Hepatitis B genotype D profile: Clinical presentations, fibrosis status, gene mutation, and HBe Ag expression in chronic HBV patients

Introduction: Chronic hepatitis B (CHB) infection is accountable for nearly 240 million cases worldwide. Hepatitis B virus (HBV) has a propensity to show a divergent phase, and isolated measure of high HBV DNA level may not reflect the stage of the disease. In this background, this study was done to detect hepatitis B e antigen (HBeAg) and HBV DNA levels among hepatitis B surface antigen (HBsAg)-positive CHB cases and to determine the stage of disease with viral markers and biochemical parameters such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Materials and Methods: Blood samples were collected from 50 participants with CHB (HBsAg positive for more than 6 months) tested for HBe Ag by enzyme-linked immunosorbent assay, HBV DNA, ALT, and AST levels. Results: Among the 50 cases, 31 (62%) were HBeAg negative. Among these 31 HBeAg-negative groups, 16 (52%) had HBV DNA levels >2000 IU/mL. In these 16 patients, six had ALT >40IU/mL. Conclusion: HBsAg, HBeAg, ALT levels, and HBV DNA are important markers to determine the clinical stage of the disease. Since it is a chronic disease, patients need long-term follow-up. Further, emergence of viral mutants among vaccinated and those on lamivudine aggravates the existing problem.

Introduction: Viral hepatitis is a public health threat that has long been underestimated. This infectious disease is the seventh cause of death in the world and even ahead of HIV in terms of epidemiological prevalence. Objective: highlight the seroprevalence of hepatitis B and C viral infections in patients seen in the medical analysis and pathology laboratory department of the Mali hospital. Method: This is a prospective and retrospective study that took place from July 2021 to August 2022. This study included 1540 samples from eligible patients with HBsAg, Anti HBe IgG Antibody, Anti HBc Antibody, HBe Ag, Antibody Anti HBs and/or anti-HCV antibodies. Results: These different methodologies allowed us to have the results of 1540 samples concerning this study. The female sex was more represented with 62.92% compared to the male sex or 37.08%. The HBSAg was mainly found positive in the male sex with 5.45%. The average age was 38 ± 17 years with extremes ranging from 2 to 92 years. The age group 21-39 years was the most represented with 47.47% and the most affected by the positivity of the HBSAg with 5.65%. 64.03% of our patients were married and also with increasing positivity for HBS Ag and anti-HCV Ac with 5.91% and 0.91% respectively. The seroprevalence of HBV, HCV and HVB/HCV co-infection were 10.06, 0.9% and 0.84% respectively. Conclusion: Hepatitis B remains largely unknown to the general public but also to many medico-social actors. This lack of knowledge represents a major obstacle to prevention and screening. It also has as a corollary the stigmatization of people who are affected, in romantic encounters or at work in particular. A high seroprevalence of HBsAg obtained indicates the spread of hepatitis B in the Malian population.

Dissecting Virological and Immunological Factors to Predict Outcome in Hbe Ag Negative Chronic Viral Hepatitis B Patients after Cessation of Nucleos(T)Ide Analogue

Background: The seroprevalence of HBs Ag among the general population in Libya was found to be 2.2 %. Libya is therefore considered an area of intermediate endemicity for hepatitis B. vertical transmission is considered as the main route of spread of this infection. Trans placental (intra-uterine) transmission is presumed to cause the minority. Risk factors for transmission of HBV include maternal HBe Ag positivity, HBs Ag titer, and HBV viral load. Active immunization with hepatitis B vaccine (Hep. B vaccine), and hepatitis B immunoglobulin (HBIG) is 85-95% effective in preventing the disease. The objective of the study: To assess the effectiveness of hepatitis B vaccine and hepatitis B immunoglobulin in the prevention of the Hep. B. virus transmission and to study the factors that affected the immune response of the newborn babies of mothers with hepatitis B positive infection during pregnancy. Patients & Methods: A longitudinal cross-section study included 40 babies born to mothers with hepatitis B during the period from 1.1.2017 To 1.3.2019 at Benghazi Medical Center. The newborn babies have been immunized with Hepatitis BIG and Hepatitis B vaccine at birth, and further 3 doses of hep. B vaccine and HBIG. Multivariable analyses were done to assess the statistical significance associated with responders and nonresponders to HB immune prophylaxis. Results: all babies were negative for hepatitis Bs Ag in 40(100%), 35 (88%) their viral load was 10 mlIU/ml) in More than two-thirds (60%) and (63%) of infants at 9 months and 12 months respectively. Birth weight >2.5 kg was significantly associated with immune response >10 mIU/ml, whereas, Maternal viral load, time of administration of HBIG, and hep. B vaccine, gestational age, mode of delivery, type of feeding were statistically not significant. Conclusion: the study reported that all the newborn babies were negative for hepatitis B sAg after delivery, more than two-thirds of the babies were responders to immune-prophylaxis, and birth weight of >2.5kg was significantly related to high immune-response.

