Hepatitis B Virus Management Research Articles

Hepatitis B Virus Prevalence among HIV-Uninfected People Living in Rural and Peri-Urban Areas in Botswana.

(1) Background: we determined the prevalence of the hepatitis B virus (HBV) amongst people without human immunodeficiency virus (HIV) in rural and peri-urban areas in Botswana. (2) Methods: We screened for the hepatitis B surface antigen (HBsAg) from archived plasma samples of people without HIV (n = 2135) randomly selected from the Botswana Combination Prevention Program (BCPP) (2013-2018). We sequenced 415 bp of the surface region using BigDye sequencing chemistry. (3) Results: The median age of participants was 31 (IQR: 24-46) and 64% (1360/2135) were female. HBV prevalence was 4.0% (86/2135) [95% CI: 3.3-4.9]) and ranged between 0-9.2%. Older participants (>35 years) had increased odds of HBV positivity (OR: 1.94; 95% CI: [1.32-2.86]; p = 0.001). Thirteen samples were sequenced and seven (53.8%) were genotype A, three (23.1%) were genotype D and genotype E each. Clinically significant mutations were identified in the surface region, but no classic drug resistance mutations were identified. (4) Conclusions: We report an HBV prevalence of 4.0% (95% CI 3.3-4.9) among people without HIV in rural and peri-urban communities in Botswana with varying rates in different communities. A comprehensive national HBV program is required in Botswana to guide HBV prevention, testing and management.

Investigating linkage to care following community-based screening for hepatitis B virus in rural Senegal: A mixed methods study.

This paper investigates linkage to care following community-based screening for hepatitis B virus (HBV) in rural Senegal. HBV-positive participants who completed a biological and clinical examination to assess liver disease and treatment eligibility were referred to a regional hospital (if eligible for treatment), invited to join the Sen-B research cohort study (adults with detectable viral load) or referred to their local health centre (all others). Logistic regressions were conducted to investigate factors associated with (i) uptake of the scheduled post-screening examination, and (ii) HBV management initiation. Obstacles to HBV management were identified using thematic analysis of in-depth patient interviews. Of the 206 HBV-positive participants, 163 (79.1%) underwent the examination; 47 of the 163 (28.8%) initiated HBV management. Women, people not migrating for >6 months/year, individuals living in households with more agricultural and monetary resources, with other HBV-positive participants, and beneficiaries of the national cash transfer program, were all more likely to undergo the examination. The likelihood of joining the Sen-B cohort increased with household monetary resources, but decreased with agricultural resources. Initiation of HBV management in local health centre was higher among participants with a non-agricultural economic activity. Individuals reported wariness and confusion about HBV management content and rationale at various stages of the care continuum, in particular with respect to venous blood sampling and management without treatment. In conclusion, HBV community-based test-and-treat strategies are feasible, but early loss to follow-up must be addressed through simplified, affordable management and community support and sensitization.

Community dialogue to enhance understanding of beliefs, behaviours and barriers to care for people living with liver disease and HBV infection in KwaZulu Natal, South Africa

IntroductionThe World Health Organisation (WHO) has set targets for the elimination of Hepatitis B virus (HBV), which include preventing new infections and reducing deaths. We explored beliefs, behaviours and barriers to diagnosis, prevention and treatment for people living with HBV infection (PLWHB) and those with liver disease in a rural South African population in KwaZulu-Natal, to gather information to inform research and support the development of improved clinical and public health services. MethodsUsing an interdisciplinary approach (combining public engagement, social science, clinical and laboratory team members) we conducted a community dialogue with members of the Africa Health Research Institute (AHRI) Community Advisory Board (CAB). Notes from the discussions were used to write up an account from which themes were identified during a team debrief session for data analysis. ResultsThere was a lack of knowledge and awareness of HBV infection and transmission and prevention amongst CAB members, also reported among community members and healthcare workers. The participants recognised liver disease symptoms. Perceived causes of liver disease reported by the CAB were alcohol and non-adherence to HIV treatment. Barriers to care included stigma, poverty, and delays in referrals for HBV diagnosis and management. ConclusionUnderstanding barriers to care is important to shape future services for diagnosis, treatment and prevention of HBV and liver disease which are accessible, affordable and acceptable to the local population. Education, awareness and advocacy for improved liver health care pathways are required to make them effective for local communities.

