Previous studies have found ethnicity to be an important predictor of outcomes of treatment with ... more Previous studies have found ethnicity to be an important predictor of outcomes of treatment with peginterferon (PEG-IFN) and ribavirin (RBV) in chronic hepatitis C. Although the expected sustained virological response (SVR) rates of Hispanics and African Americans are lower than those of Caucasians, SVR rates in Asians appear to be more favorable. However, in some of these studies, hepatitis C virus (HCV) genotype was identified by INNO-LiPA assay, which can mistype the easier-to-treat HCV genotype 6 as genotype 1. Our goal was to compare SVR rates among Caucasian and Asian-American patients with genotype 1 and 2/3 infection whose HCV genotypes were accurately classified by core sequencing testing. A cohort of 269 consecutive treatment-naive HCV-infected patients with genotype 1 or 2/3 (157 Caucasians and 112 Asians) treated with PEG-IFN+RBV from January 2001 to November 2007 at four community-based gastroenterology clinics in Northern California were studied. The analysis of data was by intention-to-treat. The SVR rates for patients with genotype 1 were 45% for Caucasians and 52% for Asians (P=0.37). The SVR rates for patients with genotype 2/3 infection was 77% for Asians and 74% for Caucasians (P=0.7). On multivariate logistic regression analyses adjusting for age, alanine aminotransferase (ALT), baseline viral load, HCV genotype, and treatment adherence, we did not find Asian ethnicity to predict SVR. On a separate analysis, we found that Asians who had HCV genotype 1 or 1b by the less accurate INNO-LiPA assay had significantly higher SVR rates than Caucasians with genotype 1 (64% vs. 45%, respectively, P=0.03). SVR rates were similar in Asian Americans and Caucasians infected with HCV genotype 1 or 2/3 when HCV genotype classification was accurately determined.
At present there is no clear consensus on how patients with chronic hepatitis B (CHB), high serum... more At present there is no clear consensus on how patients with chronic hepatitis B (CHB), high serum hepatitis B virus (HBV) DNA, and normal alanine aminotransferase (NLALT) levels should be managed. This study hypothesizes that a signifi cant proportion of such patients may have histological disease. METHODS: We carried out a retrospective study of 101 consecutive treatment-naive patients with CHB who underwent liver biopsies at a community gastroenterology clinic and had high HBV DNA and NLALT (≤ 40 U / l) levels at the time of biopsy. All patients were Asians. ALT levels were observed for a period of time before liver biopsy and were used to classify patients into two groups, namely those with only NLALT levels and those with fl uctuating ALT (FLALT) levels. All patients had at least two ALT measurements during this period of time. Signifi cant histology was defi ned as stage ≥ 2 fi brosis or stage 1 fi brosis plus grade ≥ 2 infl ammation using the Batts-Ludwig scoring system. RESULTS: In patients with NLALT levels, the proportions of those with signifi cant histology were 0, 22, and 45 % for age ≤ 35, 36-50, and >50 years, respectively (n = 11, n = 27, n = 19; P = 0.033). In patients who had FLALT levels, the corresponding proportions were 22, 42, and 69 % (n = 9, n = 22, n = 13; P = 0.091). After adjustments for gender, hepatitis B e antigen (HBeAg) status, and mean pre-biopsy HBV DNA levels, signifi cant predictors of histological disease were older age (odds ratio (OR) = 6.2 for age 36-50 years and OR = 17.6 for age >50 years compared with age ≤ 35 years, P = 0.041 and P = 0.003, respectively) and FLALT levels (OR = 3.6, P = 0.008). Subanalysis of patients with NLALT levels using lower cutoffs (30 U / l for men and 19 U / l for women) showed similar trends. CONCLUSIONS: Patients with CHB, high HBV DNA, and NLALT levels and aged more than 35 years or those with FLALT levels may have signifi cant histological disease (22-70 %).
Purpose Hepatitis B virus (HBV) genotypes can affect treatment response to interferon-based thera... more Purpose Hepatitis B virus (HBV) genotypes can affect treatment response to interferon-based therapy and disease outcomes in patients with chronic hepatitis B (CHB). Little data exist to characterize HBV genotypes in Vietnamese, one of the largest minority groups in the United States and also one with one of the highest CHB and liver cancer disease burdens. The goal of this study was to compare the distribution of HBV genotypes in Vietnamese and Chinese patients. Methods We performed a cross-sectional study of 567 consecutive patients of Vietnamese (n = 478) or Chinese (n = 89) descent, with HBV genotype mutation analysis performed between 7/2,005 and 6/2,008 at a community gastroenterology clinic and a university-affiliated liver clinic in the United States. Results There were no significant differences between the Vietnamese and Chinese groups in mean age (45 and 44 years), gender (58% and 61% male), HBeAg status (64% and 65% negative), median alanine aminotransferase (33 and 41 U/L), and log 10 HBV DNA (4.9 and 5.0 log 10 IU/ml), or the prevalence of precore/basic core promoter mutations (72% and 71%), respectively. Vietnamese patients had a much higher prevalence of HBV genotype B and a lower prevalence of genotype C than Chinese patients: 74% and 25% vs. 55% and 43% (P = 0.001). Conclusions Chinese patients with CHB often carry either B or C genotype. Vietnamese patients with CHB mostly have HBV genotype B. Additional studies are needed to further characterize the clinical significance of HBV genotype in the natural history and treatment outcomes of CHB in Vietnamese patients.
