Presence Of Hepatitis B Surface Antigen Research Articles

HEPATITIS B AND C VIRUS INFECTIONS

Patients with end stage renal disease require haemodialysis as a part of theirtreatment. The incidence of hepatitis B and C virus infection is quite high in patients undergoingmaintenance haemodialysis than in general population. This risk is specifically associatedwith use of blood and its products as well as repeated intravascular access in these patients.Objectives: To determine the seropositivity of hepatitis B and C virus infection in patientsreceiving haemodialysis. Design: Descriptive cross sectional study. Setting: NephrologyDepartment, Ayub Teaching Hospital, Abbottabad, Pakistan. Period: From October 2014 toApril 2015. Methods: Five hundred patients were included in the study based on inclusionand exclusion criteria. Demographic data was recorded and detailed history was taken fromeach patient specifically about the no of blood transfusions received, the frequency of dialysisand the dialysis done in other centers. All patients were checked for the presence of hepatitisB surface antigen (HbsAg) and antibodies to HCV using third generation enzyme linkedimmunoassay (ELISA). Results: Mean age of study sample was 46±5 years with 60.8 % males.Incidence of hepatitis positive cases was 164 (32.8 %), out of which 66 (13.2 %) patients wereHBV positive and 98 (19.08 %) patients were HCV positive. The hepatitis B and C infectionswere more common in males than females. Seropositivity of HBV and HCV was higher (HBV18.1 % and HCV 22.2 %) among haemodialysis patients who have received more than threeblood transfusions. The frequency of HBV and HCV infections increases significantly with theincrease in frequency of dialysis, with 49 (17.11 %) patients were HBV positive and 70 (24.5%) patients were HCV positive cases, who have received haemodialysis for more than fivetimes. There were 48 (15.7 %) HBV positive cases as well as 68 (22.3 %) HCV positive cases inpatients who have received their treatment from a single center. Conclusion: Hepatitis B andC infection is quite common in patients undergoing haemodialysis. The risk of these infectionscan be reduced by following infection control guidelines, proper training of the staff and strictscreening of blood and blood products specifically for hepatitis C virus.

English

Patients with end stage renal disease require haemodialysis as a part of theirtreatment. The incidence of hepatitis B and C virus infection is quite high in patients undergoingmaintenance haemodialysis than in general population. This risk is specifically associatedwith use of blood and its products as well as repeated intravascular access in these patients.Objectives: To determine the seropositivity of hepatitis B and C virus infection in patientsreceiving haemodialysis. Design: Descriptive cross sectional study. Setting: NephrologyDepartment, Ayub Teaching Hospital, Abbottabad, Pakistan. Period: From October 2014 toApril 2015. Methods: Five hundred patients were included in the study based on inclusionand exclusion criteria. Demographic data was recorded and detailed history was taken fromeach patient specifically about the no of blood transfusions received, the frequency of dialysisand the dialysis done in other centers. All patients were checked for the presence of hepatitisB surface antigen (HbsAg) and antibodies to HCV using third generation enzyme linkedimmunoassay (ELISA). Results: Mean age of study sample was 46±5 years with 60.8 % males.Incidence of hepatitis positive cases was 164 (32.8 %), out of which 66 (13.2 %) patients wereHBV positive and 98 (19.08 %) patients were HCV positive. The hepatitis B and C infectionswere more common in males than females. Seropositivity of HBV and HCV was higher (HBV18.1 % and HCV 22.2 %) among haemodialysis patients who have received more than threeblood transfusions. The frequency of HBV and HCV infections increases significantly with theincrease in frequency of dialysis, with 49 (17.11 %) patients were HBV positive and 70 (24.5%) patients were HCV positive cases, who have received haemodialysis for more than fivetimes. There were 48 (15.7 %) HBV positive cases as well as 68 (22.3 %) HCV positive cases inpatients who have received their treatment from a single center. Conclusion: Hepatitis B andC infection is quite common in patients undergoing haemodialysis. The risk of these infectionscan be reduced by following infection control guidelines, proper training of the staff and strictscreening of blood and blood products specifically for hepatitis C virus.

