HBV Viral Load Research Articles

The Prevalence of Hepatitis B and C Virus in Patients With End-Stage Kidney Disease on Regular Hemodialysis in Duhok, Iraq: A Brief Report

Background and aim: Hepatitis B and C virus (HBV and HCV) infections are considered as major global public health concerns. Chronic infections may lead to liver cirrhosis, hepatic failure, and hepatocellular carcinoma. Therefore, the aim of this study was to investigate the prevalence of HBV and HCV infections in patients with end-stage kidney disease (ESKD) and on regular hemodialysis in Duhok located in the Kurdistan region of Iraq. Methods: A cross-sectional study was conducted in Duhok, Iraq between January 2019 and October 2019. During this period, a total of 143 patients within the age range of 9-72 years old with ESKD visited the Duhok dialysis center for regular hemodialysis. Enzyme-linked immunosorbent assay (ELISA) was conducted to test HBV and HCV positivity and then HBV viral load was tested by the real-time polymerase chain reaction (RTPCR). Finally, HCV positivity was confirmed by the Xpert HCV quantification assay. Results: Among the recruited samples, 5 out of 143 (3.49%) patients were positive for HBV while HBV viral load for those patients was undetected. On the other hand, 3/143 (2.1%) patients tested positive for HCV Ab. All these 3 patients were also confirmed positive by the RT-PCR. Conclusions: ESKD patients on regular analysis showed a low prevalence of HBV and HCV in the Duhok dialysis center. An effective infection control program, vaccination, and treatment of HCV make the elimination of HBV and HCV feasible in such a group.

Association of KIR haplotypes with propensity for developing chronic hepatitis B induced liver diseases (cirrhosis and hepatocellular carcinoma) and HIV-1 infection in a West African Cohort

Objectives: A subset of specialized KIR haplotype has been shown to be strongly associated with susceptibility or resistance to viral infections in humans. Therefore, this pilot investigation sought to determine the frequencies of KIR Haplotype in hepatitis B (HBV) and HIV-1 infected patients and their clinical impacts in disease progression and staging in Burkina Faso. Methods: Hepatitis B infected patients, Human Immunodeficiency virus type 1 (HIV-1) infected individuals and healthy individuals were selected for this study. Hepatitis B surface antigen (HBsAg), anti-HCV antibodies and anti-HIV-1/2 antibody/antigen were screened using a 4th generation ELISA assay (ARCHITECT I 1000SR®TM, Abbott Laboratories, USA). In addition, SSP-PCR was used to search the frequencies of KIR haplotype. HBV viral load and HIV-1 viral load was determined in patients along with the CD4+ count.

A same day 'test and treat' model for chronic HCV and HBV infection: Results from two community-based pilot studies in Egypt.

Prompt access to confirmatory viral load testing and staging of liver disease are key barriers in uptake of treatment for chronic hepatitis B and C infection. Our objective was to establish the feasibility of a same day 'test and treat' model in two distinct community-based settings in Egypt through use of key point-of-care(POC) portable tools for HCV and HBV viral load assessment and staging of liver disease followed by treatment initiation. Community sites were a village in northern Egypt (site 1) and a government office in Cairo (site 2). The following model was adopted: community awareness raising in the week before project initiation; site assessment to ensure optimal placement and calibration of equipment and clinical care set-up; transfer of key portable laboratory instruments to the sites (four cartridge GeneXpert, FibroScan and abdominal ultrasound); screening using rapid diagnostic tests for HCV-Ab and HBsAg, with immediate venous or finger-stick blood sampling for HCV-RNA and HBV-DNA assay, FibroScan staging of liver disease and ultrasound screening for liver cancer. At site 1, 475 individuals were screened over a single day, 125 were positive for HCV-Ab and 4 for HBsAg, 43 of 56 new HCV diagnoses were HCV RNA positive, and 3 of 4 HBsAgpositive were HBV DNA positive, 40 initiated HCV treatment, and one HBVtreatment. At site 2, 3188 individuals were screened over 3days, 157 were positive for HCV-Ab, and 27 for HBsAg; 38 of 76 new HCV diagnoses were HCV RNA positive, and 15 of 18 HBsAgpositivewere HBV-DNA positive. Across both sites, 78 patients were counselled and initiated on treatment for HCV and 12 for HBV within 3 and 4hours, respectively, of initial positive rapid diagnostic test result. We have shown the feasibility of a same day 'test and treat' model for chronic HCV and HBV infection in two community-based settings in Egypt that achieved high levels of linkage to care and initial treatment.

