Hepatitis In Asia Research Articles

Burden and Trends of Acute Viral Hepatitis in Asia from 1990 to 2019.

Asia has a very high burden of acute hepatitis; thus, a comprehensive study of the current burden and long-term trends of acute hepatitis in Asia is needed. We aimed to assess the current status and trends from 1990 to 2019 of acute hepatitis burden in Asia, using the data from the Global Burden of Diseases Study 2019 (GBD 2019) results. Methods: We used the data from the GBD 2019. Absolute death, incidence, and disability adjusted life years (DALY) number and rate of acute hepatitis in Asia were derived from the database from 1990 to 2019. Age-standardized mortality, incidence and DALY rates (ASMR, ASIR and ASDR) were used to compare populations in different regions and times. The estimated annual percentage change (EAPC) in the rates quantified the trends of the acute hepatitis burden. Results: From 1990 to 2019, the ASMR and ASDR of acute hepatitis decreased significantly at different paces, with the largest decrease in acute hepatitis C and the smallest in acute hepatitis E. The ASIR of acute hepatitis decreased relatively slowly, by an average of 0.06% (95% CI, 0.05–0.08%) per year in acute hepatitis A, 0.91% (0.64–1.18%) per year in acute hepatitis C and 0.26% (0.24–0.28%) per year in acute hepatitis E; while the ASIR of acute hepatitis B decreased by an average of 1.95% (1.08–2.11) per year. From 1990 to 2019, the incidence rate of acute hepatitis A increased in most age groups (from the age of 5 to 70), with the 50–55 years group having the fastest increase by an average of 1.81% (95% CI, 1.67–1.95%) per year. In 2019, Afghanistan had the highest ASMR (10.44 per 100,000) and ASDR (357.85 per 100,000) of acute hepatitis, and the highest ASIR was in Mongolia (4703.14 per 100,000). Conclusions: In Asia, the burden of acute viral hepatitis was at a relatively high level, compared with the other four continents. International cooperation and multifaceted and multisectoral actions are needed for Asian countries to eliminate viral hepatitis and to contribute to the global elimination of viral hepatitis.

Changing clinical management of NAFLD in Asia.

Non-alcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease, affecting approximately 25% of the world's population. Recently, because of the sedentary lifestyle and overnutrition resulting from urbanisation, the burden of NAFLD has rapidly increased in many Asian countries. Currently, the prevalence of NAFLD in Asia is approximately 30%, as is the case in many Western countries. In Asia, the prevalence and presentation of NAFLD vary widely across regions because of the substantial diversity in race, socioeconomic status and living environment. Furthermore, the dual aetiology of fatty liver, particularly with viral hepatitis in Asia, makes it complex and challenging to manage. Because Asians are likely to have central adiposity and insulin resistance, approximately 7%-20% of non-obese Asians with body mass indexes of less than 25kg/m2 are estimated to have NAFLD. Accumulating evidence indicates that NAFLD is associated with various extrahepatic comorbidities such as cardiovascular disease, chronic kidney disease, malignancy, in addition to liver-specific complications. Therefore, NAFLD should be managed as a multisystem disease in conjunction with metabolic syndrome. Lifestyle modification remains the basis of NAFLD management, but few patients can achieve adequate weight loss and maintain it long term. While various pharmacological agents are in phase 3 trials for steatohepatitis, Asian patients are underrepresented in most trials. This article reviews the epidemiological trends, clinical features, optimal assessment and current management practices for NAFLD in Asia.

HEPATITIS C

Introduction: WHO estimates that there are more than 185 million people overthe globe infected with hepatitis C. Among these 350,000 die each year with hepatitis. Heprevalence of hepatitis in Asia is estimated to be 3.4%. Pakistan has been rated as the secondmost common country in the world with active hepatitis C infection. This study aims at identifyingthe frequency of risk factors for hepatitis C irus transmission. Understanding the frequency ofcommon factors of HCV would help to implement strategies in long-term prevention of hepatitistransmission among community. Objectives: To determine the frequency of common factorsfor transmission of hepatitis C in adult patients. Study Design: Descriptive cross-sectionalstudy. Setting: Department of Medicine, Saidu Teaching Center, Swat. Period: 01-01-2016 to01-12-2016. Methodology: 140 patients were observed and evaluated. Detailed medical historywas taken.5 ml of venous blood sample was collected under aseptic conditions. Blood wascentrifuged at 5000 rpm for 5 minutes and serum was transferred to separate test tubes for furthertesting. The initial screening was carried out by immunochromatography for the qualitative detectionHCV antibodies in serum or plasma. Output variable was stratified among age andgender. Chi square test was applied to see effect of modification. All the positive samples onICT were tested on ELISA (third generation) with signal-to-cut-off ratio > 1.0 for confirmation.Results: Our study shows that mean age was 45 years with SD ± 12.24. Fifty eight percentpatients were male and 42% patients were female. Forty two percent patients had hepatitis Cdue to Injection, infection and-* /transfusions, surgical scars were present in 23% patients withhepatitis C, (2%) patients with hepatitis C had tattoos, 8% patients had hepatitis C due to nose/ear piercing and 25% patients had hepatitis C due to dental procedures. Conclusion: Our studyconcludes that the most common risk factors responsible for transmitting hepatitis C in adultswere infections/transfusions (42%) followed by dental procedures (25%) and surgical scars(23%).