Objective: To investigate the carriage of HBs antigen (Ag) and hepatitis C virus in people with human immunodeficiency virus (HIV) at Grand-Yoff General Hospital.
 Materials and Methods: Sera from patients living with HIV and monitored at Grand-Yoff General Hospital have benefited from research for HBs Ag, HBe Ag, anti-H[8] Be antibodies and on these co-infected patients, a test for hepatitis C virus was also carried out.
 Results: This study included 147 HIV-infected patients and including 95 women (64.63%) and 52 men (35, 37%) with a median age of 46 years (16-78 years). The gender ratio is M/W was 0.54 and the age group most represented at inclusion was 30-39 years old with 31.97% of patients. 12, 25% of patients were co-infected HIV and hepatitis B including 11 women (61.11%) and 7 men (38.89%). The median age was 39.5 years (33-60 years), women were the affected by co-infection and 44.44% of them were married. Chronic hepatitis B and hepatitis C markers were tested for in HIV/HBV coinfected patients using a microparticulate chemiluminescence immunoassay technic. Investigation of hepatitis B chronicity markers indicated that all patient, except one, underwent anti-HBe seroconversion (94.4%) and no case of co-infection with HCV had been noted. During follow-up, all patients were under antiretroviral therapy with mainly tenofovir (TDF) which was the most used molecule with 83.33%, followed by lamivudine (3TC) 16.67%.
 Conclusion: HIV infection is a major public health problem when it is associated with hepatitis B and C virus.

Viral hepatitis B (HBV) is a major public health problem worldwide. Indeed, the World Health Organization (WHO) estimates that more than 2 billion the number of people who have been exposed to this virus, about 30% of the world population, 18% in sub-Saharan Africa and 41% in Asia, of which 5% with chronic infection or 300-350 million. So the HBV prevalence is 5.4% globally, against 1% for the HIV and 3% for hepatitis C. More than 1 million of them die each year complications essentially cirrhosis and hepatocellular carcinoma. The diagnostic of HBV (recent or chronic infection) relies on research HBs antigen in the serum of patients, it is the witness of a recent or past infection with HBV according to the presence or absence of other serological markers (HBe Ag, anti-HBs Ig and total anti-HBc and anti-HBe antibody IgM) but they do not provide information on the status of viral replication. The detection and quantification of HBV genome (replication of viral marker) can be performed in serum, liver tissue or in blood mononuclear cells. They typically based amplification methods: Polymerase Chain Reaction (PCR). The treatment of viral hepatitis B is for patients with hepatitis B associated with viral replication (HBV DNA positive), cytolysis (elevated transaminases) and presence on biopsy of an activity necroinflammatory or significant fibrosis. Despite the recent antiviral therapeutics, treatment of chronic hepatitis B is difficult and expensive, and the prevention of HBV infection through routine immunization policy and prevention measures currently remains the best option for reducing morbidity and mortality from liver failure and liver cancer. Morocco is considered far, according to WHO data, such as having an intermediate prevalence of viral hepatitis B. Currently, few studies relate the epidemiology of hepatitis B (HBV) in Morocco. The objective of this study was the evaluation of the HBV infection prevalence in a Moroccan workers population, and compare with national and international studies. A total of 20192 individuals were screened for HBsAg. HBV screening was conducted by immunoassay chemiluminescent micro particle (CMIA) PLC (Abbott Architect) and with a prevalence rate of HBsAg estimated at 0.55%. These data are of interest for the diagnosis and prognosis, and therapeutic decision, and can be for the development of an eventual national strategy for the prevention of the transmission of HBV.

