anti-HBc Positivity Research Articles

A comprehensive study of the safety of using anti-hepatitis B core (Hbc) positive subjects in living donor liver transplants.

In recent years, only few reports have addressed the safety of using living donors with a positive anti-Hepatitis B Core (HBc) antibody for liver transplants. Most reports have focused on short-term complications, short-term changes in liver function and regeneration of remnant liver. Long term follow-up data, quality of life and overall laboratory tests variations have not been appropriately studied. In our study, we aim to comprehensively investigate the safety of using anti-HBc-positive subjects in living donor liver transplants (LDLT). From March 2003 to March 2008, a total of 60 of LDLT cases were studied. All cases were right lobe transplants. Thirty donors with a positive anti-HBc were included in one group (group 1). The other 30 donors with a negative anti-HBc were included in Group 2. Preoperative parameters, intra-operative data, postoperative short- and long-term complications, laboratory tests and quality of life after surgery were compared. Preoperative demographic data, intra-operative data and graft size comparisons from both groups showed non-significant differences. Anti-HBc-positive donors (9 cases; 30%) showed more complications than negative donors (7 cases; 23.3%). However, the increase did not reach statistical significance (p = 0.563). The quality of life, postoperative serum Transaminase levels, prothrombin times and routine blood values showed non-significant differences. Anti-HBc positive donors showed higher levels of total bilirubin (TB), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) within the first 7 postoperative days. Nonetheless, all levels showed similar values for both groups in the days immediately following surgery. All indexes returned to normal levels, thirty days after surgery. However, a persistently decreased platelet count was observed in both groups. A positive serological test result for anti-HBc should not be considered as an absolute contraindication for LDLT. However, these cases require more caution than negative donors.

AB0740 The frequency of occult hepatitis b infection in rheumatic diseases and the role of anti-hbc test in routine practice

BackgroundMost of the drugs used in rheumatic diseases suppress the immune system, especially corticosteroids and anti-TNF agents, therefore may cause reactivation in patients with hepatitis B virus (HBV). Studies have...

THU0430 Serological Prevalence of Hepatitis B Virus Infection Among Patients with Different Rheumatic Diseases

BackgroundReactivation of HBV is well-recognized and frequently reported in rheumatic patients, particularly those receiving disease modifying anti-rheumatic drugs [1, 2]. This might occur during [2] or after [3] cessation of...

Lack of correlation between the antibody to hepatitis B core antigen and survival after surgical resection for hepatitis C virus-related hepatocellular carcinoma

The impact of antibodies to hepatitis B core antigen (anti-HBc) on survival after curative surgical resection (SR) for hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) remains unclear. The aim of the present study was to examine the relationship between anti-HBc positivity and survival of HCV-related HCC patients who underwent curative SR. A total of 222 patients with HCV-related, hepatitis B surface antigen (HBsAg)-negative HCC who underwent curative SR were analyzed. They included 119 anti-HBc-positive patients (53.6%) and 103 anti-HBc-negative patients (46.4%). Overall survival (OS) and recurrence-free survival (RFS) rates were compared between the two groups. The median follow-up periods in the anti-HBc-positive and anti-HBc-negative groups were 3.4 years (range, 0.3-10.9 years) and 3.2 years (range, 0.5-10.9 years), respectively. The 1-, 3- and 5-year cumulative OS rates were 88.8, 70.2 and 50.0%, respectively, in the anti-HBc-positive group and 95.8, 77.1 and 61.7% in the anti-HBc-negative group (P=0.300). The corresponding RFS rates were 68.7, 33.0 and 20.0%, respectively, in the anti-HBc-positive group and 74.4, 38.5 and 16.5% in the anti-HBc-negative group (P=0.482). Multivariate analyses identified serum albumin ≥3.8 g/dl (P=0.005) and the presence of microvascular invasion (P<0.001) as independent factors linked to OS, and interferon therapy after surgery (P=0.011), α-fetoprotein ≥40 ng/ml (P=0.030) and the presence of microvascular invasion (P<0.001) were significant predictors linked to RFS. In subgroup analyses according to maximum tumor size and background liver disease in terms of OS and RFS, no significant difference between the anti-HBc-positive and anti-HBc-negative groups was observed except in patients with non-cirrhotic liver in terms of RFS. In conclusion, anti-HBc-positivity is not a useful predictor for survival of patients with HCV-related HCC after curative SR.

