Positive HBsAb Research Articles

S3061 It Only Takes One: A Case of Drug-Induced Liver Injury Due to Cefazolin Administration

Introduction: Drug-induced liver injury (DILI) is a common cause of hepatotoxicity that has been associated with multiple medications and supplements. Herein, we present an intriguing case of DILI related to preoperative Cefazolin administration. Case Description/Methods: A 64-year-old female with history of breast cancer presented for right upper quadrant abdominal pain, nausea, vomiting, and jaundice for 1 week. The patient underwent left mastectomy with administration of a single dose of preoperative IV Cefazolin about three weeks prior to presentation. On presentation, vital signs were within normal limits. On physical exam, the patient was noticeably jaundiced with right upper quadrant tenderness. Laboratory studies showed total bilirubin 11.9 mg/dL, direct bilirubin 8 mg/dL, alkaline phosphatase 603 IU/L, AST 165 IU/L, ALT 376 IU/L. Abdominal ultrasound found no biliary obstruction. Magnetic resonance cholangiopancreatography noted mild hepatomegaly with no intrahepatic or extrahepatic ductal dilatation. Workup for autoimmune disease, Wilson disease, and hemochromatosis was negative. Testing for hepatitis A and C was negative. The patient had positive HBcAb, however, HBsAg, HBsAb, and quantitative DNA PCR were negative. Liver biopsy showed cholestatic hepatitis, no significant fibrosis, and prominent eosinophils consistent with DILI. The patient was diagnosed with DILI secondary to Cefazolin administration. She was ultimately discharged home with improvement of symptoms and repeat lab work showing normalization of liver chemistries. Discussion: Cefazolin is an antibiotic that is widely used for surgical prophylaxis, and it can be overlooked when working up acute liver injury, as it is usually a one-time dose. According to LiverTox, the latency period between administration and onset of liver injury is typically 1-4 weeks with most cases causing mild elevations of liver enzymes, however, significant elevations in aminotransferases greater than 5 times the upper limit of normal are rare (< 1%). Hepatotoxicity is likely due to hypersensitivity with primarily cholestatic patterns of liver enzymes, but mixed and hepatocellular patterns have been described. Our patient displayed a mixed pattern after one dose of Cefazolin, and eosinophils were present on biopsy consistent with hypersensitivity. This case highlights the importance of thoroughly reviewing a patient’s history to help diagnose potential causes of liver injury, especially DILI, as it is imperative to the definitive management.Figure 1.: H&E stain (high power) showing intrahepatic cholestasis (A). H&E stain (high power) showing portal inflammation with prominent eosinophils (B).

S3170 Syphilitic Hepatitis With Cholestatic Liver Injury

Introduction: The incidence of syphilis in the United States has increased, predominantly among men who have sex with men. Very few patients with early syphilis meet the criteria for syphilitic hepatitis, but many are HIV+ and engage in high-risk sexual behavior. Case Description/Methods: A 30-year-old man who identified as a MSM presented with yellowing of his eyes and hyperbilirubinemia, preceded by one month with a rash and photosensitivity and redness of his right eye. He denied any penile lesions, history of liver disease or alcohol use. A physical examination revealed multiple hyperpigmented macular lesions over his torso, arms, palms, and the soles of his feet and scleral icterus. A slit lamp examination indicated anterior uveitis in both eyes and chorioretinitis/placoid retinitis in the right eye. CBC and iron studies showed mild anemia of chronic disease (Hb 11.7 g/dL). BMP was within normal limits. LFTs were as mentioned in Table 1. Blood tests showed positive HBsAb and T. pallidum antibody with RPR 1:128. Serum markers for viral hepatitis and HIV were negative. CSF from a lumbar puncture had an elevated WBC count (9/mm3). No biliary obstruction or masses were noted during on US and MRCP. Liver biopsy showed bland perivenular cholestasis (zone 3) (Fig. 1A) without necroinflammatory changes, mild to minimal portal inflammation (Fig. 1B), bile duct damage, and ductular reaction. The patient was treated with penicillin G for neurosyphilis, prednisolone and cyclopentolate for ocular syphilis, and ursodiol for cholestasis. Total bilirubin levels decreased to 1.7 mg/dL after 8 weeks of follow-up, and liver enzymes normalized. Discussion: This patient met the criteria for syphilitic hepatitis (elevated liver enzymes, serologic evidence of syphilis, exclusion of other etiology, and improvement following appropriate therapy). He also had bilateral anterior uveitis and placoid retinitis of the right eye, suggesting ocular syphilis. Serum chemistries, testing for T. pallidum and other serologies (including positive anti-smooth muscle antibody) supported hepatic involvement, and CSF studies were consistent with neurosyphilis. Liver biopsy showed a bland cholestatic pattern without evidence of other causes of liver disease. The biopsy results are compatible with syphilitic hepatitis, though histologic features can vary and direct staining for spirochetes has limited sensitivity. These findings, together with his rapid improvement with penicillin therapy, confirmed a diagnosis of syphilitic hepatitis.Figure 1.: (A) Liver specimen (x40 magnification, hematoxylin and eosin stain) showing bland perivenular cholestasis (zone 3 with rare apoptotic hepatocytes. No necroinflammatory activity is present. (B) Liver specimen (x40 magnification, hematoxylin and eosin stain) showing periportal inflammation and bile duct damage with mild bile ductular reaction. Table 1. - Liver function test results AST 41 IU/L ↑ (ULN < 38 IU/L) ALT 53 IU/L ↑ (ULN < 42 IU/L) ALP 210 IU/L ↑↑ (ULN < 129 IU/L) Total bilirubin 11.6 mg/dL ↑↑ (ULN < 1.3 mg/dL) Direct bilirubin 8.8 mg/dL ↑↑ (ULN < 0.4 mg/dL) GGT 53 (ULN < 61 IU/L) Albumin 3.8 g/dL INR 1.0 AST, aspartate transaminase; ALT, alanine transaminase; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase; INR, international normalized ratio; UNL, upper limits of normal.