Nonalcoholic fatty liver disease in Asia: emerging perspectives.

As in the West, nonalcoholic fatty liver disease (NAFLD) is the commonest chronic liver disease in Asia, with a prevalence higher than 40% in some countries. The risk factors for NAFLD development are similar to those in Western countries, including increased body mass index, diabetes, insulin resistance, and metabolic syndrome. NAFLD in Asians is associated with different extrahepatic manifestations involving the cardiovascular, gastrointestinal, and renal systems. A considerable proportion of Asians with NAFLD are described as having "lean" NAFLD. Present in approximately 20% of the Asian population, lean NAFLD is closely linked with insulin resistance, diabetes, and other metabolic complications, but its association with disease progression to nonalcoholic steatohepatitis and cirrhosis remains to be defined. There is emerging evidence of the interactions of NAFLD with hepatitis B virus and hepatitis C virus infection in Asia. Unlike in Western countries, NAFLD constitutes only a minority of cirrhosis and hepatocellular carcinoma cases in Asia. Possible explanations are the lower prevalence of obesity and the overwhelming problem of viral hepatitis in Asia. With aging of the obesity cohort in Asia, NAFLD-related liver complications are expected to increase.

Seroprevalence of Hepatitis E Virus Among Injection Drug Users and Non-Injection Drug Users in Hamadan, West of Iran

Background: Hepatitis E virus (HEV) infection is a self-limited hepatitis and the most common cause of acute adult hepatitis in Asia. Young adults and middle-aged populations are more likely to be infected than other age groups. Objectives: The aim of this study was to determine the seroprevalence of anti-HEV among injection drug users (IDUs) compared to nonIDUs. Patients and Methods: This was a cross-sectional study performed on 131 IDUs referred to Farshchian Hospital, Hamadan, Iran and 131 nonIDUs selected from healthy visitors between March 2011 and March 2012. Anti-HEV IgG was measured in serum by ELISA method (DiaPro, Milan, Italy). Data including age, gender, education, location and duration of injection drug used were collected using a questionnaire. Results: In this study, the seroprevalence of hepatitis E virus antibody among IDUs group was 6.1%, and 1.5% among non-IDU group (Odds Ratio = 5.48; CI = 1/069-22/84), indicating that injection drug users were almost five and a half times more than non-IDUs at risk of HEV infection (P = 0.053). There was no significant association between seroprevalence of hepatitis E virus and education level (P = 0.46), duration of injection (P = 0.38) and location (P = 0.19). Conclusions: Seroprevalence of hepatitis E virus among IDUs group was higher than non-IDU group, which might be due to possible blood transmission of HEV among IDUs.

Hepatitis E with Gullain–Barré syndrome: still a rare association

Gu i l l a i n–Ba r r e s ynd r ome (GBS ) i s a n a cu t e polyradiculoneuropathy presenting, in its classical form, as a rapidly evolving symmetric and ascending motor paralysis with hypotonia and areflexia accompanied by an acellular cerebrospinal fluid response with elevated protein level. In over two third of cases, an infection precedes the onset of neuropathy by 1–4 weeks (Govoni and Granieri 2001). Cytomegalovirus and Epstein–Barr virus account for a large proportion of virus-triggered cases. There are also many reports linking acute hepatitis A, B, and C with GBS. Hepatitis E is a frequent cause of acute hepatitis in Asia, the Middle East, North Africa, and South or Central America. Locally acquired hepatitis E in individuals who have not travelled to endemic areas is, however, becoming an emerging problem in European countries (Dalton et al. 2008; Mansuy 2008) but its association with GB syndrome is rarely seen. Case report

The inhibitory effect of Gynostemma pentaphyllum on MCP-1 and type I procollagen expression in rat hepatic stellate cells

