Hepatitis B E Antibody Research Articles

Determinants of mother-to-child transmission of hepatitis B virus among pregnant women in southwestern Nigeria.

hepatitis B virus (HBV) infection is a serious public health problem in sub-Saharan Africa and a common cause of liver disease globally. This study aimed to determine the seroprevalence and the rate of mother-to-child transmission of HBV after the age of viability. the study was a cross-sectional study that involved 543 eligible consenting pregnant women and newborns of Hepatitis B surface antigen (HBsAg) positive mothers. A one-step rapid HBsAg strip was used to screen eligible patients for HBV infection. Venous blood sample (5mls) was taken from every HBsAg-positive woman for Hepatitis B e Antigen (HBeAg), Hepatitis B e antibody (HBeAb), Hepatitis B core Antibody (HBcAb) and Hepatitis B surface Antibody (HBsAb). In addition, 2mls of cord blood was taken to assay for HBsAg and HBV DNA. Data was analysed using SPSS version 22. of 543 pregnant women screened, 18 (3.3%) of them were HBsAg-positive with all of them testing negative for HBeAg. HBV DNA was detected in the cord blood of 4 (22.2%) new-borns delivered while 2 (11.1%) tested positive for HBsAg; the above finding indicated that only 4 of the neonates had detectable HBV DNA (>100copies/ml) in their cord blood. findings from this study demonstrate a low prevalence of HBV infection among pregnant women after the age of viability in Ogbomoso. HBV DNA analysis rather than HBsAg was shown to be more sensitive and specific in determining the risk of intrauterine infections.

Prevalence and clinical characteristics of hepatitis B surface antigen-negative/hepatitis B core antibody-positive patients with detectable serum hepatitis B virus DNA

BackgroundTo determine the prevalence of detectable serum hepatitis B virus (HBV) DNA in patients who are hepatitis B surface antigen (HBsAg)-negative and hepatitis B core antibody (HBcAb)-positive. The correlation between HBV DNA viral load and serological markers, as well as liver and coagulation function indicators were investigated. Furthermore, the effects of immunosuppressive therapy on DNA replication were assessed.MethodsA total of 2,013 HBsAg-negative/HBcAb-positive patients admitted to our hospital between January and December 2019 were enrolled in this study. Patient clinical characteristics including serological markers, HBV DNA viral load, liver function and coagulation function indicators, and immune function status were analyzed.ResultsIn the Hunan province in China, the prevalence of detectable HBV DNA was 5.4% in HBsAg-negative/HBcAb-positive patients. However, the prevalence of detectable HBV DNA in HBsAg-negative/HBcAb-positive patients may vary because of different HBV serological markers. In patients with detectable serum HBV DNA, the log10 HBV DNA value was positively correlated with alanine transaminase (ALT) and aspartate transaminase (AST) levels, and negatively correlated with antithrombin III (AT III) concentrations. Moreover, in patients receiving immunosuppressive therapy, ALT and AST levels were higher than those of patients who did not receive immunosuppressive therapy. The ALT and AST levels in hepatitis B e antibody (HBeAb)-positive patients were significantly higher than that observed in HBeAb-negative patients.ConclusionsFor HBsAg-negative/HBcAb-positive patients, clinicians should pay attention to the patient's immune function status. In situations where HBV DNA cannot be detected, changes in serum ALT, AST, and AT III concentrations can be used to speculate on viral replication status to reduce the risk of HBV infection and transmission.

S2604 Acute Severe Cholestatic Hepatitis B Infection in an Immune-Competent Patient

INTRODUCTION: Acute severe cholestatic hepatitis B is uncommon and usually reported in organ transplant recipients. We report a unique case of acute HBV infection with severe cholestasis in an immune-competent patient whose symptoms were initially felt to be secondary to complications from choledocholithiasis. CASE DESCRIPTION/METHODS: A 67-year-old female presented with right upper quadrant (RUQ) pain, vomiting, fatigue & jaundice for 2 weeks. She had a new sexual partner with unknown hepatitis status. The patient had no history of alcohol, drug use or new medications. RUQ tenderness & scleral icterus were noted on exam. Labs showed AST-629u/l (Normal[N]: 10–40 u/l), ALT-497u/l (N: 12–78 u/l), ALP-294u/l (N: 33–138 u/l), T. Bili-8.4mg/dl (N: 0.0–1.5 mg/dl), D. Bili-7.5mg/dl (N: 0.0 −1.5mg/dl), INR-1. On ultrasound of the abdomen cholelithiasis with gall bladder wall thickening with normal biliary ducts was noted. Endoscopic ultrasound revealed a 2.5 mm filling defect without shadowing in distal common bile duct (CBD) & Endoscopic retrograde pancreatic duodenoscopy showed a small filling defect in mid CBD and a distal CBD stricture about 1–2 cm in length. Biopsy of CBD stricture showed inflammation. A plastic biliary stent was deployed with good drainage. Her liver tests did not improve, and additional investigations performed were positive for Hepatitis B surface antigen (HbsAg), core antibody Total (Anti HBc Total) & core IgM, Hepatitis e antigen (HBeAg). She was negative for Hepatitis B e antibody (HBeAb) and Hepatitis B surface antibody (HBsAb). HBV PCR was 765,000,000 IU/ml. She was discharged with a follow up scheduled in liver clinic, but was readmitted 2 weeks later with worsening fatigue & liver tests. A liver biopsy showed active hepatitis without evidence of bridging fibrosis or cirrhosis & positive HBV staining. Anti-viral therapy with Tenofovir was initiated with improvement in symptoms. DISCUSSION: Although several case reports describe severe cholestasis with HBV post-liver transplantation, it has rarely been described in immunocompetent patients. Our patient's presentation was initially concerning for biliary obstruction. Despite biliary drainage patient's symptoms worsened, & further investigations revealed acute HBV infection with high replication which was confirmed by biopsy. Prompt therapy with antivirals improved the clinical course. Given these findings one should have high index of suspicion to evaluate for HBV infection in unusual presentation with cholestasis.Figure 1.: Immunohistochemical stain highlights Hepatitis B surface antigen within the cytoplasm of hepatocytes (200X magnification).Figure 2.: Hepatic parenchyma with dense mixed acute and chronic inflammation throughout the hepatic lobule and intermixed ceroid-laden macrophages removing dead hepatocytes (100x magnification).Figure 3.: Hepatic parenchyma with dense mixed acute and chronic inflammation throughout the hepatic lobule and intermixed ceroid-laden macrophages removing dead hepatocytes (200 X magnification).

