Hepatitis C Virus Research Articles

Perceived patient navigator services and characteristics to address barriers to linkage to hepatitis C care among people released from provincial prison in Quebec, Canada

BackgroundPatient navigation increases linkage to hepatitis C virus (HCV) care following release from prison; however, little is known about the services patient navigators should provide to maximize linkage to care. We aimed to identify perceived barriers and facilitators to linkage to HCV care post-release, and to determine patient navigator services and characteristics best suited to address barriers to linkage to care among people released from prison. MethodsTen semi-structured interviews were conducted with adult (age ≥ 18 years) men living with chronic HCV, released from the largest Quebec provincial prison, and linked to HCV care by a patient navigator. Interviews were guided by the Socio-Ecological Model (SEM) and aimed to explore the multi-level barriers and facilitators to linkage to HCV care post-release. Interviews were audio-recorded, transcribed, and analyzed using a deductive, thematic approach. ResultsThe median age of participants was 54 years. Barriers to linkage to HCV care included competing priorities post-release (e.g., substance use, mental health issues, unstable housing), stigma (related to HCV, injection drug use, and incarceration), and lack of transportation. Facilitators included social support, established relationships with existing healthcare providers, prior cure with direct-acting antivirals, and HCV-related health literacy and knowledge. Perceived essential patient navigator services to enhance linkage included pre-release discharge appointments, housing assistance, and facilitated transportation to HCV appointments. Ensuring a consistent, non-judgemental, and empathetic patient navigator were considered important characteristics; lived experiences of incarceration and/or HCV were not felt to be essential for a patient navigator. ConclusionsInterventions that seek to improve linkage to HCV care for people following release from prison should address many levels (individual, interpersonal, and policy) of the SEM. While people experience several competing priorities post-release, having an empathetic and consistent patient navigator, regardless of their lived experiences of HCV and/or incarceration, may improve linkage to HCV care post-release.

Changes in the prevalence of hepatitis B and C viral infections in Sindh province, Pakistan: Findings from two sero-surveys in 2007 and 2019.

Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. We utilised repeat sero-surveys to assess progress achieved towards hepatitis elimination in Pakistan. Multilevel logistic regression evaluated the change in HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV exposure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveys from 2007 and 2019 for Sindh province and associated risk factors. Adjusted odds ratios (aORs) were estimated and population-attributable fractions (PAF) for modifiable risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and 6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals (95% CI): 2.2-2.9) in 2007 to 1.1% (95% CI: 0.8-1.3) in 2019, while HCV-Ab prevalence increased from 5.1% (95% CI: 4.6%-5.5%) to 6.2% (95% CI: 5.6%-6.8%). The age and gender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1-0.4) among children and 60% (aOR = 0.4, 95% CI: 0.3-0.6) among adults over 2007-2019, while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2-0.7) in children and increased by 40% (aOR = 1.4, 95% CI: 1.2-1.7) in adults. HCV-Ab prevalence was lower in adults with secondary (aOR = 0.6, 95% CI: 0.5-0.8) and higher (aOR = 0.5, 95%CI:0.3-0.8) education compared to illiterates and higher among adults reporting blood transfusion (aOR = 1.7, 95% CI: 1.2-2.4), family history of hepatitis (aOR = 2.5, 95% CI: 1.9-3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6-2.7), being tattooed (aOR = 1.4, 95% CI: 1.0-1.9) and shaved by traditional barber (aOR = 1.2, 95% CI: 1.0-1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medical injection(s) accounting for 38% (95%CI,25.7-48.4%). Overall HCV has increased over 2007-2019 in Sindh province, while HBV prevalence has decreased. Medical injections should be an important focus of prevention activities.

Genomic instabilities in hepatocellular carcinoma: biomarkers and application in immunotherapies.