The evaluation of the liver structure can be done through invasive and non-invasive imaging methods. Noninvasive methods include abdominal ultrasound, transient hepatic elastography (Fibroscan). biomarkers such as hyaluronic acid (HA), alpha-2 macroglobulin, laminin, fibronectin, Fibroindex or panels such as Fibrotest-actiTest. Liver biopsy, the most invasive method of assessing the structure of the liver and the lesions present, is still indicated in certain reserved cases, when the diagnosis remains uncertain despite all the investigations. Antiviral therapy in Romania for hepatitis B virus includes the administration of pegylated interferon alfa 2a and various nucleoside/nucleotide analogs (ANN): adefovir, entecavir, tenofovir, lamivudine. IFNα is the most effective antiviral treatment in children, regarding the seroconversion of Hbe Ag to anti Hbe Ac and the disappearance of Hbs Ag. Sustained response is defined as maintaining the response to treatment for at least 6 months after its discontinuation.

The study was conducted to know the range of spread of Rubella virus, Cytomegalovirus, Hepatitis B virus,and Toxoplasma gondii among students at Al-Mustaqbal University College, its impact on society in theprovince of Babylon. Therefore this study includes the evaluation of the immune status in sera of studentsto the investigation from Toxoplasma gondii, Rubella virus, Cytomegalovirus by IgM/IgG rapid test andHepatitis B virus by HBV-5 rapid test of 90 specimens that were collected during the period extending fromJanuary 2019 to March 2019. Data about individuals have been collected aseptically in sterile containers,after getting all data in the special formula including, name, gender, age. It revealed that Cytomegalovirusformed (CMV) 13.3% followed by Toxoplasma gondii 0% Rubella 0%, depending on IgM. While showsresult in IgG seropositivity to Rubella was 60% followed by CMV was 36.7% and Toxoplasma was 10%.The results of the present study showed that all HBs Ag and HBe Ag were negative whereas HBe Ab andHBc Ab were positive, while HBs Ab was only three positive from other samples.

This study aimed to evaluate the profile of qHBs Ag profile, and also to investigate the correlation betweenqHBs Ag and HBV DNA. Seventy samples of chronic-nai?ve hepatitis B patients in Dr. Soetomo Hospitalwere analyzed in a cross-sectional study. Patients were categorized according to the HBe Ag positive (n=30)and HBe Ag negative (n=18), also based on qHBs Ag 1000 IU/mL and qHBs Ag >1000 IU/mL. qHBs Agwas correlated with HBV DNA. qHBs Ag by CLEIA method from Sysmex, KOBE HISCL, HBV DNAwas measured by real-time Polymerase Chain method from Gene Xpert, Cepheid. 70 patients nai?ve CHBtreatment showed a median of ALT level 60.21±70.76 U/L. 30 patients showed a positive-HBeAg, 18 patientsshowed negative-HBeAg, 22 patients were not evaluated (N/A). Positive-HBeAg patients had 70% qHBsAg>2500 mg/dL and median HBV DNA 7.49×107IU/mL. Negative-HBeAg patients had 55.6% HBsAg ?1000mg/dL and median HBV DNA 9.66×102 IU/mL. qHBsAg correlated with HBV DNA (p <0.001). This datademonstrated that quantitative HBsAg was associated with a phase of HBV-infection, quantitative HBsAgshowed a moderate correlation with DNA HBV, quantitative HBsAg levels might be a predictor of initiationtherapy for CHB patients.

