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Article ; Online: Velacur ACE outperforms FibroScan CAP for diagnosis of MASLD.

Loomba, Rohit / Ramji, Alnoor / Hassanein, Tarek / Yoshida, Eric M / Pang, Emily / Schneider, Caitlin / Curry, Michael P / Afdhal, Nezam H

Hepatology communications

2024 Volume 8, Issue 4

Abstract: Background: As the prevalence of metabolic dysfunction-associated steatotic liver disease increases, it is imperative to have noninvasive alternatives to liver biopsy. Velacur offers a non-invasive, point-of-care ultrasound-based method for the ... ...

Abstract	Background: As the prevalence of metabolic dysfunction-associated steatotic liver disease increases, it is imperative to have noninvasive alternatives to liver biopsy. Velacur offers a non-invasive, point-of-care ultrasound-based method for the assessment of liver stiffness and attenuation. The aim of this study was to perform a head-to-head comparison of liver stiffness and liver fat determined by Velacur and FibroScan using MRI-based measurements as the reference standard. Methods: This prospective cross-sectional study included 164 adult participants with well-characterized metabolic dysfunction-associated steatotic liver disease. Patients underwent a research exam including Velacur, FibroScan and contemporaneous magnetic resonance elastography, and magnetic resonance imaging proton density fat fraction (MRI-PDFF) scans. The primary outcome was the presence of advanced fibrosis (>F2) as measured by magnetic resonance elastography and the presence of liver fat (>5%) as measured by MRI-PDFF. Results: The mean age and body mass index were 57±12 years and 30.6±4.8 kg/m2, respectively. The mean liver stiffness on magnetic resonance elastography was 3.22±1.39 kPa and the mean liver fat on MRI-PDFF was 14.2±8%. The liver stiffness assessments by Velacur and FibroScan were similar for the detection of advanced fibrosis (AUC 0.95 vs. 0.97) and were not statistically different (p=0.43). Velacur was significantly better than FibroScan (AUC 0.94 vs. 0.79, p=0.01), for the detection of MRI-PDFF >5% (diagnosis of metabolic dysfunction-associated liver disease). Conclusions: Velacur was superior to FibroScan for liver fat detection with MRI-PDFF as the reference. Velacur and FibroScan were not statistically different for liver stiffness assessment as defined by magnetic resonance elastography.
MeSH term(s)	Adult ; Humans ; Cross-Sectional Studies ; Elasticity Imaging Techniques/methods ; Fibrosis ; Non-alcoholic Fatty Liver Disease/diagnosis ; Prospective Studies
Language	English
Publishing date	2024-03-22
Publishing country	United States
Document type	Journal Article
ISSN	2471-254X
ISSN (online)	2471-254X
DOI	10.1097/HC9.0000000000000402
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Article ; Online: A Canadian survey on knowledge of non-alcoholic fatty liver disease among physicians.

Sebastiani, Giada / Ramji, Alnoor / Swain, Mark G / Patel, Keyur

Canadian liver journal

2021 Volume 4, Issue 2, Page(s) 82–92

Abstract: Background: In Canada, non-alcoholic fatty liver disease (NAFLD) is the most frequently occurring liver disease, affecting one in four Canadians. NAFLD can in turn evolve into non-alcoholic steatohepatitis (NASH) and cirrhosis. No study in Canada has ... ...

