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  • HBeAg positive patients older than years with

    2019-06-11

    HBeAg-positive patients older than 40 years with persistently high or high to normal ALT levels may be diagnosed with significant hepatic necroinflammation or fibrosis. During treatment, the clinical significance of timing of HBeAg loss or seroconversion remains unclear. However, a longer duration of a HBeAg-positive status may indicate ongoing hepatic inflammation. Quantitative HBsAg (qHBsAg) levels have the potential for a follow-up treatment response in CHB for the prediction of a response to interferon-alpha. In HBeAg-positive patients with ETV therapy, patients with HBeAg seroclearance or seroconversion showed an early decline in their HBsAg levels. However, the baseline HBsAg level and decline at 12th week or 24th week could not predict HBeAg seroconversion at 2 years. In the present study, we did not routinely check qHBsAg during ETV treatment for CHB. Thus, we could not compare qHBsAg or HBV DNA dynamics for any prediction of HBeAg seroconversion. The ideal treatment end-point is sustained HBsAg loss with or without anti-HBs seroconversion in HBeAg-positive and HBeAg-negative patients. Actually, the duration of ETV treatment for HBeAg positive CHB may be up to 240 weeks. A duration of consolidation therapy after HBeAg seroconversion is indicated. Our results showed that HBV DNA levels < 20 IU/mL at the 24th week could early predict the likelihood of HBeAg loss. Our study had some limitations. First, in this single-institution study, the number of patients enrolled was limited. Second, HBeAg-positive gingerol patients under treatment are regularly followed-up by protocol. However, as a retrospective study, there still remained portions of missing data from our patients. Third, compliance of medication prescription schedules is important in a pharmacological study and follow-up. There are some difficulties encountered when attempting to confirm compliance of our patients by strictly reviewing medical records alone. We had 18 patients who developed virological breakthrough under follow-up, which is mostly due to poor compliance; therefore, we assumed that these patients in our study could achieve 90% compliance. Fourth, we considered that HBeAg seroclearance within 6 months of ETV was possibly due to the efficacy of antiviral therapy or spontaneous HBeAg seroclearance. We excluded patients with HBeAg seroclearance within 6 months, which might introduce a selection bias due to including only later HBeAg seroclearance patients. This could be the reason why this study failed to investigate the HBV DNA at 12th week when predicting HBeAg seroclearance within 96 weeks. Besides, further studies will be warranted to understand the association of the early dynamic change of HBV DNA and serologic response in HBeAg-positive patients. Our study demonstrated that HBV DNA levels < 20 IU/mL at the 24th week and 48th week could predict serum HBeAg loss in ETV-treated HBeAg-positive CHB patients. This finding indicates that ETV-treated HBeAg-positive CHB patients are less likely to achieve HBeAg seroclearance within 96 weeks if they did not have an HBV DNA level of < 20 IU/mL at the 24th or 48th week.
    Acknowledgments
    Introduction Marathon running has a growing popularity worldwide. This trend is also observed in Taiwan, where the number of races held has increased from a single race in 2005 to 13 races in 2014. Such competitions not only test the resiliency and character of the marathon runners but also push them to a huge physical stress. Ultramarathon is defined as a race longer than an official marathon (42.195 km or 26.2 miles) and may vary in length or time duration. Numerous reports have been published on changes in runners’ physiological characteristics that occur during long-distance and 24-hour ultramarathons, including hyponatremia, skeletal muscle breakdown, iron depletion, anemia, and possible hepatic damage. Our previous study showed that ultramarathon running is associated with a wide range of significant changes in hematological parameters, several of which can be associated with potentially serious renal and physiological abnormalities.