Hepatitis Monthly
Year:2012 | Volume:12 | Issue:2|Papers Count:11

As a practicing physician, I face clinical problems every day. To solve them, I use clinical decision making skills including reaching the most accurate diagnosis and deciding on the next step or steps to manage the problem. A clinician is a pragmatic person, i.e., s/he needs practical, implementable data to guide reasoning or decision making and nothing else! In this environment, why is Mohammad Reza Ghadir’s article on the epidemiology of Hepatitis B virus infection in this issue of the journal at all? Of course it is a Socratic question, and you may find me to be the author of similar articles.

Autoimmune hepatitis (AIH) has been the subject of numerous studies, from the late 1940s when it first came to clinical attention, and various aspects of this disease have been analyzed throughout the world. Although its clinical, laboratory and histological features, as well as demographical characteristics, have been extensively studied in many countries and in different ethnic groups, there have been no such statistics or analysis available for Iranian patients with AIH until now. The number of Iranian studies published so far about autoimmune hepatitis has been very limited.

Hepatitis C virus (HCV) infection causes chronic hepatitis, which frequently leads to hepatic fibrosis and hepatocellular carcinoma (HCC). Alanine aminotransferase (ALT) is a biomarker of hepatocyte injury and is associated with the progression of hepatic fibrosis.Advanced hepatic fibrosis also predisposes HCV carriers to a risk of HCC. In contrast, some cases with persistent HCV infection have normal ALT levels that persist for a long time, and these HCV carriers have no or mild hepatitis and hepatic fibrosis. These HCV carriers are defined as persistent normal ALT (PNALT) cases and their risk of HCC is low compared to HCV carriers with abnormal ALT. However, there are various definitions of normal ALT and PNALT, and advanced hepatic fibrosis may be missed without a liver biopsy.In addition, there is also a risk of ALT elevation in HCV carriers with PNALT, which increases the risk of progression to hepatic fibrosis and HCC. Most HCV carriers with PNALT have asymptomatic or nonspecific symptoms. HCV carriers with PNALT are also considered to be responsive to interferon-based treatment. Thus, assessment of hepatic fibrosis is important in HCV carriers, and the eradication of HCV infection is more likely in HCV carriers with evidence of hepatic fibrosis, regardless of their ALT levels.

Context: On the strength of epidemiological data, biological studies, and clinical findings, hepatitis C virus appears to be involved in the pathogenesis of a proportion of patients with non-Hodgkin lymphoma and cryoglobulinemia.Objectives: The aim of this paper is to review the published literature focused on the current knowledge concerning hepatitis C virus and its potential role in the production of non-Hodgkin lymphoma and cryoglobulinemia in susceptible individuals.Evidence Acquisition: In this review, databases such as pubMed, embase, ISI, and Iranian databases including Iranmedex, and SID were searched.Results: The results of this review indicate that HCV infection may be a likely cause of various B cell dysregulation disorders such as non-Hodgkin lymphoma and cryoglobulinemia.Conclusion: Based on current findings, it has been hypothesized that NHL and cryoglobulinemia in HCV infection may have an immune-mediated pathogenesis. In HCV infectedpatients, we showed an elevated risk of these two diseases. These finding suggested a possible role for chronic hepatitis C in the pathogenesis of NHL and cryoglobulinemia.

Background: There is limited data on the natural history of autoimmune hepatitis (AIH) and on the long-term follow-up of AIH patients who have been referred for regular medical attention.Objectives: We evaluated the clinical presentation and natural history of AIH in a large cohort of type I AIH patients from Iran.Patients and Methods: Between 1997 and 2008, 102 patients were enrolled in the study.Patients were diagnosed using the International Autoimmune Hepatitis Group criteria and were followed up for an average of 60 months. Clinical and biochemical data were gathered from all the patients at both the beginning and the end of the follow-up period.Liver biopsy was performed in all patients before treatment, and the biopsies were performed in 28 patients after treatment.Results: Biochemical remission was achieved by 80 (79.4%) patients. Of these, 53 (66.5%) showed near-normal liver histology or liver function test results and sonogram. The remaining 27 (33.5%) patients also achieved clinical and biochemical remission, but developed compensated cirrhosis. After a period of remission, 24 patients (32.5%) relapsed.Among the 22 (21.6%) patients who showed ultimate treatment failure, 6 underwent orthotopic liver transplantation and 3 died of liver failure while awaiting a transplant. Sixteen (72.7%) of the 22 patients who did not respond to therapy were non-compliant with medications and had irregular follow-up. The overall 10-year survival rate in the cohort was 96%.Conclusions: Long-term survival in AIH patients is very good. Prompt diagnosis and appropriate first-line and salvage therapy that includes close follow-up will make liver transplantation a rare necessity in the treatment of this disease.