Management of Hepatitis B Virus and Hepatitis C Virus Infections in Patients with Cancer Receiving Immune Checkpoint Inhibitors.

Patients with cancer with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection are excluded from many cancer clinical trials of immune checkpoint inhibitors (ICIs). Therefore, data are limited regarding the management of HBV and HCV infections in patients with cancer treated with ICIs. To address this gap, we reviewed the literature on management of HBV and HCV infections in patients with cancer receiving ICIs. We searched MEDLINE and PubMed for all original research articles, case reports, and systematic reviews published in English between Jul 2013 and Jul 2023 on patients with cancer with HBV or HCV infection receiving ICIs. We found 28 studies (three prospective clinical trials, seven retrospective cohort studies, nine retrospective case series, and nine case reports) that evaluated the safety of ICI therapy in patients with HBV infection and cancer. The overall rate of HBV reactivation was 1.4% (38/2799), and no HBV-related deaths were reported. The frequency of HBV reactivation in patients with chronic and past HBV infections was 2% (35/1667) and 0.3% (3/1132), respectively. The risk of HBV reactivation was significantly higher among patients with chronic HBV infection not receiving antiviral prophylaxis than among those receiving antivirals (17% vs 1%, p < 0.05). Based on high-quality evidence, for patients with chronic HBV infection, antiviral prophylaxis is recommended before ICI therapy initiation. For patients with past HBV infection, monitoring and on-demand antiviral treatment are sufficient. We found 11 studies (five clinical trials, five retrospective studies, and one prospective observational study) that evaluated the safety of ICI therapy in patients with HCV infection and cancer. The overall rate of HCV reactivation was 0.5% (2/387), and no HCV-related deaths were reported. HCV reactivation occurs primarily in patients receiving immunosuppressants for ICI-related toxic effects. ICIs are safe for HCV-infected patients with solid tumors. Chronic HBV or HCV infection should not be considered a contraindication for ICI therapy. Specific risk assessment, monitoring, and management strategies are necessary to reduce the risk of ICI-related liver injury in patients with cancer and chronic HBV or HCV infection.

Prospective study of hepatitis B and D epidemiology and risk factors in Romania: A 10-year update.

The global burden of hepatitis D virus (HDV) infection represents a major medical challenge and a public health crisis worldwide. However, there is a lack of accurate data on the epidemiology and risk factors for HDV. Hepatitis B virus (HBV) and HDV coinfection causes the most severe form of viral hepatitis, leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection, including the need for liver transplantation and death. To investigate the epidemiology, natural history, risk factors and clinical management of HBV and HDV coinfection in Romanian patients. This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania. All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled. Patients with acute hepatitis or incomplete data were excluded. Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period, 963 met the inclusion criteria. Testing for anti-HDV antibodies and HDV RNA was performed for all participants. Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires. All data were stored in an anonymized online database during the study. The prevalence of HBV was 3.8%; among these patients, the prevalence of HBV/HDV coinfection was 33.1%. The median age of the study population was 54.0 years, and it consisted of 55.1% men. A higher prevalence of HBV/HDV coinfection was observed in patients 50-69 years old. Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection (P = 0.03). Multivariate multiple regression analysis identified female gender (P = 0.0006), imprisonment (P < 0.0001), older age at diagnosis (P = 0.01) and sexual contact with persons with known viral hepatitis (P = 0.0003) as significant risk factors for HDV. This study shows that HDV infection among those with HBV remains endemic in Romania and updates our understanding of HDV epidemiology and associated risk factors. It emphasizes the need for systematic screening for HDV infection and collaborative initiatives for controlling and preventing HBV and HDV infection.

Advances in the Pharmacological Management of Chronic Hepatitis B.

