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

Living in a region with a high prevalence of liver diseases especially Hepatitis B and C Virus infections is not sufficient to compensate the gap of knowledge in the field of hepatology. Despite the fact that the knowledge in the field of hepatology is in logarithmic increasing, we are still facing many challenges and gaps in hepatology. There are still many subjects that should be clarified by researchers and scientists but we should not forget knowledge of generation is quite different from publication and knowledge of translation.

Introduction: Alveolar echinococcosis (AE) is a chronic, serious and sometimes lethal parasitic infection, which is caused by Echinococcus multilocularis (EM). AE has been reported to occur in people from the north of Iran; however, until now there have been no cases of AE reportedfrom the southern provinces, such as Khuzestan.Case Presentation: Herein, we report our experiences with three cases of hepatic AE, who presented with large masses in the liver, from both the northern and southern provinces of Iran. Three patients are described who were presented with hepatic masses from different provinces of the country. Conclusions: There were three female patients, 21, 47 and 53 year-old. They were presented with liver masses from different centers of the country i.e. Khorasan, Ardabil and Khuzestan. According to our experience, AE is not an uncommon disease in Iran. Moreover, it has a widespread epidemiology, i.e., this disease should be suspected in all provinces of Iran, not only in the northern, but also in the southern regions of the country.

Background: Hepatitis C virus (HCV) is a plus stranded RNA virus which encodes 10 different genes. The HCV NS5B gene encodes a polymerase, which is responsible for the replication of the virus and is a potential target for the development of antiviral agents. HCV has a high mutation rate and is classified into six major genotypes.Objectives: The aim of this study was to draw a representing consensus sequence of each HCV genotype, align all six consensus sequences to draw a global consensus sequence and also study the highly conserved residues.Materials and Methods: 236 HCV NS5B sequences, belonging to all six genotypes, reported from all over the world were aligned then a representing phylogenetic tree was drawn.Results: The active site residues D220, D225, D318 and D319, which bind the divalent cations, are highly conserved among all the HCV genotypes. The other catalytic pocket residues, R158, S367, R386, and T390 and R394, which interact with the triphosphate of NTPs, are also highly conserved while T390 is mutated to valine in the genotype 5. The motif B residues G283, T286, T287 and N291, which take part in sugar selection by RdRp, are also highly conserved except for T286 which is mutated to proline in the genotypes 3 and 6. The residues E18, Y191, C274, Y276 and H502, which take part in primer/template interaction, are also high conserved except for H502 which is mutated to serine in genotype 2. High variation in all the six consensus sequences was observed in a 12 amino acid beta hairpin loop, which interacts with the double stranded RNA. Nine different peptides from the highly conserved regions of HCV NS5B protein were drawn which can be used as a peptide vaccine. The HCV NS5B phylogenetic tree shows the clusters of different genotypes and their evolutionary association.Conclusions: In spite of a high mutation rate in HCV, the residues which are present in the catalytic pocket, sugar selection and template/primer interaction are highly conserved. These are target sites for the development of antiviral agents or peptide vaccines. The phylogenetic analysis suggests that different HCV genotypes have been evolved from the genotype 1a.

Dear Editor: We read with interest the paper by Pawlowska et al. (1) and we would like to add some comments. They conducted a retrospective cohort study of children with chronic hepatitis C (CHC) infection who completed treatment with ribavirin (RBV) plus pegylated IFN (peg-IFN) or recombinant IFN, and concluded that a mild decrease in hemoglobin levels, leukocyte and platelet counts during treatment may be the responsible factors for sustained viral response (SVR) induction.