Aim of the study Gynostemma pentaphyllum is a popular folk medicine that has been used for treatment of hepatitis in Asia. Our previous study demonstrates that Gynostemma pentaphyllum n-butanol extract inhibits the onset and improves the recovery of CCl 4-induced liver fibrogenesis in rats and inhibits PDGF-induced rat hepatic stellate cells (HSCs) proliferation. In this study, the effect of Gynostemma pentaphyllum extract on cytokines and type I procollagen expression was analyzed. Materials and methods Rat HSCs were treated with PDGF, Gynostemma pentaphyllum n-butanol extract, RP-18-Gyp fraction, rapamycin or vehicle. Rat cytokine antibody array chip or ELISA kit was used for cytokines detection. Intracellular protein expression was detected by Western blotting, mRNA expression was analyzed by RT-PCR. Results RP-18-Gyp fraction is the more purified gypenosides fraction from Gynostemma pentaphyllum n-butanol extract. In cell proliferation, the inhibitory effect of 200 μg/ml RP-18-Gyp fraction is similar to 500 μg/ml Gynostemma pentaphyllum n-butanol extract. Furthermore, both of them have the ability of decreasing monocyte chemoattractant protein-1 (MCP-1) mRNA expression and protein release and inhibiting type I procollagen protein expression. Conclusions Both of Gynostemma pentaphyllum n-butanol extract and its more purified RP-18-Gyp fraction have the biological activities in the inhibition of cell proliferation, MCP-1 release and type I procollagen expression in rat HSCs. These data could provide the evidence to support for the traditional use of Gynostemma pentaphyllum in hepatitis.

Freshwater Clam Extract Ameliorates Acute Liver Injury Induced by Hemorrhage in Rats

The freshwater clam is a widely-consumed shellfish and is used as a remedy for chronic hepatitis in Asia. However, its contribution to acute liver injury (ALI) remains unclear. The aim of this study is to assess the protective effects of freshwater clam extract (CE) in ALI induced by hemorrhage in rats. Rats were randomly divided into 5 groups, (1) blood loss (BL) 40%, (2) CE 150 mg/kg plus BL 40%, (3) CE 75 mg/kg plus BL 40%, (4) CE 150 mg/kg, and (5) CE 75 mg/kg groups. CE was given by femoral vein catheter in Groups 2 to 5. Initial hemorrhage was induced by withdrawing blood (loss 40% of total blood volume) from a femoral arterial catheter after CE administration in Groups 2 and 3. The levels of blood tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) were measured at several time points during the experimental period. Rats were sacrificed after 48 hours, and the liver was harvested for hematoxylin and eosin (HE) stain to show liver tissue injury. The results indicated that hemorrhage significantly decreased mean arterial pressure (MAP), increased blood AST, ALT and LDH levels and induced liver injury. Pre-treatment with the CE increased MAP and IL-10 levels and decreased AST, ALT, LDH and TNF-alpha levels after hemorrhage. The HE stains showed diminished organ injury in the CE groups. In conclusion, freshwater clam extract is a potential immunomodulating agent and ameliorates acute liver injury.

High prevalence of GB virus C/hepatitis G virus in healthy persons in Ho Chi Minh City, Vietnam.

GB virus C or hepatitis G virus (GBV-C/HGV), a novel Flavivirus, is detected in 1.5% of US blood donors. The prevalence is higher in multiply transfused patients and in persons with liver disease. Because of the increased incidence of hepatitis in Asia, sera from healthy Vietnamese were tested for the presence of GBV-C/HGV RNA by the reverse transcription polymerase chain reaction. Viral RNA was detected in 5.7% of those tested; 6 of 81 volunteer blood donors had positive samples as did 5 of 97 army recruits and 2 of 50 postpartum women. When the 188-bp product from 6 subjects was sequenced, there was 75%-85% homology at the nucleotide level compared with published sequences, indicating a high degree of genotypic variation, even within a putatively well-conserved region of the viral genome. Viremia with this non-cell-associated novel virus appears to be common among normal persons in Vietnam.