Prevalence of Hcv and/or Hbv Coinfection in Iranian HIV-infected Patients

Aim: HIV-infected patients risk coinfection with HBV and HCV. This study aimed to investigate molecular epidemiology of HBV and HCV coinfection in Iranian HIV-infected individuals. Materials & methods: In this cross-sectional study, serological markers of HBV and HCV infection (hepatitis B surface antigen [HBsAg], hepatitis B e-antigen [HBeAg], hepatitis B e-antibody [HBeAb] and hepatitis B core antibody [HBcAb]) and anti-HCV antibodies [anti-HCV Abs] were tested in 198 Iranian HIV-infected patients. From plasma, HBV viral load was determined using COBAS TaqMan 48, and HCV-RNA was detected by reverse transcriptase-nested PCR. Results: 85 out of 198 (42.9%) patients were anti-HCV Ab positive and 42/198 (21.2%) had detectable HCV-RNA. Eight (4.0%) had traceable HBV-DNA. All these patients were infected by HBV genotype D. 55 (27.8%) were HBcAb positive. Nine (4.4%) were HBsAg and anti-HCV Ab positive. Conclusion: None were HIV-RNA/HCV-RNA/HBV-DNA positive, 21.2% were HIV-RNA/HCV-RNA positive and 4.0% were HIV-RNA/HBV-DNA positive. Therefore, studies on diagnosing these infections in HIV-infected individuals may be valuable.

Association of VDR (rs2228570, rs731236, rs7975232, rs1544410) and DBP (rs7041) genes polymorphisms with chronicity of hepatitis B in Iranian patients

BackgroundHost genetic factors and single nucleotide polymorphism (SNP) in host genes play important roles in the progression of disease stages and response to treatment of viral infections, including hepatitis B infection. Vitamin D plays a key role in a wide range of biological activities such as the immune response, proliferation and cellular differentiation. Since the biological effects of this vitamin are affected by the Vitamin D receptor (VDR) and the vitamin D-Binding Protein (DBP), in this study we investigated the association between VDR and DBP SNPs with the risk of chronic hepatitis B (CHB) infection in Iranian patients. MethodsOur case-control study consisted of two groups including 100 patients with CHB and 100 healthy controls. SNP of ApaI (rs7975232), TaqI (rs731236), BsmI (rs1544410) and FokI (rs2228570) VDR-related and DBP (rs7041) gene loci were determined by PCR-RFLP method. Serum ALT and AST levels and HBV virus load were determined and its association with SNP was investigated. Statistical analysis was performed using SPSS software (V22.0). ResultsThe results of this study showed that the TT (Homozygous Mutant) genotype of FokI locus (C>T; rs2228570) compared with CC (Homozygous Wild Type) and CT (Heterozygous) genotypes may be associated with an increased risk of CHB infection (P; 0.012, OR 2.674 (1.233–5.800), 95% CI). The T allele was also significantly associated with CHB infection (P; 0.009, OR 1.687 (1.136–2.506), 95% CI) compared to the C allele FokI. In this study, no significant relationship was found between CHB infection and rs7975232, rs731236, rs1544410 and rs7041 polymorphisms (P > 0.05). Also, there was no significant relationship between serum ALT and AST levels and HBV Viral load in patients with rs2228570 polymorphism (P > 0.05). DiscussionAccording to the results, VDR FokI (rs2228570) polymorphism has an impact on the chance of chronicity of hepatitis B in Iranian patients.

