Hepatitis Monthly
Year:2013 | Volume:13 | Issue:2|Papers Count:12

Hepatocellular carcinoma (HCC) is considered as the third and also one of the most frequent global cancers, accounting for more than half a million deaths annually. There is a contentious rate in HCC incidence and mortality, which highlights the need for new and innovative therapeutic approaches. Over the last decade, the incidence of HCC remains the highest in Eastern Asia and Africa, while its frequency has grown progressively in western countries and in Japan as well.

Dear Editor, We read with interest the paper entitled “Hepatitis C Virus: The Rising Concerns and Growing Hopes, Report From the HCV Symposium, Fourth Tehran Hepatitis Congress, November 2011, Tehran, Iran”, which is written by Alavian et al. (1). This report highlights the rising concerns for future health burden of hepatitis C virus (HCV) in global scale as well as the necessity of allocating HCV awareness issues in order to control HCV in Iranian high risk populations and patients (1). In contrast to Western countries in which alcoholism remains the most common cause of HCC, in Iranian population the Hepatitis B Virus (HBV) and HCV are the main causes of Hepatocellolar Carcinoma (HCC) (2).

Background: Insulin-like growth factor is a polypeptide with endocrine, autocrine and paracrine effects which its structure is similar to the insulin molecule. While various tissues secrete IGF-1, 90% of the circulating IGF-1 is secreted by liver. Cirrhosis of liver is a condition accompanied by decreased level of IGF-1, in which the level of IGF-1 may be further decreased thorough the progression of the disease. Objectives: The aim of the present study was to demonstrate the relation between the IGF-1 levels and severity of liver disease according to Child- Pugh and Model for end stage liver diseases (MELD) Scores. Patients and Method: This was a descriptive-analytic cross sectional study performed on patients with cirrhosis admitted to gastroenterology clinic of Imam Khomeini Hospital in Tehran, Iran during the years 2007-2008. The diagnosis was based on liver biopsy. Initially for all patients, laboratory investigations including IGF-1, CBC, liver Enzymes, Alkaline phosphates, serum Albumin, Creatinine, direct and total Bilirubin were conducted. Also ultrasound and endoscopy were performed for evaluation of ascites and varices.Results: 100 patients with cirrhosis with a male to Female ratio of 63: 37 and a mean age of 44.4 ± 15 years were enrolled in the study. Median IGF-1 was 92.95 ± 91.51 ng/mL.14 patients (14%) had IGF-1 within normal limits while 86 patients (86%) had abnormal IGF-1 levels. In all patients the correlation coefficient between IGF-1 and MELD was -0.317 (P=0.001) and 0.478 between IGF-1 and Child- Pugh (P<0.001). Conclusions: Our findings showed that IGF-1 can be used as an index for evaluating the severity of cirrhosis; also it can be used for determining the severity of the disease, when liver biopsy is not possible.

Dear Editor, Yan et al. have published a useful paper about thyroid dysfunction (TD) in cases with hepatitis C by treatment with interferon (1). There are some comments which may explicit benefits of this paper in more details. When we report a methodological or statistical issue it is necessary to mention important details which are informative and necessary to know. We should report such details as brief as possible. For example we must mention that type of study is nested case-control or (nested) case-cohort.