Abstract	Background: In Canada, non-alcoholic fatty liver disease (NAFLD) is the most frequently occurring liver disease, affecting one in four Canadians. NAFLD can in turn evolve into non-alcoholic steatohepatitis (NASH) and cirrhosis. No study in Canada has investigated knowledge of NAFLD among physicians. Methods: Primary care physicians (PCPs); specialists in internal medicine, gastroenterology, and hepatology; and hepatology nurses who were members of the College of Family Physicians of Canada, Canadian Association for the Study of the Liver, or Canadian Association of Hepatology Nurses were invited to participate in this web-based survey. Results: Of 650 invited physicians and nurses, 214 (33%) responded and 171 (26%) completed the whole survey. Overall, 51% of the respondents were PCPs, 38% were specialists, and 11% were nurses. Of these, 58% of PCPs, 28% of specialists, and 39% of nurses responded that they were only somewhat familiar or unfamiliar with NAFLD. Moreover, 53% of PCPs, 20% of specialists, and 35% of nurses thought the prevalence of NAFLD in Canada was 15% or less. Also, 42% of respondents thought that NASH could be diagnosed by imaging or blood tests. Finally, more than 40% of PCPs, 22% of specialists, and 33% of nurses thought that metformin and statin were treatments for NASH. Conclusions: This survey shows that a significant proportion of Canadian physicians and nurses managing patients with NAFLD are not very familiar with the disease. This study emphasizes the need for further provider education, national practice guidelines, and improved treatment options.
Language	English
Publishing date	2021-04-29
Publishing country	Canada
Document type	Journal Article
ISSN	2561-4444
ISSN (online)	2561-4444
DOI	10.3138/canlivj-2020-0033
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Article ; Online: Pharmacy-based screening program to detect hepatitis C in 'baby-boomer' cohorts in western Canada.

Chiew, Brandon A / Fong, Anita Yp / Cosgrove, Linh T / Mohajerani, Seyed Amir / Ramji, Alnoor / Lee, Samuel S

Canadian liver journal

2023 Volume 6, Issue 4, Page(s) 388–394

Abstract: Background: The estimated prevalence of hepatitis C virus (HCV) in Canada is approximately 1.0%. However, the number of individuals living with HCV but unaware of it is estimated to be 30%-44%. Increased screening programs that are accessible, effective, ...

Abstract	Background: The estimated prevalence of hepatitis C virus (HCV) in Canada is approximately 1.0%. However, the number of individuals living with HCV but unaware of it is estimated to be 30%-44%. Increased screening programs that are accessible, effective, and feasible are important to ensure treatment and meet WHO elimination goals. We implemented an HCV point of care test (POCT) program in community pharmacies to examine the effectiveness and feasibility in screening. Methods: Twenty two London Drugs pharmacies in British Columbia and Alberta implemented an HCV POC screening program using OraQuick rapid antibody tests. Consenting patients filled out a 10-question screening questionnaire to examine risk factors. The participants then were tested using the POCT. While waiting for the test (20 minutes), patients were educated on HCV and treatment options. Results: Three hundred seventy-one participants underwent HCV screening. The most common HCV risk factor was being born between 1945 and 1975 (baby boomer) (93% of cohort), while the second most common was having a tattoo or body piercing (22%). Seven people (2%) tested positive; four were HCV-RNA PCR-positive and were treated, whereas the PCR status of three was unknown as they were lost to follow-up or not tested. Conclusions: Pharmacy-based POCT was shown to be effective and feasible in the western Canadian context, especially for baby boomers. Sustainable funding for pharmacy screening programs may be considered nationwide to identify HCV-infected persons and help meet elimination goals.
Language	English
Publishing date	2023-12-20
Publishing country	Canada
Document type	Journal Article
ISSN	2561-4444
ISSN (online)	2561-4444
DOI	10.3138/canlivj-2023-0005
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Article ; Online: Diagnosis of esophageal varices by liver stiffness and serum biomarkers in virus-related compensated advanced chronic liver disease.

Zoughlami, Amine / Serero, Jordana / Congly, Stephen / Zhao, Irene / Zhu, Julie / Ramji, Alnoor / Cooper, Curtis / Wong, Philip / Bailey, Robert / Coffin, Carla S / Sebastiani, Giada

Canadian liver journal

2023 Volume 6, Issue 3, Page(s) 332–346

Abstract: Background: Individuals infected with hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency (HIV) viruses can experience compensated advanced chronic liver disease (cACLD) leading to esophageal varices (EV). In patients at low risk of ... ...