Background: Human immunodeficiency virus (HIV) infected patients are also frequently exposed to the hepatitis B virus (HBV), due to the common routes of transmission, therefore, prevention of hepatitis B results in decreased complications of the disease.Objectives: Since the immune response of HIV patients to hepatitis B vaccination is less robust than that found in healthy individuals, this study aimed to evaluate the effect of a levamisole adjuvant on increasing the immune response.Patients and Methods: In this study, 89 HIV infected patients, without a history of HBV infection or vaccination, were randomly allocated into experimental (44 patients) and control (45 patients) groups. HBV vaccination was performed using the Hepavax-Gene TF vaccine, 40 mg three times at intervals of; zero, one, and three months. Levamisole 50 mg twice a day or a placebo, was administered to the experimental and control groups, respectively, for a period of six days before to six days after the vaccination. Immune response was evaluated by measuring hepatitis B surface antibodies (HBsAb) concurrently with the second and third vaccine administration, and at one and three months at the conclusion of the vaccination program.Results: The immune response following the three vaccinations was higher in those who were receiving levamisole compared with the controls (90% vs.65.38%) (P=0.05). Furthermore, the immune response and the mean antibody titer following the repeated vaccination in the experimental group showed a higher increase than in the control group. The immune response and the mean titer of antibody were not associated with; age, sex, body mass index, history of smoking and/or intravenous drug use in either of the groups. However, regarding CD4+cells more than 200 cell/mm3, mean antibody production significantly increased in both groups.Conclusions: Using levamisole with the hepatitis B vaccination can increase the immune response and antibody titer mean in HIV infected patients. Since these patients have a more complete response with CD4+cells more than 200 cell/mm3, vaccination and effective adjuvants seem to be most beneficial when CD4+cells are greater than 200 cell/mm3, in HIV infected patients.

Background: Thyroid dysfunction (TD) represents an extra-hepatic manifestation of chronic hepatitis C (CHC) and it may also be a side effect of interferon-alpha (IFN-a) based treatment. However, previous studies have shown a wide variation in the incidence of TD in patients with CHC. Furthermore, the long-term outcomes and the predictive factors of TD in patients who receive IFN-abased treatment have still not been fully studied.Objectives: The purpose of this study was to describe the incidence and long-term outcomes of TD in Chinese patients with CHC receiving IFN-abased treatment. We also aimed to identify the predictive factors of TD associated with this type of therapy.Patients and Methods: A retrospective case-series study of 592 consecutive CHC patients with normal baseline thyroid functions, who received IFN-abased therapy, was performed. Thyroid function was assessed at baseline and every three months during treatment, as well as in the follow-up after cessation of therapy. The incidence and long-term outcomes of TD were observed. The prevalence of pretreatment thyroid peroxidase antibodies (TPOAb) were assayed in a sex- and age-matched nested case-control study. Multivariable stepwise regression analysis was used to explore the independent effects of the baseline factors, on the incidence of TD.Results: At the end of the IFN-abased therapy, 68 patients (11.5%) in the study had developed TD, 58 patients (85.3%) presented with subclinical TD, and only 10 patients (14.7%) developed overt thyroiditis. The thyroid function of 46 patients (67.8%) spontaneously returned to normal in the six months of follow-up and only three patients (4.4%) had persistent overt TD symptoms after the 24 month follow-up period. Multivariate stepwise analysis suggested that gender and pretreatment TPOAb were the independent factors related to the incidence of TD. Both female patients (OR, 4.31; 95%CI, 2.06–7.31; P=1.26×10-4) and participants with a positive pretreatment TPOAb (OR=3.9, 95%CI, 1.72–8.54, P=0.008) had an increased risk for the development of TD.Conclusions: The incidence of TD in Chinese patients with CHC during IFN-abased therapy was 11.5%, the majority of which was subclinical, while only a very small group had long-term overt TD requiring ongoing medical therapy. Female gender and pretreatment TPOAb positivity are risk factors for the development of TD during IFN-abased therapy

