Treatment Outcomes on Chronic Hepatitis C Virus in Mongolia

( S. Munkhdemberel ),( S. Ariunaa ),( L. Undram ),( J. Oyunbileg ),( O. Baatarkhuu ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Chronic HCV infection is a major cause of cirrhosis, hepatocellular carcinoma HCC), and liver transplantation in Mongolia. HCV disease progression modeling was used to quantify the future disease burden. Methods: HCV infection and related sequelae were tracked between 1950 and 2030. Baseline assumptions were extracted from the literature, using Mongolian data where available. Scenarios were developed to reduce future burden of HCV infection by increasing treatment eligibility and sustained virological response (SVR) rates, and increasing the annual treated population. Results: In 2013, there were an estimated 200,000 viremic HCV infections, which is expected to decline by 17% (165,000) by 2030 due to mortality as the infected population ages and progressed to more advance stages of liver disease. In the same period, the prevalence of advanced liver disease is expected to increase by 30% while liver related deaths will increase by 25%. A scenario was modeled where SVR rates increase to 95% in 2016, with treatment restricted to individuals aged 40-59 years with fibrosis stage ≥F2. The overall impact on mortality and morbidity was less than 1% due to very low treatment rate (200 cases annually). A second scenario included increased SVR, along with increases in the annual treated population up to 25,000 treated in 2022. Over time, treatment was extended to individuals aged 15-74 years, and included all fibrosis stages. Chronic infections were reduced to 20,000 by 2025 (90% reduction). Liver-related mortality decreased by 85% (11,000 deaths averted) while cases of decompensated cirrhosis and HCC decreased 75-85% by 2025 and 85-90% by 2030. Conclusions: HCV prevalence in Mongolia will decrease by 2030, but cases of advanced liver disease will continue to rise. Increasing treatment with high SVR therapies can lead to significant reduction in total infections, mortality, and morbidity.

Liver Fibrosis by Fibroscan in Chronic Hepatitis B Patients during Tenofovir Disoproxil Fumarate in Mongolia

( O. Baatarkhuu ),( S. Ariunaa ),( D. Munkh-orshikh ),( J. Amarsanaa ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Liver fibrosis and its sequel cirrhosis represent a major health care burden, and assessment of fibrosis by biopsy is gradually being replaced by noninvasive methods.In clinical practice, the determination of fibrosis stage is important, since patients with advanced fibrosis have faster progression to cirrhosis and antiviral therapy is indicated in these patients. To assess the performances of liver fibrosis during antiviral treatment by liver stiffness measurement (LSM)using Fibroscan in chronic hepatitis B (CHB) patients. Methods: We followed and evaluated treatment outcome of 56 patients with CHB, initiating their TDF regimen at Happy Veritas Clinic and Diagnostic Center. Each patient underwent transientelastography measurements, HBV quantification and serum liver marker assays before treatment with TDF, orally once daily. Results: The mean age of the patients 45±11. Before treatment LSM results indicated fibrosis stage F0 in 18(32.1%) patients, F1 in 6(10.7%), F2 in 19(33.9%), F3 in 18(16.1%), and F4 in 4(7.1%) patients. After SVR 12, SVR 24 months the mean stiffness score of F1 increased from 7.8 to 8.3kPa. F2 increased from 9.4 to 10.3 kPa, F3 decreased from 13.3 to 12.3kPa, F4 increased from 23.8 to 28.4 kPa. In table 1 shows the changes of liver stiffness by Fibroscan after treatment. There was a significant negative correlation between platelet count and liver stiffness score. Conclusions: In chronic hepatitis B patients who is receiving TDF regimen, annual LSM revealed that significant advanced fibrosis improvement slows but continues during treatment.

