Annals of hepatology最新文献

{"title":"LONGITUDINAL CHANGES IN STEATOTIC LIVER DISEASE SUBTYPE CLASSIFICATION AND SUBSEQUENT RISK OF MAJOR ADVERSE LIVER OUTCOMES","authors":"Pedro Raul Ochoa Allemant ,&nbsp;Douglas Schaubel ,&nbsp;David Kaplan ,&nbsp;Marina Serper","doi":"10.1016/j.aohep.2025.102004","DOIUrl":"10.1016/j.aohep.2025.102004","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Steatotic liver disease (SLD) includes metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), and their intersection (MetALD). SLD subtype classification may change over time; however, the impact of these transitions on major adverse liver outcomes (MALO) is unknown.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective study of adults with imaging-confirmed steatosis (n=270,302) in the Veterans Health Administration (2010-2021). The primary exposure was change in SLD subtype classification between cohort entry (steatosis on imaging) and a 2-year landmark. The primary outcome was incident MALO (cirrhosis, decompensation, HCC, transplant, liver-related death). We calculated incidence rates per 100 person-years and multivariable cause-specific Cox regression models to examine the magnitud of the association between changes in SLD subtype and subsequent MALO.</div></div><div><h3>Results</h3><div>At the 2-year landmark, 8.2% of those with baseline MASLD were reclassified to MetALD or ALD, 34.2% of those with baseline MetALD were reclassified to MASLD or ALD, and 64.0% of those with baseline ALD were reclassified to MASLD or MetALD. Among baseline MASLD, the risk of MALO was higher for those reclassified to MetALD (HR 1.55;95% CI 1.40-1.71) or ALD (HR 2.13;95% CI 1.66-2.74) compared with those who remained MASLD. Among baseline MetALD, the risk of MALO was lower for those reclassified to MASLD (HR 0.55;95% CI 0.48-0.64) and higher for those reclassified to ALD (HR 1.80;95% CI 1.58-2.06) compared with those who remained MetALD. Among baseline ALD, the risk of MALO was lower for those reclassified to MASLD (HR 0.31;95% CI 0.21-0.46) or MetALD (HR 0.82;95% CI 0.70-0.96) compared with those who remained ALD.</div></div><div><h3>Conclusions</h3><div>Changes in SLD subtype classification are associated with distinct MALO risks.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102004"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"METABOLIC ASSOCIATED STEATOTIC LIVER DISEASE-RELATED SIGNIFICANT AND ADVANCED FIBROSIS' PREVALENCE IN BRAZIL AND THE ASSOCIATED ACCURACY OF FIB-4 AND VIBRATION-CONTROLLED ELASTOGRAPHY - A NATIONAL REGISTER","authors":"Cristiane Alves Villela-Nogueira ,&nbsp;Cristiane Valle Tovo ,&nbsp;Nathalie Carvalho Leite ,&nbsp;Mário Reis Álvares-da-Silva ,&nbsp;Claudia Alexandra Ivantes ,&nbsp;Claudia Alves Couto ,&nbsp;Giovanni Faria Silva ,&nbsp;Edson Roberto Parise ,&nbsp;Ana Carolina Cardoso ,&nbsp;Natalia Ballassiano Wajsbrot ,&nbsp;Luis Fernando Ferreira ,&nbsp;Muriel Manica ,&nbsp;Gabriela Perdomo Coral ,&nbsp;Matheus Michalczuk ,&nbsp;Rafael Biesek Novaes ,&nbsp;Brian Vinícius Batista Pinheiro ,&nbsp;Rosangela Réa ,&nbsp;Luciana Costa Faria ,&nbsp;Fernando Gomes Romeiro ,&nbsp;Leila Priscilla Pinheiro da Silva ,&nbsp;Claudia P.M.S. Oliveira","doi":"10.1016/j.aohep.2025.101991","DOIUrl":"10.1016/j.aohep.2025.101991","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Recent data regarding the prevalence of significant and advanced MASLD-related fibrosis in Brazil is unknown. We aimed to evaluate the prevalence of significant (SF, F≥2) and advanced (AF, F≥F3) fibrosis according to its different geographic regions, and the accuracy of FIB-4 and liver elastography by VCTE (Fibroscan, Echosens, Fr) for the diagnosis of SF and AF respectively.</div></div><div><h3>Patients and Methods</h3><div>This was a sectional study in ten Brazilian University Centers (Southeast, n=6; Northeast, n=1; South, n=3). Demographic, clinic, laboratory, liver stiffness measurement by VCTE (Fibroscan®, Echosens, Fr), and liver biopsy (LB) results were registered. The AUROCs for FIB-4 and VCTE regarding SF and AF were plotted with LB as a reference.