Purpose Although infection with hepatitis C virus (HCV) affects 32 million individuals from South... more Purpose Although infection with hepatitis C virus (HCV) affects 32 million individuals from Southeast Asia, little is known about the mode of HCV acquisition and the epidemiology of chronic hepatitis C (CHC) in these individuals. Our goal was to examine risk factors for HCV acquisition, prevalence, and clinical characteristics of HCV genotype 6 compared with genotypes 1 and 2/3 in Southeast Asian (SEA) patients. Methods We performed a cross-sectional study of 308 consecutive SEA Americans with CHC evaluated by five gastroenterologists from January 2000 to December 2008 at two community clinics in northern California via medical record review, using a case report form. Results A significant proportion of patients (41%) could not recall any specific risk factors for HCV acquisition. The most commonly reported risk factor in patients who reported at least one risk factor was history of surgeries (34%), followed by blood transfusion (25%) and acupuncture (13%). Among patients with core sequence testing for HCV genotype (n = 181), the most common HCV genotypes were genotype 1 (42%) and genotype 6 (41%), followed by genotype 2/3 (17%). There were no major differences in the clinical and virological characteristics between the different genotype groups (1 vs. 2/3 vs. 6). Conclusion HCV genotype 6 is as common as genotype 1 in SEAs. Commonly known risk factors for HCV acquisition were not readily identifiable in a large proportion of SEA Americans (41%) and may not be useful in identifying at-risk individuals for HCV screening in this population.
Background: Despite its high potency against hepatitis B virus (HBV), entecavir (ETV) 0.5 mg dail... more Background: Despite its high potency against hepatitis B virus (HBV), entecavir (ETV) 0.5 mg daily may not be sufficient to induce complete viral suppression in some patients with very high pretreatment viremia. It is not clear whether ETV 1.0 mg daily would have additive effect in such patients. Goals: Our goal was to examine virologic outcome of ETV 1.0 mg daily in patients with partial response to ETV 0.5 mg daily. Methods: We retrospectively studied 31 consecutive treatmentnaive patients who were switched to ETV 1.0 mg daily after partial response [reduction of HBV DNA Z2 log 10 IU/mL but with detectable HBV DNA levels (> 100 IU/mL) after 24 weeks of therapy or longer] with ETV 0.5 mg daily from January 2005 to January 2010 at 2 clinics. Results: All patients were Asians and 90% had positive hepatitis B e antigen. Mean HBV DNA was 8.04 ± 0.65 log 10 IU/mL before therapy and 3.64 ± 0.91 log 10 IU/mL at the time of switch. Overall rate of complete viral suppression were 29% (n = 9/31) after 24 weeks of ETV 1.0 mg daily and 22% (n = 5/23) after 48 weeks. Complete viral suppression after 24 weeks with ETV 1.0 mg daily was significantly higher in patients with lower HBV DNA (< 3 log 10 IU/mL) at time of switch: 75% versus 5%, P < 0.0001. Conclusions: The majority of patients with partial response to ETV 0.5 mg daily did not achieve complete viral suppression with the higher dose of ETV 1.0 mg daily except those with minimal residual viremia (HBV DNA <3 log 10 IU/mL).
Goals and Background: Besides United States population born between 1945 and 1965, screening for ... more Goals and Background: Besides United States population born between 1945 and 1965, screening for hepatitis C virus (HCV) is not recommended for the general US population. However, HCV may be more prevalent in certain subgroups and screening may be warranted. The goal of this study was to examine the proportion of HCV in a large sample of community Asian American patients presenting for non-liver-related complaints. Study: We conducted a cross-sectional study of 1246 patients tested for hepatitis C virus antibodies (anti-HCV) referred to 2 gastroenterology clinics for non-liver-related gastrointestinal reasons between January 2001 and February 2011. We determined HCV status and patient history via electronic medical record review. Results: Of the 1246 study patients tested for anti-HCV, the majority were Asian (81.4%) and 29 Asian patients (2.9%) had positive anti-HCV. HCV proportion in the remaining 232 non-Asians (non-Hispanic whites and Hispanics) was 1.7%. Asians with positive anti-HCV were more likely to have had blood transfusions (31.0% vs. 6.6%, P < 0.0001) or acupuncture (10.3% vs. 1.5%, P < 0.0001). Of the 976 Asian patients with hepatitis B surface antigen testing, 38 (3.9%) also had detectable hepatitis B surface antigen. Conclusions: Among patients seen at community gastroenterology clinics for non-liver-related reasons, HCV proportion was 1.7% for non-Asians and 2.9% for Asians. Screening for HCV should be offered to high-risk patients presenting to gastroenterology clinics with unrelated gastrointestinal complaints.