Epidemiology and Prognosis of Hepatocellular Carcinoma in Mongolia

( Dashchirev Munkh-orshikh ),( S. Ariunaa ),( J. Chinburen ),( M. Shagdarsuren ),( J. Amarsanaa ),( Oidov Baatarkhuu ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Hepatocellular carcinoma (HCC) is the most common cancer in Mongolia, with an occurrence of 115 cases per 100,000 people. We aimed to investigate the clinical features, therapeutic modalities, overall survival, and prognostic factors for Mongolian patients with HCC. Methods: 195 patients with HCC were consecutively enrolled in our study. Diagnosis of HCC was made according to the EASL guidelines. Results: The mean age (108 males and 87 females) was 61.7 years. A large proportion of patients (n=165, 84.6%) had underlying liver cirrhosis. The most common etiology for HCC was HBV infection (n=67, 34.4%), followed by HCV infection (n=89, 45.6%). The mean tumor diameter was 6.0 ± 2.6 cm. Only 29 (14.9%) patients had a single lesion, while 39 (20.0%) had >3 lesions. Extra hepatic metastasis to the lung (n=23), bone (n=10), and lymph node (n=3) was detected in 36 (18.5%) patients. The mean serum AFP level was 196.0 ng/ml. Most patients had advanced HCC; 88 (45.1%) in stage III and 57 (29.2%) in stage IV. Surgical resection was performed in 27 (13.8%) patients, RFA in 23 (11.8%), and TACE in 107 (54.9%). In 38 (19.5%) patients with distant metastasis or poor liver function, the best supportive care was provided. When all the patients were categorized as ‘treated’ (n=156) and ‘not treated’ (n=39), the 3 year survival was significantly lower in the ‘not treated’ group than in the ‘treated’ group (11% vs 0%, P<0.001). Tumor diameter (<3 cm vs ≥3 cm), extra hepatic metastasis, TNM stage (I/II vs. III/IV), and treatment (or supportive care) were selected as independent predictors for survival. Conclusions: The number of patients diagnosed with an advanced stage of HCC in Mongolia is relatively high, and the survival rate of these patients is lower compared to other countries due to limited treatment modalities.

Cause of Cirrhosis in Mongolia Evaluated by Non-Invasive Methods Including Fibroscan, FIB4 and APRI

( Oidov Baatarkhuu ),( Munkhchuluun Batzaya ),( D. Enkhutya ),( S. Munkhdemberel ),( S. Ariunaa ),( B. Davaakhuu ),( B. Erkhem ),( G. Egelmaral ),( J. Amarsanaa ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Liver cirrhosis is the one of the most deadly diseases in Mongolia and in rest of the world. To determine the main cause of liver cirrhosis through using methods as AST-to-Platelet Ratio Index (APRI), Fibrosis 4 score (FIB4), and Fibroscan. Methods: We collected 2758 patients who had Fibroscan, then divided them in three groups, HBV positive, HCV positive, and virus negative. Depending on the result of the Fibro scan ,we made a cut-off point of 12kPa to separate patients with F4 stage from F0, F1, F2, and F3 patients. To compare the result of the Fibroscan with other techniques we collected other laboratory results including AST, ALT level, thrombocyte number, viral markers, and viral load. Results: Among 2758 subjects 57.7% (1591) of patients were anti-HCV positive, 35.7% (984) of patients were HBV positive and 6.6% (182) of patients were virus negative. Amongst 1590 patients who were anti-HCV positive, 62.4%(992) of patients diagnosed with F4 stage of fibrosis by Fibroscan. On the other hand, 34.7%(551) of patients with HBV positive has developed cirrhosis and 2.9% (47) of patients had cirrhosis without any evidence of virus. We randomly selected 100 patients from both HBV and HCV positive groups to determine the correlation between Fibroscan, FIB4 and APRI. The correlation between Fibroscan and other non-invasive method including APRI and FIB4 was not strong. In our further study, among 2.9% patients with cirrhosis caused by non-viral etiology, 70% were frequent alcohol consumers and only 15%t admitted that they were addicted to alcohol, and rest of the patients developed liver cirrhosis caused by other factors. Conclusions: The most common cause of liver cirrhosis is HCV, followed by HBV in Mongolia.

Ledipasvir and Sofosbuvir Fixed-Dose Combination without Ribavirin for 12 Weeks in Treatment-Naive Mongolian Patients with Hepatitis C: A Multi-Center Study

