Hepatitis Monthly
Year:2011 | Volume:11 | Issue:4 (33)|Papers Count:14

Hepatitis A virus (HAV) infection usually spreads through the fecal-oral route. It is an acute, self-limiting disease with a mild course that is often silent in pediatric cases. However, this infection can be more severe and even fatal in older individuals. It usually has an uncomplicated course; however, complications such as cholestatic hepatitis, relapsing hepatitis, extrahepatic manifestations, or rarely, fulminant hepatitis and even death may occur. These complications are more prevalent in adults, especially those more than 40 years of age.

Despite the availability of an effective vaccine, Hepatitis B virus (HBV) infection still remains a foremost health problem. Undoubtedly, finding the key routes of hepatitis transmission from the point of prevention in every country, specifically in endemic regions, is of high priority. Such efforts are especially important given that many infected patients with hepatitis are asymptomatic (1, 2). Iran and Turkey are located in the Middle East, and HBV prevalence varies from intermediate to high in most countries in this region.

Approximately 170 million people worldwide are chronically infected by hepatitis C virus (HCV), which can result in progressive hepatic injury and fibrosis, culminating in cirrhosis and end-stage liver disease. The benchmark therapy for untreated HCV patients is a combination of pegylated interferon-alpha (PEG-IFN) and ribavirin (RBV). Several studies have suggested several potential new approaches to improve HCV therapy-optimization of the dose and duration of RBV therapy, accompanied by careful clinical management, is crucial in ensuring the greatest likelihood of a long response to therapy. RBV causes serious side effects, but in clinical practice, there are no alternatives for the treatment of HCV infection. Based on our results, weight-based doses of RBV are advantageous for genotype 1-infected patients, but its success in genotype 2- and 3-infected patients is unknown, particularly for shorter treatment durations.

Background: Hepatitis C virus (HCV) infection occurs in 0% to 51% of dialysis patients, and many HCV-positive patients are urged to undergo kidney transplantation. However, the outcome of renal transplantation in HCV-positive recipients is unknown.Objectives: Our review aimed to address the outcomes of renal transplantation recipients (RTRs) following kidney transplantation.Materials and Methods: We selected studies that used the adjusted relative risk (aRR) and 95% CI of all-cause mortality and graft loss in HCV-positive compared with HCV-negative RTRs as study endpoints. Cox proportional hazard analysis was used in all studies to calculate the independent effects of HCV infection on RTR outcomes. Sixteen retrospective cohort studies and 2 clinical trials were selected for our review. Sixteen studies were related to patient survival, and 12 examined graft survival.Results: The combined hazard ratio in HCV-infected recipients was 1.69-fold (1.33-1.97, p<0.0001) and 1.56 times (1.22-2.004, p<0.0001) greater than that of HCV-negative recipients for mortality and graft loss, respectively.Conclusions: Although HCV-infected RTRs have worse outcomes than HCV-negative RTRs, kidney transplantation is the preferred treatment for patients with HCV infection and end-stage renal disease.

Background: Core protein of the hepatitis C virus (HCV) has an important role in HCV self-replication, pathogenesis and carcinogenesis.Objectives: To identify the effect of core proteins from different quasispecies of HCV genotype 1b expressed in a HepG2 cell line on human gene expression profiles.Materials and Methods: Core protein eukrocytic expression plasmids (pEGFP-N1) containing different quasispecie core protein genes of genotypes 1b HCV derived from of HCV-related hepatocellular carcinoma (HCC) tumoral tissue (T) and non-tumoral tissue (NT) were constructed and then transfected to HepG2 cell line. The gene expression spectrum in the cell expression core proteins from T and NT were compared with those in the control by Affymetrix human genome HG-U 133 plus 2.0 microarray.Results: Different gene expression profiles were acquired between HepG2 expressing core proteins derived from T and NT tissues. Both core proteins caused the modulation of several genes that are up/down-regulated as compared to control, including genes involved in oncogenesis, signal transduction, cell apoptosis, and cell growth cycle regulation. Surprisingly, only one gene-CSNK1A1-was up-regulated by both T and NT core variants.Conclusions: Core proteins isolated from tumoral or non-tumoral nodules mediate expression of different cellular genes suggesting that variants isolated from different quasispecies may have different biological effects.