Abstract	Background: Individuals infected with hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency (HIV) viruses can experience compensated advanced chronic liver disease (cACLD) leading to esophageal varices (EV). In patients at low risk of esophageal varices needing treatment (EVNT), non-invasive criteria based on liver stiffness measurement (LSM) with platelets, or fibrosis biomarkers, may avoid unnecessary screening esophagogastroduodenoscopies (EGD). These approaches have not been compared among people infected with HIV, HBV, and HCV patients. Methods: Patients with a diagnosis of cACLD (LSM ≥10 kPa) and EGD availability were included from two cohorts. Baveno VI and expanded Baveno VI criteria (based on LSM and platelets), fibrosis biomarkers Fibrosis-4 Index (FIB-4), AST-to-Platelets Ratio Index (APRI), AST-to-ALT ratio (AAR), and RESIST criteria (based on platelets and albumin) were applied to determine the proportion of spared EGD and of missed EVNT. Results: Three hundred fifty three patients (30.6% with HIV, 25.3% monoinfected with HBV, and 44.1% with HCV) were included. The prevalence of EVNT was 8.2%. Both Baveno VI and expanded Baveno VI criteria performed well in patients with virus-related cACLD, by sparing 26.1% and 51.6% EGD, respectively, while missing <2% EVNT. The proportion of spared EGD were 48.2%, 58%, and 24.3% by FIB-4 (<2.78), APRI (<1.1), and AAR (<0.75), respectively, while missing <3% EVNT. RESIST criteria spared 47.8% EGD while missing 1.9% EVNT. Conclusions: Non-invasive criteria based on LSM can spare unnecessary EGD in virus-related cACLD. Simple fibrosis biomarkers can ameliorate resource utilization for EVNT screening in low resource settings.
Language	English
Publishing date	2023-10-30
Publishing country	Canada
Document type	Journal Article
ISSN	2561-4444
ISSN (online)	2561-4444
DOI	10.3138/canlivj-2022-0047
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Article ; Online: Hepatic steatosis as measured by the computed attenuation parameter predicts fibrosis in long-term methotrexate use.

Tomaszewski, Marcel / Dahiya, Monica / Mohajerani, Seyed Amir / Punja, Hanaa / Ko, Hin Hin / Sun, Muxin / Ramji, Alnoor

Canadian liver journal

2021 Volume 4, Issue 4, Page(s) 370–380

Abstract: Introduction: To determine predictors of hepatic steatosis by the computed attenuation parameter (CAP) and fibrosis via transient elastography (TE) in persons on methotrexate (MTX) therapy with rheumatologic and dermatologic diseases.: Methods: A ... ...

Abstract	Introduction: To determine predictors of hepatic steatosis by the computed attenuation parameter (CAP) and fibrosis via transient elastography (TE) in persons on methotrexate (MTX) therapy with rheumatologic and dermatologic diseases. Methods: A single-centred retrospective cohort study was performed. Patients on >6 months of MTX for a rheumatologic or dermatologic disease who had undergone TE from January 2015 to September 2019 were included. Multivariate analysis was performed to determine predictors of steatosis and fibrosis. Results: A total of 172 patients on methotrexate were included. Psoriasis was the most frequent diagnosis ( Conclusions: In patients on MTX for rheumatologic and dermatologic diseases, hepatic steatosis as measured by CAP was common and moderate to severe steatosis predicted moderate to severe fibrosis.
Language	English
Publishing date	2021-11-11
Publishing country	Canada
Document type	Journal Article
ISSN	2561-4444
ISSN (online)	2561-4444
DOI	10.3138/canlivj-2020-0040
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Article ; Online: Brief Report: Effect of Antiretroviral Switch From Tenofovir Disoproxil fumarate to Tenofovir Alafenamide on Alanine Aminotransferase, Lipid Profiles, and Renal Function in HIV/HBV-Coinfected Individuals in a Nationwide Canadian Study.