</div></div><div><h3>Results</h3><div>2905 patients were included (53% women, 64% white, 51 ± 14 yrs, 44% T2DM) According to LB (n=2122), most form the South (72%; p&lt;0.001), 75% were F0-F1, 12% F2, 9% F3 and 4% F4. Most data from VCTE are from Southeast (n = 1084, 85%). LSM&lt; 8 kPa, between 8 and 12 kPa and ≥ 12 kPa was observed in 44%, 25% and 31% of patients. Most patients from the Southeast region presented a LSM ≥ 12 kPa (p = 0.01). FIB-4 score was &lt;1.3 in 81% of patients. For F3, the AUROC for FIB-4 and LSM were 0.75 (95% CI: 0.70-0.80; p&lt;0.01) and 0.72 (95% CI: 0.68-0.77; p&lt;0.01) respectively and for F2, 0.67 (95% CI: 0.62-0.72; p&lt;0.01) for FIB-4 and 0.64 (95% CI: 0.60-0.69; p&lt;0.01) for VCTE.</div></div><div><h3>Conclusions</h3><div>Most MASLD patients with AF are from the Southeast. VCTE is primarily available in the Sotheast, affecting the stepwise fibrosis stratification of MASLD in other regions and justifying the higher proportion of LB in the South. The accuracy of FIB-4 and liver elastography by Fibroscan® is good for diagnosing AF, but not for SF.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101991"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INFLUENCE OF GLYCEMIC CONTROL ON THE SEVERITY OF HEPATIC STEATOLOGY IN PATIENTS WITH TYPE 2 DIABETES MELLITUS","authors":"Yenni Joseline Cruz Ramírez ,&nbsp;Reyna Sarai Velez Ramirez ,&nbsp;Luis Erick Cardona Rodriguez ,&nbsp;Mayra Virginia Ramos Gómez","doi":"10.1016/j.aohep.2025.101977","DOIUrl":"10.1016/j.aohep.2025.101977","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Type 2 diabetes mellitus (T2DM) has a prevalence of 18.3% in Mexico and is associated with metabolic dysfunction-associated steatotic liver disease (MASLD), which has a prevalence of 30%.Considering glycosylated hemoglobin (HbA1c) a relevant biomarker in the evaluation of glycemic control.</div><div>The objective of the study was to analyze the association between HbA1c levels and the degree of hepatic steatosis in patients with type 2 diabetes mellitus (DM2).</div></div><div><h3>Materials and Methods</h3><div>Observational, descriptive, and retrospective study in 90 patients over 18 years old with DM2 attended in the outpatient gastroenterology clinic at a tertiary care center, between February 2024 and February 2025.All patients underwent hepatic elastography using FibroScan® and HbA1c determination. Using non-parametric statistics (Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U with Bonferroni correction).</div></div><div><h3>Results</h3><div>The patients were compared according to the degree of hepatic steatosis and the levels of (HbA1c), and a statistically significant difference was observed (Kruskal-Wallis, H=9.75, p = 0.008), indicating differences in glycemic control in 2 groups. The average HbA1c ranges were: grade I hepatic steatosis 39.42%; grade II, 64.00%; and grade III 51.96%.suggesting a progressive increase in HbA1c as the severity of hepatic steatosis increases. The post hoc analysis using the Mann-Whitney U test, with Bonferroni correction, revealed significant differences between patients without steatosis and those with grade II steatosis (p = &lt;0.005).</div></div><div><h3>Conclusions</h3><div>Patients with type 2 diabetes who have moderate or severe hepatic steatosis show worse glycemic control compared to patients without steatosis or with mild steatosis.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101977"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFECTS OF MELATONIN AND PHYSICAL EXERCISE ON SECONDARY BILIARY CIRRHOSIS","authors":"Marilda da Silva Brasil ,&nbsp;Elizângela Gonçalves Schemitt ,&nbsp;Sandielly Rebeca Benitez da Fonseca ,&nbsp;Gabriela dos Santos Martins ,&nbsp;Millena de Oliveira Engeroff ,&nbsp;Giorgia Assoni ,&nbsp;Lorenzo Cercal Britto ,&nbsp;Cláudio Augusto Marroni ,&nbsp;Norma Possa Marroni","doi":"10.1016/j.aohep.2025.101973","DOIUrl":"10.1016/j.aohep.2025.101973","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Cirrhosis is characterized by the formation of septa and fibrotic nodules in the liver parenchyma, and it is a relevant public health problem. Bile duct ligation (BDL) is an effective experimental model for inducing secondary biliary cirrhosis. Melatonin (MLT) has antioxidant, antifibrotic, and cytoprotective properties. Physical exercise (EX) has shown beneficial effects in different diseases.