Hepatitis Monthly
Year:2018 | Volume:18 | Issue:5|Papers Count:5

Introduction: Hepatitis B Virus genotypes influence chronic hepatitis B evolution and show geographic preferences. In Eastern Europe, HBV-D genotype seems to be dominant, still, without enough information regarding the prevalence of its four subtypes. In addition, treatment with Nucleos(t)ide Analogues (NUCs) has lower impact on HBV-D genotype clearance compared to others. This study aimed at presenting the case of a middle age female diagnosed, followed-up and treated for eight years with entecavir 0. 5 mg/day, in whom an increase of anti-HBsAb titer was noted over the immunogenicity level and undetectable viremia, despite the continuous presence of HBsAg. This is an uncommon type of evolution, most patients with anti-HBsAb over 10 IU/mL show seroconversion in the “ s” system in a few months. Case Presentation: The researchers used the COBAS TaqMan HBV Monitor Test (Roche Diagnostics, Branchburg, NJ) in order to measure serum HBV DNA level, then, the viral DNA was extracted from 200  L of serum using QIAamp DNA blood mini kit (Qiagen, Germany). The amplification and sequencing of full DNA length was done by the Rolling Circle Amplification (RCA) technique. Hepatitis B Virus genotype was determined using the NCBI genotyping tool and phylogenetic analysis. Conclusions: The patient was proved to haveDgenotype. TheDNAanalyzes showed escape mutations in the “ a” determinant within the S gene, represented by sQ129R, respectively, sI134T, reported by the literature in a small number of C genotype patients. The paradoxical serum profile of the current patient with positive HBsAg, increased titers of anti-HBsAb, and undetectable viral load could be a possible model of evolution for D genotype HBV chronic infected patients treated with NUCs, cohort genetic studies on patients with the same serum profile are required to confirm this pattern of evolution.

Background and Objectives: Hepatitis B and C viral (HBV, HCV) infections are major the health problems worldwide. Patients undergoing hemodialysis (HD) are more vulnerable to acquire such infections than the general population. The current study aimed at assessing the prevalence and risk factors of HBV and HCV infections among patients undergoing hemodialysis in Kurdistan, Iraq. Methods: The current cross sectional studywascarried out at five governmental dialysis units in Kurdistan, Iraq; mostof the current study patients were recruited from 10 August 2015 to 11 February 2016. All the participants were clinically evaluated and detailed history of blood transfusion, duration of HD, and all the other parameters were also noted. Hepatitis B surface antigens (HBsAgs) and anti-HCV antibodies (anti-HCV Ab) were measured and seropositive HCV samples were subjected to polymerase chain reaction (PCR) for confirmation. Data regarding the serological status of such patients and potential risk factors were collected and analyzed. Results: A total of 510 patients undergoingHDwere enrolled in the study. The overall prevalence of HBV, HCV, and coinfection in the studied subjects was 1. 8%, 9. 2%, and 0. 2%, respectively. HBV and HCV infections were independently associated with age and history of HD (P = 0. 005). HBV vaccination was a strong protective factor against HBV infection (P = 0. 001), but the rate of fully vaccinated patients (77%) was still suboptimal. Other risk factors for HCV infection were the duration of HD, history of kidney transplantation, and history of dental and surgical procedures. Conclusions: The prevalence of HBV and HCV infections in the patients undergoingHDin the centers in Kurdistan was low to moderate. HBV vaccination was an efficient protective measure. The factors associated with viral hepatitis within HD units were highly suggestive for nosocomial transmission. Strict adherence to infection control measures and more effective follow-up procedures may reduce the prevalence of the studied infections.