Hepatitis B, a vaccine-preventable liver infection, remains a global public health problem. Dedicated groups of experts and funding are focusing on achieving a functional cure to eradicate this disease by 2030. With more than 40 molecules available or under investigation as new treatments for hepatitis B virus (HBV) infection, none of them is curative so far. Available treatments are effective in suppressing HBV replication and in decreasing the risk of developing cirrhosis, liver failure, hepatocellular carcinoma, and death, but do not eliminate the virus, and the risk of hepatocellular carcinoma remains. Nucleoside/nucleotide analogs are recommended as first-line therapy for patients with chronic hepatitis B infection to inhibit viral replication and lower the HBV DNA values, but long-term therapy is usually needed to maintain suppression. Cessation of the therapy in accordance with clinical guidelines can result in virological and clinical relapse. PubMed, Web of Science, clinicaltrials.gov , and gray literature sources were searched for articles discussing HBV management and new therapies. With current nucleoside/nucleotide analog therapies, fewer than 5% of patients lose hepatitis B surface antigen after 12 months, which underscores the need for new drugs that can achieve a functional cure. New therapies are being developed, including small interfering RNAs. Bepirovirsen, a modified antisense oligonucleotide, shows promising results and a good safety profile, but requires further exploration in larger number of patients to determine whether a functional cure is possible. Eradication of HBV infection with currently available therapies is not yet possible. Experts are developing innovative treatments, such as bepirovirsen, to achieve functional cure for this disease and to reduce morbidity and mortality associated with hepatic cirrhosis and hepatocellular carcinoma.

Virological, serological and clinical outcomes in chronic hepatitis B virus infection: development and validation of the HEPA-B simulation model

ObjectivesDetailed simulation models are needed to assess strategies for prevention and treatment of hepatitis B virus (HBV) infection, the world’s leading cause of liver disease. We sought to develop and...

Hepatitis B serology testing in patients with cancer initiating anticancer therapy.

375 Background: The prevalence of hepatitis B virus (HBV) in the US is ~5%. Patients receiving anticancer therapy with a history of HBV infection are at risk for viral reactivation leading to hepatitis flare, liver failure, and death. The American Society of Clinical Oncology (ASCO) updated 2020 HBV screening and management guidelines recommending all patients have HBV serologies before anticancer therapy initiation. In August 2021, only 17% of patients initiating anticancer therapy at UConn Health had HBV serology screening before treatment. We aimed to increase the HBV screening rate by at least 50%, using HBV serologies before initiation of anticancer therapy. Methods: The plan-do-study-act method was used to conduct this quality improvement (QI) project. To increase the HBV screening rate, we provided education and a two-part HBV serology ordering process improvement. Education consisted of an e-mail to cancer center providers and nurses detailing updated ASCO HBV screening and recommendations. The ordering process improvement plan included 1) multidisciplinary team created HBV serology order, which could be ordered inside or outside of anticancer treatment plan and 2) best practice advisory (BPA) alert to providers when a new anticancer treatment plan was opened. Part 2 of the ordering process improvement plan included incorporation of HBV serology order set directly into anticancer treatment plans along with other baseline laboratory orders to reduce provider time and eliminate the need for BPA. A two-part retrospective chart review was conducted, using an electronic medical record report of patients initiating anticancer treatment plans between treatment periods (pre -intervention and post-intervention). Inclusion criteria included: patients &gt; 18 years and treated with anticancer therapy for newly diagnosed cancer. Patients were excluded if they had known or suspected HBV infection; or were within the Department of Corrections. Results: During the post-implementation phase, 125 patients initiated a new anticancer treatment plan. Of these, 30 (24%) patients were excluded: 18 received prior treatment before HBV serology implementation, 6 received previous anticancer treatment, 5 did not receive anticancer treatment, and 1 was a Department of Correction patient. Out of 95 remaining eligible patients, 84 patients (88.5%) had HBV serologies performed before treatment initiation. Conclusions: Incorporating HBV serologies into anticancer treatment plans appears to be a reliable, acceptable, and valid means to increase adherence to ASCO guidelines related to HBV screening prior to initiation of anticancer therapy. We plan to initiate a follow-up analysis to identify reasons why HBV serologies were not obtained in 12% of patients to inform further QI interventions, and to ensure appropriate management of patients with positive HBV serology results.

