HBsAg-positive Individuals Research Articles

Hepatitis B virus infection in a cohort of HIV infected blood donors and AIDS patients in Sichuan, China.

BackgroundCo-infections of HBV and HIV are frequent due to similar routes of transmission. In that transmission through blood is an important route for both HBV and HIV, evaluation of the prevalence of HBV in HIV infected blood donors may be important for transfusion safety. In addition, because the epidemiological characteristics of HBV in HIV infected patients and blood donors may differ from each other, understanding of it could be significant for therapy and prevention of HBV in HIV infected adults. However, data reported on these in Chinese people remains limited.Methods614 HIV confirmed positive samples were collected from blood donors and patients and were screened for HBsAg and HBV DNA. The samples screened reactive for HBsAg or positive for HBV DNA were tested for the other serological markers of HBV including anti-HBs, HBeAg, anti-HBe and anti-HBc. For the samples tested positive for HBV DNA, the S region of HBV was amplified by nested PCR and the HBV genotypes were determined.ResultsHBV coinfections were found in 12.9% (79/614) HIV infected individuals including 42/417(10.1%) blood donors and 37/197 (18.8%) AIDS patients. In the HBsAg positive individuals, 80.0% were HBeAg negative in which 10.0% were HBV DNA negative and 38.3% with HBV DNA lower than 2000 IU/ml. The average HBV DNA levels were lower in donors than in patients. In the HBV DNA positive populations, HBV genotypes B, A and C accounted for 48.1%, 22.8% and 8.86% respectively. Mutations related to the failure of HBsAg detection were found in 2 of the 4 HBsAg-/HBV DNA + subjects.ConclusionsHigh prevalence of HBV in HIV infected individuals was found in this study. Hence, we recommend routine testing of HBV for patients newly diagnosed with HIV/AIDS in China. Some HIV-HBV co-infected patients remain undiagnosed if only conventional serological markers for HBV are used and it’s important to detect HBV DNA for HIV infected patients. HBV DNA levels were relatively low in HBeAg negative patients, thus this serologic marker may be useful in prioritizing patients on their need for HBV treatment in settings in which HBV DNA is not available.

English

OBJECTIVE: To establish the relationship between biochemical, serological and viral replication indices in an individual with incidentally detected asymptomatic HBsAg positive. METHOD: This cross-sectional study was undertaken on 73 asymptomatic HBsAg positive individuals between January 2010 and December 2011. They were divided into 5 groups on the basis of HBeAg status, ALT levels, and HBV DNA levels. RESULTS: There was statistically significant difference in HBV DNA levels and ALT between HBeAg positive and negative; and in ALT levels between cases in Group C and E and that between Groups C & D. There were significant difference in DNA levels between group D & group E and that between group C & group E. HBV DNA levels Co- related significantly with grade (r = 0.48, p 40 IU/ml) and those with normal ALT(<40 IU/ml). CONCLUSION: ALT and AST had a strong correlation with HBV DNA level. INTRODUCTION: Hepatitis B Virus (HBV) infection and its sequel are serious public health problems worldwide. Around 2 billion people are infected by hepatitis B virus (HBV) worldwide of which 400 million persons suffer chronic infection with HBV. 1 HBV infection is usually clinically in apparent. Approximately, 5-10% of infected adults develop chronic liver disease of varying severity. More than 90% of infants infected during the first year of life and 30-50% children infected between 1-4 yrs of age develop chronic infection. The risk of death from HBV related liver cancer and cirrhosis is approximately 25% in persons who become chronically infected during child hood.2, 3 15-40% of carriers will develop serious complications during lifetime like cirrhosis, decompensated liver disease or HCC. 1 75% of carriers are present in Asia. India has the second largest pool of HBsAg carriers after China. AIMS AND OBJECTIVES: This study was undertaken to establish the relationship between biochemical, serological, viral replication indices in an individual with incidentally detected asymptomatic HBsAg positive.

