HBV Screening Research Articles

P189 Should Screening For Chronic Viral Hepatitis In Patients With Tuberculosis Be Introduced To Nice Guidelines?

Background Screening for viral hepatitis is not routinely recommended in patients diagnosed with tuberculosis (TB). However there are significant similarities in the global distribution of TB and hepatitis B (HBV) and C (HCV). It remains unclear whether co-infection with HBV or HCV is a risk factor for hepatotoxicity in patients receiving anti-tuberculous therapy and significant morbidity and mortality is associated with a late diagnosis. Objectives To determine the prevalence of HBV and HCV infection among new cases of active TB across treatment centres in East London and to assess the adverse drug reactions to anti-tuberculous treatment experienced by this population. Methods We conducted a retrospective study including all patients diagnosed with active TB during 2013 at two TB clinics in London. Data on demographic characteristics, HBV surface antigen (HBsAg), HCV antibody, human immunodeficiency virus (HIV) and adverse drug reactions were retrospectively analysed. Results In total, 472 cases of active TB were notified during 2013. The mean age was 37.7 (+/- 15.3) years (range: 5–92). Males accounted for 62.3% of our cohort. 84.7% of patients were born outside of the UK with the majority of patients being born in either Bangladesh (16.5%), India (27.8%) or Pakistan (15.9%). Overall, 304 patients were screened for HBV, 302 for HCV, and 447 for HIV. Of those screened, HBsAg was detected in 3.3%, HCV antibody in 2.0% and HIV in 3.4%. All patients infected with HBV or HCV were foreign born. Hepatotoxicity was defined as an ALT greater than 5 times the upper limit of normal or requiring a change in treatment. There was no significant difference in rates of hepatotoxicity in either in HepBsAg status (p = 0.371), HCV status (p = 0.597) or HIV status (p = 0.413) but numbers of HBV and HCV infection were small. Conclusions The prevalence of HBV and HCV was significantly higher in our cohort of TB patients than the background UK prevalence, which is 0.4% for HCV, 0.3% for HBV and 0.15% for HIV. Routine screening for HBV and HCV on an opt-out basis would be justified in our setting given the high proportion of foreign-born patients. Further research into the magnitude of HBV/HCV co-infection with active or latent TB, any increased risk in drug-induced hepatotoxicity and the cost-effectiveness of routine screening is needed.

The establishment and application of a time-resolved fluoroimmunoassay in detection of HBV large surface protein

Objective To establish a method of TRFIA with high sensitivity and broad detecting range for serum HBV large surface protein (HBV-LP).Methods The monoclonal antibody of HBV-LP was covered on the microwell plate and incubated with HBV-LP in blood sample,then Eu3+ labeled antibody of HBs was added.HBV-LP in standard substance,blood samples of 66 chronic hepatitis B patients and 30 healthy controls was detected by the TRFIA and ELISA.x2 test and linear correlation analysis were used for data analysis.Results The dose-response curve of standard substance with TRFIA had good linear correlation (r=0.999).Normal reference range was established at 0-1.36 mg/L based on the ELISA results of 30 healthy controls.The sensitivity was 0.10 mg/L.The specificity was 100％ (30/30).Correlation coefficient between the TRFIA and the ELISA was 0.800 9 (P＜0.001).The positive detecting rates of the 2 methods were significantly different (89.4％(59/66) vs 77.3％(51/66),x2 =6.13,P＜0.01).The recovery rate for HBV-LP was between 95.93％-107.62％.The effective detecting range(CV＜10％) of TRFIA was 1.35-2 764.00 mg/L,and that of ELISA was 10.8-691.0 mg/L.Conclusion The TRFIA was established for HBV-LP detection with higher sensitivity and wider detecting range compared to ELISA.It has potential value for HBV screening and monitoring of antiviral therapy. Key words: Hepatitis B virus; Viral envelope proteins; Fluoroimmunoassay

Sensitivity of individual donor nucleic acid testing (NAT) for the detection of hepatitis B infection by studying diluted NAT yield samples.