KNOWLEDGE LEVEL OF THE MANAGEMENT OF HEPATITIS B DURING PREGNANCY AMONG SPECIALIST AND RESIDENTS OF THE OBSTETRICS AND GYNECOLOGY: A SURVEY STUDY FROM TURKEY

In this study, it is aimed to assess the levels of knowledge of specialists and residents of gynecology and obstetrics in Turkey, concerning management of Hepatitis B virus (HBV)-positive pregnant women. A cross-sectional online survey study was conducted on Gynecology and Obstetrics specialists and residents between November 2019 and February 2020. Questionnaire form concerning management of HBV-positive pregnant women, which was prepared by researchers on the basis of literature, has been sent to Gynecology and Obstetrics Clinics and departments of Turkey via online means. The questionnaire form consisted of sections including socio-demographic characteristics (age group, gender, time spent as a specialist doctor/resident (years), place of work) and assessing the level of knowledge concerning the management of HBV(+) pregnant women. The questions in this section were created by the researchers based on the literature. These questions are not questions of a scale whose validity and reliability studies have been conducted. Knowledge Level Score on the management of HBV-positive pregnant women (KLS) has been calculated in a range of 0 to 18 points. Statistics Package for the Social Sciences (SPSS) version 25.0 was used for statistical analysis. A total of 215 physicians, including 50 residents (23.3%) and 165 (76.7%) specialists, have participated in the study. Since normal distribution was not observed as a result of normality evaluation, mean values are presented as median (25%-75%). Median KLS was found as 8.0 (7.0-10.0). In residents, KLS was 8.0 (6.75-9.0), and in specialists, it was 8.0 (7.0-10.0). There was no statistically significant difference between the scores of residents and specialists. The median level of knowledge of the physicians participating in the study about Hepatitis B treatment in pregnant women was 8.0 (7.0-10.0). This score was interpreted as “inadequate” out of a maximum of 18 points, by researchers. Despite limitations, this study has shown the inadequacy of level of knowledge of gynecologists and obstetricians in Turkey concerning management of Hepatitis B in pregnant women. There is a need for further studies and continuous training of Gynecologists and Obstetricians.

Community Health Workers in Spain: a missing strategy to tackle hepatitis in migrant populations

Abstract Community health workers (CHWs) are health care providers which live and serve in the community and are responsible for the provision of health education to their communities, promoting healthy habits and lifestyles, diagnosing common illnesses, and encouraging the use of health services by linking people to health services. CHW programmes have been formally included as part of national health systems in many low- and middle-income countries (e.g., Ethiopia or Brazil), along with some high-income countries (e.g., Canada). Despite the major contribution CHWs have proven to make in health systems globally, Spain has yet to introduce a law acknowledging their role in the health system. The introduction of CHWs allows for the decentralization of health services and their extension beyond the regular forms of health service delivery (e.g. primary health centres or hospitals) as additional strategies for equity and person-centred care. CHWs have the capacity to reach underserved and vulnerable populations, including marginalized populations, which often encounter barriers to engage with their health systems. Migrant communities in Spain are an example of communities which are often marginalized and struggle to have their health needs met through their host health system. For instance, studies have reported a significantly higher prevalence of chronic infection of Hepatitis B virus (HBV) among migrants in comparison to the general Spanish population and late presentation to care in this population has been reported. CHWs have the potential to reach these underserved communities and provide culturally and linguistically appropriate health information, emphasizing the importance of HBV prevention, management and treatment, and vaccination. Ultimately, CHWs can offer decentralized and accessible health care and lead in co-creation processes for effective viral hepatitis - including HBV vaccination- services in community spaces and facilitate linkage to higher levels of care.