Epidemiology of hepatitis B and C in a pregnant woman in a tertiary teaching hospital in Jordan

Background: Maternal infection with hepatitis can expose the newborn to subsequent chronic hepatitis. Acquired hepatitis is a preventable condition. A low percentage of hepatitis during pregnancy was found in this study to indicate successfully adoption of the modern methods of infection control. Objective: Maternal infection with hepatitis B or C virus can expose the newborn to a subsequent chronic hepatitis infection. Perinatally acquired hepatitis B virus is a largely preventable condition. Herein, the authors aimed o determine the prevalence of hepatitis B and C virus infections among pregnant women. Materials and Methods: 48,556 pregnant women attending the delivery room between January 2005 and December 2016 were tested for hepatitis B surface antigen (HBsAg), hepatitis B antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), hepatitis B core IgM (HBc IgM), hepatitis B core IgG (HBc IgG), and hepatitis C antibody (HCV Ab). The percentages of the above variables were determined. Results: Of the 48,556 women, 118 (0.24 %) were found to have hepatitis, 107 (0.22%) with hepatitis B, and 11 (0.02%) with hepatitis C. HBsAg was positive in 102 (86.4 %), HBsAb in six (5.1%), HBeAg in 14 (11.9%), HBeAb in 52 (44.1%), HBc IgM in seven (5.9%), HBc IgG in 51 (43.2%), and HCV Ab in 11 (9.3%). Acute hepatitis B was found in two (1.7%) women, chronic hepatitis B in 60 (50.1%), chronic hepatitis B and C in four (3.4%), chronic hepatitis C in seven (5.9%), chronic inactive hepatitis B in 39 (33.1%), latent hepatitis in two (1.7%), and resolved chronic hepatitis B in four (3.4%). Conclusions: A low percentage of seroprevalence of hepatitis B and C during pregnancy was found at a tertiary university hospital in Jordan.

Prevalence of Hepatitis B Serological Markers Among People Who Referred to a Great Laboratory in Neyshabur, Northeast of Iran

Background: Iran has been known as an area with low-intermediate prevalence for the hepatitis B virus (HBV) infection. Objectives: This cross-sectional study was performed to assess the prevalence of serological markers and the potential risk factors of HBV infection among people who referred to the Neyshabur Lab of Academic Center for Education, Culture, and Research (ACECR), Razavi Khorasan Branch, northeast of Iran. Methods: The 2669 serum samples were assessed to detect the hepatitis B surface antigen (HBsAg) by enzyme-linked immunosorbent assay (ELISA) during June 2015 to February 2016. In the case of HBsAg positive, hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), total hepatitis B core antibody (anti-HBc), and IgM anti-HBc were evaluated. Moreover, demographic data and risk factors related to HBV infection were assessed. Results: A total of 2099 (78.6%) females and 570 (21.4%) males with a mean age of 32.4 ± 13.1 years were enrolled. HBsAg seropositivity was observed in 90 (3.37%) individuals. ELISA tests for HBeAg, anti-HBe, total anti-HBc, and IgM anti-HBc were positive in 8 (8.9%), 75 (83.3%), 90 (100%), and 11(12.2%) of 90 HBsAg-positive cases, respectively. Age, sex, household size, and education level were significant risk factors for the infection. Conclusions: Prevalence of HBV infection in Neyshabur could be considered as an intermediate level. Although some reasons for which individuals referred, were suggesting hepatitis.