Background: The hepatitis B virus [HBV] is an infectious disease and its one of the great public health problem, its outcome depends on the kinetics of the virus-host interaction and specifically on the strength of the innate and adaptive, humoral and cellular immune response. Thus interactions between the virus and the components of immune systems plays an important role in the pathogenesis of the disease. This study aimed to evaluate innate immune response in different clinical courses of HBV infection by estimation serum levels of granulocytemacrophagecolony stimulating factor (GM-CSF), Interleukin-1 (IL-1 ), Interleukin-8 (IL-8 ) , immunoglobulin A (IgA), IgM, IgG and Complement component (C3and C4) levels. Aim of study: to evaluate role of immune response in clinical course of hepatitis B infection Patients and Method: This study based on 78 patients with HBV infection attending the Public Health Laboratories. Their ages ranged from (14-65) years, (58 males and 20 females) compared with 20 healthy subjects (12 males and 8 females) as control group. This study extended from first of January 2015 to first of January 2017. The patients were classified to three groups on the bases of serologic markers (HBsAg, HBe Ag, HBc Ab IgM) according to WHO department of communicable disease surveillances and response, liver function tests which are used as supportive indicator for the liver injury, history of the illness, and full clinical assessment. The first group includes twenty-eight patients with acute HBV infection, second group include twenty cases identified as chronic healthy HBsAg carriers group and the last third group include thirty cases of chronic HBV group Results: By using enzyme immuno assay [ELISA] technique, serum levels of interleukin1alpha [IL-1α], interleukin-8 [IL-8], and granulocyte-macrophage-colony stimulating factor [GM-CSF] were measured in all patients compared to that of healthy control group. The mean levels of IL-1α and IL-8 showed a significant increase in serum of patients with newly infected (acute) HBV and chronic HBV compared with studied control group [P=0.04 and P=0.001 respectivel]. However, the mean serum levels for IL-1α and IL-8 recorded a non significant increase in patients with chronic healthy HBsAg carriers [P=0.17 and P=0.4 respectively]. While the mean serum levels of GM-CSF showed a significant rise in acute HBV only [P=0.01]. Moreover, serum immunoglobulins [IgG, IgM, IgA] and complement component [C3, C4] levels also evaluated by using single radial immunodiffusion test (SRID). The mean serum IgA, IgG and IgM levels showed a significant increase in chronic HBV group as compared to that of control group [ P=0.000 ,P=0.000 and P=0.001 respectively].. The mean serum C3 and C4 levels showed a significant lower serum level in all groups compared to control studied group [P=0.000]. Conclusion: this data demonstrate that immunological differences do exist between different clinical groups with HBV infection and may reflect the role of the innate immune system in host defense and disease

Background: Viral hepatitis was responsible for 1.34 million deaths globally in 2015, a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. Although hepatitis B and C viral infections are major causes of liver cirrhosis or/and hepatocellular carcinoma, knowledge is limited and prevalence underestimated because of poor surveillance programs in most developing countries. Objectives: The aim of this study was to evaluate the level of awareness/knowledge, risk factors and prevalence of viral hepatitis B and C amongst antenatal attendees in a secondary health-care facility. Study design: The study was cross-sectional, descriptive and hospital-based. Methods: A total of 218 pregnant women were recruited from the antenatal clinic of Central Hospital Warri using simple random technique after approval from the institutional review board and consent from the participants. They were screened for Hepatitis B and C viral infections using a rapid immune-chromatographic test strip. Samples positive for HBsAg were screened for other HBV biomarkers using a 5 in one test cassette. Result: Of the 218 women screened, 3 (1.4%) were positive for HBsAg while 4 (1.8%) reacted for HCV antibodies. All positive cases for HBsAg were negative for HBeAg and HBsAb, but positive for HBeAb and HBcAb. Age-grade 31-40 gave the highest age-based prevalence 1.92% for HBsAg while participants younger than 20 years had the highest age-based prevalence of 20% (2/10) for HCV. Multiparous women had 2.8% for HBsAg while nulliparous/primiparous participants have the highest HCV antibody prevalence of 3.1%. For other variables measured, self-employed, Secondary school education, lack of HBV vaccination, women who share sharps and participants that engaged the services of quacks for invasive procedures gave the highest prevalence in their respective categories. Conclusion: The prevalence of 1.4% and 1.8% reported by this study for HBV and HCV respectively is relatively low when compared to a previous report for the study region and other Nigerian studies. However, the poor level of awareness/knowledge and high level of exposure to predisposing risk factors among the study population calls for urgent intervention if vision 2030 will be a reality for the study region.

