Evidence Of Hepatitis Research Articles

A study of bone marrow failure syndrome in children

Bone marrow failure syndrome (BMFS), or aplastic anemia, includes peripheral blood single cytopenias, as well as pancytopenia due to inability of the marrow to effectively produce blood cells. To study the clinico-hematological profile and etiological factors of bone marrow failure syndrome in children. This prospective study was carried out in the Department of Pediatrics of a university teaching hospital over 36 months. Children with pancytopenia (Hb 9 /L, platelet count<100x10(9)/L) and bone marrow cellularity<25% were included in the study. History of exposure to drugs, socioeconomic status, ethnicity and occupation of father were noted. Bone marrow aspiration; trephine biopsy; Ham test; viral studies for hepatitis A, B and C; and cytogenetic investigations were carried out. Relative risk was estimated by odds ratio (OR) with 95% confidence interval (CI) in matched cases and controls. Of the 53 children studied, 6 (11.3%) were diagnosed as Fanconi anemia. Two cases had features of myelodysplastic syndrome. Forty-five children were labeled as acquired aplastic anemia, of whom one had evidence of hepatitis B infection and two patients (5.8%) had paroxysmal nocturnal hemoglobinuria. Aplastic anemia was more common in children from family with lower socioeconomic status; in Muslims; and where the father's occupation was weaving, dyeing and painting. However, the number was small to make statistically significant conclusions. No correlation could be established with exposure to drugs. Fanconi anemia was responsible for approximately one-tenth of the cases of bone marrow failure syndrome. Majority of the patients had acquired aplastic anemia. Hepatitis B infection was an uncommon cause of acquired aplastic anemia.

Epidemiological study of hepatitis E virus infection in European wild boars ( Sus scrofa) in Spain

Evidence of hepatitis E virus (HEV) infection in Spanish domestic pig has been reported and hence it was advisable to search for this zoonotic pathogen in wild boar populations. A total of 150 wild boar serum samples from eight geographic areas from South-Central Spain were used to investigate HEV infection in European wild boar ( Sus scrofa) by means of serology and PCR and its distribution by age, region and management system. Anti-HEV IgG, IgM and IgA were determined by an in-house ELISA. The overall seroprevalence was 42.7% (range 30.63–55.65%) and 19.6% (range 13.53–27.40%) of the animals tested positive for HEV RNA. Wild boar sequences were clustered within the genotype 3. This is the first description of HEV infection in Spanish wild boar and the results obtained may suggest a possible role of wild boar as a HEV reservoir for both domestic animals and humans.

154: Pre-lung transplant immunosuppression assessment of candidates with risk of possible hepatitis C (HCV) post-transplantation

Purpose: There is no consensus on evaluation of patients with HCV infection for lung transplantation. Immunosuppressive challenge (IC) was done to help predict which patients could be transplanted with minimal risk of post-transplant HCV sequelae. Methods and Materials: Patients who presented for lung transplant evaluation with possible risk of HCV disease post transplant were given a 6-week trial of Tacrolimus 2 mg bid and mycophenolate mofetil (MMF) 1000 mg bid. Outcome measures included changes in viral load, HCV RNA quantitative, bDNA, and evidence of hepatitis. Results: Patient 1: 64 year-old woman with emphysema and history of acute liver failure 22 years earlier with positive HCV antibody and no detectable viral load. Viral load was undetectable after IC and 1.5 years post transplant. Patient 2: 53 year-old man with lung fibrosis, positive HCV antibody and prior history of acute hepatitis B had undetectable viral load after IC and 11 months post transplant. Patient 3: 57 year-old man with emphysema, positive HCV antibody, viral load of 157,000 copies/ml, and no evidence of liver disease. With IC, viral load increased to 11.8 million copies/ml with abnormal liver function tests (LFT). Viral load and LFT returned to baseline post IC. Patient was transplanted at another institution. Viral load increased from 33,900 preto 4 million copies/ml 3-months post-transplant. Patient 4: 57 year old man with lung fibrosis, positive HCV antibody, viral load of 439,000 copies/ml, mild LFT abnormalities, and Grade II inflammation on liver biopsy. After MMF and prednisone treatment was initiated for lung disease, viral load increased to 64 million copies/ml associated with hepatitis. Patient was not offered transplant. Patient 5: 54 year-old man with emphysema and history of successful treatment of HCV hepatitis. No viral load elevation before or after IC. Patient awaiting transplant. Conclusions: Pre-transplantation immunosuppression may help determine which patients are at minimal risk of HCV disease following lung transplant.

