Antibody anti-HBs Research Articles

Undetectable Anti-HBs Antibodies: Need of a Booster Dose for HIV-1-Infected Individuals.

HBV vaccination effectively prevents HBV transmission and the development of liver cancer. Disease progression and liver-related complications are more common in HIV-1/HBV co-infected than HBV mono-infected individuals. A considerable body of literature, which will be reviewed here, indicates that response to HBV vaccine is suboptimal in HIV-1-infected individuals and that the poor maintenance of protective immunity to HBV vaccines in these individuals is an important medical issue. Several factors affect HBV vaccine response during HIV-1 infection including CD4+ T cell counts, B cell response, vaccine formulation, schedules, and timing of antiretroviral therapy (ART). The initial response to HBV vaccination also plays a critical role in the sustainability of antibody responses in both HIV-1-infected and uninfected vaccinees. Thus, regular follow-up for antibody titer and a booster dose is warranted to prevent HBV transmission in HIV-1 infected people.

Earlier and Higher Rate of Hepatitis B Virus Relapse After Discontinuing Tenofovir Versus Entecavir in Hepatitis B e Antigen–Positive Patients

This study investigated the incidence and predictors of hepatitis B virus (HBV) relapse in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B who discontinued entecavir (ETV) or tenofovir disoproxil fumarate (TDF). A total of 205 and 111 HBeAg-positive patients without cirrhosis who had stopped ETV or TDF treatment, respectively, for at least 6 months were recruited. In the entire cohort, patients with HBeAg seroconversion during treatment, and propensity score-matched patients, those who discontinued TDF had significantly higher rates of virological and clinical relapse than patients who discontinued ETV therapy. Multivariate analysis identified that TDF was independently associated with virological and clinical relapse in the entire cohort and subgroup analysis. Patients with HBeAg loss without anti-HBe antibody formation during treatment had significantly higher rates of off-therapy HBV relapse and HBeAg seroreversion than patients with HBeAg seroconversion during treatment. The hepatitis B core-related antigen (HBcrAg) level at end of treatment (EOT) was independently associated with HBV relapse and HBeAg seroreversion in all patients and patients with HBeAg seroconversion during treatment. TDF therapy, HBeAg loss without seroconversion during treatment, and higher HBcrAg levels at EOT are significant predictors of HBV relapse in HBeAg-positive patients who discontinued ETV or TDF.

Evolution of Hepatitis B Virus (HBV) Serologic Markers Among Antiretroviral-Naive Young People Living With Human Immunodeficiency Virus Who Had Undergone Neonatal HBV Vaccination and Initiated Antiretroviral Therapy.

With initiation of antiretroviral therapy (ART) containing nucleos(t)ide reverse-transcriptase inhibitors (NRTIs) with anti-hepatitis B virus (HBV) activity, the evolution of HBV serologic markers among people living with human immunodeficiency virus (PLWH) who were born in the era of nationwide neonatal HBV vaccination is rarely investigated. This retrospective cohort study evaluated the changes of HBV serologic markers (hepatitis B surface antigen [HBsAg], antibody to hepatitis B surface antigen [anti-HBs], and antibody to hepatitis B core antigen [anti-HBc]) of PLWH who had undergone neonatal HBV vaccination. Clinical characteristics were analyzed and the incidences of evolution of HBV serologic markers were estimated. Between 2004 and 2020, 608 PLWH (mean age, 24 years) were included and 62.0% initiated tenofovir-containing ART: 13 (2.1%) were HBsAg-positive, 312 (51.3%) tested triple-negative, 209 (34.4%) had vaccine-induced seroprotection against HBV, and 74 (12.2%) tested positive for anti-HBc with or without anti-HBs. Among 492 PLWH who received a median follow-up of 2.8 years, 4 cases of incident HBV infection occurred (0.59 per 100 person-years of follow-up [PYFU]) in PLWH testing triple-negative at baseline despite ART containing NRTIs with anti-HBV activity. Of PLWH with seroprotection against HBV at baseline, 38 subsequently lost anti-HBs (4.46 per 100 PYFU) and 4 cases of incident HBV infection occurred (0.47 per 100 PYFU). PLWH with an anti-HBs antibody titer ≥100 mIU/mL at baseline (adjusted hazard ratio [aHR], 0.10 [95% confidence interval {CI}: .02-.42]) and CD4 ≥500 cells/µL during follow-up (aHR, 0.51 [95% CI: .30-1.00]) were less likely to lose HBV seroprotection. Among young PLWH who had undergone neonatal HBV vaccination, evolution of HBV serologic markers and incident infections occurred despite ART containing NRTIs with anti-HBV activity.