Amaç: Eş zamanlı hepatit delta virüs (HDV) enfeksiyonu varlığı kronik hepatit B (KHB) ilişkili karaciğer hastalığının seyrini olumsuz yönde etkilemektedir. Bu çalışmada Siirt ilinde hepatit B virusu (HBV) ile kronik olarak enfekte olan hepatit gelişmiş ve gelişmemiş olgularda delta antikoru (anti-HDV) sıklığının belirlenmesi ve HDV koenfeksiyonu varlığının klinik etkilerinin irdelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif kesitsel çalışmaya Şubat 2017-Şubat 2018 tarihleri arasında Siirt Devlet Hastanesi Enfeksiyon Hastalıkları polikliniğine başvuran Anti-HDV testi bakılmış 288’i HBV ile kronik olarak enfekte, 174’ü KHB gelişmiş toplam 462 olgu dahil edildi. HBV deoksiribonükleik asit (DNA), hepatit B “e” antijeni (HBeAg), alanin aminotransferaz (ALT), HDV ribonükleik asit (RNA) sonuçları ile siroz ve hepatosellüler karsinom (HCC) durumu ile ilgili verilere retrospektif olarak ulaşılmıştır. Çalışmaya alınan hastalar Anti-HDV pozitif (n=128) ve negatif (n=334) olmak üzere iki gruba ayrıldı. KHB, siroz ve HCC sıklığı gruplar arasında karşılaştırılmıştır. Bulgular: Toplam 462 olgunun 205’i (%44,4) kadın, 257’si erkek (%55,6) olup, medyan yaşı 37 (çeyrekler arası aralık (IQR) 26 ila 49) idi. Anti-HDV pozitifliği saptanan toplam 128 (%27,8) olgunun 32’sinde HDV RNA çalışılabilmiş ve 9’unda pozitif olarak saptanmıştır. Çalışmamızda nonsirotik ve sirotik olgulardaki anti-HDV sıklığının sırasıyla %26,2 ve %68,8 olduğu görülmüştür. Anti-HDV pozitif olgularda KHB, siroz ve HCC sıklığının Anti-HDV negatif olgulara göre anlamlı oranda yüksek olduğu görülmüştür (p=0,003, p=0,001, p=0,021). Sonuç: Bu çalışmada elde edilen verilere dayanarak, Siirt ilinde HBV ile enfekte olgularda Anti-HDV sıklığının Türkiye ortalamasının (%5,2) çok üzerinde olduğu ve Anti-HDV pozitif olguların KHB, siroz ve HCC gelişimi açısından Anti-HDV negatif olgulara oranla daha yakın izlem gerektirdiği söylenebilir.

Objective To investigate the correlation of serum hepatitis B virus large protein (HBV-LP), HBV-DNA, and Pre S1 antigen (Pre S1-Ag) with HBV replication. Methods Serum samples were collected from 650 patients with chronic hepatitis B (CHB) who were treated in Beijing Friendship Hospital from March 2017 to March 2019. Serum HBV-LP and Pre S1-Ag were detected by enzyme-linked immunosorbent assay (ELISA). HBV markers (HBV-M) were measured using chemiluminescent microparticle immunoassay (CMIA). Quantitative real-time PCR (qRT-PCR) was used to detect HBV-DNA. The positive detection rates of HBV-DNA, HBV-LP and Pre S1-Ag were calculated and compared, and the correlation of HBV-LP (S/CO value) and hepatitis B surface antigen (HBsAg, log10 IU/ml) with HBV-DNA(log10 IU/ml)was analyzed. Results In the 650 CHB patients, the positive rates of HBV-DNA, HBV-LP and Pre S1-Ag were 65.4% (425/650), 79.2% (515/650) and 43.1% (280/650), respectively (P<0.01). The positive rates of HBV-DNA and HBV-LP in 243 HBeAg-positive patients were 93.0% (226/243) and 94.6% (230/243), and no significant difference was found between them (P=0.45). However, there was significant difference between the positive rates of HBV-DNA and HBV-LP in 407 patients negative for HBeAg [48.9% (199/407) vs 70.0% (285/407), P<0.01]. The positive rates of HBV-DNA and HBV-LP in HBsAg-, HBeAg- and HBcAb-positive groups were 92.8% (206/222) and 94.1% (209/222), which showed no significant difference (P=0.56). In HBsAg-, HBeAb- and HBcAb-positive groups, the positive rates of HBV-DNA and HBV-LP were 45.4% (124/273) and 69.9% (191/273) (P<0.01). The detection rate of HBeAg was lower than that of HBV-LP significantly in both HBV-DNA-positive and HBV-DNA-negative groups (P<0.01). With the increasing of HBV-DNA load, the S/CO value and the positive rate of HBV-LP increased significantly (P<0.05). Conclusions HBV-LP had a good correlation with HBV-DNA load as compared with Pre S1-Ag, HBeAg and HBsAg. HBV-LP in combination with HBV-M might be used as predictive markers that could efficiently reflect the status of HBV replication. Key words: Hepatitis B virus; DNA; Large protein; Pre S1 antigen; HBV markers

