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Background & Aims Fewer data exist on neuro-mental development after fetal exposure to telbivudine. We investigated the developmental consequences of infants from mothers that received telbivudine treatment for chronic hepatitis B (CHB). Methods CHB mothers with high viral load at gestational week 28 were assigned to receive either telbivudine (LdT) or usual care without antiviral therapy, based on the mothers' preference. Their infants were followed for 52 weeks to assess physical and neuro-metal development with Gesell Developmental Schedule tools. Developmental consequences were compared between the two groups. Results Among 258 mothers enrolled, 159 and 99 in the telbivudine-treated and the non-treated group, respectively. The mean duration of telbivudine therapy for the treatment group was 12.31 ± 1.02 weeks. When compared to the control group, infants at the treated-group at the age of 52 weeks had similar neuro-mental development outcomes regarding Gesell Developmental Schedule scores for gross motor (p = 0.55), fine motor (p = 0.31), adaptive (p = 0.10), linguistic (p = 0.97), and personal social (p = 0.52) domains; their physical parameters were also comparable, which included mean height (77.83±3.31 vs. 77.55±3.03 cm; p=0.51) and mean body weight (and 10.59±1.14 vs.10.57±1.19 kg; p=0.89). However, the vertical transmission rates were slightly higher in the control group (3.19% [3/94] vs. 0% [0/150]; p=0.056). Multivariate logistic regression suggested that telbivudine did not associated with negative developmental consequences. Conclusions The developmental consequences of prenatal telbivudine exposure were comparable to those without the exposure in one year observation. We now know that Telbivudine therapy is safe for hepatitis B mothers during pregnancy; ClincialTrials.gov number, NCT02301650.

Background and Aims: Previously we reported increased HBV suppression, ALT normalization, and improved renal function with TAF treatment. However, certain patients that would potentially benefit from switching to TAF, e.g. with impaired renal function, remained on non-TAF therapies. Here we further examined variables associated with TAF adoption from approval (Nov 2016) to Dec 2018.
Method(s): Patients enrolled in the TRIO HBV registry from 6 academic and 4 community centers in the US were included in this study. TAF initiation was assessed using Kaplan-Meier methods with subsequent log-rank tests. Overall TAF initiation rates were compared using z-tests.
Result(s): Study population (n = 1037): predominantly male (599, 58%), Asian (887, 86%), <60 years old (700, 68%), from academic centers (611, 59%), with HBV DNA suppression (951/1035, 92%), and receiving tenofovir disoproxil fumarate (TDF [640, 62%]) at enrollment. A history of HCC (inactive) was present for 2% (25) patients, 4% (44) fatty liver, 10% (103) diabetes, 13% (131) hyperlipidemia, 23% (237) hypertension, and 8% (78) osteopenia/osteoporosis. At enrollment, 5% (48/965) had FIB4 >3.25, 6% (65/1030) had eGFR <60 ml/min, and 29% (304/1035) had elevated ALT (>25 U/L in females or >35 U/L in males). In the study window, 396 (38%) patients initiated TAF. Adoption was significantly higher in patients receiving TDF at enrollment (52% v. 12% non-TDF, p < 0.001), at community practices (56% v. 25% academic, p < 0.001), and without HCC history (39% v. 8%, p = 0.005), fatty liver (39% v. 8%, p < 0.001), or hyperlipidemia (39% v. 28%, p = 0.005). Adoption was not significantly different by age, insurance type, osteopenia/osteoporosis, eGFR, FIB4, or ALT. [Figure] Reasons for initiating TAF were provided for 365/396 patients: 66% (241/365) indicated safety/side effects, 27% (99/365) physician preference, and 6% (21/365) efficacy.
Conclusion(s): Safety/side effects was stated as a primary reason for initiating TAF, yet osteopenia/osteoporosis, suboptimal eGFR, ALT, or FIB4 were not associated with significantly higher TAF adoption. These data suggest that prevention, rather than observation of detrimental clinical measures, accounted for most TAF adoption. Most patients with renal or bone disease were not switched to TAF which may be due to access, an issue which will be further explored.