Immune response to hepatitis B vaccine following complete immunization of children attending two regional hospitals in the Southwest region of Cameroon: a cross sectional study

BackgroundHepatitis B virus (HBV) infection despite being a vaccine preventable disease remains a global public health problem. In Cameroon, the hepatitis B vaccine was introduced in the expanded program on immunisation in 2005, but there has been limited evaluation of the HBV surface antibody response post vaccination.ObjectiveWe investigated the immune response to hepatitis B vaccine in infants who received the DPT-Hep B-Hib vaccine, and we assessed HBsAg carriage in non-responders. We also investigated factors associated with non-response or poor response.MethodsUsing a hospital based cross sectional design and a structured questionnaire over a four-month period (January to April 2019), we collected data to determine factors associated with hepatitis B surface antibody (anti-HBs) response from infants aged 6 to 9 months attending infant welfare clinics (IWC) at the Buea and Limbe regional hospitals. We collected venous blood and measured anti-HBs titres using a quantitative Foresight® ELISA. We entered and analysed data using EpiData version 3.1 and SPSS version 25 respectively.ResultsOf the 161 infants enrolled, 159 (98.8%) developed anti-HBs antibodies. Of these 159, 157 (97.5%) and 117 (72.7%) developed ≥ 10.0 mIU/ml (seroprotection) and ≥ 100.0 mIU/ml anti-HBs titres respectively. Being younger (6 months old) was associated with seroprotection (Cramer V = 0.322, p = 0.001). Spearman rho’s relational analysis showed that immunity against HBV reduced as the duration since the last dose increased (r = −0.172; P = 0.029). However, a Firth logistic regression showed no significant association of factors with inadequate immunity. All 12 (7.5%) infants exposed to HBV at birth, received the hepatitis B vaccine at birth, including four who received HBIG, and all were protected. Four infants (2.5%) had anti-HBs titres < 10.0 mIU/mL (non-responders) but had no peculiarity.ConclusionThe seroprotective rate following hepatitis B vaccination of infants is high even in exposed infants. Our study suggests that Cameroon’s HBV vaccine in the Expanded Program on Immunisation (EPI) is effective against HBV, although we could not account for the 2.5% non-response rate. Large scale studies are needed to further explore non-response to the vaccine.

JNJ-64794964 (AL-034/TQ-A3334), a TLR7 agonist, induces sustained anti-HBV activity in AAV/HBV mice via non-cytolytic mechanisms

JNJ-64794964 (JNJ-4964/AL-034/TQ-A3334), an oral toll-like receptor 7 agonist, is being investigated for the treatment of chronic hepatitis B (CHB), a condition with a high unmet medical need. The anti–hepatitis B (HBV) activity of JNJ-4964 was assessed preclinically in an adeno-associated virus vector expressing HBV (AAV/HBV) mouse model. Mice were treated orally with 2, 6 or 20 mg/kg of JNJ-4964 once-per-week for 12 weeks and then followed up for 4 weeks. At 6 mg/kg, a partial decrease in plasma HBV-DNA and plasma hepatitis B surface antigen (HBsAg) was observed, and anti-HBs antibodies and HBsAg-specific T cells were observed in 1/8 animals. At 20 mg/kg, plasma HBV-DNA and HBsAg levels were undetectable for all animals 3 weeks after start of treatment, with no rebound observed 4 weeks after JNJ-4964 treatment was stopped. High anti-HBs antibody levels were observed until 4 weeks after JNJ-4964 treatment was stopped. In parallel, HBsAg-specific immunoglobulin G–producing B cells and interferon-γ–producing CD4+ T cells were detected in the spleen. In 2/4 animals, liver HBV-DNA and HBV-RNA levels and liver hepatitis B core antigen expression dropped 4 weeks after JNJ-4964 treatment-stop. In these animals, HBsAg-specific CD8+ T cells were detectable. Throughout the study, normal levels of alanine aminotransferase were observed, with no hepatocyte cell death (end of treatment and 4 weeks later) and minimal infiltrations of B and T cells into the liver, suggesting induction of cytokine-mediated, non-cytolytic mechanisms.