Hepatitis C viral infection and depression

About 170 million individuals can be found with chronic hepatitis C viral infection all over the world. The occurrence of depression is more frequent among the persons than in the healthy population, this depression can be found in 58 per cent of patients with chronic hepatitis C. On the basis of the literature the authors review the aetiology of depression in liver diseases, examining the neuropathogenic effect of HCV. They demonstrate the scientific results which are evidences of hepatitis C viral infection for the alterations in the central nerve system. The depression is one of the side effects of the alpha-interferon treatment used in the therapy of HCV. The authors demonstrate the biological basis, development, consequences of depression produced by interferon and they give a review of the protocol in the diagnostic procedure of a patient with depression. They summarize the steps of psychiatric drug therapy in chronic liver diseases. That is also important whether the chronic HCV infected patient with depression can be treated with interferon. The loss of interferon treatment can lead to the fatal outcome of liver disease. In order to have the correct decision a collaboration between internist and psychiatric specialist is necessary.

Reply:

We agree with Dr. Jhaveri and Dr. Murray that available data show that there is no evidence of hepatitis B transmission from infected mothers to infants who are breast-fed and that breast-feeding should not be prohibited, particularly for infants who receive appropriate prophylaxis with hepatitis B immune globulin and hepatitis B vaccine. Because of space constraints, it was not possible for the guidelines to include all aspects of hepatitis B management. We appreciate Dr. Jhaveri and Dr. Murray for bringing this to our readers' attention. Anna S. F. Lok*, Brian J. McMahon , * Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI, Liver Disease and Hepatitis Program, Alaska Native Medical Center and Arctic Investigations Program, Centers for Disease Control, Anchorage, AK.

No evidence of hepatitis C virus infection in Serbian patients with oral leukoplakia

A review of the literature reveals controversy regarding the relationship between hepatitis C virus (HCV) infection and oral leukoplakia (OL). The aim of this study was to determine the frequency of HCV antibodies in patients with OL and control subjects resident in Serbia. In this cross-sectional study 73 consecutive patients with histologically proven OL and 90 control subjects, whose age and gender were matched, were examined for the presence of serological evidence of chronic hepatic disease, hepatitis B surface antigen (HBsAg) and anti-HCV seropositivity. None of the patients with OL or control subjects had antibodies to HCV or HBsAg. All patients with OL and control subjects had normal liver function. The present data indicate that patients with OL resident in Serbia do not have evidence of HCV or HBV infection.

Hepatitis B infection among health workers in Uganda: Evidence of the need for health worker protection

Hepatitis B exposure was assessed in 311 health workers in Uganda, a highly endemic country. Health workers were selected by random sampling from a categorized list of health workers at district level, proportionate to the population of each district. Whereas 60.1% of health workers have evidence of hepatitis B infection, with 8.7% being chronic carriers and one (0.3%) acutely infected, 36.3% are still susceptible and could benefit from vaccination. Only 5.1% reported having had at least one dose of hepatitis B vaccine and 3.5% were apparently immune through vaccination. Needle stick injuries reported by 77% of health workers were the most common mode of exposure to blood and body fluids. Trends suggested duration of service as a predictor while age and history of blood transfusion remained significant independent risk factors for hepatitis B infection. 98% of health workers are willing to be vaccinated. These results confirm the need for protection and vaccination of health workers in Uganda against hepatitis B.