Sarowar, Arif / Coffin, Carla S / Fung, Scott / Wong, Alexander / Doucette, Karen / Truong, David / Conway, Brian / Haylock-Jacobs, Sarah / Ramji, Alnoor / Hansen, Bettina E / Janssen, Harry L A / Cooper, Curtis

Journal of acquired immune deficiency syndromes (1999)

2022 Volume 91, Issue 4, Page(s) 368–372

Abstract: Objective: Tenofovir alafenamide (TAF) achieves increased renal safety and improved alanine aminotransferase (ALT) normalization but increased lipid profile in hepatitis B virus (HBV)-monoinfected patients switched from tenofovir disoproxil fumarate ( ... ...

Abstract	Objective: Tenofovir alafenamide (TAF) achieves increased renal safety and improved alanine aminotransferase (ALT) normalization but increased lipid profile in hepatitis B virus (HBV)-monoinfected patients switched from tenofovir disoproxil fumarate (TDF). It is unclear whether HIV coinfection perturbs these biochemical changes. To this end, we assessed these parameters in HIV/HBV-coinfected patients switched from TDF to TAF. Design: Retrospective, multicenter, observational study. Methods: HIV/HBV-coinfected patients switched from TDF to TAF-based antiretroviral therapy (ART) at 6 Canadian Hepatitis B Network (CanHepB) academic sites were included. Changes in lipid profile, estimated glomerular filtration rate (eGFR), and ALT were evaluated using linear mixed effect model regression. Results: Eighty-two HIV/HBV-coinfected patients with a mean 103-week follow-up duration were identified. At time of TAF switch, 80 of 82 (98%) were HBV virally suppressed, 29 of 82 (35%) had elevated ALT levels, and 63 of 82 (77%) had eGFR of ≥60 mL/min per 1.73 m 2 . Twenty-six/Eighty-two (32%) had preexisting renal comorbidities. There were no changes in total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglyceride levels 2 years after TAF switch. Those with elevated ALT levels achieved greater ALT normalization after TAF switch (-0.004 [-0.008 to 0.0] log 10 U/L/mo, P = 0.03). eGFR decline rate while on TDF (-0.66 [-0.23 to -1.08] mL/min/month, P < 0.005) was diminished after switching to TAF (-0.02 [-0.16 to 0.11] mL/min/mo, P = 0.7) and those with eGFR of <60 mL/min experienced increase in eGFR after TAF switch (0.45 [0.03-0.87] mL/min/mo, P = 0.04). Conclusions: Our study supports switching from TDF to TAF with positive influence on overall long-term biochemical profile in HIV/HBV-coinfected individuals.
MeSH term(s)	Humans ; Tenofovir/therapeutic use ; Hepatitis B virus ; Alanine Transaminase ; HIV Infections/complications ; HIV Infections/drug therapy ; Retrospective Studies ; Coinfection ; Alanine/therapeutic use ; Canada ; Adenine/therapeutic use ; Anti-Retroviral Agents/therapeutic use ; Kidney/physiology ; Lipids ; Cholesterol ; Lipoproteins, HDL ; Triglycerides ; Lipoproteins, LDL
Chemical Substances	Tenofovir (99YXE507IL) ; Alanine Transaminase (EC 2.6.1.2) ; Alanine (OF5P57N2ZX) ; Adenine (JAC85A2161) ; Anti-Retroviral Agents ; Lipids ; Cholesterol (97C5T2UQ7J) ; Lipoproteins, HDL ; Triglycerides ; Lipoproteins, LDL
Language	English
Publishing date	2022-10-26
Publishing country	United States
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000003079
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Article: Chronic Hepatitis with Liver Granulomas in a Patient with Granuloma Annulare: A Case Report and Review of the Literature.