Evaluation and comparison of the seroprevalence of hepatitis B and hepatitis C virus infection in patients admitted to clinics at the Recep Tayyip Erdogan Training and Research Hospital, Turkey

Objective: To evaluate hepatitis B and hepatitis C serology findings and to determine the current prevalence of those who had applied to the Turkish hospital in Mogadishu, Somalia. Material and Method : The demographic findings and hepatitis test results (HBsAg, antiHBs antibody, and anti-HCV) of the patients were recorded retrospectively from their files. Results: A total of 152,266 patients, 75,903 (49.8%) male and 76,363 (50.2%) female, with a mean age of 34 (31/61) years, were included in our study. 1,278 (1.9%) of 67,749 patients who were tested for anti-HCV were found to be positive. 27,208 patients (32.2%) were found to have developed natural or vaccine immunity for HBV. It was found that those with anti-HCV (+) were generally older than 55 years and that those with HBsAg (+) were generally younger than 55 years [OR: 6.02 (5.28-6.87): 95%, CI]. Conclusion: In our study, it can be said that HBsAg and anti-HCV seroprevalence (8.2% and 1.9%, respectively) in the Somalia population is still above desired levels. The fact that anti-Hbs antibody levels are at 32.2% underscores the importance of the development and popularization of vaccination programs.

Bir Aile Hekimliği Polikliniğinde 5-18 yaş arası Çocuklarda Anti Hbs Antikor Düzeyleri- Kesitsel Bir Çalışma

Amaç: Bu çalışma; aile hekimliği polikliniğine başvuran 5-18 yaş arası çocuklarda serum Anti-Hbs antikor düzeyleri ile hepatit B aşılanma durumlarını araştırmak için yapılmıştır. Materyal ve Metod: Çalışma tanımlayıcı- kesitsel bir çalışmadır. Çalışmaya bir Aile Sağlığı Merkezine periyodik muayene ve okul sağlık taramaları için başvuran 5-18 yaş arası 84 çocuk dahil edilmiştir. Çalışmaya dahil edilen çocukların ailesinden çocuğun aşılanma durumu, kronik hastalık varlığı, anne baba eğitim ve meslek bilgisini içeren kısa bir form doldurması istendi. Bu yanıtlarla çocukların cinsiyet, yaş ve Anti-Hbs düzeyi arasındaki ilişki sorgulandı. Düzce Halk sağlığı laboratuarında Mikro-ELİSA yöntemi ile bakılan Anti-HBs düzeyi 10 mIU/ml’nin üzerinde olan antikor değerleri seropozitif olarak kabul edildi. Bulgular: Çalışmamıza alınan çocukların 45’i (%53,6) erkek, 39’u (%46,4) kız çocuk idi. Çalışmamızdaki çocukların yaş ortalaması 12,13±2,73 olarak tespit edildi. Çalışmamızda yaş artışı ile birlikte Anti HBs antikor titresinde anlamlı bir düşüş saptanmadı(p=0,571). Cinsiyete göre anti-HBs seropozitifliği arasında anlamlı fark bulunmamıştır. Çalışmamızda çocukların yaşı arttıkça aşı yapılmamış olma durumu daha küçük yaştakilere göre anlamlı olarak yüksek bulundu (p&amp;lt;0,001). Aşılı olduğu anamnezi alınan 62 çocuğun %46,77(n=29)’sinde Anti-HBs seronegatif olarak tespit edilmiştir. Sonuç: Çalışma sonuçlarımıza göre çocukların yaşı azaldıkça HBV aşısı olma durumu anlamlı olarak artmaktadır. HBV enfeksiyonunun yol açtığı hastalık sonuçlarının ciddi olması ve aşı ile etkin bir şekilde önlenebiliyor olması bakımından avantajı düşünüldüğünde bağışıklama hizmetlerinin takibi önemlidir.