Training the healthcare workforce: the global experience with telementorship for hepatitis B and hepatitis C

BackgroundTelementorship has emerged as an innovative strategy to decentralise medical knowledge and increase healthcare capacity across a wide range of disease processes. We report the global experience with telementorship to support healthcare workers delivering hepatitis B virus (HBV) and hepatitis C virus (HCV) care and treatment.MethodsIn early 2020, we conducted a survey of HBV and HCV telementorship programmes, followed by an in-depth interview with programme leads. Programmes were eligible to participate if they were located outside of the United States (U.S.), focused on support to healthcare workers in management of HBV and/or HCV, and were affiliated with or maintained adherence to the Project ECHO model, a telementorship programme pioneered at the University of New Mexico. One programme in the U.S., focused on HCV treatment in the Native American community, was purposively sampled and invited to participate. Surveys were administered online, and all qualitative interviews were performed remotely. Descriptive statistics were calculated for survey responses, and qualitative interviews were assessed for major themes.ResultsEleven of 18 eligible programmes completed the survey and follow up interview. Sixty-four percent of programmes were located at regional academic medical centers. The majority of programmes (64%) were led by hepatologists. Most programmes (82%) addressed both HBV and HCV, and the remainder focused on HCV only. The median number of participating clinical spoke sites per programme was 22, and most spoke site participants were primary care providers. Most ECHO sessions were held monthly (36%) or bimonthly (27%), with sessions ranging from 45 min to 2 h in length. Programme leaders identified collective learning, empowerment and collaboration to be key strengths of their telementorship programme, while insufficient funding and a lack of protected time for telementorship leaders and participants were identified as major barriers to success.ConclusionThe Project ECHO model for telementorship can be successfully implemented across high and low-and-middle-income countries to improve provider knowledge and experience in management of viral hepatitis. There is a tremendous opportunity to further expand upon the existing experience with telementorship to support non-specialist healthcare workers and promote elimination of viral hepatitis.

Implementing of Nursing Intervention on Knowledge, Perceived Stigma and Health related Outcomes among Patients with Hepatitis B Virus

Background: Despite significant advances in the therapy components for hepatitis B virus (HBV) prevention and treatment, HBV-related stigma is seen as a major barrier to HBV management. The HBV-related health stigma has a direct negative impact on the process of healthcare delivery and medical decision-making. The study aimed to evaluate the effect of implementing the nursing intervention on knowledge, perceived stigma and Health-related outcomes among patients with hepatitis B Virus. Subjects and method: A quasi-experimental (pre -posttest) study research design was used. Study setting: The present study was carried out at Menoufia University Hospital (in-patient medical department) and well as in the out-patient medical department after patients discharge and followed up. Sampling. A purposive sample of 50 adult patients who were diagnosed with HBV virus. Results: The total mean knowledge score was significantly improved post-intervention than pre-intervention among studied HBV patients. The mean of hepatitis B stigma level reduced post-intervention. There were statistically significant improvements among studied patients’ related to some of abdominal, activity, and systemic symptoms post-intervention. There was a significant improvement for serum total bilirubin and serum ALT among studied patients post-intervention. There was a reverse correlation between hepatitis B knowledge and hepatitis B stigma post-intervention. Conclusion: Implementing a nursing intervention significantly enhances patient knowledge, lowers perceived stigma level and improves health-related outcomes. Recommendation: Establish periodic public awareness campaigns emphasizing hepatitis B virus transmission methods to discover new cases and control infection.

Hepatitis B virus-induced hepatocellular carcinoma: a persistent global problem.

Hepatitis B virus (HBV) infections are highly prevalent globally, representing a serious public health problem. The diverse modes of transmission and the burden of the chronic carrier population pose challenges to the effective management of HBV. Vaccination is the most effective preventive measure available in the current scenario. Still, HBV is one of the significant health issues in various parts of the globe due to non-response to vaccines, the high number of concealed carriers, and the lack of access and awareness. Universal vaccination programs must be scaled up in neonates, especially in the developing parts of the world, to prevent new HBV infections. Novel treatments like combinational therapy, gene silencing, and new antivirals must be available for effective management. The prolonged infection of HBV, direct and indirect, can promote the growth of hepatocellular carcinoma (HCC). The present review emphasizes the problems and probable solutions for better managing HBV infections, causal risk factors of HCC, and mechanisms of HCC.

