Hepatitis Monthly
Year:2012 | Volume:12 | Issue:1 (42)|Papers Count:11

Hepatitis viruses are the leading cause of liver cirrhosis and hepatocellular carcinoma (HCC) worldwide. The hepatitis C virus(HCV), together with the hepatitis B virus (HBV), accounts for 75% of all cases of liver disease around the world, with chronic hepatitis, cirrhosis, and HCC causing 500,000 to 1.2 million deaths per year (1-3)…

HCV infection is a global public health problem and can progress to cirrhosis, hepatic decompensation, hepatocellular carcinoma, an death, with asymptomatic conditions and few short-term effects in the beginning(1, 2). It is expected that over the next decade, despite a declining incidence of new infections, mortality and associated costs will increase (1)…

Context: HCV infection is strongly associated with development of insulin resistance and type-2 diabetes, however molecular mechanism of these associations is not known. The aim of this review was to conduct a comprehensive literature search to understand the nature of the association between hepatitis C virus (HCV) infection and insulin resistance (IR). We also explored the role of HCV core protein and NS5a in modulating the course of the insulin-signaling pathway.Evidence Acquisitions: We searched Directory of Open Access Journals (DOAJ) Google Scholar, Pubmed (NLM), LISTA (EBSCO), Web of Science (TS and PakMediNet).Results: Emerging evidence suggests an association between HCV infection and carotid/coronary vascular disease. IR appears to be a dominant underlying cause of accelerated atherosclerosis in patients with chronic hepatitis C (CHC). HCV can induce IR directly through the stimulation of SOCS3 and PPA2, and both of these molecules have been shown to inhibit interferon-a signaling. Improvement of insulin sensitivity may increase the response rate to antiviral treatment and prevent IR complications, including vascular diseases. The results of several clinical trials that have used insulin sensitizers (metformin and PPAR-g agonists) have been inconclusive.Conclusions: Beside the association between HCV and IR, the published data also have showed the possible association of HCV core and NS5A protein with IR.

Background: Hepatitis C virus (HCV) is the most common cause of chronic liver disease in Pakistan (1). Globally, an estimated 170 million people are infected with HCV, with approximately 3-4 million new cases each year (2, 3). Currently, the prevalence of HCV in Pakistan is 4-7% (4-6). HCV is a hepatotropic virus that causes chronic hepatitis in at least 80% of infected individuals. If untreated, 20-30% of the cases will eventually develop cirrhosis, with average latency of 15-25 years, and hepatocellular carcinoma, at the rate of 1-5% per year and average latency of 20-30 years (3, 7).Objectives: We examined the association between HCV infection and non-Hodgkin's lymphoma (NHL).Patients and Methods: This 2-year case control study was conducted From january 1, 2009 to december 31, 2010. A total of 292 NHL patients underwent staging, according to the Ann Arbor staging criteria, and were graded, according to the Working Formulation Classification. Anti-HCV antibodies (Abs) were used in an enzyme-linked immunosorbant assay (ELISA) to detect HCV in blood samples from the 292 NHL patients and 1168 age-and sex-matched control patients (2 groups) who met our selection criteria. The chi-square test was applied to compare anti-HCV Ab seropositivity in the cases and controls, and odds ratio values were computed. The NHL patients were divided into anti-HCV Ab seronegative and seropositive groups to compare the effect of anti-HCV Ab seropositivity on NHL stages and grades. A P value of 0.05 was considered statistically significant.Results: A total of 52 (17.8%) cases, including 45 (7.7%) controls in group 1 (1st degree relatives) and 50 (8.6%) controls in group 2 (non-hematological malignancy), showed positive results for anti-HCV Abs and had a odds ratio value of 2.59 (95% CI: 1.69-3.97) for group 1 and 2.31 (95% CI: 1.52-3.50) for group 2 (P value of 0.000 for both groups). NHL patients who showed positive results for anti-HCV Abs were likely to be middle-aged patients (40-60 years; odds ratio, 3.68; 95%CI: 2.07-6.50). Anti-HCV Ab seropositivity did not significantly affect the grades and stages of NHL.Conclusions: NHL is strongly associated with anti-HCV Ab seropositivity (odds risk, 2-2.5), and seropositive cases were generally middle-aged and younger patients.

Background: In Iran, the number of injecting drug users (IDUs) has increased in recent years. The rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections among IDUs are reportedly high.Objectives: The purpose of this study was to assess factors correlated with HCV and HBV infections among IDUs in Tehran.Patients and Methods: A cross-sectional study included 899 IDUs recruited from the community, drug treatment centers, and drop-in-centers. The study involved interviews conducted using an adapted version of the WHO Drug Injection Study Phase II (Version 2b) questionnaire and blood testing for the HCV antibody, hepatitis B surface antigen, and hepatitis B core antibody. A logistic regression model was used to identify independent factors correlated with HCV and HBV infections.Results: HCV infection was found to be primarily associated with female gender [odds ratio (OR) 5.0, 95% confidence interval (CI) 2.0-10.0)], unmarried status (OR 2.9, 95% CI 1.9-4.4), drug use for more than 10 years (OR 2.7, 95% CI 1.8-3.9), drug injection frequency of more than once per day (OR 2.6, 95% CI 1.6-4.2), history of imprisonment (OR 2.5, 95% CI 1.6-4.0)], and a history of shared injection needles in prison (OR 2.3, 95% CI 1.5-3.6). HBV infection was mainly correlated with a history of imprisonment (OR 1.9, 95% CI 1.4-2.7) and drug use for more than 10 years (OR 1.4, 95% CI 1.1-1.9).Conclusions: Because a considerable number of IDUs in Iran are receiving reduction services, tailoring services for prevention of hepatitis infection are necessary.