Prevalence of Hepatitis B in Insular Regions of Southeast China: A Community-Based Study

ObjectiveHepatitis B virus (HBV) infection remains a significant public health problem. The purpose of this study was to investigate the seroepidemiology of HBV in people living in the insular regions, and to provide the most recent baseline data for planning and monitoring of health.MethodsA cross-sectional, community-based survey was conducted without age restriction, on two isolated islands, Zhoushan and Yuhuan, China. The study sample was selected by random multistage cluster sampling. Serological samples and demographic information were collected from 15878 participants.ResultsThe prevalences of anti-HBV core antibody (anti-HBc), hepatitis B virus surface antigen (HBsAg), and anti-HBV surface antibody (anti-HBs) were 33.1, 10.4, and 56.1%, respectively. We found statistically significant differences of HBV markers in men versus women (P<0.01). The prevalence of HBV infection increased with age. There were significant differences in the rates of HBsAg and anti-HBc positivity between the two islands (P<0.01). Alanine aminotransferase (ALT) levels were elevated (>38 IU/L) in 15.6% and 7.2% of the HBsAg-positive and negative groups, respectively. Elevated ALT levels were significantly higher in males (12.0%) compared with females (5.8%) (P<0.01). The α-fetoprotein (AFP) positivity rate was 0.6% in HBsAg-positive participants over the age of 30.ConclusionDue to the geographic location, we found that the HBV prevalence and potential for the development of hepatocellular carcinoma remained high in insular regions of southeast China, and are far above the national figures. Although a vaccination program has been in effect over the last 20 years, several additional measures should be adopted by the government to limit the spread of hepatitis B. These include the management of high risk persons and the floating population living on the islands, expansion of the immune population, and increased health education for fisherman.

Occult hepatitis B virus infection among Egyptian blood donors

To identify blood donors with occult hepatitis B virus (HBV) infection (OBI) to promote safe blood donation. Descriptive cross sectional study was conducted on 3167 blood donors negative for hepatitis B surface antigen (HBsAg), hepatitis C antibody (HCV Ab) and human immunodeficiency virus Ab. They were subjected to the detection of alanine aminotransferase (ALT) and aspartate transaminase (AST) and screening for anti-HBV core antibodies (total) by two different techniques; [Monoliza antibodies to hepatitis B core (Anti-HBc) Plus-Bio-Rad] and (ARC-HBc total-ABBOT). Positive samples were subjected to quantitative detection of antibodies to hepatitis B surface (anti-HBs) (ETI-AB-AUK-3, Dia Sorin-Italy). Serum anti-HBs titers > 10 IU/L was considered positive. Quantitative HBV DNA by real time polymerase chain reaction (PCR) (QIAGEN-Germany) with 3.8 IU/mL detection limit was estimated for blood units with negative serum anti-HBs and also for 32 whose anti-HBs serum titers were > 1000 IU/L. Also, 265 recipients were included, 34 of whom were followed up for 3-6 mo. Recipients were investigated for ALT and AST, HBV serological markers: HBsAg (ETI-MAK-4, Dia Sorin-Italy), anti-HBc, quantitative detection of anti-HBs and HBV-DNA. 525/3167 (16.6%) of blood units were positive for total anti-HBc, 64% of those were anti-HBs positive. Confirmation by ARCHITECT anti-HBc assay were carried out for 498/525 anti-HBc positive samples, where 451 (90.6%) confirmed positive. Reactivity for anti-HBc was considered confirmed only if two positive results were obtained for each sample, giving an overall prevalence of 451/3167 (14.2%) for total anti-HBc. HBV DNA was quantified by real time PCR in 52/303 (17.2%) of anti-HBc positive blood donors (viral load range: 5 to 3.5 x 10(5) IU/mL) with a median of 200 IU/mL (mean: 1.8 x 10(4) ± 5.1 x 10(4) IU/mL). Anti-HBc was the only marker in 68.6% of donors. Univariate and multivariate logistic analysis for identifying risk factors associated with anti-HBc and HBV-DNA positivity among blood donors showed that age above thirty and marriage were the most significant risk factors for prediction of anti-HBc positivity with AOR 1.8 (1.4-2.4) and 1.4 (1.0-1.9) respectively. Other risk factors as gender, history of blood transfusion, diabetes mellitus, frequent injections, tattooing, previous surgery, hospitalization, Bilharziasis or positive family history of HBV or HCV infections were not found to be associated with positive anti-HBc antibodies. Among anti-HBc positive blood donors, age below thirty was the most significant risk factor for prediction of HBV-DNA positivity with AOR 3.8 (1.8-7.9). According to HBV-DNA concentration, positive samples were divided in two groups; group one with HBV-DNA ≥ 200 IU/mL (n = 27) and group two with HBV-DNA < 200 IU/mL (n = 26). No significant difference was detected between both groups as regards mean age, gender, liver enzymes or HBV markers. Serological profiles of all followed up blood recipients showed that, all were negative for the studied HBV markers. Also, HBV DNA was not detected among studied recipients, none developed post-transfusion hepatitis (PTH) and the clinical outcome was good. OBI is prevalent among blood donors. Nucleic acid amplification/HBV anti core screening should be considered for high risk recipients to eliminate risk of unsafe blood donation.