Screening blood donors for the presence of hepatitis B virus surface antigen (HBsAg) has been the backbone of blood safety. However, occult hepatitis B infection (OBI) in donors can be missed when only HBsAg screening is used. Nucleic acid testing (NAT) is capable of detecting OBI among donors. The aim of our study was to analyse the sensitivity of NAT for detecting OBI. The kits used during the study for serology testing were BioRad Monolisa™ HBsAg Ultra (HBsAg screening), Abbott Architect for anti-HBcAg (total) and anti-HBsAg testing, and Vitros® by Ortho Clinical Diagnostics for anti-HBcAg (IgM). Procleix Ultrio was used for individual donor-NAT (ID-NAT) and Abbott m2000 for estimation of HBV DNA. Out of 28,134 HBsAg non-reactive donors, 25 were ID-NAT-reactive. Of these 25 NAT yield samples, 18 were studied further at different dilutions from 1:2 to 1:16. The doubling dilutions were made with HBV non-reactive AB plasma. Undiluted samples were used for all serological tests and for HBV DNA estimation. Of the 18 samples studied, nine were NAT-reactive at a dilution of <1:4 and five out of these showed presence of antibody to core antigen (IgG+IgM). Antibody to surface antigen was present in only two of the nine NAT-reactive samples, one with antibody to core antigen and the other without. Six had a viral load in the range from <10 to 38 IU/mL whereas the viral load in the remaining three samples was not determined. Among the other nine samples which were NAT-reactive at dilutions≥1:4, antibody to core antigen (IgG+IgM) was present in seven. Our study showed that ID-NAT testing along with HBsAg screening could detect most potentially HBV infectious donors (including those with OBI). NAT screening for HBV on diluted samples could compromise blood safety because samples with a low viral load will escape detection.

Assessment of HBV preventive services in a medically underserved Asian and Pacific Islander population using provider and patient data.

Hepatitis B (HBV) represents a significant health disparity among medically underserved Asian and Hawaiian/Pacific Islander (API) populations. Studies evaluating adherence to HBV screening and vaccination guidelines in this population are limited. The purpose of this study was to evaluate HBV screening and vaccination practices using both provider self-report and patient records. Medical records for 20,574 API adults were reviewed retrospectively and primary care providers were surveyed to evaluate rates and adherence to HBV screening and vaccination guidelines. The study included primary care providers and their adult API patients in the San Francisco safety-net healthcare system. Patient, practice, and provider factors, as well as HBV screening and vaccination practices, were assessed using provider survey constructs and patient laboratory and clinical data. Generalized linear mixed models and multivariate logistic regression analyses were used to identify factors associated with recommended HBV screening and vaccination. The mean age of patients was 52 years, and 63.4 % of patients were female. Only 61.5 % underwent HBV testing, and 47.4 % of HBV-susceptible patients were vaccinated. Of 148 (44.8 %) responding providers, most were knowledgeable and had a favorable attitude towards screening, but 43.2 % were unfamiliar with HBV guidelines. HBV screening was positively associated with favorable provider attitude score (OR per unit 1.80, 95 % CI 1.18-2.74) and negatively associated with female patient sex (OR 0.82, 95 % CI 0.73-0.92), a higher number of clinic patients per week (OR per 20 patients 0.46, 95 % CI 0.28-0.76), and provider barrier score (OR per unit 0.45, 95 % CI 0.24-0.87). HBV vaccination was negatively associated with provider barrier score (OR per unit 0.48, 95 % CI 0.25-0.91). Rates of HBV screening and vaccination of API patients in this safety-net system are suboptimal, and provider factors play a significant role. Efforts to cultivate positive attitudes among providers and expand healthcare system resources to reduce provider barriers to HBV care are warranted.

HBV reactivation under immunosuppressive treatment – a case series

Background Inactive HBV carriers, under immunosuppressive treatment for malignancies or rheumatologic diseases, have an increased risk for HBV reactivation. HBV reactivation under immunosuppression has a high rate of acute liver failure and death. HBV screening is mandatory for patients with hematological malignancies or rheumatologic diseases who are due to receive immunosuppressive treatment.