A paucity of liver disease in Canadian Inuit with chronic hepatitis B virus, subgenotype B6 infection

Clinical observations suggest that chronic hepatitis B virus (HBV) infections in the Canadian Inuit are less often associated with serious adverse outcomes than has been described in other HBV-infected patient populations. The aim of this study was to document the clinical and biochemical features, liver-related morbidity and all-cause mortality in Canadian Inuit with chronic HBV infections. Administrative databases were reviewed for individuals identified as hepatitis B surface antigen (HBsAg) positive during a 1983-85 seroepidemiological survey of viral hepatitis in Baffin Island, Canada. An equal number of age- and gender-matched HBsAg-negative individuals from the same communities served as controls. Baseline HBV viral loads, genotypes and specific mutations were compared in HBsAg-positive survivors and nonsurvivors. A subset of surviving HBsAg-positive carriers were reassessed 25-30 years following their initial diagnosis for evidence of advanced liver disease and changes to their serological/virological findings. One hundred and forty four HBsAg-positive individuals were identified. All were Canadian Inuit. The mean age at diagnosis was 38 ± 17 years and 69 (61%) were male. Median follow-up was 23 years (range: 2-28 years). Viral quantitation from stored sera could be performed in 70 infected individuals. The median viral load was 4.3 log 10 IU/ml (range: 2.3-8.8 log 10 IU/ml), and all were genotype B, subgenotype B6. Liver biochemistry, morbidity and all-cause mortality rates were similar in HBsAg-positive carriers and controls. Following multivariate analyses, only age at diagnosis predicted mortality in HBsAg carriers. In a subset of 30 HBsAg-positive survivors who underwent follow-up assessments, clinical, biochemical and radiological examinations of the liver were essentially normal. 23/30 (77%) remained HBsAg positive and 17/19 (90%) HBV-DNA positive. The genotype and prevalence of genomic mutations in this cohort remained largely unchanged, but quantifiable viral loads were significantly lower (P < 0.003). The results of this study suggest that chronic HBV infections in the Canadian Inuit are infrequently associated with serious adverse outcomes. Whether this finding reflects unique features of the host, presence or absence of external factors that influence the course of HBV and/or intrinsic properties of the HBV B6 subgenotype remains to be determined.

Demographic and serological characteristics of Asian Americans with hepatitis B infection diagnosed at community screenings

There is limited information regarding follow-up and hepatitis B serological status of Asian Americans diagnosed with chronic hepatitis B (CHB) through community screening. The aims of this study were to evaluate the prevalence and characterize CHB among Asians living in Los Angeles, assess follow-up of individuals with CHB diagnosed at screening and compare with patients with CHB followed by community gastroenterologists. Between October 2007 and May 2010, 7387 Asians were tested for HBV. HBsAg positive individuals (CHB) underwent additional testing for ALT, HBeAg/anti-HBe and HBV DNA. Patients with CHB were contacted 6 months later to determine whether they received follow-up care. We compared serological patterns of these individuals with CHB to patients with CHB who were seen for the first time (treatment naïve) by community gastroenterologists during the study period. Prevalence of CHB was 5.2%. About 99% patients with CHB were foreign-born, and only 27% could read/write English. 297 (77%) patients with CHB could be reached 6 months after diagnosis; 43% did not receive follow-up care, mostly because of lack of medical insurance. Patients with CHB followed by gastroenterologists were more likely to have insurance (69% vs 26%, P < 0.0001). 90% patients with CHB at screening were HBeAg negative/anti-HBe positive with 62% having inactive disease compared to only 30% of patients seen by gastroenterologists (P < 0.0001). Among CHB participants, 13% met criteria for treatment compared to 51% of patients with CHB (P < 0.0001). Only a small number of CHB screening participants require antiviral therapy. Lack of medical insurance is the main reason for most patients with CHB not seeking follow-up care after screening.

Treatment Options for Hepatitis Delta Virus Infection

The hepatitis D virus (HDV), the smallest virus known to infect man, causes the most severe form of chronic viral hepatitis, hepatitis delta. It is estimated that about 15 to 20 million people are suffering from chronic HDV infection. HDV is a defective satellite virus depending on the hepatitis B surface antigen (HBsAg) for transmission. Chronic hepatitis delta is associated with a rapid progression of liver fibrosis and a high prevalence of liver cirrhosis, even in younger patients. Immunization against hepatitis B virus (HBV) protects from HDV infection, but there is no specific vaccine against HDV available for HBsAg-positive individuals. Treatment options for hepatitis delta patients are limited. So far, only interferon-alpha has shown an antiviral efficacy against HDV. Recent trials showed sustained virological response rates concerning HDV in 25%-30% of patients treated with pegylated interferons. HDV is dominant over HBV in the majority of cases, but HBV DNA-positive subjects should be treated with HBV polymerase inhibitors. Combination therapy of pegylated interferon-alpha and adefovir showed a more pronounced HBsAg decline, but the exact role of combination therapies in hepatitis delta requires further investigation. Alternative future treatment strategies may include prenylation inhibitors and HBV entry inhibitors, which are in early clinical development.