Multiple epitopes of hepatitis B virus surface antigen targeted by human plasma-derived immunoglobulins coincide with clinically observed escape mutations.

Hepatitis B immune globulin (HBIG) is a human plasma‐derived immunoglobulin G concentrate that contains a high titer of neutralizing antibodies (anti‐HBs) to the hepatitis B virus (HBV) surface antigen (HBsAg). HBIG is known to be highly effective in treating HBV infections, however, a more systematic characterization of the antibody binding sites on HBsAg and their correlation with emerging “escape” mutations in HBsAg was lacking. By using anti‐HBs antibodies from HBIG lots to screen random peptide phage display libraries, we identified five clusters of peptides that corresponded to five distinct anti‐HBs binding sites on the HBsAg. Three sites, Site II (C121‐C124), Site III (M133‐P135), and Site IV (T140‐G145), were mapped within the “a” determinant, while the two other sites, Site I (Q101‐M103) and Site V (I152‐S154), were outside the “a” determinant. We then tested in binding assays HBsAg peptides containing clinically relevant mutations previously reported within these sites, such as Y134S, P142S, and G145R, and observed a significant reduction in anti‐HBs binding activity to the mutated sites, suggesting a mechanism the virus may use to avoid HBIG‐mediated neutralization. The current HBIG treatment could be improved by supplementing it with site‐specific neutralizing monoclonal antibodies that target these mutations for control of HBV infections.

Baseline Anti-HBs Antibody Titre in Health Care Workers in a Tertiary Health Care Centre in Faridabad, India

Introduction: Healthcare workers (HCWs) are at a high risk of acquiring hepatitis B virus (HBV) infection through occupational exposure which is preventable through hepatitis B vaccination. Aims: Therefore, we aim to establish the seroprevalence of anti-Hepatitis B surface (anti-HBs) antibody in the HCWs in a tertiary care setup to assess the level of protection that workers in these high-risk zones have. Methods and Material: Serum specimens from participants were tested at the Microbiology laboratory of ESIC Medical College &amp; Hospital, Faridabad. Three ml of venous blood was collected aseptically in a vacutainer. The serum anti-HBs titre was detected by Enzyme-linked immunoassay (ELISA) using the Monolisa Anti-HBs PLUS (Bio-Rad) as per manufacturer’s instruction. Results: Of the 218 HCWs included, 145 (66.51%) were vaccinated, and 73 (33.49%) were unvaccinated. HCWs were grouped into five categories which comprise doctors from all disciplines (n=53), nursing staff (n=50), technicians (n=52), nursing orderly (NO) (n=34),and housekeeping (n=29). Among various groups of HCWs, the vaccination rate was highest among doctors (96.23%) than the other groups. While comparing the anti-HBs titre among the unvaccinated HCWs, it has been seen that out of 73 (33.49%) HCWs, majority of the NO (76.47%) were having titre below 10 mIU/ml followed by housekeeping (73.68%), technicians (70.58%), and nursing staff (33.33%). Conclusions: All HCWs should be regularly screened for HBs antigen along with administration of a booster dose and monitoring of anti-HBs titre.

English

BACKGROUND Health care personnel (HCP) are the most exposed sector to contract Hepatitis B from infected patients, and vaccination is a key modality to prevent it. We wanted to evaluate the immune status of health care workers (HCWs) post vaccination and bring to light the potential risk factors that may be responsible for low Anti-HBs antibody titres post vaccination. METHODS A cross-sectional study was conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, with 171 HCP who completed the hepatitis B vaccination. Serum Anti-HBs levels were assessed using ELISA. RESULTS Of 171 HCP, 30 (17.54 %) were males and 141 (82.46 %) were females. The mean age of the study population was 35 years. 73.68 % of the total HCP study population showed antibody titres above the predefined protective threshold. The only risk factor significantly associated with serological response was chronic illness. There was no significant association of serological response to time since last dose (P = 0.3), BMI (P = 0.67), percutaneous / mucocutaneous exposure (P = 0.7) and post vaccination period (P = 0.246). CONCLUSIONS Hospital administration should promote testing of Anti-HBs levels in all HCWs 1 - 2 months’ post Hepatitis B vaccination so that necessary precautions can be taken, and revaccination with counselling should be strictly followed. KEY WORDS Health Care Personnel (HCP), Risk Factors, Anti-HBs Levels, Immunization Status