Hepatitis B Virus (HBV) Reactivation In Anti-HB Core Antigen (anti-HBc) Positive Patients with Hematological Malignancies: A Prospective Multicenter Study

AbstractAbstract 4911Patients with haematological malignancies and overt hepatitis B (HB) infection defined by the presence of HB surface antigen (HBsAg) are at risk of hepatitis reactivation, and antiviral prophylaxis is generally recommended. HBV reactivation can also occur during immunosuppressive therapy in patients who are HBsAg negative, but are positive for antibodies to HB core antigen (anti-HBc) which suggests prior contact with HBV and potential occult infection. The risk of HBV reactivation for these patients who have evidence of viral clearance (HBV-DNA negative) and developed potential immunity (anti-HBs positive) is not clear, and there are no clear guidelines for prophylaxis in this subset of patients. We therefore performed a multicenter prospective observational study to determine the risk of HBV seroreversion in anti-HBc positive patients with or without anti-HBs and with hematological malignancies undergoing intensive immunosuppressive chemotherapy and/or hematopoietic stem cell transplantation (HSCT). Patients underwent monitoring of HBV serum markers including HBV-DNA serum levels, while patients who started antiviral prophylaxis concomitant to the cytotoxic therapy were excluded. Between 1/2008 and 12/2008, 25 consecutive HBsAg -/antiHBc +/antiHBs + patients (pts) from 3 hematological centers were enrolled into the study (20 pts with lymphoma, 2 pts with acute myeloid leukaemia, 3 with myeloma). Before starting anticancer therapy, all pts had undetectable HBV-DNA levels, 21 were anti-HBs positive, and 12 had also anti-HBe. Moreover, 3 pts had HCV co-infection. All patients underwent intense immunosuppressive therapy including rituximab in 15 pts, and HSCT in 10 pts (7 autologous and 3 allogeneic). HBV markers were monitored during immunosuppressive treatment and for 18 months after end of therapy. At present, 18 pts have completed the planned follow-up period, and other 7 pts have at least 12 months of post-treatment follow-up. Among the 25 patients, we observed 3 cases of seroreversion with positive HBV-DNA levels. All 3 seroversions occurred in patients following allogeneic HSCT despite high anti-HBs levels at baseline. The 3 seroreverted patients showed a progressive decline in anti-HBs titers during the phase of monitoring, and HBV reactivated between the 7th and 9th month after allogeneic HSCT. The pts responded to treatment with antinucleoside analogues (entecavir in 2 cases, lamivudine in 1 case), i.e. HBV-DNA decreased of at least 1 log within three months from treatment start. Moreover, we detected one case of transient anti-HBs disappearance, and one case of persistent anti-HBe loss without seroreversion. None of the HCV co-infected pts presented acute hepatitis. No seroreversions were observed in 15 lymphoma patients undergoing immunochemotherapy including rituximab. In conclusion, patients with occult HBV infection are at risk of HBV reactivation during continuous immunosuppressive therapy following allogeneic HSCT even in the presence of anti-HBs levels at baseline, while the risk appears low in patients undergoing transient immunosuppressive therapy, as immunochemotherapy including rituximab, for the treatment of lymphoma. Disclosures:No relevant conflicts of interest to declare.

The pathogenesis of arthritis associated with acute hepatitis-B surface antigen-positive hepatitis. Complement activation and characterization of circulating immune complexes.

Circulating immune complexes were identified in cryoproteins isolated from serial samples of serum from six patients with acute viral hepatitis with and without arthritic symptoms. Cryoprecipitates were analyzed for the presence of hepatitis-B surface antigen (HBsAg) and hepatitis-B surface antibody (anti-HBs) by hemagglutination inhibition and hemagglutination. Complement components were detected by counter electrophoresis, and immunoglobulins were detected by gel diffusion. HBsAg, IgG, and IgM were identified in cryoprecipitates from all hepatitis patients, but were higher in concentration in patients with arthritis. Only cryoprecipitates from hepatitis patients with arthritis contained IgA and complement components C3, C4, and C5 as well as IgG and IgM, which disappear with resolution of the arthritis. The subtypes of IgG in these cryoprecipitates were predominantly the complement-fixing IgG1 and IgG3, HBsAg and anti-HBs were concentrated several-fold in the cryoprecipitates when compared to the serum concentration. Sequential studies in two patients demonstrated that the initial appearance of anti-HBs in the cryoprotein complex was associated with the detection in the complex of IgM suggesting a primary immune response to HBsAg. The C3 activator fragment (C3A) of the properdin complex was found in fresh serum obtained from three hepatitis patients with arthritis and not in uncomplicated hepatitis. The cryoprecipitable immune complexes from patients with arthritis converted C3PA in fresh normal sera to C3A in vitro whereas cryoprotein isolated from patients with uncomplicated hepatitis had no such effect. Thus, the transient appearance of circulating complement-fixing immune complexes in patients with the arthritis of acute hepatitis is associated with activation of both classical and alternate complement pathways and suggests that they play an important role in the pathogenesis of these serum sickness-like extrahepatic symptoms.