( O. Baatarkhuu ),( B. Davaakhuu ),( N. Naranzul ),( Ch. Gantuul ),( Ch. Bolormaa ),( P. Delgermaa ),( S. Ariunaa ),( G. Sarangua ),( G. Khishigjargal ),( D. Javzmaa ),( D. Ouyntuya ),( S. Nyamaa ),( 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: In Mongolia, previous studies shown HCV prevalence is over 10% and 97-98% of people with HCV infection have infected with genotype 1b. In addition, Mongolia is on first place of HCC mortality rate per 100.000 population and this is eighth times higher than globally average rate. HCV prevalence among primary hepatic carcinoma patients is 35%-45%. Therefore activities on reducing chronic infection prevalence of hepatitis viruses and preventing complications of hepatitis viral infections have been conducted in the country. One of them is availability of Harvoni treatment for HCV patients since December 2015. To evaluate data on the antiviral efficacy and safety of direct acting antiviral (DAA) treatment with respect to sustained virological response (SVR) 12 weeks after completion of treatment. Methods: We retrospectively analyzed patient monitoring records and patient registration forms for HCV patients who received Harvoni treatment at NCCD, MNUMS, provinces and districts hospitals. Quantitative methods were applied in that retrospective study. Six hundred and forty-seven patients diagnosed as HCV and treated by Harvoni(ledipasvir/sofosbuvir) were attended the study. Results: There were totally 647 patients received Harvoni for HCV infection by September 2016. People who received treatment for less than 3 months there 31% and for longer than 3 months were 8%. Among them 91.9% have chronic hepatitis and first stage of liver cirrhosis and 8% have liver cirrhosis and carcinoma. After 1 month of treatment, HCV RNA tests result was negative for 98.8% of all Harvoni patients and for the rest 1.1% resulted in decrease of HCV RNA.After 3 month of trerapy, blood test result showed 100% recovery on transaminase level. 453/465, 10/465 and 2/465 of them were respectively genotype 1b, 2 and 1a. APRI score were pre-treatment 1.3±0.58 and post treatment 0.443±0.148. FIB4 score were pre-treatment 3.8±1.2 and post treatment 1.65±0.59. Occurrences of side effects were mild. 1.2%, 5.8% and 4.6% of them were respectively with CTP C, CTP B and CTP A scores. 88.2% of the participants were chronic hepatitis C and 1.7% of them were pre-treated by interferon. Conclusions: After treatment by Harvoni tablets, excellent SVR12 results were shown among the study participants’ and the favorable side-effect profile were observed for the Mongolian context.

Pegylated IFN-α 2a plus Ribavirin Combination Therapy Results in Mongolian Patients with Hepatitis C Virus Genotype 1b

( Оidov Baatarkhuu ),( Dashchirev Munkh-orshikh ),( G. Uugantsetseg ),( B. Davaakhuu ),( N. Naranzul ),( S. Ariunaa ),( Ch. Gantuul ),( Ch. Bolormaa ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Mongolia is one of the highest prevalent of hepatitis C virus infection of the world. The standard therapy for patients with genotype 1 chronic hepatitis C (CHC) is a combination of peg-interferon alfa -2a and ribavirin for 48 weeks. However the most appropriate duration of treatment remains to be established because of treatment -related side effects and cost. To compare the efficacies of 24-week and 48-week treatments of peg-interferon alfa-2a plus ribavirin in Mongolian patients Methods: A total of 47 patients with genotype 1 CHC was treated between August 2008 and were randomly assigned to treatment and December 2013 and at least one dose of study medication, consisting of 180 mg of peginterferonalfa 2-a once weekly plus daily ribavirin(1000 or 1200mg, depending on body weight). Patients with undetectable HCV RNA at 24 weeks of treatment were allowed to choose either 24 or 48 weeks as the duration of their treatment ; 4 patients chose the 24 week treatment regimen and the 43 patients chose the 48-week regimen. Results: The SYR rate was higher in patients treated for 48 weeks than in those treated for24 weeks(74% vs 48.8%, p=0.0013). In the multivariate analysis, age < 52 years, platelets >148000mm3, and treatment duration for 48 weeks remained significant independent predictors of SVR. Fortheen of the 47 patients who relapsed in the 24-week treatment group received split 24-week therapy, and 3 patients was achieved SVR. The overall SVR rate did not differ significantly between the 24-week treatment group, including those who underwent 24-week split therapy 48.8%, and the 48-week treatment group (48.8% vs 74%). Conclusions: SVR rate was 74% of the patients in Mongolia.The 24-week therapy following failure is a useful treatment strategy for patients with genotype 1b chronic hepatitis C.

Development and Evaluation of a Novel Automatic Cell Culture System of Perfusion Flow using Alveolar Bone Marrow Stem Cells

임기택 ( K. T. Lim ),홍지향 ( J. H. Hong ),선우훈 ( H. Seonwoo ),백수정 ( S. J. Baik ),손현목 ( H. M. Son ),( T. Ariunaa ),양민호 ( M. H. Yang ),조종수 ( C. S. Cho ),정필훈 ( P. H. Choung ),정종훈 ( J. H. Chung ) 한국농업기계학회 2010 한국농업기계학회 학술발표논문집 Vol.15 No.1