Characterization of Antigen Escape Mutations in Chronic HBV-Infected Patients in Upper Egypt.

BackgroundMutations within the “a” determinant region (position 124–147) that is present in the major hydrophilic region (MHR, position 99–160) of the hepatitis B surface antigen (HBsAg) are associated with vaccine-escape, lack of diagnosis, and failure to hepatitis B immunoglobulin (HBIG) therapy. Data regarding the amino acid changes of “a” determinant region of HBsAg are limited in Egypt. The prevalence and mutations in this region among chronic HBV (CHB)-infected patients in Upper Egypt are not known.Material and MethodsBlood samples were collected from HBsAg-positive CHB-infected patients (n=123) admitted to Assiut University Hospitals. Serum samples were screened for HBsAg, HBeAg, anti-HBs and anti-HBe antibodies using commercially available ELISA kits. Viral load was determined by qPCR. In addition, mutational analysis was carried out targeting the HBV surface gene to determine the HBV genotype and vaccine escape mutations.ResultsSequencing analysis of HBV DNA revealed that genotype D is the major circulating type (81.3%), followed by genotype E (18.7%). Analysis of the HBV genome revealed that 103/123 (83.7%) patients showed wild-type sequences and 20/123 (16.3%) showed mutations in the HBsAg gene. Mutation in seventeen patients (17/20, 85%) showed only one mutation, and three patients showed two mutations (3/20, 15%) in the “a” determinant region. The observed mutations were T115S (3/20, 15%), P120T/S (3/20, 15%), T126S (1/20, 5%), Q129R (2/20, 10%), M133T (2/20, 10%), S143L (5/20, 25%), D144E/A (3/20, 15%), and G145R/A (4/20, 20%). Mutations in the “a” determinant region were detected in genotype D isolates only.ConclusionWe described for the first time the prevalence and characterization of vaccine escape mutants in CHB patients in Upper Egypt. Mutational analysis of the “a” determinant region revealed the presence of a wide spectrum of mutants in the circulating HBV isolates that could be a potential threat to HBV diagnosis, therapy success, and HBV vaccination program in Upper Egypt.

Hepatitis B virus infection among pregnant mothers and children after the introduction of the universal vaccination program in Central Vietnam

A birth cohort study was conducted in Khan Hoa Province, central Vietnam between 2009 and 2012 to determine the seroprevalence of hepatitis B virus (HBV) in pregnant women and their children, and associated risk factors. We enrolled 1987 pregnant women with their babies at the birth phase, and 12.6% (95% confidence interval [CI]: 11.1–14.0) of mothers were hepatitis B surface antigen (HBsAg)+. At 2-year follow-up phase, 1339 (67.4%) children were enrolled of whom 76.6% completed hepatitis B vaccines (HepB) and 1.9% (95% CI: 1.2–2.7) were HBsAg+. When mothers were hepatitis B e antigen (HBeAg)+, 28.3% of children have got infected even with complete HepB. HBV infection in mothers, hepatitis B surface antibody (anti-HBs antibody) below the seroprotective level in children, and mothers with pre-pregnancy low body mass index were associated with HBV infection in children. Meanwhile, HBV infection in children, older maternal age, no or incomplete doses of HepB, and boys were associated with anti-HBs antibody below the seroprotective level in children. Our birth cohort study determined a low rate of congenital HBV infection and associated risk factors in Vietnam, however further studies are needed to advance prevention including anti-viral therapy in pregnant women at high risk.

How does the immunogenicity of hepatitis B vaccine change over the years in childhood?