Genetic variants of p21 and p27 and hepatocellular cancer risk in a Chinese Han population: A case‐control study

The p21 (Cip1/CDKN1A) and p27 (Kip1/CDKN1B) are members of the Cip/Kip family of cyclin-dependent kinase inhibitors, which can arrest cell proliferation and serve as tumour suppressors. We hypothesized that genetic variants in p21 and p27 may modify individual susceptibility to hepatocellular carcinoma (HCC). To test this hypothesis, we evaluated the associations of the polymorphisms of Ser31Arg and C+20T in p21 and C-79T and Gly109Val in p27, as well as their combinations, with HCC risk in a case-control study of 476 HCC cases and 526 cancer-free controls in a Chinese population. The matrix-assisted laser desorption ionisation time-of-flight (MALDI-TOF) mass spectrometry method was performed to detect these polymorphisms. We found that the variant genotypes of p21 Ser31Arg and p27 C-79T were individually associated with a significantly increased risk of HCC, but no associations were observed for other variant genotypes. Moreover, the combined variant genotypes of the four loci were associated with a significantly increased HCC risk (adjusted OR = 2.24, 95% CI = 1.72, 2.91 among subjects carrying 3 or more variant alleles), especially among HbsAg-positive individuals (adjusted OR = 3.09, 95% CI = 1.86, 5.14). Furthermore, the combined variant genotypes of the four loci (carrying three or more variant alleles) increased a 1.93-fold (95% CI = 1.20, 3.09) and 1.76-fold (95% CI = 1.17, 2.64) risk of HCC among smokers and nonsmokers. The variant genotypes of the two genes in this study have negative correlation with the clinicopathologicals observed. These results suggest that p21 polymorphisms individually or in combination with p27 polymorphisms increases risk of HCC, particularly among HbsAg-positive individuals.

Association of a p73 exon 2 G4C14-to-A4T14 polymorphism with risk of hepatocellular carcinoma in a Chinese population

P73, a p53 homolog, has some p53-like activities and plays an important role in modulating cell cycle, apoptosis, and DNA repair. A potentially functional dinucleotide polymorphism, G4C14-to-A4T14, has been identified in the 5' untranslated region of exon 2 of the p73 gene, which may theoretically form a stem-loop structure and affect gene expression. We hypothesized that genetic variants in p73 may modify individual susceptibility to hepatocellular carcinoma (HCC). To test this hypothesis that these two common variants play a role in HCC susceptibility, we conducted a hospital-based case-control study of 476 HCC patients and 526 cancer-free controls in a Chinese population. The matrix-assisted laser desorption ionization time-of-flight mass spectrometry method was performed to detect these polymorphisms. The results showed that the genotype and allele frequencies of the p73 G4C14-A4T14 did not differ significantly between the HCC patients and the control group (all P values are above 0.05). However, with stratification analysis by age, sex, smoking status, drinking status, HBV carrier state, and family history of cancer, we found that the variant genotypes (GC/AT + AT/AT) of the p73 G4C14-A4T14 was associated with a significant increased risk of HCC among HbsAg-positive individuals (adjusted OR = 2.19, 95% CI = 1.25-3.83) and among women (adjusted OR = 2.62, 95% CI = 1.47, 4.66). These results suggest that the p73 G4C14-to-A4T14 dinucleotide polymorphism may play a role in the development of chronic HBV-infected HCC in the Chinese population, especially among women.