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Background and Aims: TAF provides similar efficacy to tenofovir disoproxil fumarate (TDF) but with an improved safety profile particularly for bone loss and renal injury. However, continued benefit with longer-term TAF has not been sufficiently studied. Here we evaluate virologic suppression rates, eGFR, fibrosis, and ALT at 48+ weeks of TAF therapy in US clinical practice.
Method(s): TRIO has developed a national HBV network consisting of 6 academic and 4 community-based centers serving 17 US States to understand real-world HBV treatment. Of the 1037 patients enrolled from Jan 2017,270 patients initiated TAF and remained on therapy for 48+ weeks as of Jan 2019. Lab measurement data at baseline and at or after (but nearest) 48 weeks of TAF therapy were collected. Elevated ALT was defined as >35 U/L for males and?>25 U/L for females, HBV suppression was assigned for HBV DNA measures <=2000 IU/ml. Comparisons between baseline and 48-week measures were made using McNemar's test (for dichotomous variables), Bowker's test (for multi-level variables) or t-test (for continuous variables). To identify variables associated with elevated ALT, eGFR >0 ml/min, or FIB4 >1.45 at 48 weeks, logistic regressions were conducted with adjustments for multicollinearity of variables.
Result(s): The study population (n = 270) was mostly male (59%), Asian (89%), and under or normal weight (60%) with a mean age of 53 years. Prior to initiating TAF, 81% of the patients received TDF, 8% entecavir, 6% were treatment naive, 2% TDF/emtricitabine, 1% lamivudine, and 1% adefovir dipivoxil. As of Jan 2019, mean (median) TAF duration was 508 (512) days and ranged from 338 to 803 days. In paired analyses (Table), statistically significant changes were reduced mean ALT and increased DNA suppression; changes in FIB4 and eGFR were not significantly different between baseline and 48 weeks. Variables associated with elevated ALT and eGFR >0 ml/min at 48 weeks were baseline elevated ALT (p < 0.001) and baseline eGFR >0 ml/min (p < 0.001), respectively. For FIB4?>1.45 at 48 weeks, significantly associated variables were baseline FIB4 >1.45 (p < 0.001) and Medicare as primary coverage (p = 0.010, collinear with Age >=50).
Conclusion(s): This study of HBV-infected individuals receiving TAF for 48+ weeks found that statistically significant improvements occurred in ALTand HBV DNA suppression. Continued monitoring is ongoing to understand changes in these and other measures with longer term TAF.
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Background and Aims: Recent studies demonstrate that the population with CHB is aging. Tenofovir alafenamide (TAF) is a first-line treatment for chronic hepatitis B virus infection (CHB), particularly in those at risk for TDF-associated bone and renal effects, including patients with advanced age. We reviewed our experience in the subset of geriatric CHB patients participating in ongoing TAF clinical trials.
Method(s): Included were patients age >=65 y treated with TAF in 3 large Phase 3 trials (pooled analysis of viremic patients naive to TAF in Studies 108 and 110, and suppressed patients switched from TDF to TAF [vs continued TDF] in Study 4018), and data from a single arm Phase 2 study in virally suppressed patients with renal and/or hepatic impairment switched to TAF from TDF and/or other antivirals (Study 4035). Efficacy (HBV DNA >9 or >0 IU/mL) and safety (adverse events [AEs], serious AEs, changes in hip and spine bone mineral density [BMD] and changes in creatinine clearance [eGFRCG]) were assessed for older (>=65 y) vs younger (>5 y) patients. In Studies 108, 110, and 4018, results for TDF in patients >=65 y were also determined for comparison.