Background: Although there are many reports on the relationship between serum 25-hydroxyvitamin D3 levels and chronic liver diseases, the relevance of the former to the latter is still unclear. Objectives: This study aimed at clarifying the relationship between serum 25-hydroxyvitamin D3 levels and HBV-related markers, such as HBV-DNA, hepatitis B surface antigen (HBsAg), and hepatitis B virus core-related antigen (HBcrAg) in patients with chronic hepatitis B. Methods: This was a multicenter retrospective study. The subjects consisted of 236 consecutive untreated patients with chronic hepatitis B. Serum 25-hydroxyvitamin D3 levels were measured by double-antibody radioimmunoassay. The 25-hydroxyvitamin D3 levels were divided to three groups:  20 ng/mL for deficiency, 21 to 29 ng/mL for insufficiency, and  30 ng/mL for sufficiency. Results: The subjects consisted of 127 males and 109 females, with a median age of 57 years (range, 15 to 84 years). The patients with positive HBeAg and genotype C accounted for 14. 4% and 63. 1%, respectively. The median HBV-DNA level and HBsAg level were 684 IU/mL and 750 IU/mL, respectively. The median serum 25-hydroxyvitamin D3 level was significantly lower in patients (21. 0 ng/mL) than in healthy volunteers (25. 0 ng/mL, P = 0. 013). The median serum 25-hydroxyvitamin D3 level in patients with a serum HBsAg level  1000 IU/mL was significantly lower than that in patients with a serum HBsAg level of < 1000 U/mL (P = 8. 06  1 0-3). The incidence of the HBsAg level  1000 IU/mL was 55. 8% in patients with vitamin D deficiency and 3 8. 2% in patients with vitamin D insufficiency/sufficiency (P = 8. 92  10-3). On multivariate analysis, female gender, the cold season, and a serum HBsAg level of  1000 IU/mL were independently associated with vitamin D deficiency. From the opposite viewpoint, vitamin D deficiency and high serum HBcrAg level were independent factors associated with an HBsAg level of  1000 IU/mL. Conclusions: This study suggests that serum vitamin D level is closely and negatively correlated with the HBsAg level in chronic hepatitis B patients.

Background: Non-alcoholic fatty liver disease (NAFLD) has become a leading cause of chronic liver disease worldwide. We aimed to study this condition and liver fibrosis in bariatric patients at baseline using ultrasound, NAFLD fibrosis score (NFS), and fibrosis index-4 (FIB-4). Methods: Adult patients with morbid obesity without other possible causes of liver pathology were evaluated. Liver biopsy was performed in a subset of patients. Diagnostic accuracy of tests was assessed using area under the receiver operating-characteristic curve (AUROC). Results: Overall, 1944 patients with mean age of 38. 3  10. 8 years and body mass index of 44. 6  6. 4 kg/m2 comprised the study population. Liver Biopsyshowed features of NAFLDin 70%; 60. 3% hadnonalcoholic fatty liver and9. 6% steatohepatitis. Older age and higher transaminase levels were associated with higher NAFLD activity score. Fibrosis was present in 23. 3% with the majority having F1. Ultrasound detected steatosis in 76. 8%, with two-thirds having grade I to II fatty liver. Metabolic syndrome, hemoglobin A1c, age, and alanine transaminase were the strongest risk factors for fatty liver. Ultrasound showed an AUROC of 0. 75 (95% confidence interval 0. 63-0. 86) for NAFLD with a sensitivity and specificity of 72. 5% and 68. 2%, respectively (cutoff of grade II). For diagnosis of fibrosis, FIB-4 had an AUROC of 0. 72 (0. 58-0. 86) with 93. 3% sensitivity and 43. 1% specificity (cutoff of 0. 50). NFS failed to show a significant AUROC curve for diagnosing fibrosis. Conclusions: Our findings confirmed a high prevalence of NAFLD in morbidly obese patients. Despite this high prevalence, fibrosis was uncommon and low-grade. This study questions the use of current cutoffs for NFS and FIB-4 in all patients.

1. Importance of Viral Hepatitis Elimination Viral hepatitis is one of the deadliest diseases in human history. The mortality rate of viral hepatitis is majorly linked to the hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, with an estimated number of 1. 3 million deaths per year (1). Globally, there are almost half a billion people (1 out of 12 persons) living with chronic viral hepatitis, of which up to 40% will develop liver cirrhosis, hepatocellular carcinoma (HCC), or liver failure (2-4). Surprisingly, 40% to 80% of chronic carriers are not aware of their infection status (5). . . .