Hepatitis B virus infection in patients with aggressive B-cell non-Hodgkin lymphoma, indolent B-cell non-Hodgkin lymphoma and multiple myeloma

Objective To analyze the infection rate of hepatitis B virus (HBV) in aggressive B-cell non-Hodgkin lymphoma (B-NHL), indolent B-NHL and multiple myeloma (MM) and its relationship with clinicopathological features. Methods The clinical data of 293 aggressive B-NHL, 181 indolent B-NHL and 261 MM patients in Tianjin Medical University Cancer Institute and Hospital from January 2009 to April 2017 were retrospectively analyzed. The difference of HBV infection was compared among three groups. Serum samples from all patients were tested for HBV markers, including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb) and hepatitis B core antibody (HBcAb) by using chemiluminescence immunoassay. Results The positive rate of HBsAg was 9.2% (27/293), 5.5% (10/181) and 3.8% (10/261), respectively in the aggressive B-NHL group, indolent B-NHL group and MM group. The positive rate of HBsAg in the aggressive B-NHL group was higher than that in the indolent B-NHL group and MM group (χ2 = 6.987, P = 0.030), and there was no statistical difference of HBsAg positive rate between the indolent B-NHL group and MM group (P > 0.05). The positive rate of HBsAg, HBeAg, HBcAb in the aggressive B-NHL group was higher than that in the indolent B-NHL group and MM group [4.1% (12/293), 0, 0.8% (2/261); χ2= 14.976, P= 0.001], and there was no significant difference in the positive rate of HBsAg, HBeAg and HBcAb between the indolent B-NHL group and MM group (P > 0.05). Compared with HBsAg negative aggressive B-NHL patients, HBsAg positive aggressive B-NHL patients showed, higher ratio of stage Ⅲ-Ⅳ [70.4% (19/27) vs. 49.2% (131/266), χ2= 4.377, P= 0.036], more frequent involvement of spleen [51.9% (14/27) vs. 23.7% (63/266), χ2= 10.039, P= 0.002], more frequent of B symptom [55.6% (15/27) vs. 32.0% (85/266), χ2= 6.073, P= 0.014], more frequent of elevated total bilirubin [29.6% (8/27) vs. 14.3% (38/266), χ2= 4.360, P= 0.037] and more frequent of reduced albumin [55.6% (15/27) vs. 35.7% (95/266), χ2= 4.115, P= 0.042]. Conclusions The infection rate of HBV in aggressive B-NHL patients is higher than that in the indolent B-NHL and MM patients. HBsAg positive aggressive B-NHL patients are associated with adverse clinical characteristics. Key words: B-cell non-Hodgkin lymphoma, aggressive; B-cell non-Hodgkin lymphoma, indolent; Multiple myeloma; Hepatitis B virus

HBV and HDV Seroprevalence among Healthy People Admitted for Hepatitis B Vaccination

Background: An estimated 350 million persons worldwide are chronically infected with Hepatitis B virus (HBV). These are at increased risk of developing liver cirrhosis and hepatocellular carcinoma. The aim of the study was to determine the prevalence of Hepatitis B and co- existing Hepatitis D and to investigate the pattern of lab parameters among patients positive for hepatitis B and/or D. Methods: This is an observational cross-sectional prospective study conducted from 2009 to 2014 in Lyari General Hospital Karachi Pakistan. A total of 10270 patients were registered in the liver clinic from June 2009 to December 2014 for hepatitis B vaccination. All patients who had visited the Liver clinic of Lyari General Hospital for hepatitis B vaccination were first screened for hepatitis B, and D viruses by HBsAg, and Anti HDV antibodies and anti HCV by ELISA method. Patients who had HBsAg negative were then vaccinated. If HBsAg was found to be positive the patients have been underwent through further tests for the confirmation of hepatitis B and D (Hepatitis B Virus DNA polymerase chain reaction (PCR), hepatitis B e-antigen (HBeAg), hepatitis Be antibody (HBeAb), and if anti HDV positive then HDV RNA PCR was performed). Patients found to have a positive HBVDNA PCR with positive or negative HBeAg were treated. Patients with positive HBeAb were seroconverted. Patients with a positive anti HDV antibody underwent an HDVRNA PCR and if positive were treated. Statistical analysis was performed using SPSS (IBM SPSS Statistics 24.0). Results: A total of 10270 patients were registered in the liver clinic. Overall 206 (2%) were found to be HBV positive, in which 26.2% had Hepatitis D co-infection. More than half (57.3%) were male and 70.4% were married with the mean age of 33.2 ± 10.9 years. About one-fourth of the total were HbeAg positive (25.2%) and hepatitis D antibody positive (26.2%), while 21% had HDV PCR positive and 6.3% had hepatitis C antibody positive. The mean hemoglobin was 12.2, white cell count 6052.3, viral load of HBV DNA was 44100856.97, SGPT was 63.47, albumin was 4.24 and mean INR was 1.09. Conclusion: Prevalence of Hepatitis B infection was 2% and Hepatitis D infection was present in 26.2% of hepatitis B infected patients. Giriş: Dünya genelinde 350 milyon kişinin Hepatit B virüsü (HBV) ile kronik olarak enfekte olduğu tahmin edilmektedir. Bu kişier karaciğer sirozo ve hepatoselüler karsinom gelişimi riski altındadır. Bu çalışmanın amacı Hepatit B ve ko-enfeksiyon olarak Hepatit D virusunun prevelansını saptamak ve Hepatit B ve/ya Hepatit D pozitif hastalar arasında laboratuvar parametrelerinin örüntülerini inceleyebilmektir. Yöntem: Bu gözlemsel tanımlayıcı-kesitsel prospektif çalışma, 2009-2014 yılları arasında Lyari Genel Hastanesi, Karaçi, Pakistan’da yapıldı. Haziran 2009’dan Aralık 2014’e kadar toplam 10270 hasta karaciğer polikliniği’ne hepatit B aşılaması için kaydolmuştur. Lyari Genel Hastanesi’nde Karaciğer kliniğine hepatit B aşılaması için başvuran hastaların hepsi ilk gelişlerinde ELISA yöntemiyle hepatit B ve D virusleri için HBsAg, Anti HDV antikorları ve anti HCV için tarandılar. HBsAg negatif olan hastalar aşılandı. Eğer HBsAg pozitif bulgulandıysa hastalara hepatit B ve D doğrulaması için ileri testler yapıldı ( Hepatit B virus DNA polimeraz zincir reaksiyonu (PCR), hepatit B e-antijeni (HbeAb) ve eğer anti HDV pozitif ise HDV RNA PCR uygulandı). Pozitif HBVDNA PCR sonucu ile pozitif ya da negatif HbeAg sonucu olan hastalar tedavi edildi. İstatiksel yöntem olarak SPSS kullanıldı (IBM SPSS Statistics 24.0). Bulgular: Karaciğr kliniğine toplamda 10270 hasta kaydoldu. Bunlardan 206’sı (%2) HBV pozitif olarak bulgulandı ki %26.2’de Hepatit D ko-enfeksiyonu vardı. Yarısından fazlası (%57.3) erkekti ve %70.4’ü evliydi, yaş ortlaması ise 33.2 ± 10.9 yıldı. Bütünün dörte birinde HBsAg pozitif (%25.2) ve hepatit D antikoru pozitif (%26.2) iken %21 HDV pozitif ve %6.3 hepatit C antikoru pozitifti. Ortalama hemoglobin değeri 12.2, beyaz küre sayısı 6052.3, HBV DNA’nın viral yükü 44100856.97, SGPT 63.47, albumin 4.24 ve ortalama INR 1.09 idi. Sonuç: Hepatit B enfeksiyonu prevelansı %2’dir ve Hepatit D ise hepatit B ile enfekte hastaların %26.2’sinde bulunmaktadır.

