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    Clinical Significance of Quantitative HBs Antigen in the Prediction of Liver Fibrosis in Patients with Chronic Hepatitis B
    (Macedonian Academy of Sciences and Arts, 2018-07)
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    Gaseva, Magdalena
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    The assessment of liver fibrosis in patients with chronic hepatitis B (CHB) is of great importance in evaluating the phases of chronic hepatitis B viral infection, prompt administration of antiviral therapy, prevention of disease progression and late complications of CHB infection. Aim: to investigate the clinical significance of quantitative HBs antigen as a predictor for liver fibrosis in patients with HBe antigen negative chronic hepatitis B and inactive carriers. Material and Methods: the study included 44 treatment naïve patients with chronic hepatitis B, divided into two groups, HBeAg negative chronic HBV infection or inactive carriers (IC) and HBeAg negative chronic hepatitis B patients. All patients underwent laboratory, serologic testing, ultrasound and transient elastography (TE). In both patient groups, quantitative HBs antigen (HBsQ), alanine aminotransferase (ALT), hepatitis B virus deoxyribonucleic acid (HBV DNA) and liver fibrosis were analyzed. Results: The value of HBsQ is significantly higher in patients with HBeAg negative CHB 2477.02±4535.44 IU/ml than in the IC group 8791±11891 IU/ml; Z=3.32, p<0.001 (p=0.0009). In IC patients, 1 (4.76%) had fibrosis and 20 (95.24%)) did not have fibrosis. Out of 23 patients with HBeAg negative chronic hepatitis B, 8 (34.78%) had fibrosis and 15 (65.22%) did not have fibrosis. Patients with HBeAg negative hepatitis B had significantly higher liver fibrosis than IC; Fisher Exact Test p<0.05 (p=0.02). The increase of HBsQ for one single unit (IU/ml) does not have predictive value for fibrosis (Ext (B) =1.00), 95% C.I. for EXP (B): 1.00-1.00 / p>0.05. Conclusion: Quantitative hepatitis B surface antigen has intermediate weak statistically insignificant prediction for liver fibrosis R=0.25 (p<0.10).
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    The Problem of Access to Hepatitis B Treatment in the Balkan Country of North Macedonia
    (Galenos Yayinevi, 2023-08)
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    Toshevski, Boban
    Chronic hepatitis B (CHB) virus infection represents a global public health threat that causes considerable liver-related morbidity and mortality. In chronically infected patients, an elevated serum hepatitis B virus (HBV)-DNA concentration is the main risk factor for disease progression, although other clinical and viral characteristics can influence disease outcomes. At present, curing HBV infection is challenging in most patients and they need longterm antiviral treatment. The first-line treatments are nucleos(t) ide analogs (NAs) with a high barrier to resistance: tenofovir and entecavir, while in highly selected patients, an alternative treatment option is regulated interferon. Long-term therapy with NAs is safe and well tolerated, achieves potent viral suppression, and reduces the incidence of liver-related complications. For the majority of patients with CHB in North Macedonia, the current anti-HBV treatment is lamivudine with a low genetic barrier, which leads to compensatory mutations and resistance. With current vaccine strategy, applying therapies with effective high genetic barrier to resistance drugs, and improved linkage to care we should improve the treatment for patients with CHB and strive toward the World Health Organization goal of eliminating HBV as a global health threat by 2030.