Background: The impact of hepatitis B virus (HBV) vaccination campaigns on HBV epidemiology needs to be evaluated, in order to assess the long-term immunity offered by vaccines against HBV.Objectives: To evaluate the current status of anti-HBV vaccine coverage among healthcare workers (HCWs) in Southern Italy, and to determine the long-term persistence of antibodies to hepatitis B surface antigens (anti-HBs) in such a cohort of subjects.Patients and Methods: A longitudinal, retrospective seroepidemiological survey was conducted among 451 HCWs, who were working at or visiting, the Occupational Health Department of a city hospital, in Catania, Italy, between January 1976 and December 2010.Results: At the 30-year follow-up (mean follow-up 10.15±5.96 years, range 0.74-30), 261 HCWs had detectable anti-HBs titers indicating a persistence of seroprotection of 89.4% (out of 292 anti-HBs positive results, three months after vaccination). An inadequate vaccination schedule was the strongest predictor of antibody loss during follow-up (OR=8.37 95% CI: 5.41-12.95, P<0.001). A Kaplan-Maier survival curve revealed that the persistence of anti-HBs 30 years after vaccination, was 92.2% for high responders, while it was only 27.3% for low responders (P=0.001).Conclusions: A good level of seroprotection persisted in 57.9% of the subjects after 30 years. Factors related to this immunization status confirmed the importance of vaccinating HCWs early in their careers and ensuring an adequate vaccination schedule. However, with particular reference to the low rate of hepatitis B vaccine coverage among HCWs in Southern Italy, the implementation of a new educational intervention as part of an active vaccination program is needed.

Background: The impact factor (IF), as the most important criterion for journal’s quality measurement, is affected by the self-citation and number of publications in each journal.Objectives: To find out the relationship between the number of publications and self-citations in a journal, and their correlations with IF. Materials and Methods: Self-citations and impact factors of nine top gastroenterology and hepatology journals were assessed during the seven recent years (2005-2011) through Journal Citation Reports (JCR, ISI Thomson Reuters). Results: Although impact factors of all journals increased during the study, five out of nine journals increased the number of publications from 2005 to 2011. There was an increase in self-citation only in the journal of HEPATOLOGY (499 in 2005 vs. 707 in 2011). Impact factors of journals (6.5±3.5) were positively correlated with total number of publications (248.6±91.7) (R: 0.688, P<0.001). Besides, the self-citation rate (238.73±195.317) was highly correlated with total number of publications in each journal (248.6±91.7) (R: 0.861, P<0.001). On the other hand, impact factor without self-citation (6.08±3.3) had a correlation (R: 0.672, P<0.001) with the number of published items (248.6±91.7).Conclusions: The number of articles and self-citation have definite effects on IF of a journal and because IF is the most prominent criterion for journal’s quality measurement, it would be a good idea to consider factors affecting on IF such as self-citation.

Background: Despite significant advances in the treatment of chronic hepatitis C in the past decades, factors which can affect response rates to combination therapy; peginterferon and ribavirin, are still under study and reaching sustained virological response (SVR) is affected by several different factors.Objectives: To investigate predictor factors contributing to SVR in Iranian patients.Patients and Methods: The present non-randomized, clinical trial was conducted on 100 patients referred to the Tehran Hepatitis Center in 2009-2011. The patients were administered combined peginterferon a-2a-ribavirin treatment, based on the standard protocol of the Iranian Ministry of Health. At the end of the treatment, the SVR rate and predictors were evaluated.Results: The mean age of the patients was 42 and 78% were male. Genotype 1a was the most common (70%) and 55% of patients were treatment naive. The outcomes showed that 12%, 16% and 22% patients were; non-responders, breakthroughs and relapsers, respectively, while 50% of the patients reached SVR. Patients reaching SVR were aged 40 years or lower, they were less likely to have been a non-responder in prior treatments, more likely to have a non-1a genotype and a higher number had an HCV RNA of less than 600 000 IU/ml. The multivariate analysis showed that an age of 40 or lower (OR=3.74, CI95%=1.52-9.22), a non-1a genotype (OR=3.71, CI 95%=1.40-9.81) and an HCV RNA less than 600 000 IU/ml (OR=2.52, CI 95%=1.03-6.15) may be useful SVR predictors.Conclusions: The findings of the present study showed that half of the patients reached SVR through combined peginterferon a-2a and ribavirin treatment, the majority of whom had genotype 3a and a minority had genotype 1a. In addition, an age of 40 or lower, non-1a genotype and a viral load less than 600 000 IU/ml were strong SVR predictors