Association of serum total cholesterol with pegylated interferon-α treatment in HBeAg-positive chronic hepatitis B patients.

Recent studies suggest that serum lipids are associated with pegylated interferon-alpha (PEG-IFN-α) treatment response in chronic hepatitis C patients. However, the role of serum lipids in influencing the outcome of HBV treatment is not well understood. This study aims to investigate the association of serum lipids with the response to interferon-alpha treatment for chronic hepatitis B (CHB) patients. We dynamically measured 11 clinical serum lipid parameters of 119 hepatitis B e antigen (HBeAg)-positive CHB patients, including 53 patients who achieved sustained response (SR) and 66 patients who achieved non-response (NR) induced by PEG-IFN-α treatment for 48 weeks. The dynamic analysis showed that the baseline serum total cholesterol (TCHO) level was higher in the NR group than that in the SR group (P=0.004). Moreover, the correlation analysis demonstrated a significant positive correlation between TCHO and hepatitis B surface antigen (HBsAg) at baseline (P=0.009). In addition, CHB patients with high baseline TCHO levels exhibited higher HBV DNA, HBsAg, HBeAg and hepatitis B e antibody (HBeAb) levels during early treatment periods (weeks 0, 4, 12 and 24) than those with the low TCHO levels. Furthermore, the logistic regression analysis identified that baseline serum TCHO was a risk factor for NR achievement (OR=4.94; P=0.047). Our results indicated that serum TCHO was associated with PEG-IFN-α therapeutic response in HBeAg-positive CHB patients which suggested that serum TCHO could be useful as an auxiliary clinical factor to predict poor efficacy of PEG-IFN-α therapy.

Reactivation of Hepatitis B After Kidney Transplant in a Patient with Resolved Hepatitis B Infection and Review of Literature

Introduction: Hepatitis B infection is associated with significant morbidity and mortality in kidney transplant recipients (KTRs). Immunosuppression after kidney transplant (KT) affect T- and B- cell functions which plays an important role in maintaining immunological memory against hepatitis B infection. The reported incidence of reactivation varies from 0%-6.5% in KTRs. We present a case of resolved hepatitis B infection confirmed with negative hepatitis B surface antigen (HBsAg) and positive hepatitis B surface antibody (HBsAb) with a titer of < 100 IU/L who had reactivation of hepatitis B 5 months after kidney transplant. Case presentation: A 54-year-old male from Nigeria migrated 30 years ago with end-stage renal disease underwent cadaveric renal transplant. The patient had history of resolved hepatitis B infection confirmed biochemically and serologically. His lab work during KT showed negative HBsAg, positive HBsAb with a titer of 16.4 IU/L, positive hepatitis B core total antibody (HBcAb), negative Hepatitis B e-antigen (HBeAg) and positive Hepatitis B e-antibody (HBeAb). Hepatitis B virus (HBV) DNA was not detected by polymerase chain reaction (PCR) technique. Liver function test (LFT) was completely normal. The donor organ was free of hepatitis B infection. 5 months after KT, he presented with AST-844 IU/L, ALT- 1787 IU/L, ALP- 206 IU/L, TB- 12.2 mg/dl and INR- 3. HBV serology showed positive HBsAg, negative HBsAb, negative hepatitis B core IgM antibody (HBcIgMAb), positive HBcAb, negative HBeAg, positive HBeAb. HBV DNA was detected by qualitative PCR and viral load was found to be 1,550,000 IU/mL. Discussion: Kanaan et al. observed that patients who lost their HbsAb after KT had a pre-transplant antibody titer below 100 IU/L (like our patient) and there was no reactivation in patients with antibody titer >100 IU/L. Savas et al reported two cases of reactivation whose titer level of HbsAb were 12 IU/ml in one case and 33IU/ml in another. Based on these observations, we encourage physicians to consider raising the HBsAb titer to >100 IU/L prior to KT and maintaining at that level in post-transplant period.

Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital, a General Tertiary Hospital in Beijing.

Objective s To investigate the positive rate of different hepatitis B virus (HBV) serological markers, and the demographic factors related to HBV infection.Methods We enrolled all patients tested for HBV serological markers, such as HBV surface antigen (HBsAg), HBV surface antibody (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), HBV core antibody (HBcAb), and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital. The positive rate of each HBV serological marker was calculated according to gender, age, and de- partment, respectively. The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.Results Among 27 409 samples included, 2681 (9.8%) were HBsAg positive. When patients were divided into 9 age groups, the age-specific positive rate of HBsAg was 1.2%, 9.6%, 12.3%, 10.9%, 10.3%, 9.7%, 8.0%, 5.8%, and 4.3%, respectively. The positive rate of HBsAg in non-surgical department, surgical department, and health examination center was 16.2%,5.8%,and 4.7%, respectively. The positive rate of HBsAg of males (13.3%) was higher than that of females (7.3%, P=0.000). Among the 2681 HBsAg (+) patients, 1230 (45.9%) had HBV-DNA test, of whom 564 (45.9%) were positive. Patients with HBsAg (+), HBeAg (+), and HBcAg (+) result usually had high positive rate of HBV-DNA Results (71.8%, P=0.000).Conclusions Among this group of patients in our hospital, the positive rate of HBsAg was relatively high. Age group of 20-29, males, and patients in non-surgical departments were factors associated with high positive rate of HBsAg.

Association Between TT Virus Infection and Cirrhosis in Liver Transplant Patients.

Background:Cirrhosis is one of the most severe liver complications, with multiple etiologies. The torque teno virus (TTV), also known as transfusion transmitted virus, which has a high incidence in the world population, is one of the possible increasing risk factors in patients with idiopathic fulminant hepatitis and cryptogenic cirrhosis.Objectives:The aim of this study was to evaluate solitary and co-infection with TTV, in patients with cryptogenic and determined cause of cirrhosis.Patients and Methods:In this cross-sectional study, 200 liver transplant patients were consecutively recruited between years 2007 and 2011. Patients were classified, based on recognition of the etiology of cirrhosis to determined (n = 81) and cryptogenic (n = 119) patient groups. The existence of TTV infection was analyzed, using a semi-nested polymerase chain reaction method. The presence of hepatitis B virus (HBV) infective markers, including HBV DNA, hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis B core antibody (HBcAb), and hepatitis B e antibody (HBeAb), was evaluated using qualitative polymerase chain reaction and enzyme linked immunosorbent assay protocols, respectively.Results:The TTV infection was found in 37 of 200 (18.5%) and 53 of 200 (26.5%) plasma and tissue samples of studied liver transplanted patients, respectively. The TTV genomic DNA was found in 32 (26.9%) and 28 (23.5%) of 119 liver tissue and plasma samples of transplanted patients with cryptogenic cirrhosis, respectively. The genomic DNA of TTV was also diagnosed in 21 (25.9%) and nine (11.1%) of the 81 liver tissue and plasma samples of patients with determined cirrhosis, respectively. Significant associations were found between TTV infection with HBV molecular and immunologic infective markers, in liver transplanted patients, with determined and cryptogenic cirrhosis.Conclusions:The diagnosis of the high frequency of solitary TTV and co-infection with HBV, in both liver transplanted patients with cryptogenic and determined cirrhosis, emphasized on the importance of TTV infection in the development of cirrhosis, especially in the cases of cryptogenic ones, prompting for further studies the confirm this agent in the etiology of determined cirrhosis.

Cost-effectiveness analysis of lamivudine, telbivudine, and entecavir in treatment of chronic hepatitis B with adefovir dipivoxil resistance.

The purpose of this study was to analyze the cost-effectiveness of lamivudine (LMV), telbivudine (LdT), and entecavir (ETV) in treatment of chronic hepatitis B with adefovir dipivoxil (ADV) resistance. Two hundred and fifty-two patients were recruited and screened for resistance to ADV and randomly assigned into three groups: LMV + ADV, LdT + ADV, and ETV + ADV. The ratio of biochemical response, virological response, seroconversion of hepatitis Be antigen (HBeAg)/hepatitis Be antibody (HBeAb), viral breakthrough, and the cost and effectiveness of treatments were analyzed. A comparison of the results of the ratio of biochemical response, virological response and seroconversion of HBeAg/HBeAb, showed no statistical difference between the three groups, with the economic cost of LMV + ADV the lowest, LdT + ADV the middle, and ETV + ADV the highest. The side effects of the three plans are all rare and tolerable. LMV + ADV is the optimal rescue strategy, and LdT + ADV the alternative selection in the economically less developed regions, while ETV + ADV was used in the economically developed regions.