</div><div>To investigate the effects of MLT and EX on BDL-induced biliary cirrhosis in rats.</div></div><div><h3>Materials and Methods</h3><div>The study, was approved by CEUA/HCPA (2021-0642). We used 26 male Wistar rats (60 days, ±350g), distributed into four groups: CO, BDL, BDL+MLT, and BDL+EX. BDL was performed on day 1 in the experimental groups. From the 15th day onwards, MLT (20 mg/kg/day) was administered and the swimming protocol was started. On the 29th day, blood (for analysis of AST, ALT and FA) and liver were collected. Data were analyzed by One-Way ANOVA with Student-Newman-Keuls post-test (mean±SE; p&lt;0.05).</div></div><div><h3>Results</h3><div>AST, ALT and FA were increased significantly in the LDB group vs. CO (p&lt;0.05), with reduction in the LDB+MLT and LDB+EX groups (p&lt;0.05). The Picrosirius staining indicated intense fibrosis in the LDB group, this effect was attenuated by treatments. GPx activity was reduced in the LDB group (p&lt;0.01), but increased with MLT and EX. CAT increased in the LDB group and decreased with treatments (p&lt;0.05). Nitric oxide levels increased in the LDB group and decreased with MLT.</div></div><div><h3>Conclusions</h3><div>MLT and EX promoted protective effects in the liver of rats with biliary cirrhosis, attenuating biochemical, oxidative and fibrotic changes.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101973"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ARTIFICIAL INTELLIGENCE FOR SURVIVAL PREDICTION IN HEPATOCELLULAR CARCINOMA: DEVELOPMENT AND VALIDATION OF A CLINICAL DATA–DRIVEN MODEL IN A COHORT OF 129 PATIENTS","authors":"Giovane Carvalho Viola ,&nbsp;Rodolfo Viola ,&nbsp;Renato Altikes ,&nbsp;Claudia Tani ,&nbsp;Flair Carrilho ,&nbsp;Lisa Saud ,&nbsp;Mário Pessoa ,&nbsp;Aline Chagas ,&nbsp;Regiane Alencar ,&nbsp;Claudia Oliveira","doi":"10.1016/j.aohep.2025.101974","DOIUrl":"10.1016/j.aohep.2025.101974","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>To develop and validate a predictive survival model for patients with hepatocellular carcinoma (HCC) associated with metabolic dysfunction–associated steatotic liver disease (MASLD), using artificial intelligence applied to widely available clinical and laboratory data. Additionally, to compare the model’s performance with traditional prognostic scores commonly used in HCC risk stratification.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included 129 patients with confirmed HCC and underlying MASLD. Clinical, laboratory, and tumor-related variables were analyzed, including metabolic comorbidities, liver function markers, tumor burden, cirrhosis-related complications, and established prognostic scores (Child-Pugh, FIB-4, and ALBI). The predictive model was built using Cox proportional hazards regression with L2 regularization to manage high-dimensional data and minimize overfitting. The XGBoost (Extreme Gradient Boosting) algorithm was implemented, with random allocation of the dataset into a training cohort (80%) and an internal validation cohort (20%). DeepSurv, a deep learning–based survival model, was also explored as a complementary strategy.</div></div><div><h3>Results</h3><div>The regularized Cox model demonstrated robust predictive performance, achieving a concordance index (C-index) of 0.774 in the validation cohort. The variables most strongly associated with reduced survival included tumor thrombosis (HR 8.27), hepatic encephalopathy (HR 4.66), and spontaneous bacterial peritonitis (HR 6.51), all statistically significant. The proposed model outperformed widely used prognostic scores such as BCLC, CLIP, and ALBI, showing superior discriminative ability for survival prediction in patients with HCC-MASLD.</div></div><div><h3>Conclusions</h3><div>The AI-based model, built using easily accessible clinical and laboratory data, demonstrated superior performance in predicting survival in patients with HCC-MASLD. This approach enables more precise and scalable risk stratification, with direct applicability in real-world clinical practice.