Hepatitis Monthly
Year:2012 | Volume:12 | Issue:5|Papers Count:9

An analysis of cohorts of patients with compensated cirrhosis caused by the Hepatitis B Virus (HBV) indicates that the disease decompensates at an annual rate of 1.5% to 5%. Following decompensation, the 5-year survival rate has varied from 14% to 35%. the 5-year survival rate in untreated patients is higher in patients decompensating from variceal bleeding than in those decompensating from ascites (29vs.16%).

The hepatic microRNA (miRNA), miR-122, is the most abundant miRNA within the liver, where it accounts for 70% of the total miRNA pool. It is known that miR-122, as an unusual host factor, increases the abundance of hepatitis C virus (HCV) RNA in HCV infection by binding directly to the 5’-UTR of the viral genome.Therefore, it has been suggested as a potential target for the treatment of hepatitis C. However, recent evidence shows that miR-122 decreases HBV replication through the inhibitory effect of p53 on HBV transcription, and consequently it acts as a tumor-suppressor through both a decrease in HBV replication and by directly targeting cyclin G1, as well as Wnt/beta-catenin, and NDRG3 pathways. This paper will briefly discuss the underlying mechanisms for the dual role of miR-122 in viral hepatitis, and explains why therapeutic applications of miR-122 may differ based on the underlying disease.

Context: Hepatitis B virus (HBV) is the most common disease commuted through blood transfusion. Occult hepatitis B infection (OBI) is a form of the disease which does not present Hepatitis B surface antigens (HBsAg) in the serum of patients; however, HBVDNA is detectable in the serum and hepatocytes of patients. OBI is an important risk factor to induce post transfusion hepatitis (PTH), cirrhosis, hepatocellular carcinoma (HCC) and reactivation of the HBV. Recently, several reports from various regions of the world have been published regarding PTH among blood recipients as well as HCC, and cirrhosis among patients who require permanent blood transfusion, including diseases such as hemophilia, hemodialysis and thalassemia. This form of the hepatitis also creates problems for individuals that are co-infected with other viruses such as HCV and HIV. To determine the prevalence of OBI among hemophilia, hemodialysis and thalassemia patients is important because it is a high risk factor for PTH, HCC and cirrhosis therefore, its detection is a critical strategy for most health care services. This review addresses recent information regarding prevalence of OBI in relation to the mentioned diseases.Evidence Acquisition: The data presented here was collected by searching the key words in Pubmed and Scopous databases Results: Our searching in the published papers revealed that OBI prevalence is frequent in patients receiving frequent blood transfusions.Conclusions: it seems that one of the main mechanisms for OBI transmission is most likely through infected blood and its component and evaluation of the prevalence of OBI in donors and patients, especially those with hemophilia and thalassemia should be foul considered.

Context: The clinical outcome of hepatitis B virus (HBV) infection is variable, ranging from spontaneous recovery to an inactive carrier state, chronic hepatitis, occult HBV infection, liver cirrhosis, or hepatocellular carcinoma.Evidence Acquisition: This variable pattern and clinical outcomes of the infection were mainly determined by virological and host genetic factors. Since the most of host geneticfactors associated with HBV infection have currently focused on human leukocyte antigen (HLA) associations and interleukin (IL) -10 gene polymorphisms, this review focuses on the recent progresses in these issues to provide prognostic markers for the outcome of HBV infection.Results: A study on serum levels of IL-10 in occult HBV infected patients reported that the higher level of IL-10 production may suppress function of the immune system against HBV in patients with occult HBV infection (57). Ahmadabadiet al. (58) reported that IL-10 promoter polymorphism at position -592 is associated with susceptibility to occult HBV infection.Conclusions: Findings of this study suggest that the host HLA polymorphism is an important factor in determining outcome of HBV infection but regarding IL-10 gene promoter polymorphisms, we are still have a long way to achieve a definite conclusion.

Background: To determine age-specific seroprevalence rates of hepatitis A virus (HAV) immunoglobulin G (IgG) antibody in Savadkuh district, Mazandaran province, north of Iran, as well as to compare the collected data with earlier seroprevalence studies in the region and Iran in order to draw a proper epidemiological pattern for HAV infection in the country.Objectives: This study aimed to assess an age-specific HAV seroprevalence among 1- to 30-year-old people in Savadkuh, a less developed district of Mazandaran province, north of Iran.Patients and Methods: The study participants were 984 subjects who aged from one to 30 years and were residents of rural and urban areas of Savadkuh. They were selected using cluster sampling method and divided into five age groups: 1-2.9 (316 cases), 3-6.9 (254 cases), 7-10.9 (201 cases), 11-17.9 (115 cases), and 18-30 (98 cases). Anti-HAV antibody was measured by ELISA method. Seroprevalence rates among different age groups and their relationship to residency, educational levels of parents, water supply, and waste water disposal system was analyzed using chi-squared test.Results: Overall seroprevalence rate was 19.20 % with no significant difference between rural and urban residents. The seroprevalence rates increased significantly with age: from 5.7 % in age group 1-2.9 year to 34.8 % in adolescents, and to 68.4 % among young adults (P<0.0001) regardless of significant differences in educational levels among parents of residents in two areas it did not affect seroprevalence rates. Findings of this study and reviewing other reports from the region and the country suggest an epidemiological shift towards lower rates of anti- HAV antibody seroprevalence.Conclusions: It appears that anti-HAV antibody seroprevalence rate has been declining among Iranians and thereby more children would be susceptible to this infection. This would necessitate revising current strategies of preventative measures in Mazandaran and Iran.