Background: Malnutrition is the most common cause of immune deficiency. It results in reduced secretion of T-cells and B-cell-stimulating factors leading to declining of special immunoglobulins. On the other hand, hepatitis B, as a major world health problem, can be prevented effectively by vaccination. Three doses of hepatitis B virus (HBV) vaccine induce protective levels of anti-hepatitis B surface (anti-HBs) in 95% of healthy children. This level decreases gradually over time. Objectives: The goal of this study was to assess anti-HBs in malnourished children, who confronted to some degrees of immune deficiency.Patients and Methods: This is a cross-sectional study conducted during May to August 2010 in therapeutic clinics of Yazd, Iran. Samples were selected simply and consecutively among 5-6 year-old children with a history of three doses of HBV vaccine in infancy. On the basis of World Health Organization’s definition on malnutrition, which considers anthropometric measurements, malnourished children entered the study. Totally 83 cases (37 boys and 46 girls) were gathered and classified into three groups of mild, moderate, and severe malnutrition. One milliliter of venous blood was taken and anti-HBs were tested by enzyme linked immunosorbant assay (ELISA).Results: Overall, seroprotection rate and geometric mean titer (GMT) of anti-HBs were 60.2% and 15.47±10.92 mIU/mL, respectively.Seroprotection rate was 71.4%, 55.2%, and 72.7% in mild, moderate, and severe malnourished children, respectively. GMT was 30.78 mIU/mL, 12.15 mIU/mL, and 22.95 mIU/mL in these groups, respectively. None of these two indices were significant in these groups (P=0.471, P=0.364).Seroprotection rate and GMT were 54.1% and 13.26±11.59 mIU/mL in boys, and 65.2% and 17.5±10.59 mIU/mL in girls, respectively, showing no significant relationship with gender (P=0.302, P=0.602). Lowest seroprotection rate was in stunted cases (47.1%) and highest in wasted children (77.8%). This difference also was not significant (P=0.43). Conclusions: The seroprotection rate and GMT of anti-HBs observed in this study do not show a high level of immunity. These two indices were not related to severity of malnutrition. We conclude that severity of malnutrition does not affect vaccine-induced antibody level and seroprotection rate; however small sample size in each group of study hinders decisive conclusion. Moreover, GMT and seroprotection rate showed no relationship with type of abnormal anthropometric index, including weight for height, weight for age, and height for age.

To gather objective evidence for the effectiveness of their interventions, should responsible clinicians rely on the necessity to better characterize patients with nonalcoholic fatty liver disease as being affected by the benign or progressive form (simple fatty liver or nonalcoholic steatohepatitis) and by which means? Disease markers, imaging tools, histology? Just here, the Author discusses the weaknesses and the strengths of this approach in every- day practice. Insulin resistance (IR) are due to hepatic lipotoxicity, which is consequence of the increased flux of free fatty acids towards the liver.

Background: Due to a recent alarming increase in the number of HIV-HCV co-infected patients in Romania. Objectives: A cross sectional study was conducted to assess the baseline predictors of liver disease evolution.Patients and Methods: 83 HIV-HCV co-infected patients, untreated for HCV infection, were evaluated for viral replication, liver fibrosis (estimated by a noninvasive marker - FIB4), and plasma levels of IP-10 (interferon-gamma inducible protein 10) - a cytokine associated with an unfavorable outcome of HCV infection.Results: The median value for HCV viral load was high (6.3 log10 IU/mL), 98.8% of the patients were infected with HCV genotype 1. Although 53% of the patients received antiretroviral therapy (cART), only 31.8% of these achieved undetectable HIV levels. HCV viral load was significantly higher in patients with AIDS (6.4 vs.6.1 log10IU/mL; P=0.04), and in those naïve for cART (6.5 vs.5.9 log10 IU/mL; P=0.04). Severe fibrosis was directly correlated with immunosupression (56% vs.17.4%, P=0.03), HCV replication (6.1 vs.4.9 log10IU/mL P=0.008), and IP-10 median values (312 vs.139 pg/ml, P=0.008). A serum IP-10 level higher than 400 pg/mL was significantly associated with FIB-4 median values (4.09 vs.1.7, P= 0.004), HCV viral load (6.4 vs.6.1 log10 IU/mL, P=0.02) and ALT level (206.8 vs.112.4 IU/L, P=0.05). Conclusions: An important part of the HIV-HCV co-infected patients had negative baseline predictors for the evolution of HCV infection; their therapeutical management must be conducted with special attention towards adherence and potential overlapping drug toxicities. High concentrations of plasma IP-10 are reliable markers for the severity of liver disease.

Obesity is associated with an increase in mortality and primary graft nonfunction after liver transplantation (LT). Weight loss is recommended for obese patients in need of LT. Diet, exercise, or medications are rarely successful.Conversely, bariatric surgery can allow patients to achieve significant and sustained weight loss, leading to improvement of obesity-associated comorbidities such as hyperlipidemia and diabetes.

