Hepatitis Monthly
Year:2012 | Volume:12 | Issue:7|Papers Count:12

In the 70s and 80s, Italy was one of the countries with the highest prevalence of hepatitis B in Europe; the overall endemic of hepatitis B virus (HBV) was classified as intermediate, yet it resulted from a dual pattern of high endemic in south Italy and of low endemic in most of north Italy parts. The mean countrywide rate of carriers of the HB surface antigen (HBsAg) was 2.5%; however figures were as high as 10% in areas of south Italy. HBsAg rate in pregnant women was 2.4% in average; however in some areas as many as 5% of the women were carriers (1).

The hepatitis B surface antigen (HBsAg), first named as Australia antigen, was identified and linked to hepatitis in the late 1960s by Blumberg and colleagues. It is now well established that this protein forms the outer envelope of the hepatitis B virus (HBV) and constitutes the main diagnostic marker of both acute and chronic infection. This is facilitated by the fact that the protein is produced in large amount, not all of which is virus associated.

The rising concerns for future health burden of hepatitis C virus (HCV) in global scale has continuously encouraged preventing measures particularly public awareness programs. There is an increasing necessity for allocating HCV awareness issues in public scope, especially for high risk populations and patients. Proper knowledge of health care professionals and treating physicians and their attitude with regard to hepatitis C management is also crucial. Achieving this can be a constructive step forward in controlling and hopefully eradicating hepatitis C virus in our community. Having a clear scientific grasp on treatment options and protocols, the concept of “CURE” achievement in hepatitis C and the future hopes in enhancing virological response with the coming direct antiviral agents can significantly add to the current practices of treating hepatitis C. This scientific report paper outlines the insights communicated at the HCV symposium during the 4th Tehran Hepatitis Congress, November 2011, Tehran, Iran.

Background: The prevalence of hepatitis C virus (HCV) infections in elderly patients has been increasing in a number of countries. A few reports concerning pegylated interferon-a (PEG-IFN-a) -based combination treatment in elderly chronic hepatitis C (CHC) patients have been published, with slightly different treatment outcomes.Objectives: We investigated the treatment response and safety of PEG-IFN-a plus ribavirin combination therapy in elderly patients with CHC.Patients and Methods: Among a total of 181 treatment-naive CHC patients (60 patients with genotype 1, 121 patients with genotype 2 or 3), 38 were aged ³65 years (defined as the elderly group) and 143 were aged<65 years (defined as the non-elderly group).Results: The overall sustained virologic response (SVR) was lower in the elderly group than in the non-elderly group, but it was not significantly different (65.8%vs.76.2%, P=0.15). In a subgroup analysis, among patients with genotype 1, the elderly group had a significantly lower SVR rate than the non-elderly group (30.8%vs.66.0%, P=0.03). However, the SVR rate in patients with HCV genotype 2 or 3 was comparable between the two groups (84.0%vs. 81.3%, P=0.85). HCV genotype was significantly associated with SVR in the elderly patients (genotype 1vs.2 or 3, odds ratio: 0.18, 95% confidence interval: 0.000-0.869, P=0.03). The incidence of premature discontinuation of treatment (21.1%vs.9.1%, P=0.05) and dose modification (52.6%vs.31.5%; P=0.02) due mainly to adverse events or laboratory abnormalities, were higher in the elderly group than in the non-elderly group.Conclusions: PEG-IFN-a plus ribavirin combination therapy might be considered for elderly CHC patients, especially for genotype 2 or 3, with vigilant monitoring of adverse events.

Background: Torque teno virus (TTV) was the first human Circoviridae detected in a Japanese patient with unknown hepatitis in 1997. Subsequently, several studies performed to evaluate different aspects of Torque teno virus pathogenesis.Objectives: The present study aimed to determine dominant genotype of Torque teno virus in chronic hepatitis disease using 5’-UTR sequence among patients infected by hepatitis C virus in Shiraz – Iran.Patients and Methods: The study conducted in 240 patients with chronic hepatitis C from Prof. Alborzi Clinical Microbiology Research Center. The presence of Torque teno virus DNA and its genotype in plasma was assessed by nested polymerase chain reaction using two primer sets for 5’-UTR and N22 regions. Phylogenetic analysis was performed based on 5’-UTR region.Results: DNA of Torque teno virus was detected in 220 out of 240 (92%) patients with chronic hepatitis C by the use of 5’-UTR primer based PCR method and in 12 out of 240 (5%) by the use of N22 primer. Based on phylogenetic analysis it was shown that the Dominant genotype in this study was 11. Genotypes 1, 3, 17, and 22 were also detected. Some sequences could not be classified to a specific genotype.Conclusions: The prevalence of Torque teno virus DNA in patients with chronic hepatitis C disease by the use of 5’-UTR primer appeared to be higher compared to that revealed by N22 primer. We observed five genotypes among hepatitis C chronic patients in our study.