Background: The prevalence of hepatitis viruses in hemodialysis patients has been reported to be much greater than in the general population. Attention to local data, effectively guides health planners so that they can control infections and prevent nosocomial transmissions.Objectives: This cross sectional study was carried out to determine the prevalence of hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) viruses, as well as the human immunodeficiency virus (HIV) in dialysis centers in the Kerman Province, in the southeast of Iran. Patients and Methods: All hemodialysis patients (n = 228) in 7 centers were enrolled in the study. Hepatitis B surface antigens (HBsAg), HCV antibodies (Ab), HDV Ab and HIV Ab were measured using specific enzyme linked immunoassay kits (ULTRA kit, bioMerieux, France) and confirmed by a qualitative PCR assay.Results: The studied group was comprised of 92 (40.4%) females and 136 (59.6%) males. The mean age of the patients was 51 ± 9.5 years and the duration of hemodialysis was 39.7 ± 7.9 months. Positive HBsAg was found in 7% of cases, HCV Ab in 7%, and patients with both viruses were detected in 1.7% cases. HIV Ab and HDV Ab were negative in all cases. Out of the other risk factors, frequency of blood transfusions was significantly correlated with positive HCV Ab (P<0.008).Conclusion: Prevalence of HBV and HCV in hemodialysis patients was moderate to low in the Kerman Province, as in other parts of the country. Strict adherence to protective measures could lead to even lower rates.

Background: Patients with chronic renal disease should be vaccinated as soon as dialysis is forestalled, and this could improve the seroconversion of hepatitis B vaccination. Objectives: In this study, we aimed to compare seroconversion and immune response rates using 4 doses of 40 mg and 3 doses of 20 mg Euvax B recombinant Hepatitis B surface Antigen (HBs Ag) vaccine administered to predialysis patients with chronic kidney disease (CKD). Patients and Methods: In an open, randomized clinical trial, we compared seroconversion rates in 51 predialysis patients with mild and moderate chronic renal failure who received either 4 doses of 40 mg or 3 doses of 20 mg of Euvax B recombinant hepatitis B vaccine administered at 0, 1, 2, 6 and 0, 1, 6 months, respectively.Results: Differences in seroconversion rates after 4 doses of 40 mg (80.88%) compared to 3 doses of 20 mg (92%) were not significant (P = 0.4124). The mean HBs antibody level after 4 doses of 40 mg at 0, 1, 2, and 6 months (182.2 ± 286.7) was significantly higher than that after 3 doses of 40 mg at 0,1, and 6 months (96.9 ± 192.1) (P = 0.004). Seroconversion after 4 doses of 40 mg (80.8%) was also significantly higher than that after 3 doses of 40 mg (77%) (P = 0.004). Multivariable analysis showed that none of the variables contributed to seroconversion.Conclusions: We found that 4 doses of 40 mg did not lead to significantly more seroconversion than 3 doses of 20 mg.

In recent article which is published in your journal Crisan D et al. has been reported an interesting article about noninvasive assessment of liver fibrosis. They evaluated six serum marker panels (APRI, Forns, Fib-4, Hepascore, Fibro Test, Fibro meter) and transient elastography (TE) alone or in combination, for prediction of liver fibrosis stages in 446 chronic hepatitis C (CHC) patients. In addition they evaluated whether the combination of serum panels with TE could increase the diagnostic accuracy of liver fibrosis assessment or not. The authors concluded that combination of some of previously mentioned serum marker panels with TE, increases the diagnostic accuracy of non-invasive methods for the assessment of liver fibrosis stage.

The staging of liver fibrosis in chronic hepatitis C (CHC) is mandatory for both starting antiviral therapy and for starting a surveillance program for the early diagnosis of HCC. Considering that liver biopsy (LB) is "the best but not the gold standard" for the evaluation of fibrosis owed to possible limitations in the sample specimen and histological interpretation, the noninvasive evaluation of significant and severe fibrosis by means of direct or indirect biochemical and "ultrasound" fibrosis indexes is a highly complementary tool in the management of Chronic Hepatitis C (CHC).