Context: A symbiotic relationship between the liver and intestinal tract enables the healthy status of both organs. Microflora resident in intestinal lumen plays a significant role in hepatocytes function. Alterations to the type and amount of microorganisms that live in the intestinal tract can result in serious and harmful liver dysfunctions such as cirrhosis, nonalcoholic fatty liver disease, alcoholic liver disease, and hepatic encephalopathy. An increased number of pathogens, especially enterobacteriaceae, enterococci, and streptococci species causes the elevation of intestinal permeability and bacterial translocation. The presence of high levels of lipopolysaccharide (LPS) and bacterial substances in the blood result in a portal hypertension and ensuing hepatocytes damage. Several methods including the usage of antibiotics, prebiotics, and probiotics can be used to prevent the overgrowth of pathogens. Compared to prebiotic and antibiotic therapy, probiotics strains are a safer and less expensive therapy. Probiotics are "live microorganisms (according to the FAO/WHO) which when administered in adequate amounts confer a health benefit on the host”. Evidence Acquisitions: Data from numerous preclinical and clinical trials allows for control of the flora bacteria quantity, decreases in compounds derived from bacteria, and lowers proinflammatory production such as TNF-a, IL-6 and IFN-g via down-regulation of the nuclear factor kappa B (NF-k B).Results: On the other hand, probiotic can reduce the urease activity of bacterial microflora. Furthermore, probiotic decreases fecal pH value and reduces ammonia adsorption. In addition, the serum level of liver enzymes and other substances synthesized by the liver are modulated subsequent to probiotic consumption. Conclusions: According to our knowledge, Probiotic therapy as a safe, inexpensive and a noninvasive strategy can reduce pathophysiological symptoms and improve different types of liver diseases without side effects.

Dear Editor, We enjoyed reading the excellent article by Abenavoli and colleagues on the clinical role of Ribavirin (RBV), and particularly the selection and maintenance of the optimal RBV dosing strategy that are required to achieve sustained viral suppression in patients with chronic hepatitis C (CHC) infection. They concluded that contemporary therapy for CHC infection is to deliver doses of both RBV and pegylated interferon-alpha (PEG-IFN) that confer optimal antiviral efficacy for a sufficient time to minimize viral relapse.

Recently, Iran has faced a rapidly growing HIV/AIDS problem particularly among injecting drug users (IDUs).A study on IDUs who had been admitted at some DICs in Iran revealed that 20.5% were infected with HIV and 43.4% were infected with HCV (1). Studies on drug injection in Iran have been generally oriented toward opioid users (2) and transmission of blood-borne infection diseases (3). In recent years, a new trend of methamphetamine injection is also observed in the community.

Background: More than two billion people have been exposed to hepatitis B virus (HBV) worldwide. Furthermore, four hundred million of them are infected with chronic HBV infection. The predominant mutation of the precore region involves a G to A change at nucleotide1896, which creates a premature stop codon at codon 28. Two mutations of A1762T and G1764A are reported as the most prevalent mutations in the basal core promoter (BCP).Objectives: The purpose of this study was to investigate the relationship between mutations in precore (PC) and basal core promoter regions, and the viral load.Patients and Methods: Fifty serum samples from patients with hepatitis B were used. Levels of liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at the same time of serological markers of hepatitis B by ELISA. HBV-DNA was extracted from the sera, and then PCR performed on the HBV-DNA extracted with the use of specific primer of gene C. HBV viral load was determined by real-time PCR. The PC/ BCP mutations were determined by applying Line Probe Assay technique. The data were analyzed using SPSS software, version 20.Results: Only 82% of the patients were HBeAb positive and 76% of the patients had basal core/ precore mutations and mean viral load was 3/7 ¡Á 106 ¡À 9/7 ¡Á 105 IU/ml. Prevalence of mutations in the precore and basal core promoter regions were 46% and 30%, respectively. Conclusions: Our data indicated that there is a statistically significant relationship between HBV viral load and mutations in precore region (P<0.05).