Disseminated Pulmonary Kaposi Sarcoma After Lung Transplantation: The Increased Risk Donor

<h3>Introduction</h3> Kaposi sarcoma (KS) is a rare complication after lung transplantation (LTx). It is caused by human herpes virus 8 (HHV-8). We report a case of primary disseminated pulmonary KS after LTx from an increased risk donor. <h3>Case Report</h3> A 66-year-old male with end-stage COPD underwent a bilateral LTx from an increased risk donor with positive HBsAb, HBcAb and Lues Ab, in November 2020. Apart from Valganciclovir (vGCV) and co-trimoxazole, entecavir and benzylpenicillin were given as prophylaxis. Routine immunosuppression included basiliximab, tacrolimus, mycophenolate mofetil (MMF) and prednisolone. vGCV prophylaxis was discontinued at 3 months (CMV-positive donor and recipient). The patient was treated effectively for acute rejection with pulse methylprednisolone in February 2021. Unfortunately, he was readmitted with dyspnea and lung function decline in April 2021. CT-scan showed bilateral consolidations and pleural thickening and the PET-scan showed an intense uptake in both lungs and pleura. Transthoracic needle biopsy showed HHV-8 positive spindle cell lesions. Subsequently, our patient developed skin lesions on his chest and in his mouth compatible with KS (biopsy-proven). In retrospect, the recipient was HHV-8 seronegative before LTx. Therefore, the diagnosis primary HHV-8 infection leading to disseminated pulmonary Kaposi sarcoma was made. Which appeared after cessation of the vGCV prophylaxis. Valganciclovir was initiated and immunosuppression was adjusted: MMF discontinued and tacrolimus switched to sirolimus (target through levels 15 µg/l). Nevertheless, KS was progressive and liposomal doxorubicin 20mg/m2 was started. Our patient deteriorated and was transferred to the ICU for intubation. Bronchoscopy revealed brown endobronchial lesions compatible with KS. The effect of the treatment could not be assessed, because the patient decided to refuse further treatment. He died soon after his decision was made. <h3>Summary</h3> Scarcity of donor organs led to the acceptance of an increased risk donor. Prophylaxis against hepatitis B and Lues was given, but after discontinuation of vGCV our patient developed a primary HHV-8 infection leading to disseminated KS and ultimately the death of our patient. HHV-8 testing of donor serum and lifelong prophylaxis might have prevented this clinical course and should be considered in recipients of increased risk donors.

Impact of body mass index on immunogenicity of hepatitis B vaccine in bariatric surgery candidates: A retrospective study

AimsHepatitis B virus (HBV) immunization is regarded as the most effective method for the prevention of HBV infection. Various factors, including body mass index (BMI), may contribute to decreased immunization responses. This study aimed to investigate the relationship between BMI at the time of vaccination with anti-HBs levels over the following years. MethodsIn this retrospective study, 790 vaccinated participants were recruited. Of these, individuals were selected whose hepatitis B antibody (HBsAb) information was available in 2017. The researchers contacted participants by phone to gather data regarding vaccination history, and weight at the time of vaccination. All data analysis was performed by SPSS. ResultsThis study included 165 eligible adults (28 males and 137 females). Among them, 79% participants were obese. Additionally, 46 (27.88%) and 119 (72.12%) had negative and positive HBsAb, respectively. There were no statistically significant differences seen across all characteristics, except for the number of HBV vaccinations between the positive and negative HBsAb groups. Multiple logistic regression also indicated no meaningful relationship between BMI and positive antibodies. ConclusionThere was no relationship observed between BMI and immune response to HBV vaccine in bariatric candidates. Known risk factors (age, sex, diabetes, and the number of HBV vaccinations) were not independent predictors of the antibody response to the HBV vaccine.