Análisis de resultados del Programa de Control de Calidad Externo SEIMC de carga viral del VIH-1, VHC y VHB. Año 2017

BackgroundHuman immunodeficiency virus type 1 (HIV-1) and hepatitis B (HBV) and C virus (HCV) viral load determinations are among the most relevant markers for the follow-up of patients infected with these viruses. External quality control tools are crucial to ensure the accuracy of the results obtained by microbiology laboratories. This article summarised the results obtained from the 2017 SEIMC External Quality Control Programme for HIV-1, HCV, and HBV viral loads and HCV genotyping. Methods and resultsIn the HIV-1 programme, a total of five standards were sent. One standard consisted of seronegative human plasma, while the remaining four contained plasma from three different viremic patients, in the range of 2-5 log10 copies/mL; two of these standards were identical, with the aim of determining repeatability. A significant proportion of the laboratories (35% on average) obtained values outside the accepted range (mean±0.25 log10 copies/mL), depending on the standard and on the method used for quantification. Repeatability was good, with up to 94% of laboratories reporting results within the limits (D<0.5 log10 copies/mL). The HBV and HCV programme consisted of two standards with different viral load contents. Most of the participants, 82% in the case of HCV and 87% in that of HBV, obtained all the results within the accepted range (mean±1.96 SD log10 UI/mL). ConclusionsData from this analysis reinforce the utility of proficiency programmes to ensure the quality of the results obtained by a particular laboratory. Due to the marked interlaboratory variability observed, it is advisable to use the same method and laboratory for patient follow-up.

Análisis de resultados del Programa de Control de Calidad Externo SEIMC de carga viral del VIH-1, VHC y VHB. AÑO 2018

BackgroundHuman immunodeficiency virus type 1 (HIV-1) and hepatitis B (HBV) and C virus (HCV) viral load determinations are among the most relevant markers for the follow-up of patients infected with these viruses. External quality control tools are crucial to ensure the accuracy of the results obtained by microbiology laboratories. This article summarised the results obtained from the 2018 SEIMC External Quality Control Programme for HIV-1, HCV, and HBV viral loads and HCV genotyping. Methods and resultsIn the HIV-1 program, a total of five standards were sent. One standard consisted of seronegative human plasma, while the remaining four contained plasma from three different viremic patients, in the range of 2-5 log10 copies/mL; two of these standards were identical, with the aim of determining repeatability. A significant proportion of the laboratories (28% on average) obtained values outside the accepted range (mean±0.25 log10 copies/mL), depending on the standard and on the method used for quantification. Repeatability was good, with most laboratories reporting results within the limits (D<0.5 log10 copies/mL). The HBV and HCV programme consisted of two standards with different viral load contents. Most of the participants, 87% in the case of HCV and 88% in the HBV, obtained all the results within the accepted range (mean±1.96 SD log10 UI/mL). ConclusionsData from this analysis reinforce the utility of proficiency programmes to ensure the quality of the results obtained by a particular laboratory. Due to the marked interlaboratory variability, it is advisable to use the same method and the same laboratory for patient follow-up.

Surveillance of human retroviruses in blood samples from patients with hepatitis B and C in São Paulo, Brazil.

INTRODUCTION Human retroviruses and the hepatitis B and C viruses (HBV and HCV, respectively) share routes of transmission; thus, coinfections occur and could alter subsequent disease outcomes. A preliminary study on human T-lymphotropic virus types 1 and 2 (HTLV-1/2) in serum samples from HBV- and HCV-infected individuals in São Paulo revealed 1.3% and 5.3% rates of coinfection, respectively. These percentages were of concern since they were detected in HTLV-endemic regions and in high-risk individuals in Brazil. The present study was conducted to extend and confirm these data. METHODS HTLV-1/2 and human immunodeficiency virus (HIV) infection status were identified in 1,984 sera for HBV and HCV viral load quantification - 1,290 samples from HBV-infected individuals (53.3% men, mean age: 47.1 years) and 694 samples from HCV-infected individuals (56.3% men, mean age: 50.1 years). HTLV-1/2 antibodies were detected by enzyme immunoassay, followed by western blotting and line immunoassay; HIV infection was detected by enzyme immunoassay. RESULTS HTLV-1/-2 infection was detected in 1.9% HBV-infected individuals (0.7% HTLV-1 and 1.2% HTLV-2) and in 4.0% (2.4% HTLV-1 and 1.6% HTLV-2) HCV-infected individuals; HIV infection was detected in 9.2% and 14.5%, respectively. Strong associations with HTLV and HIV, male sex, and older age were found in HBV/HTLV and HCV/HTLV-coinfected individuals (p<0.05). CONCLUSIONS HTLV-1 and HTLV-2 were confirmed to be prevalent in individuals with HBV and HCV in São Paulo; coinfected individuals deserve further clinical and laboratory investigation.

