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Nababan, Saut Horas H.
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Medicine & Pharmacology

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Nucleoside/Nucleotide Analogues for the Treatment of Chronic Hepatitis B: A 3-Year Follow Up Study Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
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Introduction. Chronic hepatitis B (CHB) is endemic in Indonesia, where it is usually treated with pegylated interferon and nucleoside/nucleotide analogs (NA). The aim of this study was to determine the efficacy of treating CHB infection among Indonesian patients with NA (lamivudine, telbivudine, and tenofovir) for a 3-year period.Methods. We retrospectively reviewed the records of patients with CHB infection attending the Hepatology Clinic Cipto Mangunkusumo during 2010-2013 period. Subjects with inclusion criteria were all patients aged above 18 years treated with NA for at least three years. The degree of liver stiffness, hepatitis B virus deoxyribonucleic acid (HBV-DNA), alanine aminotransferase (ALT) levels, and hepatitis B antigen (HBeAg) were assessed before and after 3-years therapy.Results. A total of 62 subjects were included in the study. Forty-eight patients (77%) were treated with telbivudine, 9 (15%) with tenofovir, and 5 (8%) with lamivudine. At baseline prior to the onset of therapy, 52 patients (84%) had a positive HBeAg test, 15 patients (24%) had F3 liver disease (advance fibrosis), and 36 (58%) had liver cirrhosis using transient elastography. At the end of the 3 year study period, median of liver stiffness significantly decline from baseline (14.5 (3.3 – 59.3) kPa to 6.7 (3.3 – 37.2) kPa, p = 0.001), HBV DNA load significantly decline (1.31 x 107 (2.0x106 – 1.0x108) copies/mL to 0 (0 – 1.7 x 107) copies/mL, p = 0.001), alanine aminotransferase (ALT) levels significantly decline (58 (11– 404) U/L to 27 (8-291) U/L, p = 0.001). Nevertheless, there were five patients (8%) who still had F3 liver disease, and 20 patients (32.3%) had F4 liver disease, 21 (34%) had detectable HBV-DNA, 17 (27%) had not achieved ALT normalization. From 52 patients with positive HBeAg 140| Jurnal Penyakit Dalam Indonesia | Vol. 8, No. 3 | September 2021Andri S. Sulaiman, Irsan Hasan, C.R.A. Lesmana, Chyntia O.M. Jasirwan, Saut Horas H. Nababan, Kemal F. Kalista, Gita Aprilicia, Rino A. Ganibaseline, there were 20 patients (39%) who had seroconversion to negative HBeAg after three year period.Conclusion. NA therapy resulted in a reduction level of fibrosis in CHB induced liver disease.
Profil Klinis dan Kesintasan Pasien Karsinoma Sel Hati di Rumah Sakit Rujukan Tersier Indonesia Tahun 2015-2021 Hasan, Irsan; Gani, Rino Alvani; Sulaiman, Andri Sanityoso; Kurniawan, Juferdy; Lesmana, Cosmas Rinaldi A.; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Teressa, Maria
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Introduction. Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the world and Indonesia. This study aimed to describe the clinical presentation and survival rate of HCC patients in Dr. Cipto Mangunkusumo Hospital (RSCM) as the Indonesian tertiary referral hospital in year 2015-2021 Methods. Cohort study was performed in year 2015-2021. Clinical presentations at the time of diagnosis were recorded from electronical health record. All HCC patients were followed up until death. One-year survival based on staging was assessed using log rank test and presented with Kaplan Meier curve. Results. A total of 799 HCC patients were included. Majority of HCC patients were male, 619 patients (77.5%), and aged 55 (SD 11.9) years. Hepatitis B was the major etiology, found in 500 patients (62.6%). Median of alfa feto-protein (AFP) was 1,109 (0.8-3,462,499) ng/ml. At the time of diagnosis, Barcelona Clinic Liver Cancer (BCLC) stage C (37.7%) was the most commonly found. Portal vein thrombosis was found in 205 patients (25.7%). There were 271 (33.9%) HCC patients received curative and palliative treatment, and others had supportive care. One year survival rate of HCC was 61.2%. One year survival rate of HCC based on staging for BCLC A, BCLC B, BCLC C, and BCLC D were 91.1%, 68.6%, 47.6%, and 13.3%, respectively (log-rank test: p<0.001). Conclusion. The majority of patients diagnosed with HCC were at an advanced stage so that the one-year survival is poor.