Hemophilic Siblings With Chronic Hepatitis C: Familial Aggregation of Spontaneous and Treatment-Related Viral Clearance

Hemophilic siblings provide a unique population to explore the natural history of chronic hepatitis C. From 3993 hemophilic patients with hepatitis C, 257 sibling pairs, of which both members had evidence of hepatitis C infection, were studied to evaluate the genetic contribution to spontaneous and treatment-induced clearance of hepatitis C infection and progression of liver disease. Familial aggregation was assessed by comparing observed probabilities of concordance for these disease characteristics within sibling pairs to those expected for randomly paired hemophilic subjects. Additional measures of familial aggregation, heritability, and sibling relative risk were also calculated. Among human immunodeficiency virus-negative subjects, concordance for spontaneous viral clearance was 2-fold higher in siblings compared with randomly paired subjects (8.8% vs 4.3%, respectively, P = .04). Similarly, the concordance rate for treatment-related viral clearance was over twice that among sibling pairs than among randomly paired hemophiliacs (31.3% vs 13.3%, respectively, P = ns). Heritability estimates for spontaneous and treatment-induced viral clearance were 0.24 +/- 0.14 (P = .04) and 0.43 +/- 0.42 (P = .10), respectively. The sibling relative risks for these respective characteristics were 1.6 and 1.7. Concordance for advanced liver disease was higher among siblings but did not reach statistical significance (4.0% vs 2.3%, respectively, P = ns). The heritability estimate was 0.29 +/- 0.13 (P = .02). Concordance rates and heritability estimates for spontaneous and treatment-related viral clearance indicate that genetic factors have a modest influence on the outcome of hepatitis C, although shared environmental factors cannot be excluded. Investigations to map candidate disease-susceptibility genes associated with these characteristics must be approached with caution.

P.323 Serological and molecular evidence of hepatitis E virus infection in swine and environmental samples from a commercial herd in Rio de Janeiro, Brazil

P.323 Serological and molecular evidence of hepatitis E virus infection in swine and environmental samples from a commercial herd in Rio de Janeiro, Brazil

The effect of surgical immunomodulation on liver inflammation and clearance of DHBV infection

The key to developing a therapeutic vaccine for chronic hepadnavirus infection lies in the characteristics of the host-immune response which leads to clearance of acute infection. Groups of 28-day-old ducks which had been surgically bursectomized (n = 10) or thymectomized (n = 13) on the day of hatch or were untreated (n = 21) were inoculated with 10(9) viral genome equivalents (vge) DHBV, then bled twice a week, and euthanased 40 days later. Serum and liver were tested for DHBV DNA and total leukocytes and peripheral blood mononuclear cells (PBMCs) counted. Liver and spleen sections were either stained with hematoxylin and eosin, and graded for inflammation or stained with peroxidase-labeled anti-human CD3 antibody and examined for T lymphocyte distribution. PBMC counts were similar in all groups. DHBV infection combined with bursectomy increased significantly, while thymectomy decreased significantly the total leukocyte count. The spleen and liver bursectomy increased T lymphocyte number while B cells were decreased. Converse changes were observed in thymectomized ducks. Histological evidence of hepatitis was present in infected control and bursectomized ducks but not in the uninfected control or infected thymectomized ducks. In control animals, DHBV challenge caused viremia in 17 and persistent infection in 11 (56%). Fewer thymectomized ducks (3/13, 23%) and significantly more (100%) bursectomized ducks remained persistently infected (P < 0.001). Unexpectedly, bursectomy led to persistence of infection while clearance of infection occurred normally in thymectomized ducks despite decreased T lymphocyte numbers. This suggests that clearance requires T and B lymphocyte collaboration.

Detection of Immunoglobulin M Antibody to Hepatitis A Virus in Alaska Residents without Other Evidence of Hepatitis

During a 38-month period, 13 of 41 persons with test results positive for IgM antibody to hepatitis A virus did not meet the case definition for hepatitis A or have a clear indication for testing, which suggests that test results were falsely positive. No single testing platform or kit was used. Health care providers should restrict serologic testing for hepatitis A to patients with clinical or epidemiologic indications.