Hepatocellular carcinoma (HCC) is one of the deadliest cancers. For patients with advanced HCC, liver function decompensation often occurs, which leads to poor tolerance to chemotherapies and other aggressive treatments. Therefore, it remains critical to develop effective therapeutic strategies for HCC. Etiological factors for HCC are complex and multifaceted, including hepatitis virus infection, alcohol, drug abuse, chronic metabolic abnormalities, and others. Thus, HCC has been categorized as a "genomically unstable" cancer due to the typical manifestation of chromosome breakage and aneuploidy, and oxidative DNA damage. In recent years, immunotherapy has provided a new option for cancer treatments, and the degree of genomic instability positively correlates with immunotherapy efficacies. This article reviews the endogenous and exogenous causes that affect the genomic stability of liver cells; it also updates the current biomarkers and their detection methods for genomic instabilities and relevant applications in cancer immunotherapies. Including genomic instability biomarkers in consideration of cancer treatment options shall increase the patients' well-being.

Activity of Lipoxygenase and Partial Purification of Its Isoenzymes in Patients with Viral Hepatitis B

Activity of Lipoxygenase and Partial Purification of Its Isoenzymes in Patients with Viral Hepatitis B

Chronic Hepatitis D Virus Infection and Its Treatment: A Narrative Review

More than 12 million individuals worldwide are chronically infected with the hepatitis D virus (HDV). HDV infection is the most severe form of viral hepatitis since it requires hepatitis B virus co-infection and accelerates progression to cirrhosis and hepatocellular carcinoma. Therefore, treatment modalities to slow the progression of the disease are essential but not yet available. In addition, no antiviral treatment to date has been shown to reliably eradicate HDV. Pegylated interferon (PEG-IFN) is the only universally used treatment to suppress HDV RNA replication and improve liver inflammation and fibrosis. This treatment can be completed in 12–18 months, but cure rates remain low, and success does not reliably increase with the addition of a nucleos(t)ide analog. PEG-IFN therapy is also limited by poor tolerability and multiple adverse effects, including neutropenia, thrombocytopenia, and neuropsychiatric symptoms. Newer antiviral therapies in development target unique aspects of HDV viral replication and show promising results in combination with PEG-IFN for long-term HDV RNA suppression. These newer antiviral therapies include buleviritide (which blocks HDV entry), lonafarnib (which prevents HDV assembly), and REP-2139 (which prevents HDV export). In this manuscript, we discuss the characteristics of HDV infection and review the new antiviral therapies approved for treatment and those under investigation.

Human-swine interface: is the hepatitis E virus a real risk for humans?

Abstract Background Hepatitis E virus (HEV) is the agent of hepatitis E, an emerging public-health infection with an increasing incidence in Europe. Due to the apparent lack of species barriers, HEV is considered a zoonotic agent, with swine as the main reservoir. This study investigated HEV prevalence in humans and domestic pigs in Northern Italy, a highly anthropic area with the highest pig farm density, to gain insights into the risk of HEV transmission from swine to humans. Methods A total of 508 blood samples were collected from blood donors (341 males and 167 females; from 18 to 66 years old) and from 1619 pigs in 40 different farms. Serological analyses were performed with ELISA to detect anti-HEV antibodies. In addition, 120 faecal pool samples collected from the pig farms with the highest seroprevalence and 69 salami produced in the same area were analysed to detect viral genome by Real-time PCR. Results In humans, HEV seroprevalence was 4.9% (CI95% 0.03-0.07); positive donors were mainly males, with seroprevalence increasing up to 12% (CI95% 0.09-0.15) in the 46-55 age group. Seroprevalence in swine was 53.00% (CI95% 0.50-0.55), with HEV detected in only 1% (CI95% 0.001-0.045) faeces. All food samples tested negative. Conclusions Even if the seroprevalence in pigs highlighted that HEV was actively circulating in the farms, the low seroprevalence in humans, the scarce HEV detection in swine faeces, and the absence in food products suggested that HEV transmission via faecal-oral or foodborne routes is unlikely, probably due to the implementation of severe biosecurity measures and high standards of hygiene in swine farms, and the continuous assessment of the critical points in the pig supply chain (from farm to fork). The serological surveillance of humans and the monitoring of farmed animals are needed to support the competent authorities in timely managing public health issues, improving human health and veterinary safety from a One Health perspective. Key messages • In the human-swine interface is important to monitor HEV presence. • The One Health approach is essential to control zoonotic diseases.