Performance of the Xpert HBV Viral Load assay versus the Aptima Quant assay for quantifying hepatitis B virus DNA

Quantification of HBV DNA is used for initiating and monitoring antiviral treatment. We have evaluated the Xpert HBV Viral Load (VL) assay on the GeneXpert instrument. We estimated its limit of detection to be 7.5 IU/mL. Reproducibility was 1.1–12.7% as assessed by the coefficients of variation for 3 different samples. The assay was linear from 2 to 8 log10 IU/mL for HBV genotypes A to F. Its clinical performance was evaluated by testing prospectively 100 HBV DNA-positive samples with the Xpert HBV VL and Aptima Quant HBV assays. The results from the 2 assays were correlated, with a modest bias (−0.10 log10 IU/mL) between them by Bland–Altman analysis. Patient monitoring with 80 samples performed with both assays gave similar patient profiles with trends in the same direction. The Xpert HBV Viral load assay is reliable enough for quantifying HBV DNA in clinical practice.

1533 Cytomegalovirus as the Forme Fruste of Colorectal Cancer in a Young Female

INTRODUCTION: Cytomegalovirus (CMV) infection is often seen in the GI tract among patients who are immunocompromised and most commonly affects the large bowel. Studies have shown CMV infection presenting as a colorectal cancer (CRC) like mass. We present a case of CMV presenting as the forme fruste of CRC. CASE DESCRIPTION/METHODS: A 31 year old Hispanic woman presented with a one week history of worsening abdominal pain, generalized weakness, hematochezia, and a 30 lb weight loss. She was a nonsmoker who had presented similarly 6 months prior to another institution and was diagnosed with CMV colitis by flexible sigmoidoscopy and biopsy of a rectal ulcer. Pathology revealed focal atypical epithelial proliferation, indefinite for dysplasia, and CMV immunostain was positive. The patient was treated with valganciclovir with improvement in symptoms, but later worsened. She denied change in bowel habits, history of anogenital warts, or HPV vaccination, but admits to a remote history of Chlamydia which was treated. History was also positive for chronic inactive HBV infection diagnosed 6 years prior to presentation. Significant labs were Hb 4.6 g/dL, MCV 65.9, Plt 466 K/uL, AST 43 U/L, ALP 111 U/L, HIV nonreactive, AFP 3.0 ng/ml, HBsAg reactive, HBV viral load of 613 IU/mL, HBcAb total reactive, HCV Ab nonreactive and CEA 44.6. CT abd/pelvis showed an inflammatory, ulcerated, rectal mass with wall thickening compatible with neoplasm (Figure 1). Large hypodensities were seen in both hepatic lobes consistent with metastases (Figure 2). Sigmoidoscopy showed an ulcerated partially obstructing mass in the rectum which was circumferential and friable and located at the anal verge and was approximately 10 cm in length. Biopsy of the mass showed scant adenocarcinoma admixed with ulcer and granulation tissue. Liver biopsy confirmed metastatic adenocarcinoma, colon primary. DISCUSSION: Potential previous exposure to oncogenic viruses such as HBV and HPV may have predisposed our patient to develop CRC at age 31. She had no other risk factors such as HIV infection, radiation exposure, or previous chemotherapy. Her underlying malignancy may have rendered her in an immunocompromised state that would have allowed CMV reactivation. Another possibility is exposure to multiple viruses caused immunocompromise allowing both CMV reactivation and CRC formation. CMV pseudo tumors are known to mimic CRC. Alarm symptoms such as weight loss and hematochezia in this patient warranted close follow up to complete resolution or alternative diagnosis.