Hepatitis B screening: Who to target? A French sexually transmitted infection clinic experience

Hepatitis B virus (HBV) infection is a major public health burden in France and worldwide. Routine screening for hepatitis B is not currently recommended in France. Medical experts and public health agencies opinions can differ concerning targeting criteria. Our study aims at developing a risk assessment strategy for identifying possible hepatitis B cases among the patients consulting in a French Sexually Transmitted Infection (STI) clinic. 6194 asymptomatic patients requesting an STI screening were also screened for hepatitis B infection. The association between hepatitis B surface antigen (HBsAg) positivity and/or total hepatitis B core antibody (anti-HBc) positivity and self-reported risk factors for hepatitis were analysed. Only male gender, lack of employment, and birth, in medium or high endemic country, were independently associated with HBsAg positivity in multivariate analysis. Sexual behaviour or self-reported vaccination status is therefore not necessary to target high-risk populations. These three simple criteria could save 25% of unnecessary tests and 6-16% undiagnosed hepatitis B compared to usual targeting criteria. To detect HBsAg carriers, only three simple targeting criteria, without taking into account the self-reported vaccination status or sexual behaviour, could improve screening efficiency and save unnecessary testing.

Prevalence of hepatitis B among pregnant women assisted at the public maternity hospitals of São Luís, Maranhão, Brazil

IntroductionHepatitis B virus (HBV) infection is an important worldwide public health problem. In Brazil, the Ministry of Health estimates that 15% of the population has had contact with HBV, and that the mean rate of chronic carriers in Northeastern Brazil is around 0.5%. ObjectiveThe aim of this study was to assess the prevalence of HBV markers in pregnant women receiving prenatal care at the public maternity hospitals of São Luís. MethodsDemographical and epidemiological data were collected from 541 pregnant women according to the research protocol. Blood samples were collected, and the anti-HBc test was performed first. If positive, the sample was subsequently tested for HBsAg and anti-HBs. All HBsAg and/or anti-HBc positive samples were additionally tested for HBV-DNA. Results40 (7.4%) pregnant women turned out positive for anti-HBc. Of those, five (0.9%) were HBsAg positive, four (0.7%) were anti-HBc positive with negative HBsAg and anti-HBs, and 31 (5.7%) were positive for anti-HBc and anti-HBs. Anti-HBc positivity was associated with family history of hepatitis and education level below 11 years of schooling. HBV-DNA was positive in only one HBsAg-positive sample. There was no HBV-DNA positivity among HBsAg negative samples. ConclusionsThe prevalence of HBsAg in pregnant women in this study confirmed that São Luís is a low endemicity area. Occult hepatitis B was not detected in these samples.

