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HBV Factors and Clinical Outcomes M Omata. Genotypes in China and Japan. West Asia. North East Asia. Miyakawa Y et al. Intervirology 2003. North East Asia. B and C. D. West Asia. Any Difference Between B and C. Born Infected. Natural Course HBV Infection. HBeAg-positive. ALT. - PowerPoint PPT Presentation
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HBV Factors
and
Clinical Outcomes
M Omata
Genotypes
in China and Japan
Miyakawa Y et al. Intervirology 2003
North East AsiaWest Asia
North East Asia
West Asia
B and C
D
Any Difference Between B and C
HBeAg-positive
Years
Born Infected ALT
Natural CourseHBV Infection
As with Flares
Years
eAg Seroconversion
ALT
HBeAg Seroconversion
When Induced Naturally?
This Timing of Seroconversion Varies
Any Differences among
Genotypes ?
HBV
Genotypes & Seroconversion
BJ McMahon
1158 Eskimos for 20.5 years
GASTROENTEROLOGY 2007
SE Livingston Gastroenterology 2007 in press
Genotype No. of patients
Age at time of HBeAg
clearance
A 34 19B 6 20C 36 48D 305 18F 126 16
Clearance of HBeAg in Alaskan natives
Genotype C is
Late Seroconverter
Relation to Liver Diseases
Yang HI, J Natl Cancer Inst 2008
Genotype and HCC
Genotype B
Genotype C
39/803 (4.9%)
40/358 (11.1%)
Age of HCC and Genotypes
20’s 30’s 40’s 50’s
Orito et al. Hepatology 2001
60’s >60
No. of Pt.
40
20
B
C
B
C
n=117
Ages
The longer period of
eAg-pos/high viral loadMay
Bring more PatietnsTo HCC
Genotype C
Interferon Effect and Genotypes
e Loss & Seroconversion
37%
51% 49%55%
60% 60%
40%
52% 52%58%
67% 69%
0
20
40
60
80
0 1 2 3 4 5
HBeAg seroconversion HBeAg loss
Perc
ent
Wong VW, et al. Hepatology. 2010;51:1945-1953
Yrs Post-Peg IFN
32%
14%
B C
HBeAg Clearance
Genotype & HBeAg Clearance
13/41
9/66
Interferon Therapy
Wai CT, Hepatology 2002Genotype B Genotype C
32%
14%
Buster EH, Gastroenterology. 2008
Interferon & HBsAg Clearance
Follow-up 3 years
0
10
20
30
40
50
60
70
80
Pro
port
ion
of i
niti
al r
esp
on
ders
(%)
Genotype C (n=9)Genotype B (n=7)
14%
HBsAg negative
0%
Response to PEG-IFN in HBeAg positive CHB
HBeAg Loss HBsAg Loss 2
1 Janssen, Lancet 2005; 2 Flink, Am J Gastro 2006
0
10
20
30
40
50
A n=90
28%
47%44%
25%
Bn=23
C n=39
D n=103
Per
cen
tag
e o
f p
atie
nts
(%
)
0
3
6
9
12
15
A n=90
3%
9%
2%
Bn=23
C n=39
D n=103
1814%
Per
cen
tag
e o
f p
atie
nts
(%
)
1
How About
Response
To Nucs ?
Nuc and Genotype
Kobayashi M, J Med Virol. 2006
0
20
40
60
80
100
0 24 48 96 144 >192
Weeks
HB
V D
NA
Cle
ared
(%)
84%
76%
47%
Genotype C (449)
Genotype B (38)
How about Human Genotype ?
Host Factors
IL28B in HBV infection ?
In hepatitis C, Strong AssociationIL28B gene and Response to PEG-IFN + RBV
IL28B Genotype Distribution
p<0.001
AA
AG GG
AA (and CC) predominates in
Asians
Sonneveld et al. Gastroenterology 2012 in press
AA
AG
GG
Asians (n=133)
Non-Asians (n=133)
Factors
Viral
Human
Genotypes
Adjusted for HBV genotype and baseline ALT and HBV DNA
33628824019214496480
80
60
40
20
0
AA
AG/GG
P=0.018
HB
eAg
Ser
oco
nve
rsio
n (
%)
weeks
IL28B PEG-IFN induced HBeAg & HBsAg Response
Sonneveld et al. Gastroenterology 2012
AG/GG
AA
P=0.042
33628824019214496480
10
8
6
4
2
0HB
sAg
Ser
ocl
eara
nce
(%
)
weeks
N=205
We, Asian, may have been infected by Tougher Virus,
but may haveFavorable Genotype for Treatment
But this is yet to be proven in larger Asian population
And including more SNPs
Interacting “Genotypes” may answer
many of un-answered questionsIn HBV infection
Studies for the Future
Nature Review GastroHepatol 2012;9:69-70
a big step forward
Nature Review GastroHepatol 2012;9:69-70
a big step forward
GWAS
Whole Genome Sequencing
Ion Proton
You can get 3 billionIn a day
3 billion AGCT
1979 2012
3000nt 3000000000nt
Central/Kita Hospitals
Greatly appreciate your patience
謝謝
Prof Q Ning
and
Staff
劇症肝炎 Pre-core Mutant
Omata M N Engl J Med 1991;324:1699-1704
Pre-core Mutant
7/9 Fulminant
0/10 Acute
Immediate Suppression of Virus Replication Badly Needed
6 4歳女性Omata K
NanoPore