Is screening baby boomers for HCV enough? A call to screen for hepatitis C virus in persons from countries of high endemicity

Is screening baby boomers for <scp>HCV</scp> enough? A call to screen for hepatitis C virus in persons from countries of high endemicity

Correlating Perceived Hepatitis B Status With Actual Status in Asian and Pacific Islander Americans in Rhode Island

Introduction: Chronic hepatitis B (HBV) in the Asian and Pacific Islander (API) American population is an important, under-recognized health issue. Among foreign-born API Americans, the prevalence of chronic HBV is about 10% compared to less than 0.5% in the general population. No studies have quantified the prevalence of HBV in the more than 30,000 APIs in Rhode Island (RI) or assessed this population’s knowledge and attitudes about HBV. The study was to (1) explore the beliefs held by Chinese, Cambodian, and Laotian populations in RI about their personal HBV status, (2) examine selfreports of HBV status, and (3) compare self-report results with actual HBV status. Methods: We administered an investigator-designed 18-question survey, which assessed subjects’ perceived HBV status and knowledge and socioeconomic and health-related demographics such as insurance and employment status. We examined serologically confirmed HBV status of Chinese, Cambodian, and Laotian populations compared to their perception of HBV status. Written informed consent was obtained from each study subject in this IRB-approved study. Results: Of 59 participants, only 19 (32 %) correctly knew their hepatitis B status. Eighty-eight percent were foreign-born. Subjects who had at least 1 year of college and health insurance were 1.92 (p<0.05) times and 2.53 (p<0.05) times more likely, respectively, to have accurate perception than those who did not. Individuals who had “heard about HBV before” were 1.68 (p<0.05) times more likely to predict their status correctly. Six of 59 were HBV carriers (10.2%). Eighteen of 59 subjects (30.5%) were not immune and needed vaccination. College education, insurance, and prior HBV education increased the likelihood of correct perception. Conclusion: Our small pilot study suggests that community-wide public health initiatives, including increased statewide HBV screening, may have a positive impact on perception and health behaviors. We call for efforts to identify those APIs in need of medical attention or vaccination and increased education efforts to inform at-risk populations and encourage their participation in screenings. This data provides a potential framework for which the state of Rhode Island and similar settings can base large-scale culturally specific, HBV interventions to address this health disparity.

Hepatitis B reactivation during cancer chemotherapy: an international survey of the membership of the American Association for the Study of Liver Diseases.

Hepatitis B virus reactivation (HBVr) can be a serious complication of cancer chemotherapy. However, underutilization of HBV screening and secondary underutilization of antiviral prophylaxis have been frequently reported. The authors electronically distributed a 30-point questionnaire to members of the American Association for the Study of Liver Diseases to capture experiences with HBVr during cancer chemotherapy. The questionnaire specified diagnostic criteria and collected information on HBV screening, antiviral prophylaxis and clinical outcomes. Ninety-nine respondents reported 188 patients who met the criteria for HBV reactivation. Forty-one practised outside the United States, and most were hepatologists (n = 71) or gastroenterologists (n = 12). One hundred and twenty-six patients had haematologic malignancies, of which 88 (70%) had lymphoma. Seventy-five patients (40%) had screening for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc), and an additional 24 patients (13%) had HBsAg screening alone. Prophylactic antiviral therapy was reported in only 18 patients (10%). Chemotherapy was interrupted in 52 patients (41%) with haematologic malignancies and 26 of 41 patients (63%) with solid tumours (P = 0.01). Rituximab-treated patients (n = 66) required hospitalization more frequently (P = 0.04), but their overall survival did not differ from individuals not treated with rituximab. Death due to liver failure was reported in 43 patients overall (23%). Underutilization of prophylactic antiviral therapy occured in a substantial number of patients who were found to be HBV infected prior to the initiation of cancer chemotherapy. The reasons for this need further exploration because reactivation results in serious yet preventable outcomes.

Estimating the treatment cascade of chronic hepatitis B and C in Greece using a telephone survey.