ABSTRACT Hepatitis B is the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide. The incidence of HBV infection has significantly decreased with hepatitis B vaccination. Hepatitis B vaccine is administered to children at 0, 1 and 6 months of age according to the national schedule. There is a high rate of protective antibody (anti-HBs) development after hepatitis B vaccination. We conducted the study to investigate how the hepatitis B surface antibody (anti-HBs) positivity rates and the titers change over time in childhood following vaccination. Patients who presented at the general pediatric outpatient clinic of Yenimahalle Education and Training Hospital and the HBsAg and anti-HBs titers were tested for any reason between July 2011 and May 2018 were retrospectively evaluated. The cutoff level for protection by the anti-HBs titer was accepted as ≥10 mIU/mL with lower levels indicating no protection. Anti-HBs positivity was compared by age group. Anti-HBs levels were studied in 4326 children. The mean age of the included in the study was 127 ± 62 months. A protective anti-HBs level (≥10 mIU/mL) was present in 2292 children (69.2%). The highest anti-HBs antibody positivity rate was in the under 3 years’ age group. The positivity rate significantly decreased after age 7 years. The HBsAg level was determined in all children in the study and five had a positive result. In conclusion, our study found that the anti-HBs positivity rate and the anti-HBs level decreased with age. However, the anti-HBs antibody result remained positive in more than half of the children.

The Delayed Immune Response of Infants of Diabetic Mothers to Hepatitis B Vaccine: A Prospective Case-Control Study

Background: Infants of diabetic mothers (IDMs) have a significantly greater risk for perinatal morbidity, mortality, and altered immune response. Aim of work: To assess the immune response of IDMs for hepatitis B virus (HBV) vaccine and to compare them with infants of non-diabetic mothers as a control group. Patients and Methods: 150 neonates met the inclusion criteria; 100 IDMs and 50 infants’ non-diabetic mothers as controls. All neonates who met the inclusion criteria received HBV vaccine during the first 24 hours of age and at 1 and 6 months of age according to the WHO guidelines. Furthermore, hepatitis B surface antigen (HBsAg), hepatitis B virus surface antibodies (anti-HBs), and hepatitis B virus core antibodies (anti-Hbc) were measured at 9, 12, and 24 months of age. Results: IDMs had significantly higher birth weight when compared to infants of the non-diabetic mothers (3.6 ± 0.4 kg and 3.03 ± 0.5 kg, P-value 0.01). There was a significant difference between the response to anti-HBs between case group and control group at 9 months 7±12 mIU/dL versus 20±23 mIU/dL (P-value < 0.0001). However, anti-HBs antibodies levels follow-up at 12 and 24 months showed no significant differences between the case and control groups. Conclusion:At 9 months of age, post HBV vaccination, there was a delayed immune response for HBV vaccine was present in IDM compared to infants of non-diabetic mothers. However, IDM became immune at follow-up at 12 and 24 months of age.

“Titer of anti-HBs in health professions trainees: prevalence of antibody coverage in a University of Central Italy”

ABSTRACT Objective: This observational retrospective study aims at verifying hepatitis-B-virus (HBV) vaccination coverage in students vaccinated before and after 1992, in order to optimize health surveillance and vaccination recall. Methods: Vaccination status was evaluated using the anti-HBs antibody titer (anti-HBs). Student t-test and the chi-square test were performed to identify the average age and the difference in antibody coverage between the two genders and in the two populations analyzed. Results: Our study outlined a prevalence of 21.83% uncovered trainees among those vaccinated at age 12 and 45.03% among those vaccinated in neonatal age. Conclusion: In conclusion, our data showed persistent protection against HBV infection in healthcare students.

Hepatitis B vaccination response of treatment-naive patients with juvenile idiopathic arthritis.