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 101974"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FROM POLICY TO PRACTICE: HEPATITIS C CARE INDICATORS IN URUGUAY BEFORE AND AFTER THE INTRODUCTION OF PUBLIC HEALTH STRATEGIES","authors":"Victoria Mainardi ,&nbsp;Susana Cabrera ,&nbsp;Luciana Noble ,&nbsp;Daniela Olivari ,&nbsp;Solange Gerona ,&nbsp;Sebastian Marciano ,&nbsp;Huaiyang Zhong ,&nbsp;Julio Medina","doi":"10.1016/j.aohep.2025.102040","DOIUrl":"10.1016/j.aohep.2025.102040","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Uruguay has implemented measures since 2022 to strengthen its hepatitis C response, aligned with WHO’s 2030 elimination targets. These include national guidelines and awareness campaigns. In July 2024, two key policies were introduced: the inclusion of HCV RNA testing in the national health plan and a one-time anti-HCV screening during mandatory health exams for work and physical activity, initially targeting individuals aged 56–64.</div><div>We aimed to assess differences in the national hepatitis C cascade of care before and after the implementation of these public policies.</div></div><div><h3>Materials and Methods</h3><div>Data were collected through structured surveys sent by the Ministry of Health to all 44 national healthcare providers. Cascade indicators were analyzed for 2022, 2023 and 2024, including anti-HCV testing, seropositivity, HCV RNA testing, RNA positivity, and treatment initiation. All indicators were normalized per 100,000 users covered by respondents.</div></div><div><h3>Results</h3><div>In 2024, 29 healthcare providers responded (covering 90% of health system users). In 2022–2023, 22 providers reported laboratory indicators (35% coverage), while 25 reported treatment indicators (73%).</div><div>Anti-HCV testing rose from 2,883 in 2022 to 5,548 per 100,000 users in 2024. HCV RNA testing increased from 6.1 to 20.4, and treatment initiation from 2.6 to 4.9 per 100,000 users. Seropositivity remained stable (0.7%). Among anti-HCV–positive individuals, HCV RNA testing uptake increased from 37% in 2022 to 54% in 2024.</div></div><div><h3>Conclusions</h3><div>Improvements observed in the cascade of care align with the implementation of targeted hepatitis C policies, highlighting their potential role in supporting national elimination efforts.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102040"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FROM PATIENT TO EXPERT: EDUCATION FOR SELF-MANAGEMENT OF HEPATOCELLULAR CARCINOMA IN A CLINICAL EXCELLENCE PROGRAM","authors":"William Hernando Jiménez Mariño ,&nbsp;Angélica María Sanabria Jiménez ,&nbsp;María del Rosario Ariza de la Hoz ,&nbsp;Oscar Alfredo Beltrán Galvis ,&nbsp;María del Rosario Ariza de la Hoz ,&nbsp;María Cristina Torres Caro ,&nbsp;Diana Carolina Salinas Gómez ,&nbsp;Martín Garzón Jiménez ,&nbsp;Geovanny Hernández Cely ,&nbsp;Adriana Varón Puerta","doi":"10.1016/j.aohep.2025.102010","DOIUrl":"10.1016/j.aohep.2025.102010","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Education for patients and caregivers is essential to improve understanding of hepatocellular carcinoma, support self-management, and promote informed decisions. At Fundación Cardioinfantil, a structured educational program was implemented as part of the Clinical Excellence Program. This work aims to describe the program’s implementation, and the progress achieved in patient knowledge, treatment adherence, and continuity of care at home.</div></div><div><h3>Materials and Methods</h3><div>A descriptive, cross-sectional study was conducted to describe the educational process delivered to patients with hepatocellular carcinoma and their caregivers. Patients are initially assessed to determine their level of disease knowledge and classified into basic, intermediate, or advanced levels. Based on this, they receive a personalized education plan with printed materials and guided sessions. Progress is evaluated quarterly during follow-up visits to reinforce or adjust the intervention.</div></div><div><h3>Results</h3><div>Since its implementation, the program has provided education to 106 patients. Currently, 68% have progressed to intermediate or advanced levels, while 32% remain at the basic level, either because they are in the early stages of the program or awaiting the start of treatment. Among the 40 active patients, 28 have reached an advanced educational level, reflected in greater disease understanding, recognition of warning signs, and improved adherence reported during clinical follow-up.