Prevalence of Pretransplant Infections among South East Asian Kidney Transplant Recipients

Introduction: Although a number of solid organ transplantation has been rising in South East Asia, data on the prevalence and type of pretransplant infections is small. Methods: Between January 2006 and December 2011, we prospectively screened adult (age ≥18 years old) kidney transplant (KT) candidates from South East Asian Countries who underwent kidney transplantation at our center for pretransplant latent infections. We performed serological testing for viruses (HIV, HBV, HCV, CMV, VZV, HSV, EBV), strongyloides and syphillis, CBC with differential, and chest radiography. In addition, endemic parasites were tested by serology and stool examination among the candidates with peripheral eosinophila. During the same study period, pretransplant screening of the donors (anti-HIV, HBsAg, anti-HCV, anti-HBs antibody, VDRL) was done according to the standard protocol of the Thai red cross. Since 2009, thick smear and/rapid test for malaria were done among non-Thai living donors and candidates from endemic area following our first case of malaria infection early post transplantation. Results: Of the 181 KT recipients, 61.9% were Thais, 32.6% were Myanmars and 5.5% were Cambodians. The recipients, median age was 53 (15-75) years old. Majority (63%) were male. None were anti-HIV positive. Among the recipients, high rate of latent infections included varicella zoster virus (99.4%), herpes simplex virus (98.8%), cytomegalovirus (97.2%), and epstein-barr virus (95.3%). Majority (74%) of the recipients and 47.2 % of the donors had protective immunity to hepatitis B, respectively. Positive antiHBc IgG, HBsAg, and anti-HCV was noted in 57.1%, 5% and none of the donors, and 57.7%, 10.5%, and 2.2% of the recipients, respectively. Abnormal chest radiography suspicious for remote pulmonary infection was noted in 7.2%. None of the patients had an evidence of malaria infection. Only one (0.6%) patient was tested positive for strongyloides latent infection without clinical symptoms and negative stool examination. One (0.6%) patient had peripheral eosinophilia and were tested positive for gnathosomiasis by serology without clinical symptoms/signs. Both of the patients subsequently received anti-helminthic agent as treatment pretransplantation, as well as the repeated course of treatment post transplantation. No relapse of the infections was noted after 6 months follow up. Conclusions: The prevalence of latent herpes viral infections among South East Asian transplant candidates was high but the overall prevalence of parasitic infections was low. Nevertheless, pre-transplant infectious disease screening remains a critical step in preventing post transplant related-complication from donor-derived and reactivation of latent infection.

EL30 - How to Overcome the Reactivation of Hepatitis B Virus Caused by Cancer Treatment

ABSTRACT Reactivation of hepatitis B virus (HBV) has been often reported as a fatal complication, such as fulminant hepatitis, during or following chemotherapy. It is well-recognized in patients with hepatitis B surface antigen (HBsAg), but notably, it has been reported increasingly in HBsAg negative patients with anti-hepatitis B core antibody (anti-HBc) positivity or anti-hepatitis B surface antibody (anti-HBs) positivity receiving rituximab plus steroid therapy for malignant lymphoma, in whom HBV infection was generally considered to be cured. In Japan, HBsAg positive patients account for ∼1–2% of patients receiving chemotherapy, and HBsAg negative patients with anti-HBc positivity or anti-HBs positivity represent about 20% of the patients. Therefore, establishing a countermeasure for HBV reactivation is an urgent issue, and the Japanese HBV guideline for the prevention of HBV reactivation caused by immunosuppressive therapy or chemotherapy was published in 2009 by the research team at the Japan Ministry of Health, Labour and Welfare. This guideline recommends that the high risk group should be identified by measuring HBsAg levels before the commencement of chemotherapy. If the patients have HBsAg positive serology, the preventive use of an antiviral drug, such as entecavir, is recommended. In HBsAg negative patients, anti-HBc or anti-HBs should be measured before chemotherapy. If either anti-HBc or anti-HBs is positive, HBV DNA should be monitored monthly, and antiviral therapy including entecavir should be begun if HBV DNA becomes positive. However, the frequency of HBV reactivation, the type of chemotherapeutic regimen and the kind of cancer which are associated with easily reactivating HBV have not yet fully been elucidated. Furthermore, the optimal drug for prevention, the duration of prescription of an antiviral drug in patients with HBsAg receiving chemotherapy, and the usefulness of monthly monitoring of HBV DNA in HBsAg negative patients with anti-HBc or anti-HBs positivity have not yet been clarified either. Some well-designed prospective studies are warranted to resolve these issues of HBV reactivation.