To evaluate the vaccine response of treatment-naive juvenile idiopathic arthritis (JIA) patients who were fully vaccinated against Hepatitis B Virus (HBV) and then compare their antibody status with healthy controls. In this multicenter study, initial visit hepatitis B surface antigen (HbsAg) and anti-hepatitis B surface antibody (anti-Hbs) titers of 262 treatment-naive JIA patients who were followed up regularly between May 2015 and October 2019 were evaluated retrospectively from patients' medical records and compared with 276 healthy peers. Both HbsAg and anti-Hbs antibody titers were tested by the ELISA technique. Anti-HBs titers ≥ 10IU/L were considered as reactive indicating seroprotection against HBV. In the JIA group, seropositivity rate was 59.1% while 72.9% of the control group were immune against HBV (p = 0.002). The median titer for anti-Hbs was 14 (range: 0-1000)IU/L in the patient group and 43.3 (range: 0-1000)IU/L in the control group (p = 0.01). Neither JIA patients nor healthy controls were positive for HbsAg. Patients with JIA vaccinated according to the national vaccination schedule were evaluated at their first visit in pediatric rheumatology outpatient clinics for anti-Hbs presence and it was found that they have lesser seroprotectivity than their age and sex-matched routinely vaccinated, healthy peers. So, to complete missing vaccines and booster vaccine doses, assessing the immune status of the patients at the time of diagnosis against HBV should be in the check-list of physicians dealing with pediatric rheumatic diseases.

Prevalence of hepatitis B e antigenemia in Bahraini hepatitis B patients: A retrospective, single-center study.

Background and AimHepatitis B e (HBe) antigen (HBeAg) is commonly encountered among hepatitis B patients and is indicative of active infection. There is a lack of data in the literature about the prevalence of HBeAg among hepatitis B patients in Bahrain and its impact on the disease. The aims of this study were to investigate the prevalence of HBeAg among a sample of hepatitis B patients in Bahrain and to analyze their associated laboratory profile, radiological characteristics, comorbidities, and complications.MethodsThis was a retrospective record‐review study conducted on patients' records at Salmaniya Medical Complex hospital in Bahrain during the period of 2011–2016. All records of hepatitis B patients who had HBeAg tests performed were included in this study.ResultsOf 323 patients recruited, 18.9% had positive HBeAg. The prevalence of anti‐HBe antibodies and hepatitis B core immunoglobulin G (HBc IgG) differed significantly between patients with positive and negative HBeAg (P < 0.001, P = 0.026, respectively). Alanine transferase and gamma‐glutamyl transferase were significantly higher among patients with positive HBeAg (P = 0.017, P = 0.016, respectively). There was no significant difference with regard to the prevalence of hepatitis C virus, human immunodeficiency virus, hepatocellular carcinoma, or liver transplantation between HBe‐positive and ‐negative patients (P ≥ 0.05).ConclusionHBeAg is prevalent among hepatitis B patients in Bahrain and is associated with a significantly different laboratory profile.

A putative amphipathic alpha helix in hepatitis B virus small envelope protein plays a critical role in the morphogenesis of subviral particles.

Hepatitis B virus (HBV) small (S) envelope protein has the intrinsic ability to direct the formation of small spherical subviral particles (SVPs) in eukaryotic cells. However, the molecular mechanism underlying the morphogenesis of SVPs from the monomeric S protein initially synthesized at the endoplasmic reticulum (ER) membrane remains largely elusive. Structure prediction and extensive mutagenesis analysis suggested that the amino acid residues spanning W156 to R169 of S protein form an amphipathic alpha helix and play essential roles in SVP production and S protein metabolic stability. Further biochemical analyses showed that the putative amphipathic alpha helix was not required for the disulfide-linked S protein oligomerization, but was essential for SVP morphogenesis. Pharmacological disruption of vesicle trafficking between the ER and Golgi complex in SVP producing cells supported the hypothesis that S protein-directed SVP morphogenesis takes place at the ER-Golgi intermediate compartment (ERGIC). Moreover, it was demonstrated that S protein is degraded in hepatocytes via a 20S proteasome-dependent, but ubiquitination-independent non-classic ER-associated degradation (ERAD) pathway. Taken together, the results reported herein favor a model in which the amphipathic alpha helix at the antigenic loop of S protein attaches to the lumen leaflet to facilitate SVP budding from the ERGIC compartment, whereas the failure of budding process may result in S protein degradation by 20S proteasome in an ubiquitination-independent manner.Importance Subviral particles are the predominant viral product produced by HBV-infected hepatocytes. Their levels exceed the virion particles by 10,000 to 100,000-fold in the blood of HBV infected individuals. The high levels of SVPs, or HBV surface antigen (HBsAg), in the circulation induces immune tolerance and contributes to the establishment of persistent HBV infection. The loss of HBsAg, often accompanied by appearance of anti-HBs antibodies, is the hallmark of durable immune control of HBV infection. Therapeutic induction of HBsAg loss is, therefore, considered to be essential for the restoration of host antiviral immune response and functional cure of chronic hepatitis B. Our findings on the mechanism of SVP morphogenesis and S protein metabolism will facilitate the rational discovery and development of antiviral drugs to achieve this therapeutic goal.