Cell binding tropism of rat hepatitis E virus is a pivotal determinant of its zoonotic transmission to humans

Classically, all hepatitis E virus (HEV) variants causing human infection belong to the genus Paslahepevirus (HEV-A). However, the increasing cases of rat HEV infection in humans since 2018 challenged this dogma, posing increasing health threats. Herein, we investigated the underlying mechanisms dictating the zoonotic potentials of different HEV species and their possible cross-protection relationships. We found that rat HEV virus-like particles (HEVVLPs) bound to human liver and intestinal cells/tissues with high efficiency. Moreover, rat HEVVLPs and infectious rat HEV particles penetrated the cell membrane and entered human target cells postbinding. In contrast, ferret HEVVLPs showed marginal cell binding and entry ability, bat HEVVLPs and avian HEVVLPs exhibited no binding and entry potency. Structure-based three-dimensional mapping identified that the surface spike domain of rat HEV is crucial for cell binding. Antigenic cartography indicated that rat HEV exhibited partial cross-reaction with HEV-A. Intriguingly, sera of HEV-A infected patients or human HEV vaccine Hecolin® immunized individuals provided partial cross-protection against the binding of rat HEVVLPs to human target cells. In summary, the interactions between the viral capsid and cellular receptor(s) regulate the distinct zoonotic potentials of different HEV species. The systematic characterization of antigenic cartography and serological cross-reactivity of different HEV species provide valuable insights for the development of species-specific diagnosis and protective vaccines against zoonotic HEV infection.

Epidemiology of hepatitis C from 2015 to 2022 in a central Italian region: the OPT-HepaC project

Abstract Background Chronic hepatitis C virus (HCV) infection is a major global public health problem. This study investigated the evolving landscape of HCV in Tuscany (Italy) from 2015 to 2022, considering demographic shifts, clinical profiles, treatment regimens, and outcomes. Methods The study was conducted in order to characterize HCV-positive patients who started treatment between 2015 and 2022 in Tuscan prescribing centers. The study was part of OPT-HepaC, a project funded by Regional Health Service. Data on demographics, clinical history and outcomes were collected. Three different temporal eras were analysed: the period before andfter the universal availability of direct-acting antivirals (DAA) and the COVID-19 era. Treatment’s effectiveness was evaluated by the Sustained Virological Response (SVR12), assessed 12 weeks after the end of treatment. Outcomes included SVR12, non-SVR12 and lost to follow-up (LTFU). ANOVA, Kruskal-Wallis test and multinomial logistic regression were used for statistical analysis. Results 6882 HCV patients (age: 58.88±14.21) were treated by the centres participating at the study. Males (56.4%) and Italian (91.8%) were predominant. Sociodemographic and variable characteristics vary across the time. While the overall SVR12 remained stable over time (χ2(2)=0.357, p = 0.837), the LTFU rate significantly increased during the COVID-19 era. Facilitating factors for the non-SVR12 and LTFU outcomes were male gender (Odds Ratio (OR)=2.134, p = 0.006)/cirrhosis (OR = 1.713, p = 0.040)/HIV co-infection (OR = 3.251, p = 0.005) and DAA treatment of third generation (OR = 4.187, p = 0.006), respectively. Conclusions The study provides a comprehensive view of the HCV landscape, highlighting demographic changes, treatment regimens and outcomes. The COVID-19 pandemic affected service delivery, delaying HCV diagnosis/treatment and influencing the LTFU rate. Despite challenges, the region maintained high SVR12 rates, emphasizing the importance of sustained efforts in HCV care. Key messages • The study highlights the dynamic nature of HCV management in Tuscany. • The study emphasises the need for continuous adaptation to public health challenges, providing insights for future public health strategies.

