nrf2 gene and protein expression decreased significantly in female mice after APAP dosing. In conclusion, this study documents for the first time the difference in basal renal expression levels of Nrf2 and Fmo3 in male and female mice. Further studies will investigate the expression and regulation of these genes at doses of APAP resulting in renal oxidative stress and toxicity and their potential involvement in the sex‐dependent responses to APAP induced renal damage.Support or Funding InformationSupported by NSF and NIH

Hepatitis C in Children Co-infected With Human Immunodeficiency Virus.

The objective of this systematic review was to summarize evidence regarding hepatitis C in hepatitis C virus/human immunodeficiency virus (HCV/HIV)-co-infected children focusing on mother-to-child transmission, clinical and laboratory features, outcome, and therapies. A literature search was performed using multiple keywords and standardized terminology in MEDLINE, EMBASE, and Cochrane databases dating back to their inception up to April 1, 2015, using the following terms hepatitis C virus, HIV, and child. Fifty-five of 367 publications were selected for inclusion. In co-infected children, HIV impacted all the different aspects of HCV infection. Maternal HIV infection increased the risk of vertical transmission of hepatitis C. Children with HCV/HIV co-infection presented a lower rate of spontaneous clearance of HCV, were more commonly HCV viraemic, and had higher values of alanine aminotransferase when compared with HCV-monoinfected children. No relevant difference was reported between monoinfection and co-infection with regard to clinical findings. Although the data on the outcome of hepatitis C in the context of co-infection were limited, they were highly suggestive of a more severe outcome in terms of fibrosis in co-infected children. No pediatric data were available on the role of antiretroviral therapy as a cofactor of liver injury in HCV/HIV co-infection. The efficacy of pegylated interferon-α and ribavirin in children with HCV/HIV co-infection was lower than in monoinfected children. The effect of HIV co-infection on HCV-related disease was clear with most studies indicating that HIV accelerates HCV progression and reduces the efficacy of the available anti-HCV therapies.

IL28B is associated with outcomes of chronic HBV infection.

PurposeThe role of IL28B gene variants and expression in hepatitis B virus (HBV) infections are not well understood. Here, we evaluated whether IL28B gene expression and rs12979860 variations are associated with HBV outcomes.Materials and MethodsIL28B genetic variations (rs12979860) were genotyped by pyrosequencing of DNA samples from 137 individuals with chronic HBV infection [50 inactive carriers (IC), 34 chronic hepatitis B (CHB), 27 cirrhosis, 26 hepatocellular carcinoma (HCC)], and 19 healthy controls. IL28A/B mRNA expression in peripheral blood mononuclear cells was determined by qRT-PCR, and serum IL28B protein was measured by ELISA.ResultsPatients with IL28B C/C genotype had greater IL28A/B mRNA expression and higher IL28B protein levels than C/T patients. Within the various disease stages, compared to IC and healthy controls, IL28B expression was reduced in the CHB, cirrhosis, and HCC cohorts (CHB vs. IC, p=0.02; cirrhosis vs. IC, p=0.01; HCC vs. IC, p=0.001; CHB vs. controls, p<0.01; cirrhosis vs. controls, p<0.01; HCC vs. controls, p<0.01). When stratified with respect to serum HBV markers in the IC and CHB cohorts, IL28B mRNA and protein levels were higher in HBeAg-positive than negative individuals (p=0.01). Logistic regression analysis revealed that factors associated with high IL28B protein levels were C/C versus C/T genotype [p=0.016, odds ratio (OR)=0.25, 95% confidence interval (CI)=0.08-0.78], high alanine aminotransferase values (p<0.001, OR=8.02, 95% CI=2.64-24.4), and the IC stage of HBV infection (p<0.001).ConclusionOur data suggest that IL28B genetic variations may play an important role in long-term development of disease in chronic HBV infections.

Long-Term Dietary Potential Renal Acid Load During Adolescence Is Prospectively Associated with Indices of Nonalcoholic Fatty Liver Disease in Young Women 3

Nonalcoholic fatty liver disease (NAFLD), frequently already present in young subjects, has been linked to reduced growth hormone levels and signaling. Similar hormonal changes occur during metabolic acidosis (MA), which may thus contribute to an increased NAFLD risk. Because subclinical MA can be diet induced, we aimed to examine whether a higher diet-dependent acid load during adolescence is prospectively associated with several currently used NAFLD surrogates in young adulthood. Dietary acidity during adolescence (boys:10–15 y, girls: 9–14 y) was calculated as potential renal acid load (PRAL) from at least three 3-d weighed dietary records according to a published algorithm considering dietary protein and minerals in 145 healthy participants. Routine measurements derived from blood analysis and anthropometric data in participants’ young adulthood (18–25 y) were used to determine the NAFLD surrogates alanine-aminotransferase (ALT), hepatic steatosis index (HSI), and fatty liver index (FLI). Sex-stratified linear regression models, adjusted for dietary fiber, saturated fat, protein, and adolescent BMI SD scores, were run with PRAL as the independent variable. Dietary PRAL during puberty was positively associated with ALT (P= 0.02), HSI (P= 0.002), and FLI (P= 0.005) in adult females but not males. Females with an adolescent dietary acid load in the highest tertile had 3.5, 4.4, and 4.5 higher values of ALT, HSI, and FLI as adults, respectively, compared to females with the lowest PRAL. The present findings suggest that higher dietary acidity in adolescence may be prospectively associated with hepatic lipid accumulation in females. Whether this relationship is due to the higher proton load or rather represents an unhealthy dietary pattern requires further investigation.