Serological detection of hepatitis B and D virus co-infection among patients attending a tertiary health facility at Maiduguri, Nigeria

BackgroundHepatitis D virus (HDV) is highly pathogenic, and clinical studies revealed that HDV infection aggravates the natural history of the underlying hepatitis B virus (HBV) infection by progression to cirrhosis that leads to early decompensation of liver function compared with HBV mono-infection. To determine the seroprevalence of HDV among HBsAg-seropositive patients and associated biochemical profiles at Maiduguri, Nigeria, a hospital-based cross-sectional study on 180 sera of patients positive for HBsAg by ELISA were evaluated for anti-HDV, hepatitis B envelop antigen, anti-HBs antibodies and liver enzyme profiles.ResultsHDV seroprevalence of 3.3% among 180 HBsAg-positive patients. Relatively higher seroprevalence of HDV was observed in males (4.3%) than in females (2.3%). The highest infection rate (20%) was obtained in patients ≥ 56 years. However, no significant association between positive anti-HDV seroprevalence and gender (p > 0.05). Of the 6 (3.3%) anti-HDV-positive patients, only 1 (16.7%) was positive for HBeAg while all were negative for anti-HBs antibodies. The mean level of liver enzyme level of AST and ALT of the anti-HDV-positive patients significantly differ from that of HBsAg mono-infected patients (p ˂ 0.05). However, no significant difference (p < 0.05) between the mean levels of liver enzymes of ALP in anti-HDV-positive and HBsAg mono-infected patients (p ˃ 0.05) was found.ConclusionThis study revealed a relatively low presence of HDV in HBsAg-positive patients. Furthermore, HDV-HBV co-infected patients had somewhat worse liver enzyme upregulation. This underscores the need for rapid HDV testing and treatment in HBV-infected patients.

Long-term immune protection against HBV: associated factors and determinants

ABSTRACT In Italy, vaccination against hepatitis B became compulsory for all the newborns and 12-years-old adolescents in 1991. The main purpose of this study was to evaluate the persistence of long-term protection against HBV in medical students of the University of L’Aquila and in postgraduates Medical Doctors (HCWs) working in San Salvatore Hospital. The second aim was to study the variables associated with a protective anti-HBs antibody level, such as age at vaccination, gender, time elapsed from the last dose of vaccination. Three hundred and forty-two subjects were enrolled from January 2017 to January 2019 and a blood sample was collected to evaluate the levels of serum HBsAg, anti-HBs and anti-HBc. Statistical analysis calculated a multivariable logistic regression model to examine predictors of a protective anti-HBs titer. The larger part (239, 70%) of the students had an anti-HBs titer >10 mIU/mL, those were statistically significant older (26.7 vs 24.5 years, p < .001), vaccinated at age 12 years (83.5% vs 59.9% among vaccinate at infancy, p < .001) and more frequently attending postgraduate medical school (80.8% vs 57.5% among healthcare profession school, p < .001). The multivariable logistic regression model showed that HBV vaccination at age of 12 was significantly and independently associated with protective titers (OR = 10.27, p = .019). The results agreed with literature on HBV vaccination, confirming the efficacy of vaccination after 20 years. In particular, our results suggest that adolescent administration is the main predictor of a protective title, regardless of gender, course and years since vaccinations.