William F. Balistreri, MD


December 27, 2013

In This Article

Reactivation of Hepatitis B Attendant to Immune Suppression

Seto and colleagues[13] presented an interim analysis of hepatitis B virus (HBV) reactivation in patients with a history of HBV exposure who were undergoing chemotherapy. High rates of HBV reactivation were observed in HBsAg-negative, anti-HBc-positive individuals undergoing rituximab-containing chemotherapy within the first year of therapy commencement, with most occurring within the first 6 months. The earliest surrogate marker of reactivation was the serum HBV DNA level. Entecavir treatment controlled HBV reactivation in all cases.

Assessing the Global and Regional Burden of Liver Disease

Cowie and colleagues[14] categorized deaths attributable to viral hepatitis and other liver diseases worldwide, reasoning that establishing the relative contributions of the underlying causes of deaths due to liver cancer and cirrhosis is essential for appropriate targeting of public health and clinical responses at the global, regional, and national levels.

They used country-level and regional cause-of-death data to analyze the proportion of cirrhosis and liver cancer deaths attributable to HBV, HCV, alcohol, and other causes. An estimated 752,000 deaths occurred from liver cancer and 1.03 million deaths from cirrhosis in 2010, making chronic liver disease a leading cause of mortality. In the United States in 2010, an estimated 70,000 people died of these causes. HCV was the predominant cause (40%) of liver cancer/cirrhosis deaths in the United States.

On a global basis, HBV was estimated to be responsible for 45% of liver cancer deaths and 30% of deaths from cirrhosis, and HCV accounted for 26% and 28%, respectively. Alcohol abuse was estimated to be responsible for approximately one fourth of deaths from liver cancer and cirrhosis.

These data indicate that liver cancer and cirrhosis result in the deaths of 1.75 million persons each year, with chronic viral hepatitis causing approximately three fourths of these deaths. Greater priority to recognition and treatment of chronic viral hepatitis and other causes of liver disease is clearly needed to address this large burden of disease and death. The differing predominant causes of chronic liver disease identified across different regions requires prioritization of prevention responses to address global health priorities and projections, such as the potential major impact of the new antiviral strategies for HCV.


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