Bimodal distribution of HBV viral loads in a UK cohort of chronic infection and comparison with HIV and HCV

Bimodal distribution of HBV viral loads in a UK cohort of chronic infection and comparison with HIV and HCV

Practical approach to method verification in plasma and validation in cerebrospinal fluid under accreditation using a flexible scope in molecular virology: setting up the HIV, HBV and HCV Aptima™ Quant Dx assays.

Background Our laboratory obtained the ISO 15189 accreditation for the plasmatic HIV-1, HBV and HCV viral load (VL) using the m2000 RealTime™ system, which was recently changed for the platform Panther®. Here, we discuss a strategy for performing method validation/verification very quickly. Methods We performed the mandatory (repeatability, internal quality assessment [IQA], measurement uncertainty [MU]) and optional technical verifications for CE/IVD assays using the flexible scope range A. We also performed the mandatory assays for the validation of HIV-1 VL in the cerebrospinal fluid (CSF) using the flexible scope range B. The change was checked by following up on the turnaround time (TAT). Results The coefficient of variation (CV%) for repeatability and IQA complied with the limit of 0.25 log. The MU results ranged from 0.04 to 0.25 log copies or IU/mL. The comparisons of methods showed excellent correlations (R2 = 0.96 for the three parameters) but a delayed centrifugation on HCV VL showed variations of up to 2 log IU/mL. An excellent linearity for HIV-1 in the CSF was obtained from 1.5 to 5 log copies/mL with R2 = 0.99. The TAT increased (84%-98%) in routine usage. Conclusions The three Aptima assays are well suited for routine laboratory use and can be integrated within less than 2 weeks in accordance with flexible scope range A. Our data allows us to confidently perform HIV-1 VL in CSF following flexible scope range B. Finally, we provide an organizational guide for flexible scope management in molecular virology within a short time frame.

Development of Steatohepatitis and Fibrosis in Chronic HBV Infection Is Linked to Inflammatory Responses Mediated by IL-13 and CCL11

Background: In view of the importance of chronic HBV (CHB) infection and the global burden of non-alcoholic fatty liver disease (NAFLD), it is imperative to understand the potential interplay between the two diseases. Methods: Here, we retrospectively investigated the association between NAFLD and CHB infection in the context of liver fibrosis. Among the 522 consecutive CHB patients who underwent transient elastography between year 2013 and 2016, we studied 449 subjects in the current investigation. Findings: CAP and LSM scores were generally higher in patients with steatosis and fibrosis or cirrhosis. Antiviral treatment had significantly reduced the HBV viral load. Other liver function markers showed a significant positive correlation with both CAP and LSM scores. Plasma IL-13 was independently associated with increased CAP score where every increase of 1 unit of IL-13 was associated with an increase in CAP score by 0.98 unit. CCL11 was independently associated with LSM with every increase of CCL11 by a unit that, in turn, was associated with an increase of LSM score. Interpretations: Together, we found that there was a high concurrence of NAFLD among patients with CHB. The presence of metabolic syndrome and chronic inflammation in CHB patients were two independent factors that led to progression of liver cirrhosis, with IL-13 playing the key role in linking the metabolic with the inflammatory components. Plasma markers of liver steatosis and fibrosis progression are key to development of cell-targeted therapies exploiting specific molecular pathways. Funding Statement: This work was supported by a grant from the Frontier Research Grant (FRG), FG019-17AFR to Mohamed Rosmawati and Xiamen University Malaysia Research Funding (XMUMRF), XMUMRF/2018-C2/ILAB/0001. Marie Larsson is supported by the Swedish Research Council, the Swedish Physicians against AIDS Research Foundation; VINNMER for Vinnova, Linkoping University Hospital Research Fund, ALF Grants Region Ostergotland, FORSS. Declaration of Interests: The authors declare no conflicts interest. Ethics Approval Statement: The medical records of patients were extracted from the hospital database using patients’ unique hospital registration number. This study was approved by the Medical Ethics Committee of the University Malaya Medical Centre (MEC-938.42).