Viremic Hepatitis B Donors: A Case of Why It's Time to Further Expand the Donor Pool for Thoracic Transplant

In light of a national shortage of thoracic organs, patients with end stage lung disease need an expanded donor pool. There are approximately 847,000 persons with chronic hepatitis B virus (HBV) in the U.S. Previously, transplantation of HBV viremic donors into negative recipients was considered an absolute contraindication. We present a case of an HBV viremic lung donor transplanted into an HBV negative recipient without significant complication. A 66-year-old man with rapidly progressive idiopathic pulmonary fibrosis, diagnosed 1.5 years prior, was listed for lung transplant. Given his dramatic deterioration [Table 1], a broader donor pool was sought, and he was consented for hepatitis C and/or HBV viremic donors under IRB protocol. He was listed for less than 24 hours prior to organ offer. He underwent bilateral lung transplant from a donor with a positive HBsAg and HBV viral load of 726,220 IU/mL. The recipient was immunized as a child as reflected by his positive HBsAb 163mIU/mL. He was given 9360 units HBIG on d0 after transplant, 4680 units daily d1-d5 and started on entecavir 0.5mg/d d1. Since transplant, he has had normal liver function tests, and has not seroconverted his HBcAb, nor developed a positive sAg or NAT. We queried the OPTN database for all HBV mismatched solid organ transplant episodes from July 2017 through June 2019, as measured by +sAg and/or NAT. There were 214 living and deceased donor transplants utilizing HBV-positive donor organs into negative recipients, only 4 of which were lung transplants [Table 2]. There were 27 HBV mismatch recipients with 6 month follow up data on the OPTN database. By 6 months post-transplant, 2 recipients had seroconverted, only 1 of whom became viremic. Our case demonstrates HBV-infected thoracic donors can be safely transplanted to HBV negative recipients. Although optimal dosing and duration of HBIG and entecavir is not known, this may be a viable pathway to transplant for patients who need an expanded donor pool.

Seroprotection after hepatitis B vaccination amongst infants aged between 12 and 24 months in Ho Chi Minh City, Vietnam

Objective: To assess levels of HBsAb amongst infants who received hepatitis B vaccine in the Expanded Program on Immunization in Vietnam. Methods: A cross-sectional study was carried out at 16 community health centers from February 2016 to July 2017. Eligible infants were tested for HBsAb and HBsAg. Structured questionnaires were used to collect relevant information about the demographics of the parents/caregivers and their infants after physical examination. Results: A total of 199 eligible infants were selected with a mean age of (17.3±4.5) months. Protective antibody levels with HBsAb ≥10 mIU/mL were detected in 68.3% of infants. Of these, antibody levels from 10 to 99 mIU/ mL were 48.5% of those tested and antibody levels ≥100 mlU/mL were recorded as 51.5%. No cases were recorded of being infected with hepatitis B virus. The rate of positive HBsAb level in those who were not wasting and 18 months old was less than that among those who were Conclusions: Seroprotection against hepatitis B virus was low in the infants tested (at 68.3%), which suggests that the hepatitis B vaccine should be administered with one additional dose for infants between 12 and 24 months of age, particularly those with wasting.

The Effect of Hepatitis B Virus Antibody on Clinical Outcome and Prognosis in Patients with Diffuse Large B-Cell Lymphoma