Accurate diagnosis and treatment rates for chronic hepatitis B (HBV) and C virus (HCV) infections are usually missing. Aim of this study was to estimate the HBV and HCV treatment cascade (proportion and absolute numbers of tested, aware/unaware, infected and treated) in Greek adults. A telephone survey was conducted in a sample representative of the Greek adult general population. Prevalence rates were age-standardized for the Greek adult population and corrected for high-risk individuals not included in the survey. Of the 9974 participants, 5255 (52.7%) had been tested for HBV and 2062 (20.7%) for HCV with the proportion varying according to age and being higher in middle-age groups (P < 0.001). HBsAg was reported positive in 111/5255 (2.11%) and anti-HCV in 26/2062 (1.26%) tested cases. The age-adjusted prevalence was estimated to be 2.39% for HBV and 1.79% for HCV. Taking into account individuals at high risk for viral hepatitis not included in the survey, the 'true' prevalence was estimated to be 2.58% for HBV and 1.87% for HCV. Anti-HBV and anti-HCV treatment had been taken by 36/111 (32.4%) chronic HBV and 15/26 (57.7%) chronic HCV patients. In conclusion, almost 50% of chronic HBV and 80% of chronic HCV patients in Greece may be unaware of their infection, while only 32% or 58% of diagnosed chronic HBV or HCV patients, respectively, have been ever treated. Therefore, intensive efforts are required to improve the efficacy of screening for HBV and particularly for HCV as well as to reduce the barriers to treatment among diagnosed patients.

Prevention of Perinatal Hepatitis B Virus Transmission.

Hepatitis B virus (HBV) infection, the most common form of chronic hepatitis worldwide, is a major public health problem affecting an estimated 360 million people globally. Mother-to-child transmission (MTCT) is responsible for more than one third of chronic HBV infections worldwide. An estimated 15%-40% of persons chronically infected develop HBV-related complications, such as cirrhosis and hepatic carcinoma, and 25% die from these complications. MTCT can occur during pregnancy or during delivery. Screening pregnant women for HBV infection, providing infant postexposure prophylaxis, and maternal treatment with antiviral medications are strategies for reducing MTCT transmission rates and the global burden of new chronic HBV infections. Administration of hepatitis B immune globulin (HBIG) and hepatitis B (HepB) vaccine within 24 hours of birth, followed by completion of the vaccine series, is 85%-95% efficacious for prevention of MTCT. Despite timely post-exposure prophylaxis, MTCT occurs in 5%-15% of infants. Hepatitis B surface antigen (HBsAg) positive, hepatitis e antigen (HBeAg) positive mothers with HBV DNA level ≥10(6) copies/mL (>200 000 IU/mL) are at greatest risk of transmitting HBV to their infants. Consensus recommendations and evidence-based guidelines for management of chronic HBV infection and screening of pregnant women have been developed. The safety and efficacy of antiviral drug use during pregnancy are areas of ongoing research. Substantial advances have been achieved globally in reducing MTCT, but MTCT remains an ongoing health problem. Attaining a better understanding of the mechanisms of MTCT, implementing existing policies on maternal screening and infant follow-up, and addressing research gaps are critical for further reductions in MTCT transmission.

Occult Hepatitis B Virus in Gezira State Sudan

Background: Occult hepatitis B infection (OBI) is simply defined as serologically undetectable hepatitis B surface antigen (HBsAg-ve), despite the presence of circulating HBV DNA. Objective: The aim of this study was to determine the prevalence of occult HBV among Screened HBsAg subjects in Gezira State, Sudan. Materials and Methods: A total of 176 subjects including cancer patients, hospital based controls and health care workers were screened for HBsAg by ELISA, and their DNA was extracted by using polymerase chain reaction. Results: 49/176 (27.8%) were positive for occult HBV as follows: cancer patients had 31/81 (38.2%) cases, while 18.9% were reported among hospital based controls. 11.2%, 2.2% were positive for both HBsAg and DNA respectively. Ten out of the 50 (20%) healthcare workers, who were negative for HBsAg, were found to be positive for HBV DNA, while one out of the 19, who were positive for HBsAg, was found to be positive for HBV DNA. Occult HBV among this study groups showed an approximately equal distribution among males and females 18.2% and 20.5 %, respectively. Conclusion : This study concluded that the prevalence of OBI among healthcare workers, hospital based controls and cancer patients, is remarkably increasing compared with the prevalence of the disease. More molecular epidemiological studies are needed to delineate a link between OBI and cancer. Proper HBV screening should be carried out to avoid occult hepatitis B infection transmission. Keywords: Hepatitis B virus, Gezira State, cancer, healthcare workers, Sudan