Evaluation of anti-HBV drug resistant mutations among patients with acute symptomatic hepatitis B in the United States

Reported HBV drug resistance mutations among previously untreated patients with chronic hepatitis B are variable. Whether resistant HBV strains are transmitted in the acute setting is uncertain. We sought to document the presence of antiviral resistance (AVR) mutations in patients with acute HBV (AHB) infection. AHB infection was defined by HBsAg/IgM anti-HBc positivity, ALT>10X ULN and compatible clinical history. The TRUGENE HBV kit was used to perform genotyping and direct sequencing of the viral polymerase. INNO-LiPA HBV DRv2 and DRv3 were used to detect AVR mutations. Clonal sequencing was conducted on selected specimens. Twenty-three patients were evaluated (mean age, 43 years; 54% male; 39% African American, 39% Caucasian, 13% Hispanic and 4% Asian). The mean peak ALT was 1554.2IU/L and mean peak total serum bilirubin was 12 mg/dl. The HBV DNA median viral load (N = 15) was 5.14 log(10)IU/ml. Nineteen patients were genotype A, and 1 each were genotype C, D, E and G. HBV drug resistance mutations were not detected by direct sequencing or INNO-LiPA. Clonal sequencing was conducted on 192 clones isolated from three patients and showed rtA181T, rtM250V and rtS202G mutations at an overall frequency of 1.54%, 1.39%, and 1.67% respectively. We detected adefovir/lamivudine and entecavir relevant mutations in a minor population (<2%) of viral clones by clonal sequencing only. The clinical significance of these mutations is uncertain and may represent small populations of quasi-species vs. transmission of drug resistant strains.

The impact of a vaccination campaign against hepatitis B on the further decrease of hepatitis B virus infection in a southern Italian town over 14 years

BackgroundHepatitis B virus infection has decreased in Italy.The aims of this study were to identify changes, if any, in the epidemiological pattern of HBV infection in a southern Italian town first surveyed in 1996 and to assess the effectiveness of vaccination campaign against hepatitis B. MethodsIn 2010, subjects were selected from the census by a systematic 1:4 random sampling procedure. Hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B core antigen (anti-HBc) were detected by ELISA. Associations (odds ratios) linking exposure to hepatitis B virus infection to potential risk factors were estimated by univariate and multivariate analyses. ResultsOf the 1100 eligible subjects, 1020 (92.0%) agreed to participate. The prevalences of HBsAg (0.6%) and anti-HBc (15.2%) were significantly lower than in 1996 (0.8% and 21.5%) (p<0.01). No subject below 30years of age (those that had been targeted for compulsory immunization) had been exposed to HBV infection. At multiple logistic regression analysis, age>45years (OR=9.8; 95% CI=5.1–18.7) and past use of glass syringes (OR=1.9; 95% CI=1.2–3.1) independently predicted the likelihood of anti-HBc positivity. ConclusionsThese results, albeit obtained in a small town and thus not generalizable, confirm the continuous decreasing trend of HBV infection and demonstrate the effectiveness of the Italian hepatitis B vaccination program.