Background: Female prisoners are at risk of acquiring sexually transmitted infections (STIs). There has been no previous study regarding the epidemiological status of STIs among female prisoners in Isfahan, central Iran.Objectives: The aim of this study was to investigate the prevalence and risk factors of the aforementioned infections among women incarcerated in the central prison, Isfahan, to determine appropriate prevention measures.Patients and Methods: In a cross-sectional study, all of the 163 women incarcerated in the central prison, Isfahan in 2009, were voluntarily enrolled by the census method.After completing a checklist consisting of demographic, social, and risk factors, a 5ml blood sample was taken from each individual. The sera were analyzed for markers of the hepatitis B virus (HBV; HBsAg, HBsAb, HBcAb), hepatitis C virus (HCV; HCV antibodies), human immunodeficiency virus (HIV; HIV antibodies), and syphilis (RPR). Confirmatory tests were performed on HCV antibody-positive cases.Results: The mean age of the participants in the study was 34.54±11.2 years old, 94.3% of these women were Iranian, and many of them had only a primary level of education. The prevalence of HBsAg, HBcAb, HBsAb, and HCV antibodies were; 1.2%, 7.4%, 12.9% and 7.4% respectively. No positive RPR or HIV antibodies were detected.Conclusions: A significant relationship was seen between the HCV antibody, drug injection and illegal sex in the women, and also between HBc-Ab and drug injection. Regular screening, educational programs, and facilitation of access to suitable treatment care should be widely implemented in the prison population. Testing for immunity against HBV should be considered on admission, and afterwards vaccination of all prisoners and an appropriate preventative approach should be applied.

Background: Incidence of hepatocellular carcinoma has been increased as the sixth most common cancer in the world. Improvement in imaging techniques has decreased the need for tissue confirmation in diagnosis of hepatocellular carcinoma (HCC). Meanwhile, false negative and positive cases are present. Fine needle aspiration (FNA) biopsy can be helpful to identify well-differentiated HCCs with low risk of vascular invasion and better prognosis following transplantation.Objectives: We conducted this study to find useful criteria for cytological differential diagnosis between nodules of well differentiated hepatocellular in the background of cirrhosis and pure cirrhotic regenerative nodules in cytology smears.Materials and Methods: 140 fine needle aspirations (FNA) of fresh cirrhotic hepatectomy specimens were studied (100 pure regenerative nodules and 40 HCC nodules). All slides were reviewed by two expert pathologists. The most useful criteria were selected and evaluated in 560 cytology smears stained by Pap and Wright methods.Results: None of the smears from cirrhotic patients showed mitosis, transgressing endothelium, eccentric nuclei, and scant cytoplasm, but thick nuclear membrane, spindle cells and abundant, thick and monotonous cytoplasm were found in many cases with cirrhosis. Large nucleoli (2%), multiple nucleoli (6%), increased N/C ratio (4%), and broad cores (2 %) were found very rarely in the smears of regenerative nodules, but they were present in 50%, 72.5%, 87%, and 77.5% of HCC nodules, respectively.Conclusions: Combination of cytologic criteria can be helpful for differential diagnosis between HCC and regenerative nodules.