Assessing progress towards viral hepatitis B and C elimination in prisons in the European region

Abstract Background In 2016 the WHO launched the global health sector strategy for the elimination of viral hepatitis, alongside a dedicated monitoring&evaluation (M&E) framework to assess progress at national, regional and global levels. Despite being a priority setting for viral hepatitis elimination in Europe, prisons are rarely integrated into national monitoring efforts. Besides, prisons are particular contexts with a high viral hepatitis prevalence, where it is possible to utilize adequate micro-elimination strategies. Objectives We aimed to assess available metrics of viral hepatitis burden and coverage of prevention and control interventions in prison settings in Europe using routine sources of data. Methods We adapted the WHO M&E framework for viral hepatitis elimination to the prison context. The resulting M&E framework has 49 indicators of which 10 are defined as core. Data were sourced from available European prison surveillance systems at European level, namely: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and WHO Health in Prisons European Database (HIPED). Results In total 38 countries in the European region provided data to either data sources for 2020. For WHO-HIPED, among core indicators, 3 out of 10 could be calculated for HCV, and covered prevalence, HCV treatment availability and treatment outcome. Concerning HBV, 3 core indicators out of 10 could be calculated and covered prevalence, screening availability and treatment coverage in prison. With EMCDDA surveillance system we could calculate 4 HCV core indicators and 6 HBV core indicators. Lessons Availability of health data from prison settings is scarce, hampering the current capacity to monitor the progress in the viral hepatitis elimination within prisons contexts strategies and its relative contribution to global health goals achievement. A coordinated and standardised M&E framework tailored to this specific setting is needed to foster data collection and systematic monitoring. Key messages • Micro-elimination strategies in prison context contribute to the global health goals achievement. • A coordinated and standardized M&V framework, adapted to the prison context, is needed to foster data collection and monitoring of the viral hepatitis elimination strategy.

Long-term outcomes of heart re-transplantation from HCV-viremic donors based on UNOS registry

Abstract Background The use of hepatitis C virus (HCV) viremic donors increased the heart donor pool, and reduced waitlist time and mortality among first-time single-organ heart transplant (HT) candidates without compromising their post-transplant survival. The outcomes of heart re-transplantation (re-HT) with the use of HCV-viremic donor grafts have not been investigated. Methods Using the United Network of Organ Sharing (UNOS) Registry we analyzed all adult patients who underwent single-organ heart re-HT in the United States between January 1, 2016, and December 31, 2022. HCV-viremic donors were defined by a positive nucleic acid amplification test (NAT+). Graft survival rates between HCV-viremic and HCV-non-viremic donor graft recipients were compared using a log rank test. Results During the study period, of 18,259 HTs performed, 427 (2.3%) constituted single-organ heart re-transplantations. Recipients of NAT+ grafts (n=19) compared to NAT- grafts (n=408) were more often male (84.2% vs 61.3%, p=0.04). Otherwise, there were no significant differences between the two groups in age, ethnicity, BMI, blood type, history of diabetes rates or stroke, creatinine or bilirubin levels, reason for re-HT, hemodynamics, use of mechanical circulatory support, and waitlist time. Ischemic time, frequency of female donors, HLA, ABO, CMV mismatch rates, and calculated panel reactive antibodies levels were comparable across the two groups. There were no significant differences in demographics or comorbidities rates between HCV-viremic and HCV-non-viremic donors apart from the cause of death. Among the donors of HCV-viremic grafts brain anoxia was reported more often (89.5%) than among HCV-non-viremic donors (40%), p <0.01. Rates of acute rejection treated in the first year after re-HT were comparable across the two groups. Over a mean follow-up of 3.0±2.1 and 3.3±1.8 years after re-HT from NAT- and NAT+ organ donors, respectively, graft survival rate at 1 year was 82% vs. 95% (p=0.3) and at 3 years 79% vs. 89%, respectively (p=0.6) (Figure). Conclusion Graft survival rates at 1 and 3 years post-heart re-HT in adult recipients of HCV-viremic donor grafts were comparable to those of recipients of HCV-non-viremic donor grafts. The current study provides compelling preliminary evidence that HCV-viremic donors constitute a viable donor pool for patients in need of heart re-transplantation.