Perlemakan Hati Non-Alkoholik dan Risiko Fibrosis Hati pada Pasien Hepatitis B Kronik Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A.; Kurniawan, Juferdy; Jasirwan, Chyntia Olivia Maurine; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing throughout the world due to sedentary lifestyle and dietary habit, including in patients with chronic hepatitis B (CHB). In several studies, advanced of liver disease were more likely observed among those CHB patients with NAFLD. NAFLD might increase the risk of liver disease progression in CHB patients, but prior investigations were still limited. This study aimed to determine the association between NAFLD and risk of liver fibrosis in CHB patients. Methods. All patients with positive serum hepatitis B surface antigen in the Hepatobilier Data Registry, Cipto Mangunkusumo Hospital, were included in this study. Based on abdominal ultrasonography, patients were divided into two group (group I: non-NAFLD – hepatitis B patients vs. group II: NAFLD – hepatitis B patients). Data demographic and clinical examination were collected. Significant liver fibrosis was defined as stage liver fibrosis above 7 kPa (≥ F2). Logistic regression was used to identify NAFLD as risk factor for significant fibrosis. Variables were expressed as prevalence odd ratio (POR) with 95% CI. P values <0.05 were considered statistically significant. Results. Among 130 hepatitis B patients, 45 patients (34.6%) were diagnosed with NAFLD. Of 45 patients in group II, 36 patients (80%) had significant liver fibrosis. It was observed that a higher percentage of patients in group II were HBeAg negative compared to those in group I (66.7% vs. 35.9%; p=0.038). Furthermore, group II also displayed higher levels of liver stiffness compared to group I (12.22 (8.6 kPa) vs. 8.57 (7.8 kPa); p 0.016). In multivariate analysis, NAFLD was significantly associated with significant liver fibrosis (POR: 5.87; CI95%: 2.48 – 13.86; p < 0.001) after adjusted with HBeAg status. Conclusion. NAFLD associated with the higher risk of liver fibrosis in patients with hepatitis B. Modification of lifestyle and potential therapeutic intervention may help in reducing the progression of liver fibrosis.
Kesintasan Pasien Karsinoma Hepatoselular: Sebuah Studi Komprehensif tentang Pengaruh Awitan Dini versus Lambat dan Faktor Determinannya Achmad, Ibrahim; Jasirwan, Chyntia Olivia Maurine; Rajabto, Wulyo; Abdullah, Murdani; Nababan, Saut Horas H.; Nasution, Sally Aman; Koesnoe, Sukamto; Sari, Nina Kemala
Jurnal Penyakit Dalam Indonesia
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Introduction. The prognosis for patients with Hepatocellular Carcinoma (HCC) is generally poor because most cases are diagnosed at an advanced stage. Several studies indicate that HCC is more prevalent and has a worse prognosis among younger individuals. This study aims to identify and compare the variations in survival rates between early and late-onset HCC patients at Cipto Mangunkusumo Hospital and investigate the factors that impact survival outcomes in both groups. Methods. Retrospective cohort study of HCC patients registered in HCC registry 2015-2022. Survival was visualized using Kaplan-Meier curves. Prognostic factor variables in the Cox Proportional Hazard Regression analysis by backward method in the final model became independent prognostic factors for overall survival. Results. There were 896 subjects. Patients with early onset had a median survival of 2.0 months (95% CI 1.0-2.9), while late-onset patients had a median survival of 4.0 months (95% CI 3.4-4.5) (p=0.021). During the observation period, the incidence of death in early onset was found to be higher compared to late onset (92.9% vs. 87.7%, p 0.032). In the multivariate analysis for early onset, hypertension comorbidity and lack of hepatitis treatment were prognostic factors increasing the risk of death with [HR 3.7 (95% CI: 1.0-12.7)] and [HR 2.4 (95% CI: 0.9-6.2)] (p=0.053). In the multivariate analysis for late onset, prognostic factors increasing the risk of death include AFP levels ≥200 ng/mL [HR 1.2 (95% CI: 1.0-1.5)], liver cirrhosis [HR 1.2 (95% CI: 1.0-1.3)], AJCC stage 4 as the most advanced stage [HR 4.5 (95% CI: 2.2-8.9)], supportive therapy [HR 5.2 (95% CI: 3.9-6.8)], and palliative therapy [HR 1.6 [95% CI: 1.2-2.2)]. Conclusion. The median survival of early-onset HCC patients is lower compared to late-onset ones because the majority are not given curative treatment. Independent prognostic factors in early-onset are hypertension and hepatitis treatment, while in late-onset AFP levels, liver cirrhosis, AJCC stage, and therapy are given.
Co-Authors Achmad, Ibrahim Andri Sanityoso Sulaiman Aprilicia, Gita C Rinaldi A Lesmana Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Irsan Hasan Jasirwan, Chyntia Olivia M Juferdy Kurniawan Kemal Fariz Kalista, Kemal Fariz Murdani Abdullah Rino Alvani Gani Sally Aman Nasution, Sally Aman Sari, Nina Kemala Sukamto Koesnoe Teressa, Maria Wulyo Rajabto