</div></div><div><h3>Conclusions</h3><div>Educational strategy implemented within the Hepatocellular Carcinoma Clinical Excellence Program has proven effective in empowering patients through a structured and personalized approach. The educational progress underscores the value of integrating education into clinical care, allowing patients to actively and confidently participate in managing their condition. This experience represents a replicable model that could be adapted to other chronic disease care initiatives, particularly in high-complexity healthcare settings across Latin America.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102010"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT OF DIRECT-ACTING ANTIVIRALS ON THE FIB-4 INDEX IN PATIENTS WITH CHRONIC HEPATITIS C AND SUSTAINED VIROLOGICAL RESPONSE.","authors":"Raúl Ramírez Marcial ,&nbsp;Scherezada María Isabel Mejía Loza ,&nbsp;María del Rosario Herrero Maceda ,&nbsp;Rodrigo Vázquez Pérez ,&nbsp;Oswaldo Pavel Cervantes Gutiérrez","doi":"10.1016/j.aohep.2025.102019","DOIUrl":"10.1016/j.aohep.2025.102019","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Fibrosis regression is associated with broad clinical benefits and remains an important therapeutic goal in patients with advanced fibrosis who achieve a sustained virological response (SVR) to hepatitis C virus (HCV) treatment. Studies conducted in Asia have reported fibrosis regression in 55% to 75% of patients. Currently, there are no published reports from studies conducted in our country.</div><div>Evaluate the impact of direct-acting antiviral (DAA) therapy on the Fib-4 index in patients with chronic hepatitis C who achieved a sustained virological response (SVR).</div></div><div><h3>Materials and Methods</h3><div>Patients were classified into two groups: non-cirrhotic (n=28) and cirrhotic (n=62). Pre- and post-treatment Fib-4 index values were collected and compared. The Wilcoxon signed-rank test, a non-parametric test, was used to compare pre- and post-treatment Fib-4 scores within each group. The Mann-Whitney U test was applied to compare whether the magnitude of change in the Fib-4 score differed between the non-cirrhotic and cirrhotic groups. A p-value of ≤ 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Both groups experienced a statistically significant reduction in post-treatment Fib-4 scores (p&lt;0.001). The magnitude of this reduction was significantly greater in the group of patients with cirrhosis compared to those without cirrhosis (p = 0.027). (See Figure 1).</div><div>Our study demonstrates that successful DAA therapy leads to a statistically significant reduction in the Fib-4 index in a Mexican cohort of patients with chronic HCV, a finding that is consistent with reports from other regions. This reduction in a key non-invasive marker suggests a regression of liver fibrosis or, at a minimum, a significant decrease in necroinflammatory activity upon viral eradication.</div></div><div><h3>Conclusions</h3><div>DAA therapy significantly reduces the Fib-4 score in patients with chronic HCV, regardless of the presence of cirrhosis. This demonstrates a favorable impact, thereby improving the prognosis for these patients.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102019"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EXPERIENCE IN THE TREATMENT OF HEPATITIS C IN PREGNANT PATIENTS AT THE HEPATITIS CLINIC OF THE VERACRUZ HIGH SPECIALTY HOSPITAL","authors":"Maria Teresa Guzmán Terrones ,&nbsp;Eve Flynn Ferreira ,&nbsp;Luis Del Carpio Orantes ,&nbsp;Raúl Terrones Castro","doi":"10.1016/j.aohep.2025.102002","DOIUrl":"10.1016/j.aohep.2025.102002","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Currently, HCV treatment options during pregnancy are not well-defined. Typical clinical practice is to refer and link pregnant women for treatment after pregnancy and breastfeeding; however, in practice, very few have completed successful treatment. To date, three case series have been published that include safety results for HCV treatment in pregnancy. ACOG recommends that DAAs be initiated only through a clinical trial and that pregnant women while taking a DAA should be counseled about the risks and benefits of continuing treatment.