Background: Percutaneous liver biopsy is one of the most important and widely used methods for diagnosing chronic liver diseases, however, controversies related to the potential risk of complications and patient discomfort still exist.Objectives: The objective of this study was to evaluate the safety and success rate of blind percutaneous liver biopsy.Patients and Methods: We conducted a retrospective analysis of 1412 blind percutaneous thick-needle liver biopsies performed during 1977-2000 at a single center on 1110 patients, using archived medical data of the center.Results: The overall success rate of obtaining a liver sample with this method was 95.3%. Of all the samples assessed, 91.7% were determined to be fully representative for an evaluation by the pathologist. Complications occurred in 259 procedures (18.3%). While no fatalities associated with liver biopsy were noted, 9 serious complications (0.64%) directly related to biopsies were reported. Pain was the most common complication (15.3%). Significantly more complications (pain and vasovagal reactions) were reported in females (22.1%) than in males (16.1%) (P=0.005). The rate of complications was significantly correlated with the stage of fibrosis (P=0.027), i.e. the higher the fibrosis stage, the higher the complication rate. Previous surgical procedures involving the abdominal cavity or thorax influenced the effectiveness of liver biopsy (P=0.017). Less operator experience was significantly associated with a higher rate of procedure failure (P=0.002). Statistical significance of the relationship between individual operator efficiency and complication rate (P=0.000) and that between individual operator efficiency and biopsy failure rate (P=0.002) was observed.Conclusions: Blind percutaneous liver biopsy is a safe and effective invasive procedure, despite the fact that noninvasive fibrosis assessment methods are currently widely available and used instead of histological evaluation. Complications risk and failure rate are low if indications and contraindications are considered carefully and the biopsy is performed by a skilled and experienced operator. Certain groups of patients may benefit from an image-guided procedure to improve its effectiveness.

Background: The picture that has emerged from studies investigating HIV infected people with GBV-C viremia is that they have lower plasma HIV viral loads in comparison with HIV-positive people who did not have the GBV-C viremia.Objectives: Since GBV-C HIV coinfection has not been studied in Iran, we have designed a survey to study the outcomes of GBV-C infection on HIV infected individuals.Patients and Methods: We analyzed 78 serum samples from HIV-positive patients in Tehran. The HIV positive statue was confirmed by Western blot in our laboratory. Next we detected GBV-C RNA by RT nested-PCR and divided our patient into GBV-C positive and GBV-C negative groups. The final step was measuring the CD4 count and HIV viral load and comparing the means of the CD4 count and HIV viral load in HIV-infected individuals in the GBV-C positive and GBV-C negative groups.Results: We detected GBV-C RNA in 15 patients out of 78. The mean CD4 count was 607.13 compared to 415.87 in the GBV-C negative group and the difference was significant (P=0.005). In contrast to the CD4 count there was no significant difference in HIV viral loads between HIV infected individuals in the GBV-C positive and GBV-C negative groups.Conclusion: Although there was no significant difference in the mean of the HIV viral load between the GBV-C positive and GBV-C negative groups, the significantly higher CD4 mean in the GBV-C positive group compared with the GBV-C negative group suggests a beneficial effect of this coinfection.

Background: Autoimmune hepatitis (AIH) is a form of chronic hepatitis with unclear causative factors and is characterized by immunological and auto-immunological manifestations. Several extrahepatic manifestations, such as other autoimmune disorders, are associated with AIH. AIH with dermatological conditions as the initial manifestation is rare. We report the case of AIH in which erythema nodosum (EN) was the first manifestation. Case Presentation: An 8-year-old girl with several persistent dermatological lesions was referred to our hospital several months ago. Her skin had nodular, painful, dry, and erythematous lesions, predominantly on the extensor areas of both the legs, with some erythematous patches on her face. Physical examination revealed that she had hepatosplenomegaly as well. Skin biopsy indicated EN. The results of the laboratory tests showed increased levels of several liver enzymes. The patient's International Autoimmune Hepatitis Group (IAIHG) score was a definite indicator of AIH. The results of liver biopsy indicated AIH. Other causes of EN and abnormal liver function were ruled out. The only obvious cause of skin lesions was chronic inflammation due to an autoimmune response. The patient was treated for AIH, and her skin lesions along with other signs and symptoms resolved.Conclusions: AIH can present with protean clinical manifestations, and is thus associated with the risk of delayed diagnosis. Dermatological manifestations, including EN, could indicate a serious disease, and further investigation might be required. AIH should be considered as the possible diagnosis in such cases.

In previous issue of hepatitis monthly, la torre G et al. from sapienza university and the catholic university of the sacred heart located in rome, Italy, have published their findings on the incidence of hepatitis C virus (HCV) infections in Italy (1). In the Italian general population, they estimate that the overall trend, and also the trends in gender and different age groups, has decreased significantly over the period from 1996 to 2006, with an overall significant decrease in incidence from 2.02 to 0.55 per 100,000….

In western countries, HFF-linked hereditary hemochromatosis (HH) is considered to be the most common cause of iron overload.the HFE gene, first identified in 1996, is located on the short arm of chromosome 6. The majority of patients with phenotypic HH are homozygous for the C282Y mutation, a major mutation of the HFE gene, whereas compound heterozygosity (C282Y/H63D) is found in patients with a milder iron loading phenotype (1)...

I would like to thank dr sendi and mohseni for their interest in our study. In this letter the authors have summarized the contributory effects of hereditary hemochromatosis (HH) in liver diseases in different populations. I completely agree with them concerning the underlying causes of cryptogenic cirrhosis which in countries such as iran is most commonly nonalcoholic steatohepatitis (NASH)…