Sero-Prevalence of Hepatitis D Virus Infection Among Hepatitis B Surface Antigen Positive Patients in Mashhad, Northeastern Iran

Background: Transmission and persistence of Hepatitis Delta Virus (HDV) depends on presence of the hepatitis B surface antigen (HBsAg) envelope proteins. The prevalence of HDV infection has not been reported previously among HBsAg-positive patients in Mashhad, Iran. Objectives: To evaluate HDV seroprevalence among individuals with HBsAg seropositivity in Mashhad, Northeastern Iran. Methods: This cross-sectional was performed in Central Diagnostic Lab of Academic Center for Education, Culture, and Research (ACECR), Mashhad, Iran. Based on database of the lab, 606 HBsAg positive patients were tested for anti-HDV antibodies using the enzyme-linked immunosorbent assay (ELISA) during 2016-2017. Chi-square or Fisher’s exact tests and T-test were used to analyze the data by SPSS software at a significance level of 5%. Results: Among 606 HBsAg positive patients including 335 (55.3%) males and 271 (44.7%) females with a mean age of 43.6 ± 14.8 years old, 35 cases (5.8%) were found to be anti-HDV positive. HDV infection was more prevalent among males (6.9%), older patients (P = 0.008), and individuals with elevated ALT (P = 0.034) and AST serum levels (P = 0.021). Regarding HBV viral load, there was no significant difference between HBV/HDV co-infected and HBV mono-infected patients (P = 0.07). Conclusions: Prevalence of HDV infection was found to be relatively high among HBsAg-positive cases in this region. Therefore, it is suggested to assess HDV antibodies among HBsAg-positive patients, especially those with higher serum levels of transaminases.

Impact of Chronic Hepatitis B Virus Infection On Semen Parameters of Fertile Men

Aim: To investigate the effect of chronic hepatitis B virus (CHB) infection on semen parameters of males with proven fertility. Material &amp; methods: 61 fertile men with CHB infection and a control group of 42 HBV-negative fertile men were assessed for serum and semen HBV viral loads by quantitative real-time PCR, complete semen analysis, hypo-osmotic swelling test, seminal total peroxide, total antioxidant capacity assay and sperm DNA integrity evaluation. Results: CHB men demonstrated significantly lower sperm motility, sperm viability and sperm DNA integrity, seminal total antioxidant capacity assay and significantly increased seminal total peroxide and oxidative stress index compared with controls. CHB cases with positive semen HBV DNA showed a significant increase in seminal total peroxide and oxidative stress index compared with CHB cases with negative semen HBV DNA. Conclusion: CHB has a negative burden on seminal parameters in fertile men.

Analytical performance of four molecular platforms used for HIV-1, HBV and HCV viral load determinations

ABSTRACTBackground: Viral load (VL) quantification is important for the management of HBV, HCV, and HIV-1-infected patients. Several semi- or fully automated systems and assays are available that can be used to measure VL for these and other targets.Research design and methods: We assessed the accuracy, genotype/subtype inclusivity, and precision of four VL assays for three viral targets: cobas 4800 (Roche), cobas 6800 (Roche), Aptima (Hologic) and VERIS (Beckman), using WHO standards, cell culture supernatants and clinical samples.Results: Most results were close to expected values, except for significant under-quantification of HIV-1 group O, HBV genotype C, and D at high VL, and HCV genotype 3 by Aptima, and of HIV-1 CRF01_AE and group N and HCV genotype 3 by VERIS. Precision was comparable between tests except for VERIS HCV, which showed more variability. Aptima and cobas 6800 results agreed well with each other except HBV VL at lower VL (<10,000 IU/mL) where Aptima results tended to be higher.Conclusions: Results from different VL assays may not always agree in certain subsets of patients. Clinicians should we aware of these findings when making treatment decisions.

From the Editor’s desk…: June 2019

From the Editor’s desk…: June 2019

Is HBV viral load at admission associated with development of acute-on-chronic liver failure in patients with acute decompensation of chronic hepatitis B related cirrhosis?