Introduction: Diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin lymphoma (NHL), is strongly correlated with virus infection and host immunity status. To date, several kinds of virus infection have been involved in the tumorigenesis and progression of NHL, such as Epstein-Barr virus, hepatitis C virus, human immunodeficiency virus and so on. Hepatitis B virus (HBV) infection is a significant public health problem around the world, especially in China. HBV infection has been found to have an epidemiologic association with NHL and HBsAg status has been shown to be associated with the clinical feature and prognosis of DLBCL patients. However, no literature has been reported regarding the effect of HBV antibody in DLBCL. This study was to evaluate the impact of HBV antibody status on clinical outcome and prognosis in DLBCL patients. Methods: In this retrospective study, we investigated the clinical data of 190 patients with newly diagnosed and untreated DLBCL, who had received histological diagnosis and standard treatment at Shandong Provincial Hospital from May 2013 to May 2018. 127 DLBCL patients were effectively followed up to September 2018. Various statistical analyses were used to determine the significance of HBV antibody status in DLBCL patients. Results: The prevalence of HBsAg, HBsAb and HBcAb were increased in DLBCL patients compared with that in general Chinese population (Table 1).Compared with HBeAb-negative patients, HBeAb-positive patients displayed unique clinical features, such as more advanced disease stage (p=0.031) and higher International Prognostic Index (IPI) score (p=0.015, Table 2). Besides, patients in HBsAb-positive group displayed younger onset age (Figure 1). Patients in HBV antibody-negative group had better therapeutic efficiency than the positive group (Table 3), including HBsAb (p=0.013), HBeAb (p=0.013), combined HBsAb and HBcAb (p=0.019). The media progression-free survival (PFS) of HBeAb-positive group (p=0.004), HBcAb-positive group (p=0.038), HBsAb-positive and HBcAb-positive group (p=0.008) and the media overall survival (OS) of HBeAb-positive group (p=0.007), HBcAb-positive group (p=0.103), HBsAb-positive and HBcAb-positive group (p=0.035) were shorter than the negative group, respectively (Figure 2). We found the positive association between the expression of CD21 and HBsAb status (p=0.06, Table 4), both of which had no statistical significance in prognostic prediction. However, the media PFS (p=0.035) and OS (p=0.079) of patients with positive HBsAb and positive CD21 expression were worse than the negative group (Figure 3). Patients in Rituximab-containing group had better therapeutic efficiency (p=0.05), better PFS (p=0.015) and OS (p=0.008) than patients in Rituximab-free group (Figure 4). Interestingly, there were significant differences of Rituximab effect on clinical prognosis depending on the status of HBV antibody (Figure 5 and 6). For example, the positive effect of Rituximab on PFS (p=0.019) and OS (p=0.001) in HBsAb-positive patients was statistically significant while no difference was observed in PFS (p=0.251) and OS (p=0.987) in HBsAb-negative patients. In HBcAb-positive group, patients with Rituximab had better PFS (p=0.019) and OS (p=0.004) than patients without Rituximab. However, for HBcAb-negative patients, the PFS (p=0.596) and OS (p=0.80) were similar in Rituximab-containing group and Rituximab-free group. Similarly, the PFS (p=0.004 vs p=0.479) and OS (p&lt;0.001 vs p=0.936) according to the use of Rituximab displayed significant difference in HBsAb-positive and HBcAb-positive group rather than the negative group. Conclusions: The prevalence of HBV was increased in DLBCL patients and patients with positive HBV antibody displayed unique clinical features. Our investigations identified for the first time that HBV antibody had a negative effect on clinical outcome and prognosis in DLBCL patients. Interestingly, the effect of Rituximab in prognostic prediction was more significant in HBV antibody-positive group than the negative group. Therefore, our findings lead to a novel understanding of the association between HBV antibody and DLBCL development and provide promising factors for the prognostic prediction in DLBCL patients. Disclosures No relevant conflicts of interest to declare.

Hepatitis B virus reactivation with corticosteroid therapy in patients with adrenal insufficiency.

ObjectiveWhether or not reactivation of hepatitis B virus (HBV) might occur during corticosteroid therapy in hepatitis B surface antigen (HBsAg)‐negative patients with adrenal insufficiency was investigated.Patients and MethodsWe consecutively enrolled 66 patients with adrenal insufficiency undergoing physiological corticosteroid replacement therapy at Saitama Medical University Hospital between June 2013 and June 2014, and 220 patients with rheumatic disease receiving a pharmacologic dose of corticosteroids served as the positive control group. The latter group was separated into 101 patients treated only with corticosteroids, and 119 patients given corticosteroids plus immunosuppressants and/or disease‐modifying antirheumatic drugs (DMARDs). HBsAg and antibody (Ab) levels against HBs, and hepatitis B core (HBc) were determined in all the patients. In patients with positive HBsAb and/or HBcAb, real‐time PCR was performed for HBV‐DNA. The incidence rates of conversion to HBV‐DNA‐positive status were evaluated.ResultsHepatitis B virus reactivation occurred in six patients with rheumatic disease, three of whom were receiving a pharmacological dose of corticosteroids only, and three who were receiving corticosteroids with immunosuppressants and/or DMARDs. However, no reactivation occurred in patients receiving corticosteroid replacements for adrenal insufficiency. Maintenance and maximum corticosteroid doses administered to patients with rheumatic disease were significantly greater than those in patients with adrenal insufficiency.ConclusionThese results suggest that, although corticosteroid replacement therapy for adrenal insufficiency might be safe with respect to HBV reactivation, attention should be paid to HBV reactivation during corticosteroid therapy in rheumatic disease patients, since the dose of corticosteroids administered is usually large, and since other immunosuppressants are co‐administered.

Hepatitis B virus (HBV) infection amongst children in Senegal: current prevalence and seroprotection level.