Assessment of the Knowledge of Hepatitis B Virus Infection in Primary Healthcare Centers in Abuja, Nigeria

Hepatitis B virus (HBV) infection affects the liver and can lead to potentially life-threatening acute or chronic disease. The population with high HBV infection prevalence of ≥ 8%, such as Nigeria, presents the highest risk of HBV transmission among health-workers. There is a need to disseminate knowledge of HBV infection and the risk of transmission to health-workers. In this baseline study, the team assessed the knowledge of HBV infection among health-workers in Primary Healthcare Centers (PHCs) in AMAC, Abuja. We conducted cross-sectional descriptive research that studied 168 randomly selected health-workers from 58 PHCs in AMAC, collected data with a pre-tested structured questionnaire, and analyzed it with SPSS version 21.0. The knowledge level of HBV symptoms and transmission ranged from 57.1% to 85.7%s and 84.5% to 91.7%, respectively. About 67% demonstrated good knowledge of HBV screening for pregnant women and 69% of Hepatitis B vaccination at birth. All the PHCs (100%) reported the unavailability of guidelines/protocols for HBV infection in pregnancy management and prevention. Furthermore, 51.2%, 53.7%, and 55.6% demonstrated poor knowledge of referral, PMTCT eligibility, and increased need for laboratory tests, respectively. Moreover, 60.2% showed poor awareness of treatment eligibility and 61.2% of choice of drug. Concluding, the respondents demonstrated good knowledge of HBV infection symptoms, transmission, screening for pregnant women, and vaccination schedules to prevent HBV infection. They showed a poor understanding of the referral of pregnant HBV seropositive women from the PHCs to secondary/tertiary hospitals, PMTCT, laboratory requirements for pregnant seropositive clients, and management of chronic HBV in pregnancy. Keywords: Abuja, Hepatitis B virus Infection, Health-workers, Knowledge, Primary healthcare centers.

Hepatitis B core-related antigen: a novel and promising surrogate biomarker to guide anti-HBV therapy.

The current requirement for biomarkers to detect hepatitis B virus (HBV) infection is polarized. One is a fully-automated and highly sensitive measurement system; the other is a simple system for point-of-care testing (POCT) in resource-limited areas. Hepatitis B core-related antigen (HBcrAg) reflects intrahepatic covalently closed circular DNA and serum HBV DNA. Even in patients with undetectable serum HBV DNA or HBsAg loss, HBcrAg may remain detectable. Decreased HBcrAg levels are associated with reduction of the occurrence of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB). Recently, a fully-automated, novel high-sensitivity HBcrAg assay (iTACT-HBcrAg, cut-off value: 2.1 log U/mL) has been developed. This attractive assay has been released in Japan very recently. iTACT-HBcrAg can be useful for monitoring HBV reactivation and prediction of HCC occurrence, as an alternative to HBV DNA. Moreover, monitoring HBcrAg may be suitable for determining the therapeutic effectiveness of approved drugs and novel drugs under development. Presently, international guidelines recommend anti-HBV prophylaxis for pregnant women with high viral loads to prevent mother-to-child transmission of HBV. However, >95% of HBV-infected individuals live in countries where HBV DNA quantification is not available. Worldwide elimination of HBV needs the scaling-up of examination and medication services in resource-limited areas. Based on this situation, a rapid and easy HBcrAg assay as a POCT is valuable. This review provides the latest information regarding the clinical use of a new surrogate marker, HBcrAg, in HBV management, based on iTACT-HBcrAg or POCT, and introduces novel agents targeting HBV RNA/protein.

Hepatitis B in Africa Collaborative Network: cohort profile and analysis of baseline data.