A functional NQO1 609C&gt;T polymorphism and risk of hepatocellular carcinoma in a Chinese population

NAD(P)H:quinone oxidoreductase 1 (NQO1) is a cytosolic flavoprotein that catalyzes the two-electron reduction of quinoid compounds into hydroquinones, thus protecting cells from oxidative damage. A single base substitution (C→T) polymorphism at 609 in the NQO1 gene reduces quinone reductase activity. Thus, the lack of enzymatic activity in the homozygous C609T NQO1 polymorphism (rs1800566) may play a pivotal role in tumor development. We hypothesized that a genetic variant in NQO1 may modify individual susceptibility to hepatocellular carcinoma (HCC). To test this hypothesis that the variant may play a role in HCC susceptibility, we conducted a hospital-based case-control study of 476 HCC patients and 526 cancer-free controls in a Chinese population. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry method was performed to detect the polymorphism. The results showed that the variant alleles and genotypes of NQO1 C609T were more common among cases than those among controls (P = 0.003 and P = 0.024). Compared with the NQO1 609CC genotype, there was a significantly greater risk of HCC associated with the variant NQO1 609TT [adjusted odds ratio (OR) = 1.60, 95% confidence interval (CI) = 1.12-2.28] and combined NQO1 609TC/TT (adjusted OR = 1.37, 95% CI = 1.04-1.80) genotypes. Moreover, when subgroup analyses were performed, we found that the increase in risk was more evident among younger subjects, men, HbsAg-positive individuals, never smokers, never drinkers, and subjects without family history of cancer. These results suggest that the presence of the NQO1 C609T polymorphism may be a marker of genetic susceptibility to HCC.

Hepatitis Delta Virus Diagnosis

The first step in the diagnosis of hepatitis delta virus (HDV) infection is testing HBsAg-positive individuals for the antibody to the HD antigen (anti-HD).In anti-HD-positive patients, the next step is testing for HDV RNA in serum to determine whether the antibody reflects an ongoing active HDV infection (HDV-RNA-positive) or represents a serologic scar to past HDV infection (HDV-RNA-negative). In the HDV-positive individual with liver disease, it is critical to distinguish acute HDV/hepatitis B virus (HBV) coinfection from chronic HDV superinfection in HBsAg carriers; the course, prognosis, and management of the two conditions are different. The differential diagnosis can be achieved through the scrutiny of the battery of HDV and HBV markers, which combine in patterns characteristic for each condition.Standardized competitive and μ-capture commercial assays are available to determine the IgG and IgM antibody to HDV. Several in-house assays were developed to determine HDV RNA in serum; the sensitivity threshold of current polymerase chain reaction-based assays is 10 copies of HDV RNA/mL. Unfortunately, HDV-RNA assays are not yet standardized and the results from different laboratories often are not comparable due to different sensitivities. The development of an international reference HDV-RNA standard remains an unmet diagnostic need.

Long-term Follow-up Study of Asymptomatic HBsAg-Positive Carrier

Objectives: Hepatitis B virus (HBV)-related chronic liver disease is a common health problem in our country. About 5.2 to 7.8% population of Bangladesh is chronic HBV carriers. There is no long-term follow-up study of asymptomatic HBV carriers in our country. Aim of the present study is to know the outcome of these cases in 10 years. Materials and methods: Twelve hundred and eighty-six cases of asymptomatic HBsAg-positive individuals were evaluated and followed up for 10 years at gastroenterology department, combined Military Hospital, Dhaka Cantonment, from January 2000 to December 2009. Results: Age of the patient’s ranges from 3 to 50 years (mean, 27 ± 6 years). Majority cases were males 1,236 (96.12%). Baseline alanine aminotransferase (ALT) >45 IU/l was found in 168 (13.06%) cases. Ultrasonography revealed coarse hepatic echotexture in 62 (5.63%) cases out of 1,200 cases. Hepatic histology revealed chronic hepatitis in 318 cases (35.02%) and cirrhosis of liver in 24 cases (2.64%), hepatocellular carcinoma 1 (0.11%), fatty liver in eight (0.88%) out of 908 cases. After follow-up, compensated cirrhosis of liver was found in 90 (15%) cases, decompensated liver disease in 50 (8.33%) cases and hepatocellular carcinoma (HCC) in 42 (7%) out of 600 cases. Twenty (3.33%) cases died due to liver failure, HCC and other complications. Spontaneous HBsAg seronegativity occurred in five cases out of 600 cases (0.83%), and spontaneous HBeAg seroconversion occurred in 10 cases out of 180 cases (5.55%). Conclusion: Asymptomatic HBsAg-positive carriers should not be considered as inactive disease. They should be followed up every 3 to 6 months to know activity of the disease and development of complications. Antiviral treatment should be instituted in cases of active liver disease.