IntroductionHepatitis B virus (HBV) infection is highly endemic in Senegal. HBV vaccine of all children has been introduced in 1999 and included in the Expanded Programme on Immunization in 2004. The aim of this study was to assess the HBV prevalence and immunity status against HBV amongst children in Senegal.MethodsBetween March and August 2016, consecutive children aged from 6 months to 16 years old were recruited in outpatient department of three main children hospitals in Senegal. Serum samples were analyzed for HBV serology (HBsAg, HBcAb, HBsAb) using ARCHITECT analyzer. Children with HBsAb levels ≥ 10 IU/l) were considered as seroprotected against HBV.ResultsDuring the study period, 295 children fulfilled the criteria for the study and were further analyzed. Three children were HBsAg positive giving a seroprevalence at 1.1% (95% CI: 0.2-3.3), 12/267 (4.5%, 95% CI=2.3-7.7) had positive HBcAb and 226/295 (76.6%, 71.4-81.3) had positive HBsAb including 191 (77.3%, 71.6-82.4) with isolated HBsAb related to previous active immunization. However only 165 children (56%, CI 50-62) had seroprotective HBsAb levels (HBsAb ≥ 10 UI/L) and 63 (21.4, 16.8-26) had a strong seroprotectiondefined by HBsAb ≥ 100 IU/L.ConclusionOur results suggest that although HBV prevalence has significantly decreased in children in Senegal following a better HBV vaccine coverage, the number of children correctly seroprotected is insufficient (56%). Assessing the levels of HBsAb and providing HBV vaccine boosters should be considered in children in Senegal.

SERO-PREVALANCE OF ANTI HBSAG AMONG FEMALE UNIVERSITY STUDENTS OF DISTRICT PESHAWAR

Background: Hepatitis B is a liver infection caused by hepatitis B virus (HBV). This infection can be acute or chronic. HBV infection can be prevented through immunization included in EPI in 2004 in Pakistan. Females are more unsafe and risky group for HBV infection having lots of chances for exposure to blood contact and female can transmit infection vertically to their children. Therefore immunization of females is very important. Methods: The study was carried out among female university students of district Peshawar of age range 20 to 30.A written informed consent was taken from the head of departments of different universities of district Peshawar and from individual responder. Similarly about 200 questionnaires were filled from female University students of the defined age range. The information regarding the demography, HBV vaccination history and family history of HBV infection was gathered. About 3 to 5ml blood samples were collected from all HBV vaccinated and non vaccinated female students for determination of natural or vaccine induced immunity against hepatitis B surface antigen (HBs Ag). The collected blood samples were transferred to PHRC centre Khyber medical college for anti HBs Ag test. Data was gathered and analysed by SPSS version 22. Results: This study consists of 200 female university students, among them 163(81.5%) were from urban and 37(18.5%) were from rural area. Out of 200 female students 45(22.5%) were none vaccinated and 131(65.5%) were vaccinated. Only 64(32%) have completed their vaccination course and only 79(60.3%) university students were having positive immunity against HBV (positive HBsAb). Results shows that 5(2.5%) university students have infected persons in their families, and only 2(40%) infected families were HBV vaccinated. Conclusion: This study provided low HBV vaccination status and antibody sero-prevalence in spite of HBV vaccination. Schedule vaccination need full attention. HBsAb test should be done after every 5-10 years of HBV vaccination to ensure a booster dose vaccine.

Antibody Response to Hepatitis B Virus Vaccine is Impaired in Patients With Inflammatory Bowel Disease on Infliximab Therapy.

Studies have demonstrated an association between anti-TNF/immunomodulator agents used in inflammatory bowel disease (IBD) and impaired hepatitis B virus (HBV) vaccine immunogenicity, but little data exist on whether specific medication types affect protective HBsAb titers. Our aim was to analyze this association. This is a retrospective cohort study. Inclusion criteria: age ≥18, diagnosis of Crohn's disease (CD) or ulcerative colitis (UC), previous HBV vaccination series and/or ≥1 positive HBsAb, and record of IBD therapy in 6 months before titer level. Patients were stratified based upon medication exposures: anti-TNF, immunomodulator, combination anti-TNF and immunomodulatory, and a reference arm. Titer levels following vaccination and specific medication types given in the 6 months before titer were recorded. Seroprotection was defined as HBsAb ≥10 IU/l and ≥100 IU/l. The study cohort (N = 391) was 70.8% white, 51.4% female and 64.2% had CD and 35.8% had UC. The mean age was 45.8 years. A significantly lower percentage of patients exposed to anti-TNF, immunomodulator or dual therapy had titers ≥10 (P < 0.01). Regarding specific medications, only patients exposed to infliximab (P < 0.01) were less likely to have titer levels ≥10, after controlling for other medication exposures, age at titer level, and interval time between vaccination/titer level. This was not found for patients exposed to adalimumab, methotrexate, 6-mercaptopurine, or azathioprine. Patients exposed to infliximab were significantly less likely to have protective HBsAb titer levels following vaccination, a trend not seen in patients on adalimumab. Efforts to vaccinate IBD patients against HBV before use of immunomodulators and anti-TNFs, infliximab specifically, and screen periodically thereafter must be reinforced.

Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Infection in Multi-Transfused Thalassemic Patients, Kermanshah, Iran, 2015

Background: Repeated blood transfusions in Thalassemic patients predispose them to blood-borne infections including Hepatitis B, Hepatitis C, and human immunodeficiency virus. These infections cause cirrhosis, portal hypertension, and acquired immunodeficiency syndrome. Objectives: The current study aimed at determining the prevalence of these infections in Thalassemic patients of Kermanshah province, Iran. Methods: Thalassemic patients registered at Mohammad Kermanshahi university hospital were included. Demographic data, history of blood transfusions, Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HBC Ab), Hepatitis B surface antibody (HBs Ab), Hepatitis C antibody, and Human immunodeficiency virus (HIV) antibody were extracted. Serologic tests were done using the third-generation enzyme linked immunosorbent assay (ELISA) and positive Hepatitis C virus (HCV) Ab and HIV Ab results was confirmed by Western Blotting. Results: A total number of 232 patients were enrolled (111 females and 121 males), among whom HBsAg and HIV Ab were both negative. Positive HBS Ab was reported in 222 subjects (95.7%) and 19 cases (8.2%) had positive HBC Ab. Immunity to hepatitis B was the result of vaccination in 87.5% of cases. Hepatitis C antibody was positive in 14 cases (6%). Finally, a significant relationship was found between HCV infection and blood transfusion done before 1996. Conclusions: High rate of hepatitis C was found to be due to the lack of screening for HCV Ab among blood donors before 1996. The negative HBS Ag can be justified by regular hepatitis B vaccination program in patients with thalassemia. The lack of HIV infection was concluded to be attributed to the low prevalence of this virus in the general population and blood donors as well as proper screening methods.

Evaluation of the Immunological Status to Hepatitis B Vaccine of individuals after 20 years from Receiving Hepatitis B Vaccine in Compulsory Program in Egypt.

Background: Hepatitis B virus (HBV) is a worldwide public health problem. The prevalence of chronic HBV infection is highly variable. Egypt is considered to be a region of intermediate prevalence for HBV infection with reported figure of 4.5% In 1991, the World Health Organization (WHO) recommended that hepatitis B vaccination should be included in national vaccination programs in all countries with a hepatitis B carrier prevalence (HBsAg) of > 8% by 1995 and in all countries by 1997.Objectives: This study aimed to determine the immunologic status (An anti-HBs level of >10 mIU/ml that is protective against HBV infection) among individuals after 20 years from receiving hepatitis B vaccine in compulsory program in Egypt. Methods: It is a cross sectional study. It was carried out on 57 medical students. They are studying in the 2nd year of Faculty of Medicine, Suez Canal University (FOM, SCU). It was conducted at Family Practice clinic affiliated to Suez Canal University Hospital. In the current study a self-administered questionnaire was fulfilled by the studied population. A blood sample was taken to measure serum anti-HBs Ab titre. Individuals with positive protective titre(>10 mIU/mL) were tested for HBcIgG to determine whether they are positive due to vaccination or old infection, positive HBcIgG individuals were tested for HBsAg to determine if they were still infected or not. Results: The current study showed that; only 35.1 % of the studied population have got a positive protective HBsAb titre (>10 mIU/mL). Conclusion: The current study concluded that, after 20 years of receiving HBV vaccine in the compulsory vaccination program in Egypt about 2/3 of individuals (64.9%) had anti-HBs titre < 10 mIU/mL. This level of antibodies puts the studied population at an increased risk of acquiring infection with HBV during their future life.

Incidence of hepatitis B virus reactivation in patients with resolved infection on immunosuppressive therapy for rheumatic disease: a multicentre, prospective, observational study in Japan

BackgroundAlthough the reactivation of hepatitis B virus (HBV) is recognised as a serious complication in patients with rheumatic disease (RD) receiving immunosuppressive drugs (ISDs), the incidence and risk factors for...

SY-2-7 - Effectiveness of hepatitis alert system implementation on regimen adaptation for electronic medical record