Main challenges and measures taken by public health institutions in response to war in Kyiv Region

Abstract Background The establishment of martial law due to Russia’s military aggression against Ukraine led to specific adjustments in the functioning of the Centers for Diseases Control and Prevention (СDС). The negative impact of hostilities is determined by the increased morbidity rate of communicable and non-communicable diseases, insufficient supply of safe drinking water and food to damaged sites, inadequate living conditions, etc. Objectives The purpose of the work was to create an effective system for responding to biological, chemical and radiation hazards and eliminating the consequences of an emergency situation in the realities of martial law. Methods We used the most common methods, namely descriptive, statistical, microbiological and сhemical laboratory tests. Results The activities of the CDC under martial law include daily monitoring studies of environmental objects. The epidemic situation of acute intestinal infection (AII) and other communicable diseases (CD) is constantly analyzed. The Kyiv Oblast CDC became the basic institution for the implementation of the ‘pilot project’ in the direction of sanitary and epidemic assessment and monitoring of environmetal objects in 188 de-occupied areas. The main public health risks were identified: providing the population with high-quality drinking water; low immunization rate of the population; sites for the location of internally displaced persons; natural foci of especially dangerous diseases, such as tularemia, leptospirosis, infection fevers, etc. In 2022, the overall level of CD in the Kyiv region decreased by 44.0% from 2021. The most common nosologies were acute respiratory viral infections and influenza (98.9%), AII (42.4%), tuberculosis (15.3%), Lyme disease (15.3%), and viral hepatitis (14.2%). Conclusions Based on the research conducted, mechanisms have been developed for responding to hazards of various origins by public health institutions, including risk assessmant and laboratory studies. Key messages • The main focus of the Centers for Diseases Control and Prevention is aimed at effective response to hazards of various origins in order to ensure public health under martial law. • Risk assessment in de-occupied territories has become an important tool for identifying correct approaches to prevent negative consequences for public health.

Relationship between fibrosis-4 index and new onset hypertension in the general population

Abstract Background/Introduction Non-alcoholic fatty liver disease (NAFLD) is a risk for cardiovascular events and malignant tumors as well as liver cirrhosis, and the risk increases with increasing fibrosis of the liver. Thus, the fibrosis-4 (FIB-4) index, developed as a noninvasive test to stage liver fibrosis, may predict the development of hypertension. Purpose The present study investigated the relationship of FIB-4 index with the prevalence and future development of hypertension in the general population. Methods A total of 16125 participants who visited our hospital for a physical check-up at least twice from 2008 to 2018 (male=9700, 52.0±12.3 year-old) were subjected for cross-sectional analysis. Among them, 3995 participants were hypertensive. The remaining 12111 normotensive participants (male=6984, 49.5±11.9 year-old) were followed up for the median of 1643 days with the endpoint being the development of hypertension, defined as systolic blood pressure ≥140mmHg, diastolic blood pressure ≥90mmHg or the use of antihypertensive medication. FIB-4 index was calculated as follows; (age×AST)/(platelet number×√ALT). Results Cross-sectional analysis revealed that FIB-4 index was higher in hypertensive than normotensive participants (1.40±0.74 vs. 1.09±0.54, p<0.001). During the follow-up, 2819 participants (45.7 per 1000 person-year) developed hypertension. The incidence was more frequent in male (55.6 per 1000 person-year) than female participants (32.7 per 1000 person-year, p<0.001). High level of FIB-4 index (≥2.67, n=194) showed a significant impact on the incident hypertension (80.5 per 1000 person-year) as compare with middle (≥1.30, <2.67, n=3082) or low level (<1.30, n=8835) of FIB-4 index (65.4 and 38.8 per 1000 person-year, respectively). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of FIB-4 index for the new onset of hypertension was 1.483 (1.416-1.553). In multivariate Cox hazard analysis adjusted for sex, body mass index, systolic blood pressure, pulse rate, serum creatinine, uric acid, HbA1c, LDL-cholesterol, triglyceride, hemoglobin, current smoking, frequent alcohol consumption and family history of hypertension, FIB-4 index was an independent predictor of the development of hypertension (HR 1.321, 95%CI [1.213-1.438]). Similar results were obtained in analyses of male (HR 1.382, 95%CI [1.300-1.470]) and female subgroups (HR 1.369, 95%CI [1.230-1.524]). History of viral hepatitis or frequent alcohol consumption did not affect the results (data not shown). Conclusions FIB-4 index is a useful predictor of the development of hypertension in the general population. Increased risk of cardiovascular events in patients with NAFLD may partially be attributable to the development of or coexistence with hypertension.