</div><div>To report the experience of the HAEV Hepatitis Clinic with the treatment of 3 pregnant women with HCV on DAAs during the second half of pregnancy with sustained viral response (SVR) and no adverse effects to the combination to date.</div></div><div><h3>Patients and Methods</h3><div>Since 2021, three cases of pregnant women with HCV infection confirmed by viral load have been presented. After evaluation and categorization as F0-F1 by FIB 4, they were treated with Sofosbuvir-Velpatasvir 400/100 mg for 90 days</div></div><div><h3>Results</h3><div>Patients were treated with Sofosbuvir-Velpatasvir 400/100 mg for 90 days, with no reports of perinatal abnormalities. The subsequent negative viral load was achieved in the pair. Only one patient reported headache and dizziness as adverse symptoms. After monitoring, a planned termination of pregnancy was decided to reduce the risk of vertical transmission, and counseling on proper breastfeeding techniques was provided to discontinue breastfeeding.</div></div><div><h3>Conclusions</h3><div>Sofosbuvir-Velpatasvir was administered for 12 weeks without adverse effects on the pair, and SVR was achieved at the time of treatment in the three treated patients, demonstrating the effectiveness and safety of the treatment. This provides a solution to a public health and maternal-fetal problem in our setting, which prevents perinatal transmission. Following these results, we propose evaluating its use in similar cases with the intention of contributing to the eradication of HCV infection.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102002"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NURSING CARE STRATEGIES FOR INDIVIDUALS WITH VIRAL HEPATITIS IN THE CONTEXT OF PRIMARY HEALTH CARE","authors":"Joao Vítor da Silva Mota ,&nbsp;Ana Paula Maciel Gurski ,&nbsp;Carla Francisca dos Santos Cruz ,&nbsp;Mario Peribanez Gonzalez ,&nbsp;Elton Carlos de Almeida ,&nbsp;Aline Alves da Silva ,&nbsp;Ana Mônica de Mello ,&nbsp;Nathalia da Silva Cruz ,&nbsp;Isabelle Cristine de Jesus Macedo ,&nbsp;José Nilton Neris Gomes ,&nbsp;Leonardo Carrara Matsuura","doi":"10.1016/j.aohep.2025.102045","DOIUrl":"10.1016/j.aohep.2025.102045","url":null,"abstract":"<div><h3>Introduction and Objectives</h3><div>Nursing professionals play an important role in the prevention, diagnosis, and care of viral hepatitis in Primary Health Care. Understanding nursing practices is essential to strengthening disease elimination strategies.</div><div>To identify nursing actions in the care of people with viral hepatitis in the context of Primary Health Care.</div></div><div><h3>Materials and Methods</h3><div>Data were collected through a form developed by the General Coordination for the Surveillance of Viral Hepatitis and the Federal Nursing Council, sent to nursing professionals in Brazil. The data were then tabulated, entered into an electronic database, and analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>The sample consisted of 1,573 participants. It was found that 91.3% of nursing professionals assess users' vaccination status. However, 71.3% of nurses reported never having requested viral load or molecular tests for viral hepatitis, although 83.6% stated that doing so would simplify diagnosis and patient referrals. Regarding complementary exams, 42.8% of nurses had never made such requests, despite recognizing they have legal support based on established clinical protocols. Additionally, 47.6% acknowledged that allowing nurses to request viral load and complementary tests would simplify diagnosis and referrals, highlighting the need for training to support this role.</div></div><div><h3>Conclusions</h3><div>Nursing plays a strategic role in eliminating viral hepatitis within Primary Health Care. Ongoing training and professional empowerment are essential to expand access, overcome barriers, and implement the actions outlined in Technical Note 369/2020 at the local level.</div></div>","PeriodicalId":7979,"journal":{"name":"Annals of hepatology","volume":"30 ","pages":"Article 102045"},"PeriodicalIF":4.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145154241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}