Background: Hepatitis A was ranked first among all of the different types of viral hepatitis in China, which occurred an average of 500, 000 cases annually during the 1980’s. A live attenuated hepatitis A vaccine was applied in preventing of the disease in 1992, large scale used in vaccination program in 1995, and incorporated in the Expanded Program of Immunization in 2008 in China.Objective: The objective of this study was to determine whether, and to what extent, the decline in the incidence of hepatitis A in China was the result of hepatitis A (HA) vaccination.Materials and Methods: Official documents and longitudinal serological follow-up studies were reviewed to compare the incidence of HA before and after the introduction of the vaccine.Results: National trends in the incidence of HA in China saw rates decrease by 92.7% in 2009, compared to the levels seen in 1992. A mass vaccination program was carried out in 3-18 year old children (Wuhan City, China), and its protective efficacy was 85.4%. In a mass vaccination program of an entire population (Shenshi County, China), the annual HA incidence decreased from 359.7/100, 000 to 17.7/100, 000 (almost 20.3 times). There was a significant relationship found between vaccine coverage and the incidence of HA, the correlation of the negative regression was significant at the 1% (Kendall rank correlation, significant level P<0.05).Conclusions: In summary, this study highlights the important role of implementing a vaccination program in decreasing the incidence of HA, and the large protective efficacy of such a strategy, as demonstrated in China.

Background: HIV and HCV infections are basic issues of many health systems. Since HIV and HCV are transmitted similarly, it is common to become infected by them simultaneously. No consensus exists on the effect of HCV infection on the survival of HIV-infected patients.Objectives: This study aimed to investigate the issue in a relatively large cohort of patients who had a high prevalence of this coinfection in Shiraz (South of Iran).Patients and Methods: In this historical cohort study, we evaluated the survival time of 1338 HIV-infected individuals who had been referred to a behavioral consultation center in Shiraz over 10 years (from April 2001 to July 2011). Kaplan-Meier method and log-rank test were used to investigate patient survival and compare their survival curves, respectively. Moreover, Cox proportional hazards model was used to examine the effect of HCV infection on patient survival after control for age, sex, having the injection drug use (IDU) risk factor, CD4 count at baseline, more than a 30% decline in CD4 cell count, and highly active antiretroviral therapy (HAART).Results: In our cohort, 1044 patients (78.03%) were infected by HCV. The median follow-up was 43.48 months (95% CI=61.18–26.63). The median survival time in HCV-infected and uninfected patients was 163.8 and 194.8 months, respectively (P=0.039). After controlling for other covariates, HCV infection increased the mortality rate 2.13 times more in HCV-infected patients than HCV -uninfected patients (CI: 95%, 1.1–4.52).Conclusions: HCV infection increases AIDS-related deaths. To control HCV infection and transmission and eliminate HCV, timely diagnosis and treatment and serious harm reduction programs must be implemented.

Background: Hepatitis B is the most common chronic viral infection in humans and the most common cause of death among viral hepatitis. As 70% to 80% of chronic hepatitis cases are caused by HBV in Iran, this virus alone is considered the most important cause of liver diseases and the major cause of mortality arising from viral hepatitis cases in Iran.Objectives: We planned this study to determine the prevalence of hepatitis B in the general population of Qom, central Iran.Patients and Methods: The present study is a cross-sectional study. A total of 3690 samples were collected from 7 rural clusters and 116 urban clusters. Ten teams, each consisting of 2 trained members, were assigned to conduct the sampling and fill the questionnaires.The data were analyzed using SPSS.Results: The prevalence rate of hepatitis B infection in Qom Province was 1.3%. The mean age of the patients with hepatitis B was 44.17 years. The prevalence of hepatitis B was 1.6% in men and 1.1% in women. Moreover, the prevalence of hepatitis B correlated positively with age, tattooing, and literacy level.Conclusions: The prevalence rate of hepatitis B in Qom is 1.3%. It is possible to prevent the disease by increasing public awareness. Further investigation on clinical presentations and a determination of the genotype of the virus are suggested.

Hepatitis C virus (HCV), as a causative agent of chronic liver disease, has infected approximately 175 million people (almost 3%) of the world’s population, and 3 to 4 million new cases are added to this figure annually. Chronic HCV infection may progress to severe outcomes in the form of cirrhosis and hepatocellular carcinoma (HCC).

The epidemiology of chronic liver diseases (CLD) in Italy is changing. This is due to the decreasing rate of viral hepatitis and the increased number of steatosis and nonalcoholic steatohepatitis cases, which are emerging as a new epidemic with a wide spectrum of metabolic disorders.

Hereditary hemochromatosis (HH) is the most frequent genetic disease in populations of European origin.The HH gene was cloned by Federet al. in 1996, and 2 major mutations were discovered: C282Y and H63D. Geographical differences with mutation frequencies have been published with a decreasing gradient of occurrence in Europe from north to south. HH leads to liver iron overload and raised liver iron concentration (LIC) is associated with liver fibrosis. When the LIC reaches 60μmol/g, or approximately twice the upper limit of the normal range (36mmol/g), activation of stellate cells appears. These cells are principally responsible for the beginning of liver fibrosis and fibrosis.