An optimized protocol for quality control of gene therapy vectors using nanopore direct RNA sequencing.

Despite recent advances made toward improving the efficacy of lentiviral gene therapies, a sizeable proportion of produced vector contains an incomplete and thus potentially nonfunctional RNA genome. This can undermine gene delivery by the lentivirus as well as increase manufacturing costs and must be improved to facilitate the widespread clinical implementation of lentiviral gene therapies. Here, we compare three long-read sequencing technologies for their ability to detect issues in vector design and determine nanopore direct RNA sequencing to be the most powerful. We show how this approach identifies and quantifies incomplete RNA caused by cryptic splicing and polyadenylation sites, including a potential cryptic polyadenylation site in the widely used Woodchuck Hepatitis Virus Posttranscriptional Regulatory Element (WPRE). Using artificial polyadenylation of the lentiviral RNA, we also identify multiple hairpin-associated truncations in the analyzed lentiviral vectors (LVs), which account for most of the detected RNA fragments. Finally, we show that these insights can be used for the optimization of LV design. In summary, nanopore direct RNA sequencing is a powerful tool for the quality control and optimization of LVs, which may help to improve lentivirus manufacturing and thus the development of higher quality lentiviral gene therapies.

Statistical analysis of seroprevalence and risk factors of hepatitis C in Nowshera District, Pakistan

Hepatitis C virus (HCV) transmission remains a significant public health concern. It is well documented globally, however, Nowshera district, Pakistan, is lacking such profile. This study aims to explore the relationship between HCV infection and several risk factors, including socio-demographic, clinical and personal life-style factors. This study using a cross-sectional design, examined 606 randomly selected individuals visiting the Pathology department at Qazi Hussain Medical Complex and District Headquarter (DHQ) Hospital Nowshera between May 1, 2022 and Jun 30, 2023. This research investigation employed a methodical approach involving formal interviews in conjunction with structured questionnaires to gather comprehensive information related to socio-demographic characteristics, clinical history, and personal hygiene practices. We collected 10 ml of blood samples and tested the separated serum to identify markers using the Immuno-Chromatographic Test (ICT) and the Enzyme-Linked Immunosorbent Assay (ELISA). IBM SPSS Statistics version 27 was used for data analysis. To measure the association between dependent variable and independent variables, a chi-square and risk analysis was carried out; multiple logistic regression was employed for modeling the risk factors associated with independent variable. A statistical significance level was established at a P-value of less than 0.05. In present study, which included 606 participants, 12% were found to be infected with HCV. Importantly it revealed that facial shave at barber (adjusted odds ratio, aOR = 40.65, p = 0.000) represents the most prevalent mode of HCV transmission. Additionally, a strong association was observed between HCV infection and history of past surgery (RR = 2.98, p = 0.001), HCV infected family member (aOR = 4.28, p = 0.001), workplace injuries (aOR = 6.68, p = 0.000), history of hospital admission (RR = 2.09), practicing ear and nose piercing (aOR = 5.01, p = 0.001), dental treatment (RR = 2.31) and the frequency of injections (aOR = 8.607, p = 0.000). These findings underscore the pressing need for targeted interventions. This study highlights the paramount importance of understanding the modes of HCV transmission and their associated risk factors. The results emphasize the need for educational initiatives, both within the healthcare sector and among the general public, to combat HCV transmission effectively. By implementing sterilization procedures and increasing awareness, we can make significant strides in reducing the burden of HCV infection. Moreover, proactive measures within families can help contain the spread of the virus, ultimately contributing to improved public health.