Background: The primary treatment endpoint for hepatitis B e antigen (HBeAg)-positive chronic hep... more Background: The primary treatment endpoint for hepatitis B e antigen (HBeAg)-positive chronic hepatitis B is HBeAg seroconversion; however, data on the durability of response are inconsistent. Goals: Our goal was to investigate the rate of recurrent viremia after HBeAg seroconversion and subsequent discontinuation of therapy. Methods: We retrospectively studied 88 consecutive Asian American patients who achieved HBeAg seroconversion [loss of HBeAg and development of antibody to HBeAg (anti-HBe)] among 458 HBeAg-positive patients who received oral antiviral therapy at 3 US clinics between March 1998 and November 2010. Recurrent viremia was defined as reappearance of detectable serum hepatitis B virus DNA (> 100 IU/mL) on 2 consecutive laboratory tests from previously undetectable levels. Results: Antiviral medications used at the time of HBeAg seroconversion included: lamivudine (23%), adefovir (34%), entecavir (36%), tenofovir (4%), and combination therapy (3%). Antiviral therapy was continued after HBeAg seroconversion in 49 patients (group I) and discontinued in the other 39 patients after consolidation therapy [median = 12 months (range, 1 to 55 mo)] (group II). No patients in group I experienced recurrent viremia, whereas 90% in group II did. Elevated alanine aminotransferase also occurred in 38% of group II patients [median peak alanine aminotransferase 249 IU/mL (range, 93 to 1070 IU/mL)]. Conclusions: Despite consolidation therapy, almost all patients who discontinued therapy after achieving HBeAg seroconversion and complete viral suppression experienced recurrent viremia, and close to half also experienced biochemical flares. HBeAg seroconversion does not seem to be a durable treatment endpoint for many patients, and they should be monitored carefully for virologic relapse and biochemical flares if antiviral therapy is withdrawn.
Gastroenterology, Volume 138, Issue 5, Pages S-793, May 2010, Authors:Mindie H. Nguyen; Huy N. Tr... more Gastroenterology, Volume 138, Issue 5, Pages S-793, May 2010, Authors:Mindie H. Nguyen; Huy N. Trinh; Son T. Do; Phuong L. Tran; Thuan T. Nguyen; Khanh K. Nguyen; Huy A. Nguyen; Nghia H. Nguyen; Ruel T. Garcia.
Gastroenterology, Volume 138, Issue 5, Pages S-783, May 2010, Authors:Khoa D. Lam; Huy N. Trinh; ... more Gastroenterology, Volume 138, Issue 5, Pages S-783, May 2010, Authors:Khoa D. Lam; Huy N. Trinh; Son T. Do; Thuan T. Nguyen; Ruel T. Garcia; Tuan Nguyen; Quang Q. Phan; Huy A. Nguyen; Khanh K. Nguyen; Long H. Nguyen; Mindie H. Nguyen.
Gastroenterology, Volume 134, Issue 4, Pages A-312, April 2008, Authors:Philip S. Tsang; Ruel T. ... more Gastroenterology, Volume 134, Issue 4, Pages A-312, April 2008, Authors:Philip S. Tsang; Ruel T. Garcia; Huy N. Trinh; Jeanine Phan; Nghiem B. Ha; Huy A. Nguyen; Khanh K. Nguyen; Emmet B. Keeffe; Mindie H. Nguyen.
Gastroenterology, Volume 134, Issue 4, Pages A-309, April 2008, Authors:Long H. Nguyen; Nghiem B.... more Gastroenterology, Volume 134, Issue 4, Pages A-309, April 2008, Authors:Long H. Nguyen; Nghiem B. Ha; Philip Vutien; Nghi B. Ha; Ruel T. Garcia; Huy N. Trinh; Huy A. Nguyen; Khanh K. Nguyen; Brian S. Levitt; Emmet B. Keeffe; Mindie H. Nguyen.
Biliary complications occurred more frequently in the LRD group (54% vs. 25%, P=0.08), while LRD ... more Biliary complications occurred more frequently in the LRD group (54% vs. 25%, P=0.08), while LRD patients were less likely to have an episode of AR (30% vs. 62%, P=0.04). Conclusions: In this single center report of 48 patients, patient and graft survival were similar between LRD and DD pediatric transplant recipients when patient status at transplant, waiting time, and graft type were taken into account. In contrast, LRD may offer an immunologic advantage, as the incidence of AR was significantly lower in LRD patients. These results are somewhat divergent from previous studies, and suggest that our understanding of the donor and recipient factors which influence patient and graft survival remains incomplete.