Purpose: There are some cases to become fulminant hepatitis and reached to death from fulminant hepatitis by Hepatitis B virus (HBV) reactivation after administration of the strong immunosuppressive agent or anticancer agents for the blood malignancy or malignant cancer disease patients. So it is necessary to check the HBV-DNA and liver function test for patients with Hepatitis B surface (HBs) antigen(Ag)-positive or HBsAg-negative but HBs antibody(Ab) or Hepatitis B core(HBc)Ab positive cases with regimen adaptation. We examined the number of HBV markers checked patients at adapted regimen of anticancer agent past five years in our hospital. In addition, we evaluated change of HBV markers checked ratio at the time of regimen application after hepatitis alert system implementation of electronic medical record system May 2015.Results: There are 1,726 chemotherapy patients adapted regimen in our outpatients chemotherapy room from January 1 2010 to December 31 2015.The HBsAg checked cases were 1611/1726 (93.3%) and HBsAg-positive cases were 22/1611 (1.3%). Among HBsAg-negative patients, HBsAb, HBcAb checked ratio drastically rose to 84%, 83% at after May 2015 when hepatitis alert system implementation from 18%, 10% at 2010, 21%, 16% at 2012, 29%, 28% at 2014, 58%, 56% at 2015. HBsAb and HBcAb positive rate were 100/528 (19%) and 100/472 (21.8%)before alert system, 29/156(19%) and 33/155 (21%) after. The HBV-DNA checked ratio of patients with positive HBsAb or positive HBcAb was 106/128 (83%) before, 34/38 (89%) after.Conclusion: Hepatitis alert system implementation for EMR are drastically effective for increasing checked ratio of the HBV-related marker for the chemotherapy patients at the time of the regimen adaptation on EMR system. Purpose: There are some cases to become fulminant hepatitis and reached to death from fulminant hepatitis by Hepatitis B virus (HBV) reactivation after administration of the strong immunosuppressive agent or anticancer agents for the blood malignancy or malignant cancer disease patients. So it is necessary to check the HBV-DNA and liver function test for patients with Hepatitis B surface (HBs) antigen(Ag)-positive or HBsAg-negative but HBs antibody(Ab) or Hepatitis B core(HBc)Ab positive cases with regimen adaptation. We examined the number of HBV markers checked patients at adapted regimen of anticancer agent past five years in our hospital. In addition, we evaluated change of HBV markers checked ratio at the time of regimen application after hepatitis alert system implementation of electronic medical record system May 2015. Results: There are 1,726 chemotherapy patients adapted regimen in our outpatients chemotherapy room from January 1 2010 to December 31 2015. The HBsAg checked cases were 1611/1726 (93.3%) and HBsAg-positive cases were 22/1611 (1.3%). Among HBsAg-negative patients, HBsAb, HBcAb checked ratio drastically rose to 84%, 83% at after May 2015 when hepatitis alert system implementation from 18%, 10% at 2010, 21%, 16% at 2012, 29%, 28% at 2014, 58%, 56% at 2015. HBsAb and HBcAb positive rate were 100/528 (19%) and 100/472 (21.8%)before alert system, 29/156(19%) and 33/155 (21%) after. The HBV-DNA checked ratio of patients with positive HBsAb or positive HBcAb was 106/128 (83%) before, 34/38 (89%) after. Conclusion: Hepatitis alert system implementation for EMR are drastically effective for increasing checked ratio of the HBV-related marker for the chemotherapy patients at the time of the regimen adaptation on EMR system.

HBIg-Induced Transient Hepatitis B Core Antibody in Liver Transplant Recipient: Misleading Serology Testing?

Introduction: The rate of HBV transmission in liver transplantation from donors with positive Hepatitis B core Antibodies is reported to be higher in liver transplants when compared to other solid organ transplants due to the fact that HBV resides in donor hepatocytes. The administration of hepatitis B immune globulins (HBIg) and effective antiviral therapy has been successful in reducing the rate of is transmission. In this case, we describe a patient who received a deceased donor liver transplant from an HBcAb positive donor and developed a transient seropositive HBcAb from HBIg administration. Case Presentation: A 61-year-old woman with a history of end-stage liver disease secondary to hepatitis C genotype 1a liver cirrhosis who underwent a deceased donor orthotopicliver transplant on August 7th,2015. HCV viral PCR on August 13th, 2015 was 54,787 IU/mL. She was treated with simeprevir plus sofosbuvir for 12 weeks with sustained viral response. RepeatHCV viral PCRs in October and November 2015 as well as February2016 were all undetectable. Patient's donor serology was noted to have negative Hepatitis B Surface Antigen (HBsAg) and a positive HBcAb total but and a negative HBcAbIgM while HBV PCR, and HCV PCR were both negative. The transplant procedure was uneventful. The recipient received a single dose of 10,000 units of HBIg intravenously during the hospitalization per protocol and was continued on entecavir 0.5 mg daily.Of note, she was immunized with hepatitis B vaccine series (total 3 doses) and acquired immunity to Hepatitis B in March 2013 but lost her immunity to hepatitis B in February 2015 prior liver transplant. Upon follow up in transplant infectious disease clinic 1 month following her liver transplant, she was doing well. Interestingly enough, hepatitis B serology during that time showed positive HBsAb and HBcAb testsand negative HBsAg and HBV DNA. We continued to monitor recipient hepatitis B serology (table1) and found that her HBcAb which was positive became negative 9 months after the transplant and her HBsAb which was positive became negative after 9 months following the transplant despite after receiving a hepatitis B booster dose in December 2015. In our patient, she was initially non-immune to hepatitis B and received HBIg plue entecavir after the transplant. A recent study of 80 consecutive patients with chronic HBV undergoing liver transplantation on an HBIg-free regimen of entecavir monotherapy found a 91% loss of HBsAg and 98.8% achievement of serum HBV DNA clearance over a median follow-up time of 26 months post orthotopic liver transplant makes the role of HBIg diminish. HBIg is a polyclonal purified preparation of human anti-HBs (hepatitis B surface antibody) derived from pooled plasma and has maximum benefit during the first 6-12 months after the transplant when recipients were receiving intense immunosuppressant. In our patient, she initially was non-immune toHBV and then her HBcAb became positive, however HBV DNA was negative and HBsAb was positive for the first 6-7 months after the transplant. HBsAb seropositive may be explained by passive immunity from HBIg which can last long for 6-12 months.Figure 1