BackgroundHepatitis B virus (HBV) reactivation is one of the most common precipitating events associated with acute decompensation (AD) or acute-on-chronic liver failure (ACLF) in chronic hepatitis B (CHB)-related cirrhotic patients. However, whether their serum HBV deoxyribonucleic acid (DNA) levels are associated with ACLF incidence and short-term mortality rate is still ambiguous.MethodsThe ACLF incidences, 28-day and 90-day liver transplantation (LT)-free mortality rates, previous nucleoside/nucleotide analogues (NUCs) treatments and serum HBV DNA levels at admission (ad-levels) of 111 hospitalized patients with AD of CHB-related cirrhosis were analyzed.Results43 (38.7%) patients developed ACLF. The 28-day and 90-day LT-free mortality rates of the ACLF cases were 15.4 and 40.9%, respectively. Though NUCs inhibited HBV replication effectively, there were no differences in the ACLF incidence between antiviral treatment-naïve patients and NUCs treatment-experienced patients with or without interruptions (37.5, 41.7 and 45.5%, respectively, P>0.05). The serum HBV DNA ad-level was similar between the patients with and without ACLF development (logarithms: 4.50 ± 1.96 vs 4.32 ± 1.99; ≥2000 IU/ml: 67.4% vs 67.6%; both P>0.05), so was between the ACLF patients died or survived in 28 or 90 days (logarithms: 4.31 ± 1.91 vs 5.54 ± 2.53, 4.81 ± 1.76 vs 4.84 ± 2.40, respectively, both P>0.05).ConclusionSerum HBV DNA ad-level and previous NUCs treatment are not associated with incidence of ACLF and short-term mortality rate in the hospitalized patients with AD of CHB-related cirrhosis.

A Real-World Prospective Study of Mother-to-Child Transmission of Hepatitis B Virus in China Using a Mobile Health Application (Shield 01)

Background: The World Health Organization (WHO) has set a goal of eliminating viral hepatitis as public health threat by 2030. To assess feasibility of this goal in China, we carried out a real-world study to determine whether WHO's goal could be achieved. Methods: One thousand and eight hepatitis B surface antigen (HBsAg) positive pregnant women were enrolled at ten hospitals. Immunoprophylaxis was routinely administered to infants. In addition, mothers with HBV DNA level > 2,000,000 IU per milliliter were advised to initiate antiviral therapy during late pregnancy. A health application called SHIELD was used to manage the study. Findings: Nine hundred and five of enrolled mothers with 924 infants completed the follow-up, including 561 hepatitis B e antigen (HBeAg) positive mothers and 499 mothers with HBV DNA level > 2,000,000 IU per milliliter. There were 446 mothers who received antiviral therapy, including 72·3% of the mothers with HBV DNA level > 2,000,000 IU per millilitre and 21·0% of the mothers with HBV DNA level of < 2,000,000 IU per millilitre. Birth-dose hepatitis B vaccine (HepB) and hepatitis B immunoglobulin (HBIG) were received by 99·9% and 99·8% of infants within 24 hours after birth, respectively. Eight infants became infected with HBV. The overall rate of mother-to-child transmission (MTCT) was 0·9% (95% confidence interval, 0·4% to 1·7%). Birth defects were rare (0·5% among infants with maternal antiviral exposure versus 0·7% among infants without exposure; P=1·00). Interpretation: In real-world practice, there was a low rate (<1%) of MTCT with administration of combined immunoprophylaxis to infants, and initiation of maternal antiviral therapy during pregnancy among a subset of mothers with high HBV viral load. This study suggested that a comprehensive management composing of immunoprophylaxis to infants and antiviral prophylaxis to mothers was a feasible strategy in China which may accelerate achieving the WHO goal of eliminating the MTCT of HBV. Funding: This work was funded by China Foundation for Hepatitis Prevention and Control (CFHPC) and National Natural Science Foundation of China (Grant No.81673243). Declaration of Interest: JH is a consultant for AbbVie, Arbutus, Bristol Myers Squibb, Gilead Sciences, Johnson & Johnson, and Roche, and received grants from Bristol Myers Squibb, Johnson & Johnson, and Gilead science, all outside the submitted work. The remaining authors declare no competing interests. Ethical Approval: The study protocol was approved by the ethics committee at each participating centre.

THU-228-HBV RNA can influence HBV viral load results depending on the test used

THU-228-HBV RNA can influence HBV viral load results depending on the test used