The liver stiffness measurement is a novel method which allows to evaluate indirectly and noninva... more The liver stiffness measurement is a novel method which allows to evaluate indirectly and noninvasively the liver fibrosis stage. The reproducibility of the method in patients with different fibrosis stage and in the different weight groups is still under discussion. Aim. To evaluate the reproducibility of transient elastography in patients of different weight and fibrosis stage groups. Methods. The liver stiffness measurements were performed to 187 consecutive patients who suffered from chronic liver diseases using FibroScan (EchoSens, France) equipment. Not less than 22 measurements during the examination were performed to each patient. We analyzed an intra-observer agreement between results of two series by 11 measurements using Intraclass Correlation Coefficient (ICC). Results. There were no statistically significant differences between medians of two series of measurements (N=187, M±s 9.35±7.32 for the 1st series vs 9.22±7.98 for the 2nd series, p=0.27). The Intraclass Correlation Coefficient for two series of measurements was excellent ICC=0.9887, 95%CI [0.985-0.992]. There was no statistical difference between ICCs for two series of measurements in patients with an excessive weight (BMI≥25 kg/m2, N=88) and normal weight (BMI<25 kg/m2, N=99)-0.9865 (95% CI [0.9794-0.9911]) vs ICC=0.9900 (95% CI [0.9851-0.9931]), p=0.3122. The intraobserver coefficients for patients with different liver fibrosis stage were as follows: F0-1-0.82 (N=107), F2-0.61 (N=36), F3-0.92 (N=13), F4-0.98 (N=31). Conclusions: Transient elastography is a reproducible technique for assessing liver fibrosis in patients with chronic liver diseases. The intraobserver agreement does not significantly depend on the patients' weight. The reproducibility of transient elastography is lower in patients with mild liver fibrosis stages.
Background Screening for hepatocellular carcinoma (HCC) has been shown to improve survival via ea... more Background Screening for hepatocellular carcinoma (HCC) has been shown to improve survival via earlier cancer detection. Although HCC screening is considered standard of care in the USA, little is known of the adherence to this practice, especially in a community setting. Aims Our primary goal was to evaluate adherence to HCC screening and to find predictors of screening adherence in a community setting. Our secondary objective was to determine the impact of screening on survival. Methods We studied a cohort of 557 consecutive patients at high risk for HCC: patients with cirrhosis and older chronic hepatitis B (CHB) patients without cirrhosis (C45 years old). Patients initiated screening 1/2001-1/ 2005 and were monitored C12 months to 12/2008 in two community gastroenterology clinics in Northern California. HCC screening was categorized into four groups based on combined frequency of serum alpha-fetoprotein and imaging: optimal, suboptimal, poor, and no screening. Results About 40.6% of our cohort received poor or no screening. Noncirrhotic CHB patients had worse screening than cirrhotic patients. Multivariate analysis revealed that patients with a greater number of clinical visits per year were 3.4 times more likely to have regular screening than patients with fewer clinical visits per year (P \ 0.001). There was a trend for association between HCC screening and greater access to curative treatment. Conclusion Since more frequent clinic visits is a strong independent predictor of improved screening adherence, regular routine clinic visits may help improve adherence to HCC screening, which may also lead to improved clinical outcomes.
To determine the yield of colonoscopy in a predominantly Asian American gastroenterology practice... more To determine the yield of colonoscopy in a predominantly Asian American gastroenterology practice in California from 8/2003 to 2/2005. A total 2,723 subjects were included: 87% were Asian and 13% were non-Asian. Advanced neoplasia prevalence was 12% in Asian men and 9% in non-Asian men (P = 0.21), and 8% and 7% in women (P = 0.62). Similar results were found in asymptomatic patients (13% and 13%, P = 0.99, for men; 8% and 6%, P = 0.46, for women). Factors associated with presence of advanced neoplasia were total number of polyps and presence of right-sided lesions. Asian men were more likely to have neoplasia overall compared with non-Asian men with odds ratio (OR) of 2.14 (1.23-3.72); however, there were no significant differences in the prevalences of advanced neoplasia in the two groups. Colorectal neoplasia is as prevalent in Asian Americans and preventive guidelines for colorectal cancer should also be advocated for this ethnic group.