Hepatitis E virus antibodies in swine herds of Mato Grosso state, Central Brazil

There is no information about evidence of hepatitis E virus (HEV) infection in swines in Central Brazil. In order to assess if HEV circulates in swines of the State of Mato Grosso, Central Brazil, a seroprevalence study was conducted including pigs from 17 farms, corresponding to 13 counties. The animals were randomly chosen among pigs arriving to two slaughterhouses between December 2002 and February 2003. Serum samples were collected and tested for IgG antibodies against HEV (anti-HEV) by enzyme immunoassay (EIA). This EIA uses two HEV recombinant proteins as antigens, a mosaic protein (MP-II) and a protein containing region 452-617 of the ORF2 of the HEV Burma strain as coating antigens. 211 out of 260 pigs (81.2%; 95CI = 75.7%, 85.6%) were anti-HEV reactive. The seropositivity did not vary with gender or age, but ranges from 15% to 100% among the farms. Our results point out that HEV seems to circulate among pigs in Mato Grosso State, suggesting that this virus is spread over the region, as seen in other countries worldwide.

Cold Agglutinin Disease and Cryoglobulinemia

Cold agglutinin disease is a form of direct, extravascular, antiglobulin-positive hemolysis. In vivo, immunoglobulin (Ig) M fixes complement molecules to the red cell membrane. Successive passages through the mononuclear phagocyte system result in loss of red cell membrane. The resultant spherocytes lose resiliency and are ultimately lost from the circulation extravascularly. The high concentration of complement molecules on the red cell surfaces makes this syndrome resistant to the standard therapies for immune-mediated hemolysis. Rituximab has been reported to reduce the severity of hemolysis. Type II cryoglobulins are composed of a monoclonal IgM and a polyclonal IgG. These complexes have rheumatoid factor activity and can produce immune-complex vasculitis. The target organs are the skin, nerves, kidney, liver, and joints. More than 80% of patients have evidence of hepatitis C infection. Interferon and interferon plus ribavirin have been shown to produce serologic responses. When vasculitis is active, corticosteroids are often required to permit healing of ulcers in the skin or to treat the membranoproliferative glomerulonephritis that is seen, thereby preventing loss of renal function. Rituximab therapy has been found to be effective in mixed cryoglobulinemia, with decreases in cryoglobulin values and improvement in complement values.

Hepatitis C virus infection‐related Type 1 diabetes mellitus

Hepatitis C virus (HCV) has been associated with Type 2 diabetes mellitus, and many other viral infections have been associated with Type 1 diabetes mellitus (Type 1 DM). An association between HCV and Type 1 DM, however, has never been reported. We report the case of a 66-year-old man who developed Type 1 DM 1 year after a blood transfusion-related HCV infection. Testing of serum specimens obtained in the weeks following blood transfusion demonstrated evidence of both acute HCV infection and development of Type 1 DM-related autoantibodies. A 66-year-old Taiwanese male received blood transfusions during coronary artery bypass surgery in 1987. Serum specimens, obtained as part of a study on post-transfusion hepatitis, demonstrated that the patient had no evidence of hepatitis C prior to transfusion, but developed acute HCV infection after transfusion. One year later, the patient, who had no personal or family history of diabetes, presented with diabetic ketoacidosis, and tests for C-peptide confirmed that he had Type 1 DM. Testing of pre- and post-operative serum specimens demonstrated that the patient developed positive tests for islet cell and glutamic acid decarboxylase antibodies 4 weeks after transfusion, concurrent with the development of acute HCV infection. The simultaneous development of HCV infection and diabetes-related autoantibodies suggest a relationship between HCV and Type 1 DM.