High HBV Viral Loads in HIV-Infected Pregnant Women at a Tertiary Hospital, South Africa

High HBV Viral Loads in HIV-Infected Pregnant Women at a Tertiary Hospital, South Africa

A community-based sero-epidemiological study of hepatitis B infection in Lianyungang, China, 2010

The 2010 targets of the China Hepatitis B Prevention Programme were a prevalence of hepatitis B surface antigen (HBsAg) less than 1.0% for children less thanfive years old and less than 6.0% for the total population. This survey assessed the prevalence of Hepatitis B infection in Lianyungang, Jiangsu province, China in 2009-2010. Multistage sampling was used with 2372 subjects among 17 selected villages. Blood specimen collection and testing by enzyme-linked immunosorbnet assay (ELISA) were completed using the following markers for hepatitis infection: HBsAg and antibody to HBsAg (anti-HBs); hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe); and hepatitis B core antibody (total anti-HBc). The data were analysed with Epi Info, version 3.3.2. The prevalence of HBsAg was 2.4% (95% Confidence Interval [CI]: 1.8-3.0; Adjusted Prevalence [AP] 2.9%); anti-HBs prevalence was 51.1% (95% CI: 49.1-53.1; AP 49.2%) and total anti-HBc prevalence was 41.7% (95% CI: 39.8-43.7; AP 45.5%). The prevalence of HBsAg and total anti-HBc positivity increased from young to older age groups, yet the prevalence of anti-HBs positivity decreased from young to older age groups (P<0.001 for all). There was no difference in the prevalences of HBsAg and anti-HBs among females and males (P=0.108 and 0.089), but females had a higher prevalence than males for total anti-HBc positivity (P<0.001). This survey showed that in 2010 the prevalence of HBsAg among children aged less thanfive years was lower than the national target of 1.0% and that the prevalence of HBsAg for the total population was lower than the national target of 6.0%.

Response to Vaccination Against Hepatitis B Virus with a Schedule of Four 40-μg Doses in Cirrhotic Patients Evaluated for Liver Transplantation: Factors Associated with a Response

We performed a retrospective study to evaluate the rate of and factors associated with a response to recombinant hepatitis B virus (HBV) vaccination using 4 intramuscular doses (40 μg) administered at 0, 1, 2, and 6 months among 278 cirrhotic patients being evaluated for orthotopic liver transplantation (OLT). We re-vaccinated 57 non-responders with the same schedule. The 39.2% overall response rate to vaccination included 36% after three and 40.7% after four doses, namely, a median anti-HBs level of 100 IU/mL (range, 10 to 1000 IU/mL). The 51% revaccination response rate achieved a median hepatitis B surface antibody (anti-HBs) level of 99 IU/mL (range, 11 to >1000 IU/mL). Upon univariate analysis, variables associated with a higher response were: better liver function (Child-Pugh class [A, 53.8% B, 33.3%, C, 30.1%; P = .002), Model for End-stage Liver-Disease (MELD) score (11.4 versus 13.6; P = .001]), absence of diabetes (43.6% versus 20.8%; P = .002), presence of isolated hepatitis B core antibody (anti-HBc) positivity (80% versus 37.7%; P = .007), and younger age (< 45 years, 52.2%; range, 45 to 55 years, 40.4%; > 55 years, 34.1%; P = .031). Upon multivariate logistic regression analysis, lower MELD score (odds ratio [OR]: 0.922; P = .046), absence of diabetes (OR:0.359; P = .008) and isolated anti-HBc positivity (OR:5.826; P = .034) were associated with a higher response. No differences were observed to be associated with gender, weight, body mass index, etiology or tobacco consumption. Among the same patient cohort (n = 79), the responses after the third and fourth doses were 36.7% and 51.9% respectively. In conclusion, the response rate to HBV vaccination in cirrhotic patients evaluated for OLT reached more than 35% among those who received at least 3 doses. It was higher among patients who showed isolated anti-HBc positivity, better liver function, younger age, and non-diabetic status. The fourth dose only increased the response rate by 24% over that obtained after the first three doses, whereas a revaccination achieved a 50% response rate, which probably accounts for revaccination after no response to 3 doses. Vaccination should be introduced against HBV in the early stages of the disease.