A label-free immunosensor for the sensitive detection of hepatitis B e antigen based on PdCu tripod functionalized porous graphene nanoenzymes

Background:Hepatitis B Surface antigen (HBsAg) seroclearance and seroconversion (development of antibodies against HBsAg) can increases the survival of Chronic hepatitis B (CHB) patients. The aim of this study was to determine the percentage and timing of HBsAg seroclearance and seroconversion in patients with chronic hepatitis B infection.Methods:1026 patients with CHB infection who referred to a private clinic were included. These patients had been followed-up for an average of 15 years. The patients whose HBs Ag was cleared from the blood and remained negative until the end of follow-up were designated as HBs Ag serocleared and the patients whose HBs Ab was positive during follow-upwas designated as HBs Ag seroconverted. The time of seroclearance and seroconversion of patients was recorded. Liver function tests, alpha-fetoprotein (AFP) and Hepatitis B early antigen (HBe Ag) status were extracted from the patients’ medical records. Data were analysis with SPSS 17.Results:The duration of follow-up was from 2 to 410 months and most patients were males (58.2%).The survival rate of HBs Ag positivity after 5, 10 and 15 years were 95.6, 89.4 and 80.7%, and 98, 93.5 and 84.9% of patients had not yet developed anti-HBs antibodies after 5, 10 and 15 years, respectively. Age, gender and taking medication had no effect on HBs Ag clearance from the blood or anti-HBs productionConclusion:The HBs Ag seroconversion is a rare occurrence, but the incidence of this may increase with time, age and drug consumption. Though there was no relationship in our patients

To investigate the conversion rate from negative to positive (positive rate) of HBsAb in lymphoma patients inoculated with different dose of hepatitis B vaccine, to evaluate the immune efficacy of different dose of hepatitis B vaccine, and to analyze the influencing factors. Two hundred thirty six patients with lymphoma were selected, whose 5 indexes of hepatitis B (HBsAg, HBsAb, HBeAg, HBeAb and HBcAb) were all negative confirmed by ELISA. The hepatitis B vaccine was inoculated according to 0, 1 and 6 months immune procedures at 1-2 weeks before chemotherapy. The HBsAb level was detected at 1 month after the immunization, the differences in each indexes between HBeAb+ and HBeAb- patients were compared. The positive rate of HBsAb was 75% in all patients with lymphoma.The positive rate of high dose (20 μg) group was 81.4%, which was significantly higher than that of the low dose (10μg) group with 68.6% (χ2=5.09, P＜0.05). The positive conversion rate of HBsAb significantly higher in the patients of young, female, B-cell (except DLBCL subtype), early Ann Arbor stage, and the treatment regimens without glucocorticoid and rituximab. There were no statistical significances in systemic symptoms or no and treatment regimens with or without lenalidomide. Two doses of hepatitis B vaccine not displayed obvious adverse reactions. The high dose of hepatitis B vaccine can achieve better immune efficacy than that of the low dose in the patients with lymphoma.