Updated recommendations for HBV screening

Updated recommendations for HBV screening

U.S. Preventive Services Task Force HBV-Screening Recommendations

The U.S. Preventive Services Task Force (USPSTF) has recommended HBV screening for pregnant women — but not testing of asymptomatic nonpregnant

HCV/HBV infection in Italian patients (pts) with solid tumor candidates for chemotherapy (CT).

e12521 Background: There are few studies dealing with the prevalence of chronic infection by HBV or HCV in Italian pts candidated to CT for solid tumors and on the episodes of hepatitis reactivation during the CT. Methods: Pts referred to S.Orsola-Malpighi Hospital Medical Oncology Unit undergo to blood tests (BT) that include a screening for HBV and HCV infection by testing the positivity for HbsAg and anti-HCV. We examined the records of 564 consecutive new pts from January to December 2012. Pts who performed at least 1 BT were considered elegible: 479/564 (84.9%). Results: Pts screened: 435(90.8%) HbsAg, 397(82.9%) anti-HCV and 397 (82.9%) for both. 24 pts were found positive: 9 (1.9%) HBsAg+, 14 (3.5%) anti-HCV+, 1 (0.3%) HBsAg+/anti-HCV+. Males 16 (66.7%). Primary tumors: 9 (37.5%) liver, 4 (16.7%) lung, 3 (12.5%) head-neck, 3 (12.5%) colon, 2 (8.3%) bladder, 1 (4.2%) anus, 1 (4.2%) breast, 1 (4.2%) gastric, 1 (4.2%) skin. 3/24 pts (12.5%) with abnormal liver function tests at baseline were not treat...

Lower than expected hepatitis B virus infection prevalence among first generation Koreans in the U.S.: results of HBV screening in the Southern California Inland Empire.

BackgroundHepatitis B virus (HBV) infection is prevalent in Asian immigrants in the USA. California’s Inland Empire region has a population of approximately four million, including an estimated 19,000 first generation Koreans. Our aim was to screen these adult individuals to establish HBV serological diagnoses, educate, and establish linkage to care.MethodsA community-based program was conducted in Korean churches from 11/2009 to 2/2010. Subjects were asked to complete a HBV background related questionnaire, provided with HBV education, and tested for serum HBsAg, HBsAb and HBcAb. HBsAg positive subjects were tested for HBV quantitative DNA, HBeAg and HBeAb, counseled and directed to healthcare providers. Subjects unexposed to HBV were invited to attend a HBV vaccination clinic.ResultsA total of 973 first generation Koreans were screened, aged 52.3y (18-93y), M/F: 384/589. Most (75%) had a higher than high school education and were from Seoul (62.2%). By questionnaire, 24.7% stated they had been vaccinated against HBV. The serological diagnoses were: HBV infected (3.0%), immune due to natural infection (35.7%), susceptible (20.1%), immune due to vaccination (40.3%), and other (0.9%). Men had a higher infection prevalence (4.9% vs. 1.7%, p = 0.004) and a lower vaccination rate (34.6% vs. 44.0%, p = 0.004) compared to women. Self-reports of immunization status were incorrect for 35.1% of subjects.ConclusionsThis large screening study in first generation Koreans in Southern California demonstrates: 1) a lower than expected HBV prevalence (3%), 2) a continued need for vaccination, and 3) a need for screening despite a reported history of vaccination.

PP-028 - Rapid testing: screening of HIV-1, HBV and HCV in an assisted reproductive low resource setting

PP-028 - Rapid testing: screening of HIV-1, HBV and HCV in an assisted reproductive low resource setting

USPSTF Advises HBV Screening for US Groups at High Risk of Infection

USPSTF Advises HBV Screening for US Groups at High Risk of Infection

Hepatitis B vaccination and screening awareness in primary care practitioners.