Alsahafi, Majid / AlJasser, Mohammed I / Kalia, Sunil / Yang, H M / Ramji, Alnoor

Case reports in gastrointestinal medicine

2017 Volume 2017, Page(s) 8768529

Abstract: Granuloma annulare (GA) is a benign granulomatous skin disorder of unknown etiology. GA is rarely associated with liver diseases. We report a unique case of chronic hepatitis with liver granulomas in a patient with GA. Despite an extensive workup, no ... ...

Abstract	Granuloma annulare (GA) is a benign granulomatous skin disorder of unknown etiology. GA is rarely associated with liver diseases. We report a unique case of chronic hepatitis with liver granulomas in a patient with GA. Despite an extensive workup, no clear etiology for the hepatitis was found. Based on the possible immune pathophysiology of GA and the presence of liver granulomas, the patient was treated with prednisone and azathioprine which resulted in complete normalization of the liver enzymes and concurrent improvement of GA. The association between liver diseases and GA is reviewed.
Language	English
Publishing date	2017-02-23
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627636-7
ISSN	2090-6536 ; 2090-6528
ISSN (online)	2090-6536
ISSN	2090-6528
DOI	10.1155/2017/8768529
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Article: Chronic hepatitis C infection is associated with higher incidence of extrahepatic cancers in a Canadian population based cohort.

Darvishian, Maryam / Tang, Terry / Wong, Stanley / Binka, Mawuena / Yu, Amanda / Alvarez, Maria / Alexander Velásquez García, Héctor / Adu, Prince Asumadu / Jeong, Dahn / Bartlett, Sofia / Karamouzian, Mohammad / Damascene Makuza, Jean / Wong, Jason / Ramji, Alnoor / Woods, Ryan / Krajden, Mel / Janjua, Naveed / Bhatti, Parveen

Frontiers in oncology

2022 Volume 12, Page(s) 983238

Abstract: Introduction: Chronic infection with hepatitis C virus (HCV) is an established risk factor for liver cancer. Although several epidemiologic studies have evaluated the risk of extrahepatic malignancies among people living with HCV, due to various study ... ...

Abstract	Introduction: Chronic infection with hepatitis C virus (HCV) is an established risk factor for liver cancer. Although several epidemiologic studies have evaluated the risk of extrahepatic malignancies among people living with HCV, due to various study limitations, results have been heterogeneous. Methods: We used data from the British Columbia Hepatitis Testers Cohort (BC-HTC), which includes all individuals tested for HCV in the Province since 1990. We assessed hepatic and extrahepatic cancer incidence using data from BC Cancer Registry. Standardized incidence ratios (SIR) comparing to the general population of BC were calculated for each cancer site from 1990 to 2016. Results: In total, 56,823 and 1,207,357 individuals tested positive and negative for HCV, respectively. Median age at cancer diagnosis among people with and without HCV infection was 59 (interquartile range (IQR): 53-65) and 63 years (IQR: 54-74), respectively. As compared to people living without HCV, a greater proportion of people living with HCV-infection were men (66.7% vs. 44.7%, P-value <0.0001), had comorbidities (25.0% vs. 16.3%, P-value <0.0001) and were socially deprived (35.9% vs. 25.0%, P-value <0.0001). The SIRs for liver (SIR 33.09; 95% CI 29.80-36.39), anal (SIR: 2.57; 95% CI 1.52-3.63), oesophagus (SIR: 2.00; 95% CI 1.17-2.82), larynx (SIR: 3.24; 95% CI 1.21-5.27), lung (SIR: 2.20; 95% CI 1.82-2.58), and oral (SIR: 1.78; 95% CI 1.33-2.23) cancers were significantly higher among individuals living with HCV. The SIRs for bile duct and pancreatic cancers were significantly elevated among both individuals living with (SIR; 95% CI: 2.20; 1.27-3.14; 2.18; 1.57-2.79, respectively) and without HCV (SIR; 95% CI: 2.12; 1.88-2.36; 1.20; 1.11-1.28, respectively). Discussion/conclusion: In this study, HCV infection was associated with increased incidence of several extrahepatic cancers. The elevated incidence of multiple cancers among negative HCV testers highlights the potential contributions of screening bias and increased cancer risks associated with factors driving acquisition of infection among this population compared to the general population. Early HCV diagnosis and treatment as well as public health prevention strategies are needed to reduce the risk of extrahepatic cancers among people living with HCV and potentially populations who are at higher risk of HCV infection.
Language	English
Publishing date	2022-10-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.983238
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Article ; Online: Direct-acting antiviral treatment uptake and sustained virological response outcomes are not affected by alcohol use: A CANUHC analysis.