Hepatitis B e Antibody Positive before Rituximab Combination Chemotherapy Is Associated with a Lower Risk of Hepatitis B Virus (HBV) Reactivation in HBV Carriers with Diffuse Large B-Cell Lymphoma

Background: With antivirus prophylaxis, reactivation of hepatitis B virus (HBV) also occurred in HBV carriers (hepatitis B surface antigen [HBsAg] positive) undergoing rituximab combination chemotherapy. It was reported that most HBV carriers with improved long-term outcomes were seropositive for hepatitis B e antibody (HBeAb). In this study on HBsAg-positive lymphoma patients with prophylaxis, the objectives were to determine the HBV reactivation rate in patients with HBeAb positive compared with the patients with HBeAb negative.Methods: We retrospectively analyzed the medical records of 113 HBV carriers with CD20(+) diffuse large B-cell lymphoma (DLBCL) received R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy with antivirus prophylaxis between August 1, 2002 and November 31, 2011 at Sun Yat-sen University Cancer Center, China.Results: Among 113 HBV carriers with CD20(+) DLBCL, 68(60.2%) were hepatitis B e antibody (HBeAb) positive. There was no significant difference in terms of sex distribution, age, ECOG PS, stage, baseline HBV DNA detectable rate, or ALT, AST, bilirubin, or LDH between the HBeAb positive group and the HBeAb negative group. However, there were a significantly higher proportion of HBeAg seronegativity (94.1%v 24.4%; P< .001), and HBcAb seropositivity (100.0%v 82.2%; P< .001) in the HBeAb positive group.All the patients received antiviral therapy before chemotherapy. The antiviral treatments were used as follows: lamivudine in 68 (60.2%) patients, entecavir in 18 (15.2%) patients, others in 27 (23.8%) patients. Other antiviral treatments were including adefovir, lamivudine plus entecavir, lamivudine at beginning and then entecavir, and so on. No significant difference was observed in the antiviral drugs between the two groups.After R-CHOP chemotherapy, HBV reactivation was found in 23.0% of HBV carriers (26/113). And its incidence rate was lower in HBsAg- positive / HBeAb positive patients than in HBsAg-positive/ HBeAb negative patients (16.1% versus 33.3%; P =.034). Multivariate analysis showed that patients positive for HBeAb before chemotherapy was the only significant and independent protective factor associated with hepatitis due to HBV reactivation after chemotherapy.Chemotherapy was continued when the serum HBV-DNA level reduced or liver function improved. Survival was not affected by the occurrence of HBV reactivation or the status of HBeAb.Conclusion: HBeAb positive before rituximab combination chemotherapy was associated with a lower risk of HBV reactivation in HBV carriers with CD20(+) DLBCL. A more effective antivirus prophylaxis may be considered in HBV carriers with HBeAb negative in order to reduce HBV reactivation. DisclosuresNo relevant conflicts of interest to declare.

NIR‐Emitting Quantum Dot‐Encoded Microbeads through Membrane Emulsification for Multiplexed Immunoassays

NIR-emitting CdSeTe/CdS/ZnS core/shell/shell QD-encoded microbeads are combined with common flow cytometry with one laser for multiplexed detection of hepatitis B virus (HBV). A facile one-pot synthetic route is developed to prepare CdSeTe/CdS/ZnS core/shell/shell QDs with high photoluminescence quantum yield and excellent stability in liquid paraffin, and a Shirasu porous glass (SPG) membrane emulsification technique is applied to incorporate the QDs into polystyrene-maleic anhydride (PSMA) microbeads to obtain highly fluorescent QD-encoded microbeads. The relatively wide NIR photoluminescence full width half maximum of the CdSeTe/CdS/ZnS QDs is used to develop a 'single wavelength' encoding method to obtain different optical codes by changing the wavelengh and emission intensity of the QDs incorporated into the microbeads. Moreover, a detection platform combining NIR-emitting CdSeTe/CdS/ZnS QD-encoded microbeads and Beckman Coulter FC 500 flow cytometry with one laser of 488 nm is successfully used to conduct a 2-plex hybridization assay for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and a 3-plex hybridization assay for hepatitis B surface antibody (HBsAb), hepatitis B e antibody (HBeAb), and hepatitis B core antibody (HBcAb), which suggests the promising application of NIR QD-encoded microbeads for multiplex immunoassays.