Background: Although the World Health Organization (WHO) classifies Turkey as a country with a moderate-high prevalence of hepatitis B virus (HBV) infection, there is little data on HBV transmission in this country.Objectives: To identify risk factors for HBV infection, we performed a retrospective case-control study between January 2007 and December 2009.Patients and Methods: Acute HBV patients and population controls were selected, and data from these groups were analyzed by logistic regression. method.Results: The study included 129 patients with acute HBV infection and 219 controls. Hemodialysis (OR: 8.2, 95% CI: 4.17-16.61, p<0.05), having an HBsAg (+) spouse (OR: 4.3, 95% CI: 2.17-8.53, p<0.05), living with an HBsAg (+) parent (s) (OR: 3.25, 95% CI: 1.73-6.12, p<0.05), and being male (OR: 1.34, 95% CI: 0.82-2.21, p<0.05) were independent risk factors that were potentially associated with HBV infection. More than one-third of female patients had a significantly higher risk (34.5% vs.13.5%, p<0.05) of acquiring HBV from their sexual partners. Hemodialysis was the most frequent risk factor (46.9% vs.20%, x²=10.45, p<0.05) for patients aged over 31 years, and living with HBsAg (+) parents was a significantly higher risk factor (28.8% vs.10.2%, x²=6.15, p<0.05) that is more likely to lead to HBVin patients aged under 30 years.Conclusions: This study suggests that persons in Turkey who undergo hemodialysis are at high risk for acquiring HBV. Having an HBsAg (+) spouse (sexual transmission) or living with HBsAg (+) parents (household transmission) are significant risk factors for HBV transmission. Vaccination appears to be better preventive method against the spread of HBV.

Background: Hepatitis D virus (HDV) is dependent on hepatitis B virus (HBV) infection. Acute infection with HDV can occur simultaneously with acute HBV infection or be superimposed onto a chronic HBV infection.Objectives: This study aimed to identify cases of HDV and determine its prevalence in patients with chronic HBV infection for the first time study in Isfahan, central Iran.Patients and Methods: In a cross-sectional study in 2009, 346 who had been diagnosed for at least 6 months with chronic HBV were enrolled consecutively. Anti-HDV was measured by ELISA in the serum of these patients.Results: The study included 245 males (70.8%) and 101 (29.2%) females with a mean age of 39±12.4 years. Anti-HDV was present in 8 (3.5%) HBe antibody-positive patients (p=0.36) and in 2 (2.3%) HBe antigen-positive cases (p=0.68). No association was found between hepatitis D and probable risk factors.Conclusions: This study demonstrates that the prevalence of HDV infection is higher in patients who are positive for HBeAb compared those who are HBeAg-positive. Therefore, most HDV antibody-positive cases in Isfahan are HBV/HDV superinfections but not coinfections.

Background: Married couples constitute a target group for reducing the risk of infections with hepatitis B virus (HBV) and hepatitis C virus (HCV).Objectives: This study attempted to assess HBV seromarkers, anti-HCV-positive rates, and risk behaviors among married couples in a bordered province of western Thailand.Materials and Methods: A cross-sectional study of 114 married couples aged 15-44 years was performed. Approximately 25-30 married couples were randomly selected from 4 districts in a province of western Thailand. All study participants who participated voluntarily were interviewed using structured questionnaires. Their blood specimens were collected to screen for HBV seromarkers (HBsAg, anti-HBs, and anti-HBc) and anti- HCV.Results: Approximately 21.1% of husbands and 2.6% of wives had a history of extramarital sex without using a condom; 18.4% of husbands and 4.4% of wives had tattoos; and 18.4% and 3.5%, respectively, consumed alcohol regularly. Additionally, 4.4% of husbands and 2.6% of wives had a history of sexual contact before marriage. In the serological study, 10.5% of husbands and 5.3% of wives were HBsAg-positive, and 1.8% of husbands and 0.9% of wives were anti-HCV-positive. Among HBsAg-positive subjects, 15/18 had spouses who were positive for any HBV marker, and 1 had a spouse who was HBsAg- and anti-HBc positive. Three participants were positive for anti-HCV (2 males and 1 female). One anti-HCV-positive male had a history of regular alcohol consumption and extramarital sex without a condom, and another had a history of intravenous drug use. The anti-HCV-positive female had a history of sexual contact before marriage.Conclusions: This study found high percentages of risk behaviors and HBsAg positivity among married couples in a bordered province of western Thailand, especially in husbands. These findings support the evidence of HCV transmission via sexual contact and intravenous drug use.

