The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 493
Slide Session
K-LI-01 Liver
A Comparison of Effi cacy with Tenofovir Monotherapy Versus Tenofovir Based Combination Therapy for Chronic Hepatitis B Patients with Prior Lamivudine and Adefovir Resistance
Seung Young Seo1, Seong Hun Kim1, Sang Wook Kim1, In Hee Kim1, Seung Ok Lee1, Soo Teik Lee1, Dae Ghon Kim1
Departments of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Korea1
Background: Current guidelines recommend tenofovir (TDF) and nucleoside ana- logues(NAs) combination therapy for chronic hepatitis B (CHB) patients with prior lamivudine (LMV) and adefovir (ADV) resistance. This study was aimed to evaluate the effi cacy of TDF monotherapy and TDF plus NAs combination therapy for CHB patients with prior LMV and ADV resistance.
Methods: A total of 30 CHB patients with prior LMV and ADV resistance who received with TDF (300 mg/day) (Group A, n=12) or TDF (300 mg/day) plus NAs (Group B, n=18) for 48 weeks were included retrospectively. 8 patients were treated with TDF plus LMV and 10 patients with TDF plus ETV in group B.
Results: There was no signifi cant difference in mean serum HBV reduction between two groups after 48 weeks treatment. [group A vs. group B; -2.7±0.9 vs. -3.0±0.6, p=0.452]. The complete virologic response (HBV DNA =20 IU/mL) also showed no significant difference between the groups. [group A vs. group B; 10/12(83.3%) vs.
16/18(88.9%), p=0.454]. Only 1 patient in group A showed persistent serum HBV DNA =2,000 IU/mL, but the HBV DNA titer was in decrease trend. The rates of serum alanine aminotransferase normalization was similar in two groups. The overall HBeAg loss or seroconversion rate was 10.7%(3/28). [group A vs. group B; 1/10(12.5%) vs 2/18(11.1%) p=1.000]. Virological breakthrough did not occur in both two groups dur- ing TDF based rescue therapy.
Conclusions: TDF monotherapy has similar effi cacy with TDF plus NAs combination therapy as a rescue therapy in CHB patients with prior LMV and ADV resistance. How- ever, more large, prospective, randomized controlled study is need to clear the effi cacy of TDF monotherapy in CHB patients with prior LMV and ADV resistance.
K-LI-02 Liver
Hepatitis C Virus Infection is Risk Factor for
Antituberculous Treatment Induced Hepatitis, but Not Hepatitis B Virus Infection
Wan-Soo Kim1, Sang Soo Lee1, Chang Min Lee1, Hong Jun Kim1, Hyun Ju Min1, Chang Yoon Ha1, Hyun Jin Kim1, Tae Hyo Kim1, Woon Tae Jung1, Ok Jae Lee1
Department of Internal Medicine, Gyeongsang National University Hospital, Korea1
Background: The aim of this study is to investigate the incidence, risk factor for an- tituberculous treatment induced hepatotoxicity in patient with chronic viral hepatitis (CVH).
Methods: The patients diagnosed with pulmonary and extrapulmonary tuberculosis (TB) from January 2005 to February 2014 were reviewed retrospectively. There were 83 patients in hepatitis B virus (HBV) infection (HBV group), 41 patients in hepatitis C virus (HCV) infection (HCV group), and 4 patients were both (HBV+HCV group).
Patients without hepatitis virus infection were categorized to control group (n=251) from february 2013 to february 2014. Defi nition of drug induced hepatitis(DIH) is liver transaminase level exceeded 120IU/L with symptom of acute hepatitis or exceeded 200IU/L with without symptom, and transaminase level increased to >120 U/L when rechallenged the drug.
Results: The incidence of drug induced hepatitis was signifi cantly higher in HCV (13/41 [31.7%] vs. 25/251 [10.8%] p=0.001) and HBV+HCV group (3/4 [75%] vs. 25/251 [10.8%], p=0.002) compared to control group. However, no significant differences were noted in incidence of DIH between HBV group and control group (11/83 [21.7%]
vs. 25/251(10.8%) p=0.400). In all patients, risk factors of DIH were HCV infection, HBV+HCV co-infection, age, and baseline liver function abnormality.
Conclusions: In patients with HCV infection, antituberculosis treatment induced hepa- totoxicity occurred in 30%. Further prospective study on antitubertulosis treatment induced hepatotoxicity in patients with HCV infection may be warranted.
K-LI-03 Liver
Several Factors May Be Considered When Applying the Liver Stiffness by Transient Elastography in Patients with Chronic Hepatitis B
Young Kul Jung1, Kwangseok Kim1, Ji Kyoung Lee1, Sang-Yoon Chung1, Chang-Bum Bae1, Joo Hee Park1, Sang Jun Suh1, Seung Young Kim1, Jong Jin Hyun1, Ja Seoul Koo1, Hyung Joon Yim1, Sang Woo Lee1
Korea University Ansan Hospital, Korea1
Background: The aim of this study is to compared with transient elastography and other invasive fi brosis marker, and to investigate several factors infl uencing the liver stiffness measurement (LSM) in chronic hepatitis B patients.
Methods: Two hundred twenty eight patients with chronic hepatitis B who underwent liver biopsy and TE in the same time were recruited from January 2008 to December 2013.
Results: 159 (69.7%) of them were Male, and mean age was 41.9 years old. Mean of AST and ALT were 114.9 IU/L and 165.1 IU/L, respectively. Platelet count was 1.75 x 103 cell/uL.. 102 (44.7%) patients had HBeAg positivity. In liver Biopsy, 39 patients (17.1%) had F0-1, 57 (25.0%) had F2, 76 (33.3%) had F3, and 56 (24.6%) had F4, respectively.
In view of the signifi cant fi brosis (F4), TE showed signifi cantly good estimate of liver fi brosis, and corresponding area under the ROC curves of LSM was 0.733 that showed slightly good estimate value compared with APRI (0.468) and FIB-4 (0.641). Among the lower ALT patients (ALT under 100 IU/L) corresponding area under the ROC curves of LSM was 0.804, and among HBeAg negative patients corresponding area under the ROC curves of LSM was 0.755. The cutoff LSM values for >F2, >F3, and F4 were 6.9, 8.5, and 10.1 kPa, respectively, whereas they were 6.2, 7.5, and 9.6 kPa, respectively, in those with ALT <X2 UNL.
Conclusions: TE has good estimate performance for liver stiffness and fi brosis com- pared with AFRI and FIB-4 in chronic hepatitis B patients. However, ALT and HBeAg could influence liver stiffness. So, different cutoff LSM values may be applied in chronic hepatitis B patients.