Result(s): A total of 124 patients >=65 y were included, representing 6.5% of all enrolled patients. Other than age, decreases in renal/bone parameters, and increased comorbidities, the older and younger groups were generally similar. Efficacy and safety results are summarized in the Table. Rates of virologic suppression was comparable in geriatric vs non-geriatric patients treated with TAF. Overall, AEs and SAEs were similar between older vs younger patients; there were no Grade 3/4 AEs related to study drug in patients >=65 y. Compared with younger patients, declines in eGFRCGand hip/spine BMD were greater in viremic older patients; however, the decreases were less than in older patients on TDF. In suppressed patients, eGFRCGincreases were greater in younger vs older patients receiving TAF, while changes in hip and spine BMD were similar; TDF treatment resulted in declines in BMD and eGFRCG.
Conclusion(s): The efficacy and safety of TAF in geriatric CHB patients were generally similar to younger patients. Small improvements in renal and bone parameters can be seen in older patients switched from TDF to TAF.
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When alcohol-related liver disease occurs, the number and composition ratio of intestinal microorganisms will accordingly change. The alcohol-induced changes in the intestinal microbiota play a pivotal role in the process of developing the alcohol-related liver disease through the translocation of microbial products due to increased intestinal permeability. In recent years, therapeutic interventions with a concentration on regulating intestinal microbiota have been conducted for patients with alcohol-related liver disease. We aimed to provide a critical review and updates on the prevention and treatment of alcohol-related liver disease through regulating intestinal microbiota. A literature search was performed on the PubMed database for studies published in English about the therapeutic intervention with microbiota using animal models and patients with alcohol-related liver disease (1/2010-4/2020). The accumulating pieces of evidence suggest that the therapeutic use of probiotics, prebiotics, antibiotics, phages, or fecal microbial transplantation may have several influences on alcohol-related liver disease patients. Emergent data unveiled that these interventions can further regulate the composition of intestinal microbiota, minimize the negative impact of microbiota on the liver, and prevent disease progression from mild to severe alcoholic hepatitis, fibrosis, cirrhosis, or even liver cancer. The current review provides updates on the advances of therapeutic interventions with the effects of regulating intestinal microbiota on patients who have alcohol-related liver disease. In addition, the data gaps and research directions on further exploration of the role of intestinal microbiota for the management of the alcohol-related liver disease are also discussed.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

BACKGROUND:Data on tenofovir alafenamide fumarate (TAF) therapy for preventing mother to child transmission of hepatitis B virus (HBV) are lacking. AIMS/OBJECTIVE:To investigate the efficacy and safety of TAF therapy for preventing hepatitis B mother to child transmission. METHODS:Mothers with chronic HBV infection, positive for hepatitis B e-antigen and with HBV DNA >200 000 IU/mL received TAF for preventing mother to child transmission were enrolled retrospectively from multiple centres with data collection on mother-infant dyads up to postpartum week 24-28. Primary measurements were the mother to child transmission rate and infants' malformation rate. Secondary assessments included maternal HBV DNA reduction at delivery, and maternal or infant adverse events during follow up. RESULTS:Among 71 mothers enrolled, the mean (±SD) age was 30.3 (±2.2) years. TAF therapy was initiated during the second or third trimester and continued to delivery with a mean (±SD) duration of 12.8 (±4.0) weeks. At delivery, 85.9% (61/71) of the mothers achieved HBV DNA <200 000 IU/L. Seventy-three infants (two sets of twins) were born from mothers treated with TAF and none had congenital defects or malformations. All infants received HBV immunoglobulin and vaccine at birth with additional HBV vaccinations at one and six months. At age 24-28 weeks, all infants had negative hepatitis B surface antigen and undetectable levels of HBV DNA (<100 IU/mL). Body weight, height, and head circumferences were comparable to national standards for physical development. No severe adverse effects were reported in either mothers or infants. CONCLUSIONS:TAF for highly viraemic mothers effectively prevented mother to child transmission of hepatitis B. There were no safety concerns for either mothers or infants with 24-28 weeks of follow up.