The dose recommendation for entecavir (ETV) is 0.5 mg daily for treatment-naïve chronic hepatitis... more The dose recommendation for entecavir (ETV) is 0.5 mg daily for treatment-naïve chronic hepatitis B (CHB) patients and 1.0 mg daily for lamivudine-refractory patients; however, few data are available for the efficacy of a 1.0-mg daily dose in treatment-naïve CHB patients. Our goal is to examine the treatment outcome of treatment-naïve patients placed on ETV 0.5 mg or ETV 1.0 mg daily through week 48. Cases were 40 consecutive hepatitis B e antigen (HBeAg)-positive CHB patients treated with ETV 1.0 mg daily between January 2005 and September 2010, and controls were 40 consecutive CHB patients treated with ETV 0.5 mg daily between January 2005 and September 2010 at three US gastroenterology/liver clinics. Controls were matched for age (±5 years), sex, HBeAg, and baseline hepatitis B virus (HBV) DNA (±0.5 log10 IU/ml). Complete viral suppression was defined as undetectable HBV DNA by polymerase chain reaction…
Previous studies have found ethnicity to be an important predictor of outcomes of treatment with ... more Previous studies have found ethnicity to be an important predictor of outcomes of treatment with peginterferon (PEG-IFN) and ribavirin (RBV) in chronic hepatitis C. Although the expected sustained virological response (SVR) rates of Hispanics and African Americans are lower than those of Caucasians, SVR rates in Asians appear to be more favorable. However, in some of these studies, hepatitis C virus (HCV) genotype was identified by INNO-LiPA assay, which can mistype the easier-to-treat HCV genotype 6 as genotype 1. Our goal was to compare SVR rates among Caucasian and Asian-American patients with genotype 1 and 2/3 infection whose HCV genotypes were accurately classified by core sequencing testing. A cohort of 269 consecutive treatment-naive HCV-infected patients with genotype 1 or 2/3 (157 Caucasians and 112 Asians) treated with PEG-IFN+RBV from January 2001 to November 2007 at four community-based gastroenterology clinics in Northern California were studied. The analysis of data was by intention-to-treat. The SVR rates for patients with genotype 1 were 45% for Caucasians and 52% for Asians (P=0.37). The SVR rates for patients with genotype 2/3 infection was 77% for Asians and 74% for Caucasians (P=0.7). On multivariate logistic regression analyses adjusting for age, alanine aminotransferase (ALT), baseline viral load, HCV genotype, and treatment adherence, we did not find Asian ethnicity to predict SVR. On a separate analysis, we found that Asians who had HCV genotype 1 or 1b by the less accurate INNO-LiPA assay had significantly higher SVR rates than Caucasians with genotype 1 (64% vs. 45%, respectively, P=0.03). SVR rates were similar in Asian Americans and Caucasians infected with HCV genotype 1 or 2/3 when HCV genotype classification was accurately determined.
At present there is no clear consensus on how patients with chronic hepatitis B (CHB), high serum... more At present there is no clear consensus on how patients with chronic hepatitis B (CHB), high serum hepatitis B virus (HBV) DNA, and normal alanine aminotransferase (NLALT) levels should be managed. This study hypothesizes that a signifi cant proportion of such patients may have histological disease. METHODS: We carried out a retrospective study of 101 consecutive treatment-naive patients with CHB who underwent liver biopsies at a community gastroenterology clinic and had high HBV DNA and NLALT (≤ 40 U / l) levels at the time of biopsy. All patients were Asians. ALT levels were observed for a period of time before liver biopsy and were used to classify patients into two groups, namely those with only NLALT levels and those with fl uctuating ALT (FLALT) levels. All patients had at least two ALT measurements during this period of time. Signifi cant histology was defi ned as stage ≥ 2 fi brosis or stage 1 fi brosis plus grade ≥ 2 infl ammation using the Batts-Ludwig scoring system. RESULTS: In patients with NLALT levels, the proportions of those with signifi cant histology were 0, 22, and 45 % for age ≤ 35, 36-50, and >50 years, respectively (n = 11, n = 27, n = 19; P = 0.033). In patients who had FLALT levels, the corresponding proportions were 22, 42, and 69 % (n = 9, n = 22, n = 13; P = 0.091). After adjustments for gender, hepatitis B e antigen (HBeAg) status, and mean pre-biopsy HBV DNA levels, signifi cant predictors of histological disease were older age (odds ratio (OR) = 6.2 for age 36-50 years and OR = 17.6 for age >50 years compared with age ≤ 35 years, P = 0.041 and P = 0.003, respectively) and FLALT levels (OR = 3.6, P = 0.008). Subanalysis of patients with NLALT levels using lower cutoffs (30 U / l for men and 19 U / l for women) showed similar trends. CONCLUSIONS: Patients with CHB, high HBV DNA, and NLALT levels and aged more than 35 years or those with FLALT levels may have signifi cant histological disease (22-70 %).
Purpose Hepatitis B virus (HBV) genotypes can affect treatment response to interferon-based thera... more Purpose Hepatitis B virus (HBV) genotypes can affect treatment response to interferon-based therapy and disease outcomes in patients with chronic hepatitis B (CHB). Little data exist to characterize HBV genotypes in Vietnamese, one of the largest minority groups in the United States and also one with one of the highest CHB and liver cancer disease burdens. The goal of this study was to compare the distribution of HBV genotypes in Vietnamese and Chinese patients. Methods We performed a cross-sectional study of 567 consecutive patients of Vietnamese (n = 478) or Chinese (n = 89) descent, with HBV genotype mutation analysis performed between 7/2,005 and 6/2,008 at a community gastroenterology clinic and a university-affiliated liver clinic in the United States. Results There were no significant differences between the Vietnamese and Chinese groups in mean age (45 and 44 years), gender (58% and 61% male), HBeAg status (64% and 65% negative), median alanine aminotransferase (33 and 41 U/L), and log 10 HBV DNA (4.9 and 5.0 log 10 IU/ml), or the prevalence of precore/basic core promoter mutations (72% and 71%), respectively. Vietnamese patients had a much higher prevalence of HBV genotype B and a lower prevalence of genotype C than Chinese patients: 74% and 25% vs. 55% and 43% (P = 0.001). Conclusions Chinese patients with CHB often carry either B or C genotype. Vietnamese patients with CHB mostly have HBV genotype B. Additional studies are needed to further characterize the clinical significance of HBV genotype in the natural history and treatment outcomes of CHB in Vietnamese patients.