Background: There have been studies regarding the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody (HCVAb) in Iran. However, the majority of these have reported a variety of rates, depending on their study population, which limits the generalizability of their results to the general population. On the other hand, cultural diversity in the different provinces of Iran also necessitates the performing separate population-based studies in the various regions.Objectives: To evaluate the population-based prevalence of HBsAg and HCVAb and their correlates in Zahedan City, Iran.Patients and Methods: Included in this study were 2587 individuals, using a random and cluster sampling approach. The participants were drawn from the Family Registry of the public health centers in Zahedan City, Iran, from 2008 to 2009. Following data collection from the interviews, subjects were assessed for seropositivity of HBsAg and HCVAb. We then calculated the prevalence of HBsAg and HCVAb, and evaluated these viral markers for an association with; age, sex and potential risk factors.Results: Weighted seroprevalence of HBsAg and HCVAb was 2.5% (CI 95%: 1.9 to 3.3 %) and 0.5% (CI 95%: 0.27 to 0.9 %), respectively. Prevalence of HBsAg increased significantly with age (P value<0.001), but this was not true for HCVAb (P value: 0.67). We observed no sex dominance in the prevalence of HBsAg (3.2% and 2.2% for males and females, respectively, P value: 0.15) or HCVAb (0.4% and 0.7% for males and females, respectively, P value: 0.27). In a multivariate regression analysis, every additional year in age resulted in a 2% increment in the odds of HBsAg seropositivity. HBsAg was also three times more prevalent among married, than single subjects (with a P value reaching toward significance: 0.065) in multivariate analysis. Prevalence of HCVAb did not differ with respect to any of the potential risk factors.Conclusions: This is the first population-based study on the prevalence of HCVAb and one of the few population based studies on HBsAg in Zahedan City. We detected lower prevalence rates of HBsAg and HCVAb than in previous studies conducted in Zahedan City. In addition to improvements in social awareness and general health elements, we think that the observed low prevalence rates have been achieved due to the efficiency of mass vaccination projects, implemented against HBV infection in Iran.

Background: Chronic hepatitis C (CHC) is a global infection. In Saudi Arabia, the prevalence of CHC is declining due to the implementation of a blood screening program. However, CHC still remains a leading cause of liver cirrhosis and hepatocellular carcinoma.Objectives: This is a retrospective study of CHC patients at the King Abdul Aziz University Hospital, Jeddah, Saudi Arabia.Patients and Methods: Out of a total of 291 CHC patients from the hepatology clinic at King Abdul Aziz University hospital, Jeddah, 279 patients were included in the present study. They were primarily male (152, 54.5%), with a mean age of 50.41±1.72 years. The majority of patients were either Saudi (108, 38.7%) or Egyptian (60, 21.5%). A total of 61 patients received combination treatment with pegylated interferon and ribavirin, and one patient with sickle-cell anemia received pegylated INF monotherapy. Demographic, clinical and laboratory features of the CHC patients, and their responses to treatment were studied.Results: Decompensated cirrhosis was documented in 60 patients (21.5%), and hepatocellular carcinoma in 14 (5%). The mean level of serum alanine aminotransferase was 83.6±231 u/L. The predominant genotype among the 70 patients tested, was genotype 4, followed by genotype 1 (39 and 18 patients, respectively). The sustained viral response (SVR) rate was 82.99%. The main predictive factors for SVR were baseline HCV viral load and rapid virologic response (RVR). The mean duration of follow-up was 4.2±.85 years. There were 24 patients who had liver disease-related mortality.Conclusions: our data showed that 22% of CHC patients progress to cirrhosis and another 22% had treatment. Liver related mortality was more common in patients with advanced cirrhosis.

Dear Editor: We read with interest the recent report by Nokhodian et al. based on prevalence and risk factors of sexually transmitted infections including hepatitis C infection among female prisoners in Isfahan (1). The researchers successfully presented a picture of the current situation in the prevalence of such important factors in a selected group with specific social behaviors and risk factors. Hepatitis C virus is one of the important causes of hepatitis worldwide. It is also a major cause of cirrhosis and end stage of liver disease (2).