Adefovir Is Effective to Promote Development of Immunity to Donor Origin Hepatitis B Virus in an Allogeneic Transplant Recipient: A Case Report

Hepatitis B infection is a serious health problem in endemic areas particularly among immunocompromised patients. The more profound immunosuppression in recipients of hematopoietic stem cell transplantations (HCT) can lead to more complicated hepatitis B virus (HBV)-related events. Despite the high risk of recipient infection allogeneic HCT donors with HBV infection are not excluded in the absence of an alternative donor. A 25 year-old man with severe aplastic anemia underwent allogeneic HCT from his HLA-identical sibling. The patient was hepatitis B naive and had normal liver function tests. However the donor had hepatitis B surface antigen (HbsAg) positivity, and collected stem cells were positive for HBV DNA (1 × 104 copies/mL). Lamivudine was initiated to treat the patient prior to transplantation. Forty days after the HCT, the patient displayed hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb), and hepatitis B e antibody (HBeAb), with HBV-DNA negativity. Cyclosporine was tapered and finally stopped at day + 256. On day +368, 112 days after the cessation of cyclosporine HBV reactivation was detected with an HBV-DNA level of 10 × 104 copies/mL despite lamivudine. After demonstration of the YMDD mutation, adefovir dipivoxil was combined with lamivudine. The HBV-DNA became negative; AST ALT levels decreased to normal levels after a month of combination therapy. In conclusion adefovir was effective to treat lamivudine-resistant HBV infection in an allogeneic HCT recipient.

Hepatitis B virus infection status is an independent risk factor for multiple myeloma patients after autologous hematopoietic stem cell transplantation

The purposes of this study were to evaluate the infection by hepatitis B virus (HBV) and its impact on survival and to provide a clinical reference for monitoring and treating HBV during and after autologous hematopoietic stem cell transplantation (ASCT) in patients with multiple myeloma (MM). A retrospective analysis of HBV infections was performed in 70 MM patients who received a sequential bortezomib-containing induction therapy and ASCT in our department from June 2006 to February 2012. Among the 70 patients in our study, 11 cases (15.7 %) were hepatitis B surface antigen positive (HBsAg+), and 23 cases (33.3 %) were hepatitis B core antibody positive (HBcAb+). Eight cases were HBsAg, hepatitis B e antibody (HBeAb), and HBcAb positive, while one case was HBsAg, hepatitis B e antigen (HBeAg), and HBcAb positive. The median follow-up times for the HBsAg+ group and the HBsAg-negative (HBsAg-) group were 27.0 (7.6-85.2) months and 28.7 (7.1-111.0) months, respectively. The 1-year, 2-year, and 3-year overall survival rates of the HBsAg+ group were 90.9, 80.8, and 34.6 %, respectively, and the median survival time was 31.2 months (95 % CI, 24.8-37.6). The 1-year, 2-year, and 3-year overall survival rates of the HBsAg- group were 98.2, 94, and 84.6 %, respectively, while the median survival time was not yet available. There was a statistically significant difference (p=0.008) in the overall survival rate between the two groups. By Cox regression analysis, we found that the HBsAg+ status was a prognostic factor, which could independently influence the overall survival rate for ASCT. In conclusion, the HBsAg+ status is an independent risk factor for patients with MM receiving ASCT. The application of standard antiviral treatment might help to overcome this risk factor.

A Ruptured Hepatoma in a Non-cirrhotic Patient with Chronic Inactive Hepatitis B

Case Presentation: A 77-year-old male with no prior history of liver disease presented with an acute onset of diffuse abdominal pain. He had no history of illicit drug use, tobacco, or recent alcohol use. Laboratory studies were normal. A large liver mass with findings consistent of hemoperitonium was seen on CT scan. Peritoneal fluid analysis was negative for malignant cells. Hepatitis viral serologies showed positive Hepatitis B surface Antigen (HBsAg), negative Hepatitis B surface Antibody, positive Hepatitis B core antibody, negative Hepatitis B e-Antigen (HBeAg), positive Hepatitis B e-Antibody (HBeAb), and undetectable Hepatitis B virus DNA. Other serologies were negative. Serum alphafetoprotein was within normal limits. A partial hepatectomy was performed. Pathology confirmed hepatocellular cancer (HCC) in a background of a non-cirrhotic liver. Discussion: • Cirrhotic liver disease is the leading cause of primary HCC. • More than 20,000 new cases are diagnosed each year in the United States alone. • Worldwide 50% of patients diagnosed with HCC have chronic hepatitis B infection with 70-80% having underlying cirrhosis. •A direct correlation between HBV viral load and risk of developing HCC has been illustrated. •Patients with inactive or active chronic HBV have a higher incidence of HCC than the general population. •A positive HBsAG and HBeAg puts patients at higher risk when compared to patients positive for HBsAg with a negative HBeAg. • Patients with inactive HBV who consume alcohol habitually have been shown to have an increased risk of progression to HCC. • Later age of seroconversion from HBeAg to HBeAb has also been found to be directly correlated to an increased risk of developing HCC and related death. Conclusion: Though infrequent, the development of HCC in non-cirrhotic patients who are inactive carriers of HBV is still of concern. Several variables increase the risk of HCC in this patient population. Clinical follow-up with laboratory testing and radiographic studies is important, however, the frequency of surveillance in this population is not known.Figure: Abdominal MRI.