Purpose Although infection with hepatitis C virus (HCV) affects 32 million individuals from South... more Purpose Although infection with hepatitis C virus (HCV) affects 32 million individuals from Southeast Asia, little is known about the mode of HCV acquisition and the epidemiology of chronic hepatitis C (CHC) in these individuals. Our goal was to examine risk factors for HCV acquisition, prevalence, and clinical characteristics of HCV genotype 6 compared with genotypes 1 and 2/3 in Southeast Asian (SEA) patients. Methods We performed a cross-sectional study of 308 consecutive SEA Americans with CHC evaluated by five gastroenterologists from January 2000 to December 2008 at two community clinics in northern California via medical record review, using a case report form. Results A significant proportion of patients (41%) could not recall any specific risk factors for HCV acquisition. The most commonly reported risk factor in patients who reported at least one risk factor was history of surgeries (34%), followed by blood transfusion (25%) and acupuncture (13%). Among patients with core sequence testing for HCV genotype (n = 181), the most common HCV genotypes were genotype 1 (42%) and genotype 6 (41%), followed by genotype 2/3 (17%). There were no major differences in the clinical and virological characteristics between the different genotype groups (1 vs. 2/3 vs. 6). Conclusion HCV genotype 6 is as common as genotype 1 in SEAs. Commonly known risk factors for HCV acquisition were not readily identifiable in a large proportion of SEA Americans (41%) and may not be useful in identifying at-risk individuals for HCV screening in this population.
Background: Despite its high potency against hepatitis B virus (HBV), entecavir (ETV) 0.5 mg dail... more Background: Despite its high potency against hepatitis B virus (HBV), entecavir (ETV) 0.5 mg daily may not be sufficient to induce complete viral suppression in some patients with very high pretreatment viremia. It is not clear whether ETV 1.0 mg daily would have additive effect in such patients. Goals: Our goal was to examine virologic outcome of ETV 1.0 mg daily in patients with partial response to ETV 0.5 mg daily. Methods: We retrospectively studied 31 consecutive treatmentnaive patients who were switched to ETV 1.0 mg daily after partial response [reduction of HBV DNA Z2 log 10 IU/mL but with detectable HBV DNA levels (> 100 IU/mL) after 24 weeks of therapy or longer] with ETV 0.5 mg daily from January 2005 to January 2010 at 2 clinics. Results: All patients were Asians and 90% had positive hepatitis B e antigen. Mean HBV DNA was 8.04 ± 0.65 log 10 IU/mL before therapy and 3.64 ± 0.91 log 10 IU/mL at the time of switch. Overall rate of complete viral suppression were 29% (n = 9/31) after 24 weeks of ETV 1.0 mg daily and 22% (n = 5/23) after 48 weeks. Complete viral suppression after 24 weeks with ETV 1.0 mg daily was significantly higher in patients with lower HBV DNA (< 3 log 10 IU/mL) at time of switch: 75% versus 5%, P < 0.0001. Conclusions: The majority of patients with partial response to ETV 0.5 mg daily did not achieve complete viral suppression with the higher dose of ETV 1.0 mg daily except those with minimal residual viremia (HBV DNA <3 log 10 IU/mL).
Goals and Background: Besides United States population born between 1945 and 1965, screening for ... more Goals and Background: Besides United States population born between 1945 and 1965, screening for hepatitis C virus (HCV) is not recommended for the general US population. However, HCV may be more prevalent in certain subgroups and screening may be warranted. The goal of this study was to examine the proportion of HCV in a large sample of community Asian American patients presenting for non-liver-related complaints. Study: We conducted a cross-sectional study of 1246 patients tested for hepatitis C virus antibodies (anti-HCV) referred to 2 gastroenterology clinics for non-liver-related gastrointestinal reasons between January 2001 and February 2011. We determined HCV status and patient history via electronic medical record review. Results: Of the 1246 study patients tested for anti-HCV, the majority were Asian (81.4%) and 29 Asian patients (2.9%) had positive anti-HCV. HCV proportion in the remaining 232 non-Asians (non-Hispanic whites and Hispanics) was 1.7%. Asians with positive anti-HCV were more likely to have had blood transfusions (31.0% vs. 6.6%, P < 0.0001) or acupuncture (10.3% vs. 1.5%, P < 0.0001). Of the 976 Asian patients with hepatitis B surface antigen testing, 38 (3.9%) also had detectable hepatitis B surface antigen. Conclusions: Among patients seen at community gastroenterology clinics for non-liver-related reasons, HCV proportion was 1.7% for non-Asians and 2.9% for Asians. Screening for HCV should be offered to high-risk patients presenting to gastroenterology clinics with unrelated gastrointestinal complaints.