Protective efficacy against chronic hepatitis B virus infection after neonatal hepatitis B vaccination in China: A summary

Transmission of hepatitis B virus (HBV) during the perinatal period and in young children has been effectively prevented in recent years, with increased rates of coverage and timely immunization of hepatitis B vaccine to neonates in mainland China. Prevalence of HBV surface antigen (HBsAg) and chronic HBV infection in children have decreased both in rural and urban areas. The incidence of hepatitis B and primary hepatocellular carcinoma has also been reduced in children and young people. The effects of immunoprotection against HBV infection were found to last for at least 20 years. The presence of immune memory was associated with titers of antibody to HBV surface antigen (anti-HBs) in young children vaccinated at an early age. Results from our recent clinical investigation suggest that a universal booster immunization is not necessary for children and teenagers after neonatal vaccination. In this review, issues arising from representative vaccination-coverage areas, including Qidong, Jiangsu Province, are also discussed. These include immunoprophylaxis failure against vertical transmission, low or no response to the vaccines, isolated anti-HBc positivity, occult HBV infection after vaccination, and the effects of vaccination on HBV genotype and mutation.

Anti-hepatitis B core positivity as a risk factor for hepatocellular carcinoma in alcoholic cirrhosis: A case–control study

Hepatocellular carcinoma (HCC) is occasionally developed in patients with alcoholic cirrhosis. Old age, male gender, lifetime quantity of alcohol, and presence of hepatitis C virus (HCV) infection are risk factors for HCC in alcoholic cirrhosis. In this study, we investigated whether anti-hepatitis B core (HBc) positivity or occult hepatitis B virus (HBV) infection is a risk factor for HCC in patients with alcoholic cirrhosis. Between January 2006 and August 2008, a total of 72 cirrhotic male patients with an initial diagnosis of HCC, hospitalized in three major hospitals in the Incheon area, were enrolled as cases. Another 72 cirrhotic male patients without HCC, who matched the cases by age (±3 years), were enrolled as controls. All cases and controls were negative for hepatitis B surface antigen and anti-HCV, but had history of chronic alcohol intake over 80g per day. The clinical characteristics including presence of anti-HBc or serum HBV DNA (identified by nested polymerase chain reaction) were investigated. The mean age of both the cases and controls was 62±10 years. The basal laboratory data, Child–Pugh scores, total lifetime alcohol intake (1459±1364 versus 1641±1045kg), and detection rates of serum HBV DNA [31.7% (20/63) versus 29.9% (20/67)] of the cases and controls were not significantly different. However, the anti-HBc positivity rate was higher among the cases [86.1% (62/72)] than in the controls [66.7% (48/72); p=0.005] and was the only significant risk factor for HCC (odds ratio; 3.1, 95% confidence interval; 1.354–7.098, p=0.007). Anti-HBc positivity was identified as a risk factor for the development of HCC in patients with alcoholic cirrhosis.

Hepatitis B virus infection and waste collection: Prevalence, risk factors, and infection pathway

Waste collectors have a potential risk of infectious diseases. The aim of the study was to assess; the prevalence of hepatitis B (HBV), risk factors for infection and possible ways of virus transmission among municipal solid waste workers (MSWWs) in a municipality of central Greece. A cross-sectional study was conducted among the employees of a municipality in Central Greece. The prevalence of an HBV infection biological marker (anti-Hbc) and its association with exposure to waste, socio-demographic factors, and history of occupational injuries with sharp objects/needle sticks was examined among 208 employees. The prevalence of HBV infection among the municipal waste collectors was 23%. Logistic regression analysis showed that exposure to waste (OR = 4.05;95%CI = 1.23-13.33) and age (OR = 5.22;95% CI = 1.35-20.1) were independently associated with the anti-Hbc positivity. Moreover, waste collectors who reported occupational injuries with needle sticks were at higher risk of HBV infection (RR = 2.64; 95% CI = 1.01-6.96). Occupational exposure to waste is a possible risk factor for HBV infection. Occupational injury with sharp instruments could be a means of hepatitis B virus transmission. Immunization of MSWWs and adoption of more safe ways for waste collection could be considered in order to control the risk of HBV infection.