Frequency of HIV and HCV Co-Infections in Chronic HBV Patients Referred to Taleghani Hospital, Tehran, Iran from 2006 to 2010

Co-infection with hepatitis C virus (HCV) and/or human immunodeficiency virus (HIV) in patients with chronic hepatitis B virus (HBV) infection can alter the course of the disease. In this study, we investigated the frequency of HIV and/or HCV co-infection in chronic HBV patients and related risk factors in acquiring the HCV and or HIV co-infectionit. We studied 264 chronic HBV patients who visited the Gastrointestinal and Liver Ward of the Taleghani Hospital, Tehran, Iran between 2006 and 2010. Demographic information and records of possible risky behavior were obtained. Antibodies against HBV, HCV, and HIV, levels of alanine transaminase (ALT) and aspartate transaminase (AST), and conversion from hepatitis B e antigen (HBeAg) to hepatitis B e antibody (HBeAb) were evaluated. Of 264 patients with chronic HBV in this study, 184 patients (70%) were men and 78 patients (30%) were women. Only 1 patient (0.37%) was positive for anti-HIV antibody, whereas 12 patients (4.54%) were positive for anti-HCV antibody. None of the patients had co-infection with all 3 viruses (HBV, HIV, and HCV). This study demonstrated that the prevalence of HCV is higher than that of HIV in chronic HBV patients. Since HCV or HIV co-infection affects the therapeutic outcome in chronic HBV patients, testing for HIV and HCV is recommended, especially for patients with a history of risky behavior.

Association of core promoter mutations of hepatitis B virus and viral load is different in HBeAg(+) and HBeAg(-) patients

To identify the prevalence of hepatitis B e antigen (HBeAg) and to assess the association of hepatitis B virus (HBV) core promoter mutations and viral load in Indonesian patients. Sixty-four patients with chronic hepatitis, 65 with liver cirrhosis and 50 with hepatocellular carcinoma were included in this study. HBeAg and hepatitis B e antibody (HBeAb) tests were performed using enzyme-linked immunosorbent assay and the mutations were analyzed by sequencing. Viral load was measured by real-time polymerase chain reaction. Of 179 patients, 108 (60.3%) were HBeAg(-) and 86 (79.6%) of these HBeAg(-) patients had been seroconverted. The A1896 mutation was not found in HBeAg(+) patients, however, this mutation was detected in 70.7% of HBeAg(-) patients. This mutation was frequently found when HBeAg was not expressed (87.7%), compared to that found in HBeAg seroconverted patients (65.1%). The A1899 mutation was also more prevalent in HBeAg(-) than in HBeAg(+) patients (P = 0.004). The T1762/A1764 mutation was frequently found in both HBeAg(+) and HBeAg(-) patients, however, the prevalence of this mutation did not significantly differ among the two groups (P = 0.054). In HBeAg(+) patients, the T1762/A1764 mutation was correlated with lower HBV DNA (P < 0.001). The A1899 mutation did not correlate with HBV DNA (P = 0.609). In HBeAg(-) patients, the T1762/A1764 mutation alone was not correlated with HBV DNA (P = 0.095), however, the presence of either the T1762/A1764 or A1896 mutations was associated with increased HBV DNA (P < 0.001). The percentage of HBeAg(-) patients is high in Indonesia, and most of the HBeAg(-) patients had been seroconverted. The A1896 mutation was most likely the major cause of HBeAg loss. The T1762/A1764 mutation alone was associated with lower viral loads in HBeAg(+) patients, but not in HBeAg(-) patients.

Frequent Occurrence of Chronic Hepatitis B Virus Infection among West African HIV Type-1--Infected Children

The aim of this study, conducted in Ivory Coast, was to evaluate the prevalence and evolution of viral hepatitis in children coinfected with human immunodeficiency virus type 1 (HIV-1). Hepatitis B virus (HBV) and hepatitis C virus (HCV) markers were retrospectively and longitudinally assessed among 280 HIV-1-infected children enrolled in the Agence Nationale de Recherches sur le SIDA et les Hépatites Virales B et C 1244/1278 cohort. Among these, 173 (61.8%) received highly active antiretroviral therapy (HAART), including lamivudine (3TC) for 122 children. Detection of the hepatitis B s antigen (HBsAg) was performed on specimens collected at inclusion and 6 months later. If results of both tests were positive, hepatitis B e antigen (HBeAg)/hepatitis B e antibody (HBeAb) and HBV DNA levels were measured at inclusion and during follow-up. A fourth-generation HCV enzyme immunoassay was used for HCV screening at inclusion. In our pediatric cohort, no patients were infected with HCV, but the prevalence of HBsAg at inclusion was 12.1% (34 of 280; 95% confidence interval [CI], 8.6-16.6). Among the HBV-HIV-1-coinfected children, a high rate of positive HBeAg chronic hepatitis B (CHB) was noted at inclusion (82.4% [ 28 of 34]; 95% CI, 65.5%-93.2%) and after a median follow-up of 18 months (78.3%; 95% CI, 45.5%-92.7%), with no significant difference between children treated with HAART (with or without 3TC) and untreated ones. These children showed high HBV DNA levels (usually >8.0 log(10) copies/mL) and viral population consisting of nearly exclusively wild-type HBeAg-positive HBV strains, strongly suggesting that most of them were in the initial immunotolerant phase of chronic hepatitis B. In sub-Saharan Africa, children with chronic hepatitis B and who are treated with 3TC-based HAART are at risk of developing 3TC resistance. Further studies are required to guide the management of HBV-HIV-1-coinfected children.