Background: The primary treatment endpoint for hepatitis B e antigen (HBeAg)-positive chronic hep... more Background: The primary treatment endpoint for hepatitis B e antigen (HBeAg)-positive chronic hepatitis B is HBeAg seroconversion; however, data on the durability of response are inconsistent. Goals: Our goal was to investigate the rate of recurrent viremia after HBeAg seroconversion and subsequent discontinuation of therapy. Methods: We retrospectively studied 88 consecutive Asian American patients who achieved HBeAg seroconversion [loss of HBeAg and development of antibody to HBeAg (anti-HBe)] among 458 HBeAg-positive patients who received oral antiviral therapy at 3 US clinics between March 1998 and November 2010. Recurrent viremia was defined as reappearance of detectable serum hepatitis B virus DNA (> 100 IU/mL) on 2 consecutive laboratory tests from previously undetectable levels. Results: Antiviral medications used at the time of HBeAg seroconversion included: lamivudine (23%), adefovir (34%), entecavir (36%), tenofovir (4%), and combination therapy (3%). Antiviral therapy was continued after HBeAg seroconversion in 49 patients (group I) and discontinued in the other 39 patients after consolidation therapy [median = 12 months (range, 1 to 55 mo)] (group II). No patients in group I experienced recurrent viremia, whereas 90% in group II did. Elevated alanine aminotransferase also occurred in 38% of group II patients [median peak alanine aminotransferase 249 IU/mL (range, 93 to 1070 IU/mL)]. Conclusions: Despite consolidation therapy, almost all patients who discontinued therapy after achieving HBeAg seroconversion and complete viral suppression experienced recurrent viremia, and close to half also experienced biochemical flares. HBeAg seroconversion does not seem to be a durable treatment endpoint for many patients, and they should be monitored carefully for virologic relapse and biochemical flares if antiviral therapy is withdrawn.
Gastroenterology, Volume 138, Issue 5, Pages S-793, May 2010, Authors:Mindie H. Nguyen; Huy N. Tr... more Gastroenterology, Volume 138, Issue 5, Pages S-793, May 2010, Authors:Mindie H. Nguyen; Huy N. Trinh; Son T. Do; Phuong L. Tran; Thuan T. Nguyen; Khanh K. Nguyen; Huy A. Nguyen; Nghia H. Nguyen; Ruel T. Garcia.
Gastroenterology, Volume 138, Issue 5, Pages S-783, May 2010, Authors:Khoa D. Lam; Huy N. Trinh; ... more Gastroenterology, Volume 138, Issue 5, Pages S-783, May 2010, Authors:Khoa D. Lam; Huy N. Trinh; Son T. Do; Thuan T. Nguyen; Ruel T. Garcia; Tuan Nguyen; Quang Q. Phan; Huy A. Nguyen; Khanh K. Nguyen; Long H. Nguyen; Mindie H. Nguyen.
Gastroenterology, Volume 134, Issue 4, Pages A-312, April 2008, Authors:Philip S. Tsang; Ruel T. ... more Gastroenterology, Volume 134, Issue 4, Pages A-312, April 2008, Authors:Philip S. Tsang; Ruel T. Garcia; Huy N. Trinh; Jeanine Phan; Nghiem B. Ha; Huy A. Nguyen; Khanh K. Nguyen; Emmet B. Keeffe; Mindie H. Nguyen.
Gastroenterology, Volume 134, Issue 4, Pages A-309, April 2008, Authors:Long H. Nguyen; Nghiem B.... more Gastroenterology, Volume 134, Issue 4, Pages A-309, April 2008, Authors:Long H. Nguyen; Nghiem B. Ha; Philip Vutien; Nghi B. Ha; Ruel T. Garcia; Huy N. Trinh; Huy A. Nguyen; Khanh K. Nguyen; Brian S. Levitt; Emmet B. Keeffe; Mindie H. Nguyen.
Biliary complications occurred more frequently in the LRD group (54% vs. 25%, P=0.08), while LRD ... more Biliary complications occurred more frequently in the LRD group (54% vs. 25%, P=0.08), while LRD patients were less likely to have an episode of AR (30% vs. 62%, P=0.04). Conclusions: In this single center report of 48 patients, patient and graft survival were similar between LRD and DD pediatric transplant recipients when patient status at transplant, waiting time, and graft type were taken into account. In contrast, LRD may offer an immunologic advantage, as the incidence of AR was significantly lower in LRD patients. These results are somewhat divergent from previous studies, and suggest that our understanding of the donor and recipient factors which influence patient and graft survival remains incomplete.