Effect and Predictive Elements for 52 Weeks’ Telbivudine Treatment on Naïve HBeAg Positive Chronic Hepatitis B

: Background: Antiviral treatment with nucleoside analogs has been used for chronic hepatitis B (CHB). each kind of nucleoside analog has its own characteristics and suitability for patients. Telbivudine (LdT, brand name: Sebivo, Beijing novartis pharma Ltd) is the newest nucleoside analog, with strong and rapid viral suppression. However, its resistance rate is relatively high during long-term application, due to low genetic barriers to resistance. So, it is necessary to increase the effect and reduce resistance with effective management, according to baseline factors and early on-treatment responses. Objectives: To reveal possible predictive factors of the effect of telbivudine (LdT) treatment on naïve HBeAg-positive chronic hepatitis B (CHB) patients to optimize treatment. Patients and Methods: A total 71 naïve chronic hepatitis B (CHB) patients who met the inclusion criteria were enrolled. All patients were treated with LdT 600 mg Qd for at least 52 weeks. Multiple logistic regression analyses were done to investigate the predictive values of baseline factors and responses at Week 24. Results: The reduction in hepatitis virus B (HBV) DnA level was 6.44 ± 2.38 lg copies/mL at Week 52 compared with baseline. The complete virus response (CVR), biochemical response (BR), serological response (SR), and drug resistance (DR) were 61.99%, 77.46%, 35.21%, and 8.45% respectively. By multiple regression analysis, baseline alanine aminotransferase (ALT) levels significantly affected CVR (P = 0.024, oR = 1.008), and baseline ALT and baseline HBV DnA levels were independent compact factors of SR (P = 0.012, oR = 1.007; P = 0.001, oR = 0.423). The differences in CVR, SR, and DR in patients with ALT > 120 Iu/mL compared with patients with ALT ≤ 120 Iu/mL were statistically significant. The differences in SR in patients with HBV DnA > 107 copies/mL compared with patients with HBV DnA ≤ 107 copies/mL were statistically significant. Additionally, CVR, BR, and SR were differed significantly between patients with HBV DnA lower than 300 copies/mL at Week 24 and patients with HBV DnA higher than 300 copies/mL (P = 0.000, P = 0.0016, and P = 0.000, respectively). Conclusions: There were more responders among naïve HBeAg-positive chronic hepatitis B patients with lower HBV DnA levels (especially lower than 107 copies/mL) and higher ALT values (especially higher than 120 Iu/mL at baseline) to LdT treatment. Adjustments for treatment strategy should be considered if HBV DnA > 300 copies/mL at Week 24 is observed.

Effect and Predictive Elements for 52 Weeks’ Telbivudine Treatment on Naïve HBeAg positive Chronic Hepatitis B

Antiviral treatment with nucleoside analogs has been used for chronic hepatitis B (CHB). Each kind of nucleoside analog has its own characteristics and suitability for patients. Telbivudine (LdT, brand name: Sebivo, Beijing Novartis Pharma Ltd) is the newest nucleoside analog, with strong and rapid viral suppression. However, its resistance rate is relatively high during long-term application, due to low genetic barriers to resistance. So, it is necessary to increase the effect and reduce resistance with effective management, according to baseline factors and early on-treatment responses. To reveal possible predictive factors of the effect of telbivudine (LdT) treatment on naïve HBeAg-positive chronic hepatitis B (CHB) patients to optimize treatment. A total 71 naïve chronic hepatitis B (CHB) patients who met the inclusion criteria were enrolled. All patients were treated with LdT 600 mg Qd for at least 52 weeks. Multiple logistic regression analyses were done to investigate the predictive values of baseline factors and responses at Week 24. The reduction in hepatitis virus B (HBV) DNA level was 6.44 ± 2.38 lg copies/mL at Week 52 compared with baseline. The complete virus response (CVR), biochemical response (BR), serological response (SR), and drug resistance (DR) were 61.99%, 77.46%, 35.21%, and 8.45% respectively. By multiple regression analysis, baseline alanine aminotransferase (ALT) levels significantly affected CVR (P = 0.024, OR = 1.008), and baseline ALT and baseline HBV DNA levels were independent compact factors of SR (P = 0.012, OR = 1.007; P = 0.001, OR = 0.423). The differences in CVR, SR, and DR in patients with ALT > 120 Iu/mL compared with patients with ALT ≤ 120 Iu/mL were statistically significant. The differences in SR in patients with HBV DNA > 107 copies/mL compared with patients with HBV DNA ≤ 107 copies/mL were statistically significant. Additionally, CVR, BR, and SR were differed significantly between patients with HBV DNA lower than 300 copies/mL at Week 24 and patients with HBV DNA higher than 300 copies/mL (P = 0.000, P = 0.0016, and P = 0.000, respectively). There were more responders among naïve HBeAg-positive chronic hepatitis B patients with lower HBV DNA levels (especially lower than 107 copies/mL) and higher ALT values (especially higher than 120 Iu/mL at baseline) to LdT treatment. Adjustments for treatment strategy should be considered if HBV DNA > 300 copies/mL at Week 24 is observed.