Molecular characterization of hepatitis B virus (HBV) genotypes in HBsAg positive individuals of Khyber Pakhtunkhwa, Pakistan

Hepatitis B virus (HBV) is a crucial health problem with up to 350 million people infected globally. The epidemiological significance of HBV genotypes has been well established however, no such large scale data available for HBV genotypes and much little is known about the mixed infection with more than one HBV genotypes. The main aim of the present study was to determine the molecular characterization of HBV genotypes in HBsAg positive patients in Khyber Pakhtunkhwa, Pakistan. A total of 713 HBsAg positive individuals were included in the present study. All the samples were confirmed for HBV DNA with nested polymerase chain reaction (PCR) and HBV DNA positive samples were further processed for HBV genotypes with type specific primers. This study demonstrated that genotype A (33.66%) is the predominant genotype followed by genotype D (29.5%), genotype C (2.10%), genotype F (1.40%) and mixed genotypes A+D (10.52%) while 5.9% of the samples were untypable. Genotype B and E was not found in this study. The current study shows the high frequency of genotype A and a heterogeneous distribution of HBV genotypes. Further study needs to investigate genetic and geographical divergence and characteristics of the virus in this area especially. Key words: Hepatitis B virus, HBsAg, HBV DNA, genotype, characterization.

A Multicentre Molecular Analysis of Hepatitis B and Blood-Borne Virus Coinfections in Viet Nam

Hepatitis B (HBV) infection is endemic in Viet Nam, with up to 8.4 million individuals estimated to be chronically infected. We describe results of a large, multicentre seroepidemiological and molecular study of the prevalence of HBV infection and blood-borne viral coinfections in Viet Nam. Individuals with varying risk factors for infection (n = 8654) were recruited from five centres; Ha Noi, Hai Phong, Da Nang, Khanh Hoa and Can Tho. A mean prevalence rate of 10.7% was observed and levels of HBsAg were significantly higher in injecting drug users (IDUs) (17.4%, n = 174/1000) and dialysis patients (14.3%, n = 82/575) than in lower-risk groups (9.4%; p<0.001). Coinfection with HIV was seen in 28% of HBV-infected IDUs (n = 49/174) and 15.2% of commercial sex workers (CSWs; n = 15/99). HCV infection was present in 89.8% of the HBV-HIV coinfected IDUs (n = 44/49) and 40% of HBV-HIV coinfected CSWs (n = 16/40). Anti-HDV was detected in 10.7% (n = 34/318) of HBsAg positive individuals. Phylogenetic analysis of HBV S gene (n = 187) showed a predominance of genotype B4 (82.6%); genotypes C1 (14.6%), B2 (2.7%) and C5 (0.5%) were also identified. The precore mutation G1896A was identified in 35% of all specimens, and was more frequently observed in genotype B (41%) than genotype C (3%; p<0.0001). In the immunodominant ‘a’ region of the surface gene, point mutations were identified in 31% (n = 58/187) of sequences, and 2.2% (n = 4/187) and 5.3% (n = 10/187) specimens contained the major vaccine escape mutations G145A/R and P120L/Q/S/T, respectively. 368 HBsAg positive individuals were genotyped for the IL28B SNP rs12979860 and no significant association between the IL28B SNP and clearance of HBsAg, HBV viral load or HBeAg was observed. This study confirms the high prevalence of HBV infection in Viet Nam and also highlights the significant levels of blood-borne virus coinfections, which have important implications for hepatitis-related morbidity and development of effective management strategies.

PMO-171 A pilot of targeted case finding for hepatitis B virus (HBV) and hepatitis C (HCV) in the British South Asian community

IntroductionChronic HBV (cHBV) and HCV (cHCV) are frequent causes of cirrhosis and liver cancer. cHBV and cHCV are prevalent in subjects from South Asian countries and many infected individuals are...