Driedger, Matt / Vachon, Marie-Louise / Wong, Alexander / Conway, Brian / Ramji, Alnoor / Borgia, Sergio / Tam, Ed / Barrett, Lisa / Smyth, Dan / Feld, Jordan J / Lee, Sam S / Cooper, Curtis

Canadian liver journal

2021 Volume 4, Issue 3, Page(s) 283–291

Abstract: Background: Alcohol use and hepatitis C virus (HCV) are two leading causes of liver disease. Alcohol use is prevalent among the HCV-infected population and accelerates the progression of HCV-related liver disease. Despite barriers to care faced by HCV- ... ...

Abstract	Background: Alcohol use and hepatitis C virus (HCV) are two leading causes of liver disease. Alcohol use is prevalent among the HCV-infected population and accelerates the progression of HCV-related liver disease. Despite barriers to care faced by HCV-infected patients who use alcohol, few studies have analyzed uptake of direct-acting antiviral (DAA) treatment. Objective: We compared rates of treatment uptake and sustained virological response (SVR) between patients with and without alcohol use. Methods: Prospective data were obtained from the Canadian Network Undertaking against Hepatitis C (CANUHC) cohort. Consenting patients assessed for DAA treatment between January 2016 and December 2019 were included. Demographic and clinical characteristics were compared between patients with and without alcohol use by means of Results: Current alcohol use was reported for 217 of 725 (30%) patients. The proportion of patients initiating DAA treatment did not vary by alcohol use status (82% versus 83%; Conclusion: Patients engaged in HCV treatment have highly favourable treatment uptake and outcomes regardless of alcohol use. Public health interventions should be directed toward facilitating access to care for all patients irrespective of alcohol use. Research into high-level alcohol use and DAA outcomes is needed.
Language	English
Publishing date	2021-08-09
Publishing country	Canada
Document type	Journal Article
ISSN	2561-4444
ISSN (online)	2561-4444
DOI	10.3138/canlivj-2021-0003
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Article ; Online: Reduced immune responses to hepatitis B primary vaccination in obese individuals with nonalcoholic fatty liver disease (NAFLD).

Joshi, Shivali S / Davis, Rachelle P / Ma, Mang M / Tam, Edward / Cooper, Curtis L / Ramji, Alnoor / Kelly, Erin M / Jayakumar, Saumya / Swain, Mark G / Jenne, Craig N / Coffin, Carla S

NPJ vaccines

2021 Volume 6, Issue 1, Page(s) 9

Abstract: Obesity and cirrhosis are associated with poor hepatitis B virus (HBV) vaccine responses, but vaccine efficacy has not been assessed in nonalcoholic fatty liver disease (NAFLD). Sixty-eight HBV-naïve adults with NAFLD were enrolled through the Canadian ... ...

Abstract	Obesity and cirrhosis are associated with poor hepatitis B virus (HBV) vaccine responses, but vaccine efficacy has not been assessed in nonalcoholic fatty liver disease (NAFLD). Sixty-eight HBV-naïve adults with NAFLD were enrolled through the Canadian HBV network and completed three-dose HBV or HBV/HAV vaccine (Engerix-B
Language	English
Publishing date	2021-01-11
Publishing country	England
Document type	Journal Article
ISSN	2059-0105
ISSN (online)	2059-0105
DOI	10.1038/s41541-020-00266-4
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