From November 15-19, 2024, the 75th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) was held in San Diego, USA. At this prestigious event, Dr. Liang Peng’s team from the Third Affiliated Hospital of Sun Yat-sen University presented four studies, including one oral presentation and three poster presentations. The research covered various topics, such as chronic hepatitis B (CHB) and hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF), showcasing significant advancements in infectious diseases research from China and drawing widespread attention. Hepatology Digest brings you an exclusive report.Study 1: Personalized Nutritional Support for HBV-ACLF Patients at Nutritional Risk: Preliminary Findings from a Randomized Controlled Trial
Authors: Zhipeng Li, Peipei Wang, Wenxiong Xu, Chan Xie, Liang Peng
Malnutrition is a prevalent issue in HBV-ACLF patients, impacting quality of life and survival. This study assessed a novel nutritional intervention in an open-label RCT. HBV-ACLF patients at nutritional risk were randomized to receive either personalized nutritional support or standard hospital meals for 10 days. The intervention targeted 1.2 times resting energy expenditure and 1.2 g/kg/day of protein. Primary endpoints were 30-day and 90-day non-transplant-related mortality. As of May 2024, 20 patients were evaluated. While differences in mortality and adverse outcomes were not statistically significant, the intervention group showed improved mid-arm circumference (P=0.003) and muscle circumference (P=0.183) compared to the control group. No severe adverse events related to the intervention were reported. Preliminary findings suggest potential benefits of personalized nutritional support in HBV-ACLF patients, with significant improvements in muscle parameters. Further results are awaited.
Study 2: Innate Immunity Drives Virological Response to TAF in HBeAg-Positive, ALT-Normal Chronic HBV Infection
Authors: Qiumin Luo, Wenxiong Xu, Yeqiong Zhang, Chan Xie, Liang Peng
This RCT enrolled HBeAg-positive patients with high HBV DNA and normal ALT, no cirrhosis/liver cancer history. After 48 weeks of tenofovir alafenamide (TAF), patients were categorized as virological responders (VR) or low-level viremia (LLV). PBMCs from three VR and three LLV patients underwent single-cell transcriptome sequencing. Analysis identified seven cell types, with NK and NKT cells predominant in the VR group. Specific NK and NKT subsets showed increased activity in the VR group, and 15 upregulated genes were identified, related to lipid metabolism and protein translation. Innate immunity may be key in promoting virological response during TAF treatment in this patient group. Further research is needed.
Study 3: Impact and Cost-Effectiveness of a Hospital-Based Hepatitis B Screening Program in China: A Mathematical Modeling Study
Authors: Jia Chen, Qiumin Luo, Hanting Liu, Bo Zhang, Jinghua Li, Liang Peng
In 2022, China’s Third Affiliated Hospital of Sun Yat-sen University launched the “Hot Wave Program” to improve hepatitis B management. A study used a model to project the program’s impact and cost-effectiveness in Guangzhou from 2023-2030. Scaling the program to 80% screening coverage could prevent 57,745 new infections and 2,405 deaths. Combined screening and vaccination was most cost-effective, with an average cost per QALY of $10,754. Increased screening reduced healthcare costs. The program is cost-effective and recommended for broad implementation to accelerate hepatitis B elimination in China.
Study 4: Cost-Effectiveness of DPMAS+LPE Versus PE for Early HBV-ACLF
Authors: Jia Chen, Qiumin Luo, Lu Wang, Lihua Zheng, Yeqiong Zhang, Ying Liu, Wenxiong Xu, Liang Peng
This retrospective study compared DPMAS+LPE to plasma exchange (PE) in 215 early HBV-ACLF patients. After matching, 101 patients were in each group. DPMAS+LPE showed higher 30-day survival (99.01% vs. 97.01%) and was cost-effective, especially for patients with PTA 30%-40%. DPMAS+LPE is a cost-effective option for improving 90-day survival in early HBV-ACLF patients within this PTA range.