F5-3 Treatment of hepatitis in Asia and future perspectives

Production of infectious hepatitis C virus in tissue culture from a cloned viral genome. Wakita T, Pietschmann T, Kato T, Date T, Miyamoto M, Zhao Z, Murthy K, Habermann A, Krausslich HG, Mizokami M, Bartenschlager R, Liang TJ.Hepatitis C virus (HCV) infection causes chronic liver diseases and is a global public health problem. Detailed analyses of HCV have been hampered by the lack of viral culture systems. Subgenomic replicons of the JFH1 genotype 2a strain cloned from an individual with fulminant hepatitis replicate efficiently in cell culture. Here we show that the JFH1 genome replicates efficiently and supports secretion of viral particles after transfection into a human hepatoma cell line (Huh7).Particles have a density of about 1.15–1.17 g/ml and a spherical morphology with an average diameter of about 55 nm. Secreted virus is infectious for Huh7 cells and infectivity can be neutralized by CD81-specific antibodies and by immunoglobulins from chronically infected individuals. The cell culture-generated HCV is infectious for chimpanzee. This system provides a powerful tool for studying the viral life cycle and developing antiviral strategies.[Abstract reproduced by permission of Nat Med 2005;11(7):791–6]Complete replication of hepatitis C virus in cell culture. Lindenbach BD, Evans MJ, Syder AJ, Wolk B, Tellinghuisen TL, Liu CC, Maruyama T, Hynes RO, Burton DR, McKeating JA, Rice CM.Many aspects of the hepatitis C virus (HCV) life cycle have not been reproduced in cell culture, which has slowed research progress on this important human pathogen. Here, we describe a full-length HCV genome that replicates and produces virus particles that are infectious in cell culture (HCVcc). Replication of HCVcc was robust, producing nearly 10(5) infectious units per milliliter within 48 hours. Virus particles were filterable and neutralized with a monoclonal antibody against the viral glycoprotein E2. Viral entry was dependent on cellular expression of a putative HCV receptor, CD81. HCVcc replication was inhibited by interferon-alpha and by several HCV-specific antiviral compounds, suggesting that this in vitro system will aid in the search for improved antivirals.[Abstract reproduced by permission of Science 2005;309(5734):623–6]Robust hepatitis C virus infection in vitro. Zhong J, Gastaminza P, Cheng G, Kapadia S, Kato T, Burton DR, Wieland SF, Uprichard SL, Wakita T, Chisari FV.The absence of a robust cell culture model of hepatitis C virus (HCV) infection has severely limited analysis of the HCV life cycle and the development of effective antivirals and vaccines. Here we report the establishment of a simple yet robust HCV cell culture infection system based on the HCV JFH-1 molecular clone and Huh-7-derived cell lines that allows the production of virus that can be efficiently propagated in tissue culture. This system provides a powerful tool for the analysis of host-virus interactions that should facilitate the discovery of antiviral drugs and vaccines for this important human pathogen.[Abstract reproduced by permission of Proc Natl Acad Sci USA 2005;102(26):9294–9]

Association of hepatitis E virus with an outbreak of hepatitis in Pakistan: serologic responses and pattern of virus excretion.

Hepatitis E virus (HEV), a positive-strand RNA agent, has been associated with enterically transmitted non-A, non-B hepatitis in Asia, Africa, and Mexico. To evaluate the role of HEV in an outbreak of hepatitis in Pakistan, we used immune electron microscopy to detect 1) antibody to HEV, for evidence of infection, and 2) virus, to determine the pattern of HEV excretion. Paired sera from 2 patients were assayed for antibody by using reference HEV: one seroconverted, an atypical finding for HEV infections; the other had high levels of anti-HEV in both sera. Virus particles with the size (29 x 31 nm) and morphology of HEV were detected in feces from 10 of 85 patients and serologically identified as HEV by using reference antibodies from an HEV-infected chimpanzee. One of these HEV-containing specimens was collected 9 days before the onset of jaundice; it was among feces from 38 outpatients with nonspecific symptoms and biochemical hepatitis, 12 of whom subsequently developed jaundice. The other 9 feces with HEV were among 36 collected within 7 days of the onset of acute icteric hepatitis; all 11 feces from days 8 to 15 were negative for HEV. Fecal concentrations of HEV appeared to be lower than those of many enteric viruses: only one specimen contained as many as 5 particles per EM grid square. It is concluded that HEV was etiologically associated with the epidemic and was predominantly excreted at very low levels during the first week of jaundice.

Non-A, non-B fulminant viral hepatitis in France in returnees from Asia and Africa.

Among 61 patients admitted for non-A, non-B fulminant viral hepatitis to Hôpital Beaujon, 10 had returned from Asia or Africa, and 51 had not been outside France, within the month preceding jaundice. This suggests that hepatitis might have been contracted in Asia or Africa in the former, and in France in the latter. The interval between the onset of jaundice and the onset of hepatic encephalopathy was 10 days in the former and 26 days in the latter (P less than 0.03). The serum of the patient returning from Asia contained, and the sera of the nine patients returning from Africa did not contain, antibodies to a virus isolated from the stools of patients suffering from an epidemic fecal-oral non-A, non-B viral hepatitis in Central Asia. It is concluded that infection with Asian-African non-A, non-B viruses can be the cause of fulminant hepatitis in persons returning from these countries, that the course of this type of non-A, non-B fulminant viral hepatitis is shorter than that of non-A, non-B fulminant hepatitis contracted in France, and that different viruses might be responsible for non-A, non-B hepatitis in Asia and Africa.