Approximately 80 million people live with chronic hepatitis B virus (HBV) infection in the WHO Africa Region. The natural history of HBV infection in this population is poorly characterised, and may differ from patterns observed elsewhere due to differences in prevailing genotypes, environmental exposures, co-infections, and host genetics. Existing research is largely drawn from small, single-centre cohorts, with limited follow-up time. The Hepatitis B in Africa Collaborative Network (HEPSANET) was established in 2022 to harmonise the process of ongoing data collection, analysis, and dissemination from 13 collaborating HBV cohorts in eight African countries. Research priorities for the next 5years were agreed upon through a modified Delphi survey prior to baseline data analysis being conducted. Baseline data on 4,173 participants with chronic HBV mono-infection were collected, of whom 38.3% were women and the median age was 34years (interquartile range 28-42). In total, 81.3% of cases were identified through testing of asymptomatic individuals. HBeAg-positivity was seen in 9.6% of participants. Follow-up of HEPSANET participants will generate evidence to improve the diagnosis and management of HBV in this region.

Management of Hepatitis B and C during Pregnancy: Neonatal Implications

Over the last several decades, we have seen increased rates of infants born to persons with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV). Due to this, many obstetric and pediatric organizations have updated their guidelines about screening and management of HBV and HCV during pregnancy, as well as the management of the exposed infant. Current guidelines suggest that all pregnant individuals should be screened for both HBV and HCV during each pregnancy. Appropriate medical care of pregnant persons and the newborn can significantly reduce the risk of vertical transmission.

Updated Treatment Guidelines for Chronic Hepatitis B

Chronic hepatitis B virus (HBV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma in Korea. While the prevalence of HBV infection is gradually declining in Korea, 3 of the population still suffers from HBV-related chronic liver diseases. In this review, we summarize the updated clinical guidelines for management of chronic HBV, as revised by the Korean Association for the Study of the Liver in 2022.

Risk of drug-induced liver injury in chronic hepatitis B and tuberculosis co-infection: A systematic review and meta-analysis.

Patients with tuberculosis (TB) disease treated with multi-drug regimens are at risk of developing drug induced liver injury (DILI), and DILI risk might be even higher in patients with underlying liver disease. We aimed to evaluate whether underlying chronic hepatitis B virus (HBV) and TB co-infection are associated with a higher risk of TB therapy-related DILI. We conducted a systematic review and meta-analysis using MEDLINE/PubMed from inception to 31 December 2021. Primary outcome assessed was development of DILI following multi-drug TB treatment. Meta-analysis using random-effects models were utilized to evaluate whether underlying chronic HBV was associated with increased risk of DILI in patients undergoing active TB treatment. A total of 10 studies met inclusion criteria to be analysed, among which 520 patients had HBV-TB co-infection and 2988 patients had active TB disease without HBV. Prevalence of DILI was 21.9% in HBV-TB co-infected patients and 11.9% in TB patients without HBV. On meta-analysis, HBV-TB co-infected patients had significantly higher risk of DILI when treated with TB therapies compared with TB patients without HBV (pooled risk ratio 1.98, 95% CI 1.38-2.83, I2 = 68%). Sub-analysis of prospective cohort studies conducted after year 2000 detected a pooled risk ratio of 2.75 (95% CI 2.10-3.59, I2 = 0%). In conclusion, HBV-TB co-infected patients undergoing multi-drug TB therapy have 2-3 times higher risk of DILI compared with TB patients without HBV. Routine HBV screening prior to initiation of TB therapy is critical for early identification of HBV-TB co-infection, so that clinicians can modify TB and HBV treatment and management to reduce risks of DILI.

Hepatitis B Virus Research in South Africa.

Despite being vaccine-preventable, hepatitis B virus (HBV) infection remains the seventh leading cause of mortality in the world. In South Africa (SA), over 1.9 million people are chronically infected with HBV, and 70% of all Black chronic carriers are infected with HBV subgenotype A1. The virus remains a significant burden on public health in SA despite the introduction of an infant immunization program implemented in 1995 and the availability of effective treatment for chronic HBV infection. In addition, the high prevalence of HIV infection amplifies HBV replication, predisposes patients to chronicity, and complicates management of the infection. HBV research has made significant progress leading to better understanding of HBV epidemiology and management challenges in the SA context. This has led to recent revision of the national HBV infection management guidelines. Research on developing new vaccines and therapies is underway and progress has been made with designing potentially curative gene therapies against HBV. This review summarizes research carried out in SA on HBV molecular biology, epidemiology, treatment, and vaccination strategies.