Ultrasound-guided percutaneous microwave ablation for metabolic-associated fatty liver disease-related hepatocellular carcinoma (HCC) versus hepatitis virus B-related HCC: a propensity score matching study

Objectives To compare the long-term outcomes of microwave ablation (MWA) for primary hepatocellular carcinoma (HCC) in patients with metabolic-associated fatty liver disease (MAFLD) with those infected by hepatitis virus B (HBV). Methods The clinical data of HCC patients under the treatment of MWA were analyzed retrospectively between 2010 and 2021 at Chinese PLA General Hospital. Patients were divided into MAFLD-HCC and HBV-HCC group according to the chronic liver disease etiology. The propensity score matching (PSM) was performed to reduce the interference of confounders. The primary outcomes were overall survival (OS), recurrence-free survival (RFS), cancer-specific survival (CSS) and intrahepatic distant recurrence (IDR). Results A total of 648 patients (age range, 18–91 years) with 1019 lesions were enrolled including 601 with HBV-HCC and 47 with MAFLD-HCC. After a variable ratio of 1:n ≤ 4 PSM, 100 patients were included in the HBV-HCC and 41 in the MAFLD-HCC group. No statistical differences in OS and CSS (p = 0.880 and p = 0.980, respectively) were observed between the two groups in the matched cohort, while MAFLD-HCC exhibited better RFS and lower IDR rates compared to HBV-HCC (p = 0.043 and p = 0.041, respectively). Additionally, MAFLD-HCC generated lower ascending range in the liver function indexes like ΔALT (46.7 vs. 98.5, p < 0.001), ΔTBIL (1.9 vs. 7.5, p = 0.001) and ΔAST (38.1 vs. 148.6, p < 0.001) than HBV-HCC after MWA. Conclusions MWA is an effective treatment for HCC patients with MAFLD. The recurrence prognosis of MAFLD-HCC was better than HBV-HCC and the degree of liver injury after MWA was lower.

Treating chronic HCV infection in children: challenges and regional perspectives

The article discusses the treatment of chronic form of viral hepatitis C (HVGS) in children. Many problems of the issue under consideration relate to both the scarcity of official statistics and the ambiguity of approaches to the treatment of HVGS in children in our country and abroad. The authors show the most problematic loci from various aspects: from the side of epidemiology and clinical points of view - infectology, clinical pharmacology, and also proposed rational ways to solve existing problems.

Clinical Presentation And Etiology of Acute Hepatitis In Children: An Experience From A Tertiary Centre of Bangladesh

Background: The prevalence of Acute hepatitis is still high in developing countries even though the availability of vaccines, prophylactic measures and improved sanitation. Objective: To investigate clinical features, biochemical parameters and etiology of acute hepatitis among hospitalized children in a tertiary care center. Method: This cross sectional study was conducted in the Department of Pediatrics Dhaka Medical College Hospital between June 2021 to July 2022.A total of 120 children aged bellow 15 years who presented with acute hepatitis were included in the study. Results: Most of the studied children were in 5-10 years age group 73(61%).Most of the children presented with jaundice 112 (93.3%), nausea &amp; vomiting 105(87.5%),low grade fever 73(61%),upper abdominal pain 79(65.8%), pruritus 15(12.5%), melena 12(10%), pale stool 10(8.3%), anicteric 8(6.6%). On physical examination tender hepatomegaly was found 110(91.6%) cases, just palpable spleen 8(6.6%), hepatic encephalopathy 6(5%), ascites 4(3.3%) cases. Among the studied patients 102 (85%) were having herbal or homeopathic medicines at the time of admission. All of patients had increase serum bilirubin and ALT and most of them 79(65.8%) had ALT between 500-1500 IU/L.AST was also raised. Increase prothrombin time/INR 17(14.1%) and low serum albumin was seen in7 (5.8%) cases. Majority cases were HAV 81 (67.5%), followed by HEV 10 (8.3%), non A and non B 9(7.5%), HBsAg &amp; anti-HBcIgM were found with positive 4 (3.3%) cases, HAV with HEV co-infection 3 (2.5%). Other than viral hepatitis Salmonella positive 5(4.1%), drug induced hepatitis due to anti-TB and valproic acid 3(2.5%) cases,3(2.5%) cases Wilson’s disease and 2(1.7%) following Wasp bite. Conclusions: The study found the common presenting features of acute hepatitis were jaundice, anorexia, nausea, vomiting, fever, abdominal pain, tender hepatomegaly and ascites. Acute hepatitis due to HAV was the commonest followed by HEV. Vaccination programme should be taken by government to control hepatitis A in children. J Dhaka Med Coll. 2023; 32(1) : 32-37