To evaluate the efficacy and safety of Gantaishu Capsules in the treatment of viral B hepatitis. The randomized controlled trials( RCT) retrieved from Cochrane Library,PubMed,Sino Med,CNKI,Wan Fang and VIP were enrolled. The methodology quality of the included studies was evaluated,and a Meta-analysis was performed using Rev Man 5. 3 software. A total of six randomized controlled trials were included. Meta-analysis results showed that the similarities in the negative conversion rate of HBe Ag( RR = 2. 09,95%CI[0. 90,4. 85],P = 0. 09,I2= 0%),the HBV-DNA negative rate( RR = 1. 49,95% CI[0. 56,3. 95],P = 0. 43,I2= 0%) and the changes in ALT levels before and after treatment( RR =-6. 28,95%CI[-72. 83,60. 27],P = 0. 85,I2= 99%),with no statistical difference. In terms of quality of life,Gantaishu Capsules can significantly alleviate the symptoms of hepatitis B patients,with less adverse reactions. Gantaishu Capsules and Dongbao Gantai Tablets were similar in antiviral effect. In this term,Gantaishu Capsules was superior to Dangfei Liganning Capsules. It can significantly alleviate the symptoms of chronic hepatitis B patients,with a good clinical safety.Therefore,it can be applied in the case of syndrome differentiation and treatment. In view of the low quality of the included studies,more high-quality clinical trials were required to confirm its efficacy.

Objective To reveal the characteristics of S gene sequence of hepatitis B surface antigen (HBsAg) in hepatitis B virus (HBV)-infected patients with low HBsAg level. Methods From February 2016 to December 2017, 1 308 serum samples of inactive HBsAg carriers were collected from the 903rd Hospital of PLA and Hangzhou Jianggan District People′s Hospital.The cases were divided into high-level group and low-level group according to the level of serum HBsAg (10 IU/mL) expression. The HBV S gene was sequenced in patients with low-level HBsAg expression. In addition, in patients with high-level HBsAg, 100 patients were randomly selected (stratified sampling) for HBV S gene sequencing based on the matching of age and serological pattern (hepatitis B e antigen [HBeAg] negative) of low-level HBsAg group. A comparative analysis was conducted between HBV S gene sequences from inactive HBsAg carrier in low HBsAg expression group and the HBV reference S gene sequences from inactive HBsAg carrier in high HBsAg expression group.The results of normal distribution data were expressed as Mean±SD, and analyzed using t-test. The results of non-normal distribution data were expressed by M(QR), and analyzed using Mann-Whitney U test.Chi-square test or Fisher exact test was used to compare continuous variables and classification variables between the two groups. Results There were 276 serum samples from the low level group and 1 032 serum samples from the high level group, including 257 HBsAg/HBeAg/anti-HBc-positive cases, 753 HBsAg/anti-HBe/anti-HBc-positive cases, and 22 HBsAg/anti-HBc-positive cases. Successful HBV S gene sequencing was performed on 126 out of 276 patients in the low-level HBsAg group. According to the age inthe low-level HBsAg group, 100 samples with negative HBeAg in the high-level HBsAg group were randomly selected, among which 94 patients were genotyped and hemotyped. The results showed that there were statistically significant differences in HBV serological markers, HBV DNA level and HBV genotype distribution between the high level group (94 cases) and the low level group (126 cases) (all P 0.05). For genotype B, 12 single point mutations and 4 dual co-mutations were found in low level group. Among them, one single point mutation (S210R) and 3 dual co-mutations (G44E/V+ T45P/I, G44E/V+ L49P/R and N40S+ I208T) were not hot spot mutations, while 2 dual co-mutations and 2 single point mutations were found in high level group. The difference between two groups was statistical significant (χ2=7.533, P=0.006). For genotype C, 5 single point mutations (T5A, A45T, T47A/K, Q101R and I126S/T) were found in low level group and 1 single point mutation (N3S) in high level group. The difference in mutation frequency between two groups were statistical significant (χ2=47.914, P=0.000). Conclusions Significant mutations in multiple regions and at multiple sites (including co-mutations) on both sides of the MHR may be one of the causes of low HBsAg expression level in this population. Key words: Hepatitis B surface antigens; Genotype; HBV markers; HBV DNA; S gene; Mutation site

Hepatitis B virus infection: Prevention of mother-to-child transmission and exacerbation during pregnancy