Prevalence of markers of hepatitis B virus infection or vaccination in HBsAg-negative subjects.

The implementation of mass vaccinations against hepatitis B virus (HBV) has significantly reduced the prevalence of HBsAg-positive subjects. At the same time, the prevalence of the other markers of infection has decreased, but there has been an increase in the percentage of subjects with markers of a successful vaccination. It has been suggested that increasing immigration from countries in which this virus is highly endemic is changing the epidemiology of HBV infection. The aim of this study was to assess the prevalence of the serological markers of HBV in Italian and non-Italian HBsAg-negative subjects. In the years 2007-2008, 8,018 samples from HBsAg-negative subjects (7,521 Italians and 497 non-Italians) were received for detection of anti-HBs and/or anti-HBc. The findings in the 1,358 samples from candidate blood donors were compared with those obtained in 1991 and 1999. The rate of anti-HBc positivity was 18.3% in the Italian samples and 32.8% in the non-Italian samples; the corresponding percentages of anti-HBs/anti-HBc positive samples (indicating past infection), anti-HBs positive only samples (vaccination) and anti-HBc positive only were, 11.3% vs. 22.5%, 25.8% vs. 17.2%, and 6.9% vs. 9.9% in Italians and non-Italians, respectively. The differences were more marked when stratified by age. In relation to candidate blood donors, simultaneous positivity for anti-HBs and anti-HBc decreased from 11.0% in 1991 to 8.1% in 1999 and 3.9% in 2007-2008, whereas isolated anti-HBs positivity increased from 2.2% in 1991 to 21.4% in 1999 and 42.9% in 2007-2008. The frequency of markers of past infection among Italians has decreased over time as a result of mass vaccination and is significantly lower than that observed in non-Italians. The increasing number of immigrants from countries in which HBV is highly endemic is changing the epidemiology of HBV infection in Italy.

Reactivation of hepatitis B virus with mutated hepatitis B surface antigen in a liver transplant recipient receiving a graft from an antibody to hepatitis B surface antigen– and antibody to hepatitis B core antigen–positive donor

BACKGROUNDFresh-frozen plasma (FFP) may contain antibodies to hepatitis B surface antigen (HBsAg, anti-HBs). These anti-HBs may lead to a misinterpretation of the actual hepatitis B immune status. Furthermore, they may not only confer protection against hepatitis B virus (HBV), but may also favor the selection of HBsAg mutants.CASE REPORTWe report a case of de novo HBV infection in a HBV-naïve recipient with alcoholic liver disease, who received a liver from a donor with antibodies to hepatitis B core antigen (HBcAg, anti-HBc) and anti-HBs.RESULTSA lookback investigation revealed the following: 1) Due to anti-HBs passively acquired through FFP, the recipient was considered immune to HBV and did not receive anti-HBV prophylaxis. 2) Within 1 year after transplantation he developed hepatitis B in absence of any elevated liver enzymes after the anti-HBs by FFP declined. 3) Despite an infection with HBV-containing wild-type HBcAg, the patient did not seroconvert to anti-HBc positivity. 4) The replicating HBV encoded two HBsAg mutations, first sQ129R and 4 months later sP127S. They map to the highly conserved “α” determinant of the HBsAg loop.CONCLUSION1) Passive transfer of anti-HBs from FFP led to an erroneous pretransplant diagnosis of HBV immunity when the patient was in fact HBV-naïve. 2) HBsAg mutations might have been selected in escape from donor's actively produced anti-HBs and the recipient's anti-HBs by FFP might have favored this selection. 3) It is doubtful whether hepatitis B immunoglobulin could have prevented the reactivation. 4) Antiviral prophylaxis would have been crucial.