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정숙향 ( Sook Hyang Jeong ) 대한내과학회 2015 대한내과학회지 Vol.88 No.6
The anti-hepatitis C virus (HCV) prevalence in South Korean adults is estimated to be 0.8%, suggesting that at least 290,000 people are HCV infected. HCV positivity increases with age and is slightly more prevalent in women than men. Among patients with chronic HCV infection, intravenous drug users comprise < 10%, which is a distinct epidemiological feature of Western data. HCV genotype is a critical factor determining treatment regimen and duration. The major HCV genotypes in Korea are genotypes 1 (mostly genotype 1b) and 2. A peculiar intra-national geographic difference in anti-HCV prevalence was seen, as higher prevalence was found in southern coastal areas, such as Busan and Jeonnam. This geographic difference in exposure to risk factors for HCV infection suggests that active recognition and treatment is a priority in the Jeolla area, and that active prevention is an urgent issue in Busan. Considering the low recognition of HCV disease and the high cure rate using current antiviral therapy, the inclusion of a HCV screening test in the national health check examination program for people 40 years of age should be considered. Further studies on the HCV disease burden are warranted in this direct acting antiviral era. (Korean J Med 2015;88:630-634)
정숙향 ( Sook-hyang Jeong ) 대한간학회 2016 간학회 싱글토픽 심포지움 Vol.2016 No.1
Treatment of hepatitis C virus (HCV) infection is now facing a breakthrough arising from successful development the direct acting antivirals (DAA). the treatment paradigm is rapidly shifting from interferon-based therapy to interferon-free, all oral DAA combination therapy, which lead to SVR rates of 90% with minimal adverse events and shorter duration of treatment for 12-24 weeks. As interferon-free, DAA against HCV were approved in Korea since 2015, the Korean Association for the study of the liver (KASL) revised the practice guideline of hepatitis C, which is now published on line at KASL home page. This paper presents the summary of the DAA treatment options and brief guide for DAAs therapy.
정숙향 ( Sook-hyang Jeong ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Treatment of hepatitis C virus (HCV) infection is now facing a breakthrough arising from successful development the direct acting antivirals (DAA). Pegylated interferon alpha and ribavirin combination therapy for 24-48 weeks was a longstanding standard therapy despite high rate of adverse events and relatively low efficacy, showing sustained virological response (SVR) rate of 60% in genotype 1 and of 80% in genotype 2 HCV infected patients in South Korea. The first approved DAA therapy in Korea was daclatasvir and asunaprevir combination therapy for 24 weeks in 2015 with expected SVR rate of 80-90%. It is reimbursed for HCV genotype 1b chronic hepatitis and compensated cirrhosis patients in whom resistance associated variation (RAV) was not detected in NS5A region of HCV genome (L31 or Y93 codon). The next approved DAA therapy is ledipasvir/sofosbuvir fixed dose combination in one tablet and only reimbursed for genotype non-1b patients with expected SVR rate of 90-99% using 12-24 week regimen with or without ribavirin since May 2016. For genotype 2 infection, sofosbuvir and ribavirin combination for 12 weeks is approved with expected SVR rate of 95%. Under the resource restraint, DAA therapy is strictly regulated by National Health Insurance (NHI). However, at least for genotype 1b patients with baseline NS5A RAV or with decompensated cirrhosis, ledipasvir/sofosbuvir or other new DAA therapy should be reimbursed by NHI. In addition to the high cost, drug-drug interactions, and development of resistance associated mutants in DAA therapy are problems to overcome.
정숙향 ( Sook Hyang Jeong ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.6
One of the major cause of recent acute viral hepatitis in Korean adults is hepatitis A virus (HAV) infection. Most of hepatitis A cases are young adults in their twenties or thirties, and the severity of the disease is related to the age of patients. The seroprevalence of HAV among the adolescents and young adults in their teens and twenties is about 10%, which suggests that a growing number of young adults are susceptible to HAV infection. Development of more adult cases with severe presentation is expected in the near future, and some preliminary data suggest the incidence rate of hepatitis A in Korea might be higher than 20/100,000 population. This clinical features and the epidemiological shift of HAV urge to promote childhood vaccination and consider catch-up vaccination for adolescents and young adults. More extensive evaluation on the nationwide epidemiology of HAV infection, cost-benefit analysis of HAV vaccination, and setting-up of guidelines for HAV vaccination are urgently warranted. (Korean J Gastroenterol 2008;51:331-337)
정숙향 ( Sook Hyang Jeong ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2(S)
Autoimmune liver disease is an undefined immune mediated attack to the hepatocyte, small intrahepatic bile ducts, and the entire biliary system leading to chronic inflammation and fibrosis. It includes autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), IgG4-associated cholangitis (IAC), and variant forms such as overlap syndrome. PBC, PSC and IAC are cholestatic diseases showing different clinical features, diverse serological profiles, and different therapeutic regimens. AIH is characterized by circulating autoantibodies, elevated immunoglobulins, and dramatic response to immunosuppression. Despite of distinction of two main disorders, some patients showed an overlap disease with mixed features of both disorders. To prevent the progression to the end stage liver disease, early and precise diagnosis and initiation of therapeutic measures are essential. Liver transplantation is indicated for the treatment refractory advanced cirrhosis. Further studies on the autoimmune liver diseases in Korea are warranted.
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정숙향 ( Sook-hyang Jeong ) 대한간학회 2016 임상연구방법론워크숍 Vol.2016 No.1
As rare liver diseases, only a few population-based epidemiology studies of primary biliary cholangitis (PBC) or Budd-Chiari syndrome (BCS) have been reported. The nationwide Health Insurance Review and Assessment Sevice claims data and Rare Intractable Disease registration data on PBC and BCS, identified with the International Classification of Diseases (ICD 10) code of K74.3 or I82.0, respectively, we identified all patients with PBC or BCS, and the age- and sex-adjusted incidence and prevalence of both diseases were separately calculated with analysis of complications and direct medical costs. These are the first population-based studies on the epidemiology and disease burden of PBC and BCS in South Korea.