Evidences of Hepatitis C Virus Replication in Hepatocytes and Peripheral Blood Monocuclear Cells from Patients Negative for Viral RNA in Serum

In this study, we examined the expression of hepatitis C virus (HCV) components in hepatocytes and peripheral blood mononuclear cells (PBMC) from patients positive for anti-HCV antibodies and negative for serum HCV-RNA. The samples obtained from 25 randomly selected patients (13 of 25 patients showed no histological evidences of chronic hepatitis and had normal serum ALAT and GGTP levels) were studied by in situ Hybridization and Immunofluorescence assays. The findings show that HCV-RNA of both positive and negative polarity was carried in the hepatocytes of more than 80% of cases. The proportion of cells expressing the negative strand (mean ± SD, 10.25% ± 5.56%) was lower than those expressing positive strand (mean ± SD, 19.88% ± 9.19%) (p=0.0076; Student’s t test). In addition, reaction products suggestive of HCV core, E1 and E2 antigens within hepatocytes were also observed. Both hybridization and immunofluorescence signals were localized in the cytoplasm suggesting that this is the place of active HCV replication. On the other hand, the HCV-RNA of positive polarity was detected in PBMC from 16 out of 17 samples analyzed (94%) while the HCV-RNA of negative polarity was detected in 82% of samples investigated. Positive hybridization signals were localized in the cytoplasm of PBMC. Interestingly, 12 out of 13 patients with clinical and histological resolution of hepatitis, contain HCV-RNA in either liver or PBMC. These results provide further evidences that the intermediate replicative form of the HCV genome can persist in hepatocytes and PBMC after apparently complete resolution of chronic hepatitis C.

Impact of Adherence on the Outcome of Antiviral Therapy for Chronic Hepatitis C

Nearly 4 million people in the United States have evidence of hepatitis C infection (HCV), representing a significant cause of cirrhosis and liver cancer as well a major burden to our healthcare systems and society. Antiviral therapy can successfully eradicate HCV over the long term, potentially reducing the risk of progression and improving patients' quality of life. The currently preferred HCV treatment is a combination of pegylated interferon alfa and ribavirin, which can achieve an overall sustained viral eradication rate of 55%. The duration of this treatment is typically determined by HCV genotype and the patient's early virologic response to the antiviral regimen. Evidence has accumulated over the past few years to indicate that close adherence to the optimal antiviral regimen can enhance sustained virologic response. But optimal treatment outcomes require diligence and careful management of side effects related to combination therapy. Although reducing the dose of pegylated interferon alfa, ribavirin, or both can effectively treat side effects, suboptimal doses of this regimen, especially ribavirin, may negatively affect virologic response. An alternative strategy is to use growth factors to treat cytopenias. This strategy can obviate dose reductions while potentially improving patients' quality of life. Patient support seems especially important early after the initiation of antiviral therapy. Encouraging study findings involving the growth factors, epoetin alfa and darbepoetin alfa, suggest improved anemia and quality of life while maintaining the optimal ribavirin dose. Future work should be aimed at providing stronger evidence for the use of these "supportive products" during anti-HCV therapy. As we strive to develop better treatment options for our HCV patients, the importance of adhering to the treatment regimen continues to play a central role. Effective side effect management is crucial for the success of this treatment because adherence is negatively affected by side effects related to the antiviral regimen. By identifying and addressing the important side effects of combination therapy for HCV, adherence to treatment can be improved and optimal outcomes can be achieved.