Background: Hepatitis C virus (HCV) /human immunodeficiency virus (HIV) co-infection has become a serious public health problem especially in high risk groups such as injection drug users in China. However, the impact of HIV infection and antiretroviral therapy (ART) on HCV viral load which is usually regarded as a predictor of liver disease progress had not been well studied in this country.Objectives: To explore correlations of HIV co-infection and ART with plasma HCV load among HCV-infected patients in an ethnic minority area in Yunnan Province, China.Patients and Methods: HCV/HIV co-infected patients and HCV mono-infected controls were examined and compared for plasma HCV RNA and related risk factors.Results: A total of 145 HCV/HIV co-infected patients and 25 HCV mono-infected controls were studied. The majority of the participants were male, belonged to an ethnic minority and were younger than 45 years old. HCV viral suppression rate with undetectable plasma HCV viral load was 28.3% in the HCV/HIV co-infected patients, 36% among HCV mono-infected controls and 29.4% overall. ART-prescribed HCV/HIV co-infected patients had significantly higher HCV viral loads (IQR: (3.80-6.44) *log10 copies ml-1) than those naive to ART (IQR: (undetectable-6.41) *log10 copies ml-1) and HCV mono-infected patients (IQR: (undetectable-5.44) *log10 copies ml-1). Men, from the Dai minority and those with more than six years education, were also shown to have a higher plasma HCV viral load, according to multiple logistic regression analysis.Conclusions: ART potentially increases the plasma HCV viral load among HCV/HIV coinfected patients in an ethnic minority area in China. Future large scale prospective cohort studies are needed to address the controversy associated between HIV co-infection and the natural history of HCV.

Background: The global epidemic of hepatitis B and hepatitis C is a serious public-health problem. Chronic hepatitis B and hepatitis C are among the leading causes of preventable death worldwide. World Health Organization (WHO) estimates that up to two billion people in the world have been infected with HBV; about 350 million people live with chronic HBV infection, and about 600, 000 people die from HBV- related liver disease or HCC each year. The endemicity of infection is considered high in Yemen. Data for prevalence of HBsAg and HCV antibodies in Ibb city in Yemen is rare and inadequate.Objectives: The study was undertaken to study the epidemiology and prevalence of viral hepatitis (HBV) and (HCV) in Ibb city, Yemen.Patients and Methods: 554 pre-designed questionnaires and sera samples were collected in July 2010. Sera were tested for HBsAg and HCV antibodies by ELISA quantitative technique. Each individual’s data were collected in a pre-designed questionnaire.Results: The prevalence of HBV in Ibb city was 1.81%, whereas, the prevalence of HCV was 1.99%.Conclusions: This study revealed low level risk of hepatitis B virus and hepatitis C virus infections. Inadequate information on the prevalence and risk determinants of viral hepatitis among the different population groups in Yemen are responsible about morbidity and mortality of HBV and HCV in Ibb city, Yemen.

Dear Editor: We greatly enjoyed reading the article by Zahediet al. (1) about the prevalence of viral hepatitis and human immunodeficiency virus (HIV) infection in hemodialysis (HD) patients in South-East of Iran. They reported that hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV) were found in 7% of cases individually. Anti-HIV and hepatitis D antibody (anti-HDV) were negative in all cases (1). Patients on maintenance hemodialysis, potentially are prone to infection with parentally transmitted viral agents especially hepatitis B (HBV) and hepatitis C virus (HCV) due to impaired host immune response and multiple transfusion requirements.Viral hepatitis considered as a problem for HD patients because 1.9% of all deaths among this population were related to the consequence of viral hepatitis (2, 3). The prevalence of HCV and HBV infection in hemodialysis patients is quite variable among different HD units in varying countries (4).

Dear Editor: In their recent interesting published manuscript, Ahmadiet al. showed that in predialysis patients with chronic renal failure (CRF) doubling the dose of Hepatitis B virus (HBV) vaccine from 20mcg to 40mcg was not benefit regarding the seroconvertion rate (1). Although somewhat provocative, the above highlights the complexity of the immune system and the difficulties in interfering effectively and safely with its function.

Dear Editor: We read with great interest the article “epidemiology of occult hepatitis B infection among thalassemia, hemophilia and hemodialysis patients” by Arababadi et al. (1). because of our common field of interest in investigation of occult hepatitis B infection (OBI) in high risk patients such as HIV infected cases and hemodialysis patients. OBI is defined as the presence of HBV-DNA in the liver tissue or serum without detectable hepatitis B surface antigen (HBsAg) (2). About 20% of OBI cases are negative for all HBV markers except HBV-DNA, 50 % are positive for hepatitis B core antibody (anti-HBc) and 35% are positive for hepatitis B surface antibody (anti-HBs) (3).