The liver stiffness measurement is a novel method which allows to evaluate indirectly and noninva... more The liver stiffness measurement is a novel method which allows to evaluate indirectly and noninvasively the liver fibrosis stage. The reproducibility of the method in patients with different fibrosis stage and in the different weight groups is still under discussion. Aim. To evaluate the reproducibility of transient elastography in patients of different weight and fibrosis stage groups. Methods. The liver stiffness measurements were performed to 187 consecutive patients who suffered from chronic liver diseases using FibroScan (EchoSens, France) equipment. Not less than 22 measurements during the examination were performed to each patient. We analyzed an intra-observer agreement between results of two series by 11 measurements using Intraclass Correlation Coefficient (ICC). Results. There were no statistically significant differences between medians of two series of measurements (N=187, M±s 9.35±7.32 for the 1st series vs 9.22±7.98 for the 2nd series, p=0.27). The Intraclass Correlation Coefficient for two series of measurements was excellent ICC=0.9887, 95%CI [0.985-0.992]. There was no statistical difference between ICCs for two series of measurements in patients with an excessive weight (BMI≥25 kg/m2, N=88) and normal weight (BMI<25 kg/m2, N=99)-0.9865 (95% CI [0.9794-0.9911]) vs ICC=0.9900 (95% CI [0.9851-0.9931]), p=0.3122. The intraobserver coefficients for patients with different liver fibrosis stage were as follows: F0-1-0.82 (N=107), F2-0.61 (N=36), F3-0.92 (N=13), F4-0.98 (N=31). Conclusions: Transient elastography is a reproducible technique for assessing liver fibrosis in patients with chronic liver diseases. The intraobserver agreement does not significantly depend on the patients' weight. The reproducibility of transient elastography is lower in patients with mild liver fibrosis stages.
Background Screening for hepatocellular carcinoma (HCC) has been shown to improve survival via ea... more Background Screening for hepatocellular carcinoma (HCC) has been shown to improve survival via earlier cancer detection. Although HCC screening is considered standard of care in the USA, little is known of the adherence to this practice, especially in a community setting. Aims Our primary goal was to evaluate adherence to HCC screening and to find predictors of screening adherence in a community setting. Our secondary objective was to determine the impact of screening on survival. Methods We studied a cohort of 557 consecutive patients at high risk for HCC: patients with cirrhosis and older chronic hepatitis B (CHB) patients without cirrhosis (C45 years old). Patients initiated screening 1/2001-1/ 2005 and were monitored C12 months to 12/2008 in two community gastroenterology clinics in Northern California. HCC screening was categorized into four groups based on combined frequency of serum alpha-fetoprotein and imaging: optimal, suboptimal, poor, and no screening. Results About 40.6% of our cohort received poor or no screening. Noncirrhotic CHB patients had worse screening than cirrhotic patients. Multivariate analysis revealed that patients with a greater number of clinical visits per year were 3.4 times more likely to have regular screening than patients with fewer clinical visits per year (P \ 0.001). There was a trend for association between HCC screening and greater access to curative treatment. Conclusion Since more frequent clinic visits is a strong independent predictor of improved screening adherence, regular routine clinic visits may help improve adherence to HCC screening, which may also lead to improved clinical outcomes.
To determine the yield of colonoscopy in a predominantly Asian American gastroenterology practice... more To determine the yield of colonoscopy in a predominantly Asian American gastroenterology practice in California from 8/2003 to 2/2005. A total 2,723 subjects were included: 87% were Asian and 13% were non-Asian. Advanced neoplasia prevalence was 12% in Asian men and 9% in non-Asian men (P = 0.21), and 8% and 7% in women (P = 0.62). Similar results were found in asymptomatic patients (13% and 13%, P = 0.99, for men; 8% and 6%, P = 0.46, for women). Factors associated with presence of advanced neoplasia were total number of polyps and presence of right-sided lesions. Asian men were more likely to have neoplasia overall compared with non-Asian men with odds ratio (OR) of 2.14 (1.23-3.72); however, there were no significant differences in the prevalences of advanced neoplasia in the two groups. Colorectal neoplasia is as prevalent in Asian Americans and preventive guidelines for colorectal cancer should also be advocated for this ethnic group.
The dose recommendation for entecavir (ETV) is 0.5 mg daily for treatment-naïve chronic hepatitis... more The dose recommendation for entecavir (ETV) is 0.5 mg daily for treatment-naïve chronic hepatitis B (CHB) patients and 1.0 mg daily for lamivudine-refractory patients; however, few data are available for the efficacy of a 1.0-mg daily dose in treatment-naïve CHB patients. Our goal is to examine the treatment outcome of treatment-naïve patients placed on ETV 0.5 mg or ETV 1.0 mg daily through week 48. Cases were 40 consecutive hepatitis B e antigen (HBeAg)-positive CHB patients treated with ETV 1.0 mg daily between January 2005 and September 2010, and controls were 40 consecutive CHB patients treated with ETV 0.5 mg daily between January 2005 and September 2010 at three US gastroenterology/liver clinics. Controls were matched for age (±5 years), sex, HBeAg, and baseline hepatitis B virus (HBV) DNA (±0.5 log10 IU/ml). Complete viral suppression was defined as undetectable HBV DNA by polymerase chain reaction…
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