Assessment of Clinical Utility of Low and High Normal Alanine Aminotransferase Values in Patients with Chronic Hepatitis B Virus Infection in Bangladesh

Background/Aims: There is a lack of consensus about the currently accepted range of normal values for serum alanine aminotransferase (ALT) levels because some investigators have claimed that the true values are significantly lower than those listed by kit manufacturers. Methods: A total of 255 chronic hepatitis-B-virus (HBV)-infected patients with traditional, normal levels of ALT (≤42 U/l) were divided into 2 groups: (1) low normal ALT (men: ≤30 U/l; women: ≤19 U/l) and (2) high normal ALT (men: 31–42 U/l; women: 20–42 U/l). The extent of hepatic inflammation and fibrosis was evaluated in these patients by examining liver biopsy specimens. Results: The levels of HBV DNA were >10,000 copies/ml in 58.4, 52.9 and 61.2% of the patients with traditional normal ALT, low normal ALT and high normal ALT values, respectively (p > 0.05). Also, the moderate degrees of hepatic necroinflammation [histological activity index (HAI)-NI score of ≧9] and severe hepatic fibrosis (HAI-F score of ≧3) were similar among the 3 groups of patients (p > 0.05). Conclusion: The newly defined low normal cutoff values for ALT did not exhibit any added clinical benefit for assessing the extent of liver damage in patients with chronic HBV infection in Bangladesh.

Nutritional status of children with chronic hepatitis B in a population with low socioeconomic status

Chronic infections and liver diseases may lead to malnutrition. However, growth failure is rarely reported in chronic hepatitis B. We aimed to establish the nutritional status of children with chronic hepatitis B and the relation between anthropometric data and laboratory findings in a population with low socioeconomic status. Anthropometrical and laboratory findings were noted from the hospital records. Cases with and without malnutrition were compared with regard to sex, age, histological activity (HAI) scores, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, protein, albumin, and hepatitis B virus (HBV) DNA levels. Eighty children, of which 36 (45%) were girls, with a mean age of 11.5+/-3.2 years were enrolled in the study. Malnutrition was found in 39 (49%). Acute malnutrition (24 out of 39, 61.5%) was the most common form. There was no difference of age or sex between children with and without malnutrition. Age of diagnosis was higher and duration of follow-up was shorter in cases with malnutrition (P = 0.051 and P = 0.016, respectively). In children with malnutrition, aspartate aminotransferase levels were significantly higher but other laboratory results were not different. Malnutrition rate was not different between groups that did and did not receive treatment or that did and did not respond to treatment. Anthropometrical data and malnutrition rate was similar in children with high and low HAI scores. As features suggesting severe liver disease like high alanine aminotransferase values, HAI scores, or HBV DNA levels were not different in children with and without malnutrition, it may be proposed that chronic HBV infection does not have an effect on nutritional status.

Optimal blood donation screening annotation.

Optimal blood donation screening annotation.

Hepatitis C virus genotypes in a non-cirrhotic Italian population with chronic hepatitis C: correlation with clinical, virological and histological parameters. Results of a prospective multicentre study.

To identify correlations between the distribution of hepatitis C virus (HCV) genotypes and demographic, pathological and virological parameters of HCV-infected patients, we prospectively recruited 650 patients with biopsy-proven chronic hepatitis C without histological aspects of cirrhosis; none had been treated with antiviral therapy. Data regarding gender, age, mode of HCV transmission, alanine aminotransferase (ALT) and HCV RNA levels, immunoglobulin M (IgM) anticore values, liver histology and histological activity were obtained from each patient and correlated on multivariate analysis with infecting HCV genotype. Fifty-five per cent of the patients were infected with HCV genotype 1, 20% with HCV genotype 2, 18% with HCV genotype 3 and 7% with HCV genotype 4. Non-transfusional HCV transmission, low ALT levels, IgM anticore reactivity and a low histological grading score were independent variables associated with HCV genotype 1. Older age, female gender, post-transfusional transmission and a high histological grading score were related to HCV genotype 2, whilst younger age, history of current/previous drug abuse, high ALT values, low IgM anticore reactivity and high viraemic levels were associated with HCV genotype 3. History of illicit use of intravenous drugs and low HCV RNA levels were the only independent variables correlated with HCV genotype 4. Genotype 1 remains predominant in Italy but the prevalence of HCV genotypes is changing in relation to age and mode of transmission: Italian patients with HCV genotype 3 are younger and exhibit higher levels of ALT and HCV RNA than patients with other genotypes.