Destructive Effect of DBCD Plasma on HBsAg in Human Blood and Its Impact on Erythrocyte Functions

This paper aimed to investigate the destructive effect of an atmospheric-pressure low-temperature plasma (LTP) on hepatitis B surface antigen (HBsAg) in human blood as well as its impact on the functions of erythrocytes. Dielectric barrier corona discharge was used to generate the atmospheric-pressure LTP to treat the blood samples collected from hepatitis B patients with positive HBsAg, HBeAg, and anti-HBc, but negative HBsAb and HBeAb. The experimental results showed that the antigenicity of HBsAg in blood samples changed from positive to negative after being treated with the LTP for more than 40 s. Furthermore, the investigations demonstrated that after more than 30 s treatment of the LTP, osmotic fragility and malondialdehyde level of erythrocytes increased significantly, and Na+–K+-ATPase activity of erythrocytes decreased remarkably. Our results revealed that the LTP could effectively destruct HBsAg in blood and inhibit erythrocyte functions during the process.

A case of prolongable curative course by PegIFN on treating chronic hepatitis B with positive HBsAg and HBsAb

A case of prolongable curative course by PegIFN on treating chronic hepatitis B with positive HBsAg and HBsAb

Seroprevalance of Hepatitis B Virus Markers Among Village Midwives in Khartoum State, Sudan, 2014

Background information: HBV infection is a serious health problem and a leading cause for morbidity and mortality. Objective: To determine HBV markers ((Anti-HBcore (IgM), Anti-HBcore (IgG), HBsAb, HBsAg, and HBeAg)) among Village Midwifes in Khartoum State, Sudan, 2014. Method: It is a cross sectional study where 335 village midwives were surveyed. A pre-tested close ended questionnaire was used for demographic data. Five ml of venous blood was collected; sera were separated and stored at-20° centigrade for Eliza testing. All specimens were tested for Anti-HBcore (IgM), Anti-HBcore(IgG) and HBsAb. Positive specimens for Anti-HBcore were tested for HBsAg and positive specimens for HBsAg were tested for HBeAg. Data was analyzed by using statistical package of social sciences (SPSS) version (16). Z-test for single proportion was used to compare between the actual prevalence of HBV markers and the expected rates in the absence of risk. P value equal or less than 0.05 was considered statistically significant value. Result: Positive Anti-HBcore (IgG) accounted to 113 (34%), positive HBsAgwas 57 (57%), and positive HBsAb was 7%. The results were significant at 5% confidence level, since all P-values were less than 0.001. There was no positive HBeAgto express high infectivity rate or Anti-HBcore (lgM) to reflect acute infection rate among the respondents. Conclusion: Infection rate of HBV was high, while the related immunity was low among Village Midwives in Khartoum State, Sudan.

Untreated highly viraemic pregnant women from Asia or sub‐Saharan Africa often transmit hepatitis B virus despite serovaccination to newborns

Mother-to-child (MTC) hepatitis B virus (HBV) transmission has been mainly studied in Asia. The geographical origins of women and HBV genotypes differ in Europe. The aims were to determine the rate and risk factors of MTC HBV transmission from women with high HBV DNA loads in a maternity hospital in Paris, France. Retrospective study of HIV-negative, HBs Ag-positive pregnant women with HBV DNA loads above 5 Log10 I.U/ml who were not given lamivudine or tenofovirDF during pregnancy between 2004 and 2011. Among 11 417 pregnant women, 437 (4%) showed a positive HBs Ag. Among these women, 52 had HBV DNA loads above 5 Log10 I.U/ml: 41, 10 and 1 born in Asia, sub-Saharan Africa and Europe respectively. Among the 52 women, 40 were eligible for the analysis: no antiviral therapy during pregnancy; children over 9 months old. Twenty-eight (70%) women were assessed, corresponding to 41 childbirths. Eleven children (27%) had positive HBs Ag, 14 (34%) had positive HBc and HBs Ab, 16 (39%) had positive HBs Ab only. The risk of having positive HBs Ag, according to maternal HBV DNA loads, was 14% for HBV DNA loads less or equal to 8 Log10 I.U/ml, 42% for HBV DNA loads over 8 Log10 I.U/ml, P = 0.04, but not related to the women's origin, HBV genotype. This study confirms that serovaccination does not fully protect newborns from MTC HBV transmission, when maternal HBV DNA loads exceed 5 Log10 I.U/ml, regardless of the women's origin or HBV genotype.