Background: Esophageal variceal hemorrhage is a devastating complication of portal hypertension that occurs in approximately one-third of cirrhotic patients.Objectives: We assessed the value of the platelet count/ bipolar spleen diameter ratio as a noninvasive parameter for the prediction of esophageal varices (EVs) in Egyptian cirrhotic patients.Patients and Methods: Laboratory and ultrasonographic and imaging variables were prospectively evaluated in 175 patients with liver cirrhosis. All patients underwent upper gastrointestinal endoscopy. Patients with active gastrointestinal bleeding at the time of admission were excluded.Results: The platelet count/ bipolar spleen diameter ratio in patients with EVs was significantly lower than in patients without EVs. In an analysis of the receiver operating characteristic curves (ROCs), we calculated an optimal cutoff value of 939.7 for this ratio, which gave 100% sensitivity and negative predictive values, 86.3% specificity, a 95.6% positive predictive value, and an area under the ROC curve of 0.94±0.02, reflecting its overall diagnostic accuracy. These findings were extended to a subset analysis of compensated cirrhotic patients.Conclusions: The platelet count/ bipolar spleen diameter ratio has excellent accuracy in the noninvasive assessment of EVs in patients with compensated or decompensated liver cirrhosis. It is easy to calculate and can lower the financial and sanitary burdens of endoscopy units, especially in developing countries.

Background: There are several studies on seroprevalence of hepatitis A virus (HAV) in adults in the Middle East.Objectives: To determine seroprevalence of HAV among adult population in Fars province, southern Iran.Patients and Methods: In a cross-sectional study, we checked anti-HAV antibody (IgG) in subjects refereed to our health care centers to perform laboratory tests before getting married between March 2008 and March 2009. Age-specific seroprevalence was also determined. Some risk factors like level of education, type of residence, job, numbers of family members, and access to treated water were also evaluated in these participants.Results: From 1050 subjects studied, 927 (88.2%) had ant-HAV antibody; 123 (11.8%) were antibody negative. Among subjects aged<20 years, the anti-HAV seroprevalence was the lowest (79.3%) followed by subjects aged 20–30 years (91.3%) and those >30 years (99%) (p=0.01).85.1% of studied individuals in urban areas had anti-HAV IgG while 95.9% of subjects in rural regions were anti-HAV positive (p=0.001). The seroprevalence of HAV antibody was significantly associated with number of family members (p=0.001).Conclusion: HAV is highly prevalent in our region especially in rural areas. It is better to vaccinate the children for HAV by the time they receive HBV vaccine or when they are five years.

I read with interest the article "A study of genotype, mutants and nucleotide sequence of HBV in Pakistan" by Mumtaz et al. in your journal. The study revealed a prevalence of 96.2% of genotype D in different areas of Pakistan. Hepatitis B virus (HBV) has been classified into 10 genotypes (based on the intergroup divergence of >8% to<17%), with a characteristic geographic distribution that largely coincides with human history and migration. Among the different HBV genotypes, genotype D has been found worldwide, with its highest prevalence in the Mediterranean, the Middle East, and Southern Asia

We read with interest the recent article by Mumtaz and colleagues published in Hepatitis Monthly. The authors attempted to describe an epidemiological pattern of hepatitis B virus (HBV) in Pakistan and compare this pattern to other parts of the world. To determine the genotype of 257 isolated HBV, a line probe assay was used. The HBV genotype D was determined among 247 cases, and 9 patients were infected with genotypes B and D. One strain with genotype A was isolated as well.

In a recent paper, OmidKhoda and colleagues evaluated the efficiency of confidential unit exclusion (CUE) in improving blood safety in Iran’s blood-transfusion system. This paper reported a significantly higher risk of HBV and HCV markers in donors who use CUE option to prevent their donated blood from being used.

I read with great interest the paper by Taheri et al. published in Hepatitis Monthly (Number 31, February 2011). The results of this follow-up study are hopeful of hepatitis-B vaccine efficacy in patients who lost HBsAg and did not seroconvert to anti-HBs with no detectable HBV DNA. However, the editorial in the same issue, as well as Taheri et al. themselves, noted some important limitations to this study.