Epidemiology of Viral Hepatitis and Hepatocellular Carcinoma

Most cases of hepatocellular carcinoma (HCC) are associated with cirrhosis related to chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Changes in the time trends of HCC and most variations in its age-, sex-, and race-specific rates among different regions are likely to be related to differences in hepatitis viruses that are most prevalent in a population, the timing of their spread, and the ages of the individuals the viruses infect. Environmental, host genetic, and viral factors can affect the risk of HCC in individuals with HBV or HCV infection. This review summarizes the risk factors for HCC among HBV- or HCV-infected individuals, based on findings from epidemiologic studies and meta-analyses, as well as determinants of patient outcome and the HCC disease burden, globally and in the United States.

Mo1899 Hepatocellular Carcinoma Among the Golestan Cohort Study Participants Infected With Hepatitis B Virus: A Population-Based Study

Background and Aim: Hepatitis B virus (HBV) infection is the most common cause of cirrhosis and end-stage liver disease in Golestan province, Northeast Iran where 95% of HBV is of the genotype D. Hepatocellular carcinoma (HCC) is not amongst the 10 most common cancers according to the Golestan Cancer Registry. We aimed to prospectively evaluate the incidence of HBV-associated HCC in the Golestan Cohort Study (GCS) participants. Methods: We evaluated 49,338 participants of the GCS who have been systematically followed up from 2004 2011 with the follow up success rate of 98%. All participants were tested for HBsAg and HCVAb. Subsequently, HBsAg positive individuals and their family members were tested for HBsAg, HBsAb, and HBcAb. In case of hospitalization or death, participants or their family members and the corresponding medical centers were contacted. Diagnosis of HCC was independently made by reviewing the documents and ‘verbal autopsy' forms by two internists. Disagreements were resolved by a senior hepatologist. Results: 74.4% of the participants of the GCS are of Turkmen ethnicity and 57.6% are female. Overall, 3502 (7.1%) HBV, 155 (0.3%) HCV, and 26 HBV/HCV co-infection cases were identified. 1931 (55.2%) cases of HBV infected population were male. The mean age of HBV infected participants was 57 years (range 43 82). The participants were followed up for 21012 person-years (average of 6 years). Overall, 12 (0.03%) individuals (11 male, 1 female) developed HCC; 9 of whom were HBV infected. The mean age of HCC patients was 68 years (range 49-79). The other 3 cases of HCC were not associated with either HBV or HCV infection. After 6 years of follow up, 9 (0.25%) of HBV infected participants developed HCC with the overall incidence of 0.42 per 1000 person-years. Conclusion: Despite the intermediate prevalence rate of HBV in our study population (7.1%), we found a very low incidence of HBV (D genotype)-induced HCC.

Update on the Management of HBV-HDV Coinfection

Hepatitis Delta is caused by coinfection with the hepatitis B virus and the hepatitis D virus and has to be considered as the most severe form of viral hepatitis. HDV infection may affect between 15 and 20 Million individuals worldwide with significant regional differences of HDV prevalence rates. The diagnosis of hepatitis delta in HBsAg-positive individuals is based on the detection of HDV antibodies and HDV RNA. Interferon alpha remains the only effective treatment as currently available nucleoside or nucleotide analogous are not effective against HDV. Recent trials showed that about 25 % of HDV-infected patients may clear HDV RNA by therapy with pegylated interferon alpha. Liver transplantation remains the only treatment option for the majority patients with advanced liver disease

Prevalence of hepatitis B virus infection and carriage after nineteen years of vaccination program in the Western Brazilian Amazon

Reductions in the prevalence of hepatitis B virus (HBV) infection and carriage, decreases in liver cancer incidence, and changes in patterns of liver dysfunctions are described after hepatitis B vaccination. We conducted a population-based seroprevalence study aimed at estimating the HBV prevalence and risk of infection in the rural area of Lábrea following nineteen years of HBV vaccination. Half of the subjects showed total anti-HBc of 52.1% (95% CI 49.6-54.7). The HBsAg prevalence was 6.2% (95% CI 5.1-7.6). Multivariate analysis showed an inverse association between HBV infection and vaccination (OR 0.62; 95% CI 0.44-0.87). HBsAg remained independently associated with past hepatitis (OR 2.44; 95% CI 1.52-3.89) and inversely to vaccination (OR 0.43; 95% CI 0.27-0.69). The prevalence of HBeAg among HBsAg-positive individuals was 20.4% (95% CI 12.8-30.1), with the positive subjects having a median age of 11 years (1-46) p=0.0003. We demonstrate that HBV infection is still an important public health issue and that HBV vaccination could have had better impact on HBV epidemiology. If we extrapolate these findings to other rural areas in the Brazilian Amazon, we can predict that the sources of chronic infected patients remain a challenge. Future studies are needed regarding clinical aspects, molecular epidemiology, surveillance of acute cases, and risk groups.