Introduction. The goals of Healthy People US 2020 have called for increased screening and vaccination of high-risk groups for Hepatitis B (HBV). Methods. We performed a survey of 400 randomly chosen primary care practitioners (PCPs) in Wisconsin to assess their knowledge, attitudes, and practices regarding screening and vaccination for HBV. Results. Screening rates of patients at risk of sexual transmission were low, with 61% of respondents stating that they screen patients who had more than 1 sex partner in 6 months and 86% screening patients with a history of sex with prostitutes. Screening rate for persons with a history of intravenous drug use was 94%. Children of immigrants were screened by 65%, persons on hemodialysis by 73%, and prison inmates by 69%. Screening increased with provider experience with HBV. Deficiencies in vaccination rates mirrored screening practices. Major barriers to screening were cost, someone else's responsibility, time constraints, or lack of knowledge. Conclusions. Without improved education and practices of PCPs about HBV screening and vaccination, the goals of healthy people 2020 regarding HBV will not be met. Barriers to screening and vaccination need to be addressed. Cost-effectiveness of alternative strategies such as universal vaccination under the age of 50 should be explored.

Hepatitis B and C Seroprevalence in Solid Tumors - Necessity for Screening During Chemotherapy

Hepatitis B and C are the leading causes of liver diseases worldwide. For hematological and solid malignancy patients undergoing chemotherapy, increases in HBV DNA and HCV RNA levels can be detected which may result in reactivation and hepatitis-related morbidity and mortality. The aim of this study was to determine the seroprevalence of Hbs ag and Anti HCV positivity in patients with solid malignancies undergoing chemotherapy and consequences during follow-up. The files of 914 patients with solid malignancies whose hepatitis markers were determined serologically at diagnosis were reviewed retrospectively. All underwent adjuvant/palliative chemotherapy. For the cases with HBV and/or HCV positivity, HBV DNA and HCV RNA levels, liver function tests at diagnosis and during follow-up and the treatment modalities that were chosen were determined. Of 914 cases, Hbs Ag, anti Hbs and anti HCV positivity were detected in 40 (4.4%), 336 (36.8%) and 26 (2.8%) of the cases respectively. All of the Hbs ag positive patients received prophylactic lamuvidine before the start of chemotherapy. In the Hbs ag and anti HCV positive cases, liver failure was not detected during chemotherapy and a delay in chemotherapy courses because of hepatitis was not encountered. Just as with hematological malignancies, screening for HBV and HCV should also be considered for patients with solid tumors undergoing chemotherapy. Prophylactic antiviral therapy for HBV reduces both the reactivation rates and HBV related mortality and morbidity. The clinical impact of HCV infection on patients undergoing chemotherapy is still not well characterized.

Advances and applications of molecular cloning in clinical microbiology

Molecular cloning is based on isolation of a DNA sequence of interest to obtain multiple copies of it in vitro. Application of this technique has become an increasingly important tool in clinical microbiology due to its simplicity, cost effectiveness, rapidity, and reliability. This review entails the recent advances in molecular cloning and its application in the clinical microbiology in the context of polymicrobial infections, recombinant antigens, recombinant vaccines, diagnostic probes, antimicrobial peptides, and recombinant cytokines. Culture-based methods in polymicrobial infection have many limitation, which has been overcome by cloning techniques and provide gold standard technique. Recombinant antigens produced by cloning technique are now being used for screening of HIV, HCV, HBV, CMV, Treponema pallidum, and other clinical infectious agents. Recombinant vaccines for hepatitis B, cholera, influenza A, and other diseases also use recombinant antigens which have replaced the use of live vaccines and thus reduce the risk for adverse effects. Gene probes developed by gene cloning have many applications including in early diagnosis of hereditary diseases, forensic investigations, and routine diagnosis. Industrial application of this technology produces new antibiotics in the form of antimicrobial peptides and recombinant cytokines that can be used as therapeutic agents.