Epidemiological Characteristics and Spatiotemporal Clustering of Symptomatic Hepatitis E Virus Reinfection in Zhejiang Province, 2005–2023

Hepatitis E virus (HEV) reinfection is prevalent among the population, posing a significant burden on prevention and control efforts. In this study, we conducted a comprehensive analysis of data from China’s Disease Prevention and Control Information System’s infectious disease surveillance system to identify the epidemiological characteristics, spatiotemporal clustering, and high-risk populations of HEV reinfection. From 2005 to 2023, HEV reinfection in Zhejiang Province exhibited a fluctuating trend, peaking in 2020, with a 3–5-year lag compared to the pattern of HEV incidence. The Cox model indicated that individuals aged 40–50 and females are at higher risk of reinfection. Spatial autocorrelation was observed in reinfection cases from 2011 to 2016, with high–high clustering areas concentrated in downtown Hangzhou. Additionally, spatiotemporal scanning revealed that the clustering of reinfection cases has shifted from Hangzhou to coastal areas in recent years. Our findings suggest that targeted prevention and control measures for HEV rein fection should be implemented based on the characteristics of high-risk populations and spatiotemporal clustering patterns.

Rich dynamics of a hepatitis C virus infection model with logistic proliferation and time delays

AbstractIn this paper, we study a dynamic model of hepatitis C virus (HCV) infection with density‐dependent proliferation of uninfected and infected hepatocytes and two time delays, which is derived from a three‐dimensional model by the quasi‐steady‐state approximation. The model can exhibit forward bifurcation or backward bifurcation, and an explicit control threshold parameter is obtained for the case of backward bifurcation. It is shown that if the proliferation rate of infected hepatocytes is greater than the proliferation rate of uninfected hepatocytes by a certain amount, it becomes more difficult for the virus to be removed. The model has rich dynamical properties: (i) In some parameter regions, bistability can occur; (ii) both time delays (virus‐to‐cell delay) and (cell‐to‐cell delay) can lead to Hopf bifurcations; (iii) same length of time delays and can lead to at most one stability switch, but different time delays can lead to multiple stability switches. Several sufficient conditions for the global stability of the disease‐free equilibrium and the endemic equilibrium are obtained for both forward and backward bifurcation scenarios. In particular, several sharp results on global stability are obtained. Theoretical and numerical results portray the complexity of viral evolutionary dynamics in chronic HCV‐infected patients.

Thyroid Metastases from Hepatocellular Carcinoma after Liver Transplantation

Hepatocellular carcinoma (HCC) patients with metastases to the thyroid are extremely rare. A patient who underwent liver transplantation for HCC recurrence had metastatic thyroid recurrence detected 4 years later. A literature review identi"ed six documented cases, analyzing relevant data on HCC with thyroid metastasis following liver transplantation. !ere is a prevalence of hepatitis B virus (HBV ) and hepatitis C virus (HCV ) as etiologies of liver disease (83.3%), with alpha-fetoprotein (AFP) levels elevated in "ve cases. Additionally, the time between the diagnosis of HCC and thyroid metastasis was within 3 years. !e patient remains clinically stable in outpatient follow-up, with an 8-month current survival after total thyroidectomy.