The frequency of incidental injuries related infections in health care workers and other persons in celje region, their prevention and postexposure prophylaxis

Background: Injuries with sharp, potentially infected objects represent a danger, particularly due to the possibility of viral transmission, such as hepatitis B, hepatitis C and human immunodeficiency virus, and consequentially, the possibility of infections with these viruses. The possibility of a tetanus infection should always be excluded as well. In percutaneous exposure of patient’s blood to hepatitis B the possibility of infection ranges between 5–30%, while in exposure to hepatitis C it is 3–10% and in exposure to human immunodeficiency virus this rate is 0.3% (in exposure of mucous membranes 0.09%). Methods: The prospective investigation carried out in the period from 1997 to July 2004 was aimed at establishing the frequency and type of incidents as well as the categories of the affected health care workers along with the procedures and types of sharp objects involved in those incidents. A protocol with 20 incident-related questions was prepared. Post-exposure prophylaxis (immunoprophylaxis) against hepatitis B (specific anti-hepatitis B immunoglobulin and/or anti-hepatitis B virus vaccine) and against human immunodeficiency virus infection (chemoprophylaxis) was carried out by infectologists according to state-of-the-art doctrine. Considering the possibility of infection with hepatitis B virus, hepatitis C virus and human immunodeficiency virus, the injured persons were subjected to a clinical, laboratory and serological follow up for at least 6 months or more following the incident. Exactly the same follow-up approach after injury was used also in the rest of the injured persons from Celje region. In co-operation with the Commission for Control of Nosocomial Infections, the infectologists prepared written guidelines regarding the post-exposure prophylaxis for health care workers in hospitals with the risk for hepatitis B virus, hepatitis C virus and human immunodeficiency virus transmission, and also participated in the implementation of immunoprophylaxis program against hepatitis B infection. Results: In the seven-year study period, there were 373 cases of percutaneous injuries with sharp objects and exposures of open wounds or eye mucosa to the blood or visibly hemorrhageous body fluids treated in 116 men and 257 women at a mean age of 36 years. The majority of incidents occurred in medical nurses and technicians (181), which were followed by orderlies and cleaning service staff (43), physicians (41) and other personnel (11). In 97 cases the incident occurred outside the hospital setting, to persons who were not employed in health care. In the majority of cases, i. e. in 255 instances (68.4%), the injury was caused by piercing with a hollow needle. The source of possible infectious substance was identified in 225 (60.3%) cases. The source of infection was found in hepatitis B virus carriers in 26 cases, in anti-hepatitis B virus antibody carriers in 4 and in human immunodeficiency virus carriers in 3 cases. At the time of incident, a sufficient quantity of protective antiHBs antibodies (≥ 10 ml U/ml) was established in 183 (49.1%) of the injured persons, mostly health care workers of the General Hospital Celje, due to previous immunoprophylaxis. Following the incident, the majority of the injured, i. e. 194 (52.0%) persons, received at least one revitalizing dose of vaccine against hepatitis B while 68 (18.2%) persons also received a passive prophylaxis with specific anti-hepatitis B immunoglobulin; a 4-week chemoprophylaxis against human immunodeficiency virus was required in 2 persons. In the course of 6-month follow up, none of the injured persons showed evidence of hepatitis B virus, hepatitis C virus or human immunodeficiency virus in the blood nor the presence of seroconversion; the 32 persons injured in 2004 are still being followed up. Conclusions: In health care institutions, the incidence of injuries with sharp objects can be reduced by ensuring a safe working environment, safe medical-technical equipment, organization of continuous education and training in the use of different techniques (workshops), as well as by appropriate use of sealed containers for sharp object collecting. The staff should be currently informed about the Commission for Control of Nosocomial Infections guidelines regarding the measures to be taken in the case of an incident, and, after having received a first aid intervention, should have the possibility of reporting as fast as possible (within 2–3 hours) to the infectological service for possible immuno- or chemoprophylaxis. In the future, it will be necessary to ensure an even wider vaccination of health care workers against hepatitis B, take care of an accurate registration of all incidents, and enable expert data analyses along with a permanent care for further improvement of the situation.