Assessment of chronic hepatitis B: the importance of hepatitis B virus DNA testing

Chronic hepatitis B (CHB) has an estimated prevalence of 90 000 to 160 000 in Australia. Cirrhosis and hepatocellular carcinoma are important complications of CHB and appropriate evaluation of hepatitis B surface antigen (HBsAg)-positive individuals is vital to identify treatment candidates. A review of the database of a tertiary hospital was performed and 348 HBsAg-positive individuals with baseline demographic, virological, serological and biochemical variables were identified and evaluated cross-sectionally. A small subgroup of hepatitis B e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) at baseline were identified and followed longitudinally. 175/348 (50%) of patients were in the HBeAg-negative, chronic hepatitis phase of disease, 22% in the HBeAg-positive immune clearance and 6% in the immune tolerant phases. HBeAg-negative patients were older and more likely to be male than HBeAg-positive patients. The correlation between hepatitis B virus (HBV) DNA and ALT levels was examined. ALT and HBV DNA levels showed no correlation in HBeAg-positive CHB and only a weak correlation in HBeAg-negative patients. Furthermore, 35% of HBeAg-negative patients with detectable HBV DNA had a normal ALT. Conversely 38% of HBeAg-negative patients with no detectable HBV DNA had an elevated ALT. A persistently normal ALT over 24 months was seen in five of nine HBeAg-negative patients with normal initial ALT and detectable HBV DNA. Appropriate evaluation of HBeAg-negative CHB must include HBV DNA because the ALT is not a reliable guide to underlying viral replication.

Detection of HBV-DNA and Its Correlation with the HBeAg/Anti-HBe Serological Status in HBsAg-positive Patients

Background : In the past years, HBeAg and anti-HBe status in individuals with positive HBsAg were often correlated to viral replication. This study was aimed to find correlation between the HBV viremia and HBeAg/anti-HBe serological status in HBsAg-positive individuals. Method : An observational-analytic design was performed in this study. The sera of all positive HBsAg patients at Biomedika Hospital Laboratory were collected and examined for HBeAg and anti-HBe using immunochromatography technique between January and April 2012. The sampling method was purposive sampling. Afterwards, the sera were examined for HBV-DNA by polymerase chain reaction (PCR). Results: Sufficient amount of sera were collected from 44 patients consisting of 33 males and 11 females. The mean age was 15-68 years. Positive HBeAg and negative anti-HBe status was found in 11 (42%) patients. Negative HBeAg and positive anti-HBe was found in 26 (59.1%) patients. Both HBeAg and anti-HBe were negative in 7 (16.3%) patients. HBV-DNA was detected in all 11 (100%) patients with positive HBeAg and negative anti-HBe. HBV-DNA was also detected in 11 (42%) patients with negative HBeAg and positive anti-HBe. However, there was only one patient (14.3%) with both negative HBeAg and anti-HBe status, who had detectable HBV-DNA. Conclusion: Positive HBeAg can be used as an indicator of viremia, but negative HBeAg cannot be used as an indicator of the absence of viremia without further HBV-DNA testing. Patients with negative HBeAg and positive HBV-DNA were suspected for having pre-core mutant. Keywords : HBV-DNA, positive HBsAg, HBeAg, anti-HBe, pre-core mutant

P54 CHASE-B (Chinese Hepatitis Awareness, Surveillance and Education): a pilot of targeted case finding for hepatitis B virus (HBV) in the British-Chinese community

IntroductionChronic HBV (cHBV) is a frequent cause of cirrhosis and liver cancer. Many infected individuals are unaware of their condition. Migrants from countries with high prevalence of cHBV, such as...