Renal safety of adefovir dipivoxil in patients with chronic hepatitis B: Two double-blind, randomized, placebo-controlled studies

The incidence of adefovir dipivoxil (ADV) nephrotoxicity has been previously reported with the 60 and 120 mg daily dose in human immunodeficiency virus (HIV). We report a complete analysis on the renal tolerance of ADV at the currently approved dose of 10 mg daily for the treatment of chronic hepatitis B. To investigate the efficacy, safety, and the tolerability of two dosing regimens of ADV (10 mg daily or 30 mg daily), two double-blind, placebo-controlled studies were performed in patients with chronic hepatitis B and compensated liver disease who were not undergoing current treatment and who had evidence of hepatitis B virus (HBV) replication. There was no overall median change from baseline at week 48 in serum creatinine or serum phosphorus levels in the ADV 10 mg group. In the ADV 30 mg group there was a slight increase of 0.2 mg/dL in median serum creatinine levels, and decrease of 0.1 mg/dL in serum phosphorus levels at week 48. Serum creatinine increase and hypophosphatemia were more frequently observed in patients receiving ADV 30 mg daily compared with ADV 10 mg and placebo. There were no grade 4 proteinuria, hematuria, or glycosuria events. Mild nephrotoxicity was demonstrated with the dose of 30 mg daily. Nephrotoxicity, as defined by an increase >/=0.5 mg/dL from baseline in serum creatinine or a serum phosphorus value of <1.5 mg/dL on two consecutive occasions, was not observed in patients treated with ADV 10 mg for a median follow-up period of approximately 64 weeks.

Prevalence of hepatitis A, B, C and human immunodeficiency virus seropositivity among patients with acute icteric hepatitis at the Kenyatta National Hospital, Nairobi

To determine the prevalence of hepatitis A, B, C and HIV seropositivity among patients with acute icteric hepatitis. Cross-sectional descriptive survey. Kenyatta National Hospital, Nairobi. Eighty four patients aged above six months with a history of jaundice not exceeding six months were recruited. There were 47 males and 17 females with an age range of eight months to 67 years and a median age of 25 years. History was obtained physical examination done and blood taken for determination of bilirubin, ALT, AST and ALP levels. Sera that had disproportionately greater transaminase than ALP elevation were assayed for IgM anti-HAV, IgM anti-HBc, HbsAg, anti-HCV and anti-HIV antibodies. Evidence of hepatitis A, B, and C was round in 41.7%, 26.2%, and 7.1% of the patients respectively, 13.1% of the patients were HBsAg carriers while 30.1% of all patients were HIV positive. Thirty two patients did not have evidence of hepatitis A, B, or C infection and this group was significantly associated with HIV infection (p = 0.003). Hepatitis A was the commonest overall type of acute icteric hepatitis seen at the KNH, and among patients aged 15 years and below. Hepatitis B was the leading identified cause of acute hepatitis among those aged over 15 years. Hepatitis C accounted for 7.1% of acute icteric hepatitis 30.1% of all patients and 50% of those admitted with acute hepatitis were also HIV positive.

Complications of β-thalassemia major in North America

AbstractTreatment of patients with β-thalassemia major has improved dramatically during the past 40 years; however, the current clinical status of these patients remains poorly characterized. We performed a cross-sectional study of 342 patients in the Registry of the National Institutes of Health-sponsored Thalassemia Clinical Research Network. Evidence of hepatitis C exposure was present in 35% of tested patients, was associated with age, and had a rate of spontaneous viral clearance of 33%. Ferritin levels ranged from 147 to 11 010 ng/mL (median, 1696 ng/mL). Median hepatic iron content was 7.8 mg/g dry weight and 23% of patients had values of 15 mg/g dry weight or higher. No patients 15 years or younger and 5% of patients aged 16 to 24 years had heart disease requiring medication. Ten percent had cirrhosis on biopsy. Endocrinologic complications were common among adults. Seventy-four (22%) patients had recent implantable central venous access devices (CVADs) placed. Among 80 episodes of bacteremia in 38 patients, 90% were attributable to the CVAD. Among 330 patients who had received deferoxamine chelation therapy, 224 (68%) reported no complications. We conclude that hepatitis C, iron-related organ dysfunction, and complications of iron chelation therapy are strongly age-dependent in North American patients with β-thalassemia.