Prevalence Of Hepatitis Virus Infection Research Articles

Prevalence and predictors of hepatitis C infection among antenatal attendees in a tertiary hospital in Southern Nigeria.

Hepatitis C virus infection as it specifically relates to pregnancy has been a neglected condition, thus its recognition and treatment in pregnancy is relevant because of the risks of the long-term complications of the infection in the mother, potential effects of the infection on the pregnancy and risk of vertical transmission to the newborn. To determine the proportion of pregnant women with serologic markers of hepatitis C infection, identify risk factors as well as factors that predict the occurrence of the infection in them. Over a 3-week period, blood samples from 456 pregnant women were assessed for antibodies to hepatitis C virus, while a pre-tested questionnaire was used to obtain socio-demographic data and the presence of risk factors in the University of Uyo Teaching Hospital, Nigeria. The prevalence of HCV infection in pregnancy was 4.6%. No known risk factors for HCV infection in pregnancy were identified. Only increasing gestational age was a predictor of HCV infection in pregnancy in the study. The prevalence of hepatitis virus infection among the study population was high. Second trimester and increasing gravidity were protective of the infection in pregnancy. There is therefore need for introduction of general routine screening of all pregnant women presenting for antenatal care.

Hepatitis screen in children with malignancy at child’s central teaching hospital

Introduction: Transfusion-transmitted infections continue to be a threat to the safety of the blood supply, in particular the risk is high for parenterally transmitted viral hepatitis in pediatric malignancy. The aim was to estimate the prevalence of hepatitis in children with malignancy, identify some variables that could affect the prevalence of hepatitis in these patients, and to have an idea about the effect of vaccination in controlling hepatitis infection. Method: A Cross sectional study of (180) children between the age of [1-15] years with malignancy, in the period seven months, diagnosed and treated in CCTH were studied. Among those children with malignancy, testing for HBV and HCV were done through blood samples taken from the patients and sent to lab. of CCTH. Results: patients were referred from different parts of the country, from (180) patients with malignancy, 48(27%) were HBV positive &33(20%) with HCV positive. History of clinical jaundice was reported in 33 of cases (18%). The no. of blood transfusion had significant impact on prevalence of hepatitis virus infection. Conclusion: There is a high prevalence of HBV&HCV infection in patients with malignancy treated in Child's Central Teaching Hospital (CCTH).

MO831: Hepatitis Virus Infection in End-Stage Kidney Disease Patients Treated by Haemodialysis in Romania After 5 Years of Active Antiviral Therapy, Revisited

Abstract BACKGROUND AND AIMS After 5 years from the previous national prospective observational study and a modern antiviral program, we aimed to re-evaluate the prevalence of hepatitis virus infection and its impact in end-stage kidney disease (ESKD) patients treated with haemodialysis (HD) in Romania. METHOD A total of 1516 ESKD patients (909 men and 608 women, median age 60.1 ± 12.9 years) treated with chronic HD in twelve centres from all the historical regions of Romania have been assigned to this study. Data regarding their HBs Ag and anti-HCV antibodies were recorded. RESULTS HBsAg was positive now in 5% (n = 76) patients and it was significantly lower than in 2015 (9.5%, n = 57), P = 0.0001, anti-HCV antibodies were detected in 11.5% (175) versus 27.3% (n = 164), P < 0.0001; and 1.5% (n = 24) versus 5% (n = 30) were positive for both HBV and HCV infection, P < 0.0001. When we split the cohort between the historical regions of Romania (Moldavia 426 patients, Muntenia 321 patients, Transylvania 769 patients), in Moldavia (Eastern Romania), the prevalence of both HBV and HCV infection was significantly lower than 2015 (4.2% versus 16.8%; P < 0.001, respectively for HCV 20% versus 42.9%; P < 0.0001). The prevalence of HBV infection in Muntenia region was 3.1% versus 9.9% in 2015 (P = 0.003), but Muntenia recorded a significant decrease in the prevalence of HCV infection in haemodialysis patients from 2015 until now (9.6% versus 36.4%, P < 0.001). Data from Transylvania are similar, there are no significant differences in terms of HBV infection (3.7% versus 4.7% in 2015; P = 0.455) but the prevalence of HCV infection is significantly <2015 (7.6% versus 13.9%; P = 0.001). CONCLUSION This study shows that the systematically nationwide applied measures for significant reduction of infection risk and antiviral therapy significantly decreased HV infection prevalence in HD patients in Romania.

Abstract 807: Asian prevalent ABCB5 genetic variants rs2074000 and rs17143187 predicts overall survival and clinical outcomes in hepatocellular carcinoma patients

Abstract Background/Aims Incidence of HCC varies in diverse localities with differences on ethnicity and risk factors. The majority of HCC cases worldwide are from China, thus raising the concern on genetic susceptibility in addition to the prevalence of hepatitis virus infection. Drug transporter ABCB5 has been reported to be overexpressed in HCC and associated with poor survival. Recently a panel of SNPs and INDELs in ABCB5 gene have been reported to associate with HCC risk (Leung et al. 2020). We aim to further examine the ethnic differences on the ABCB5 genetic variations between local cohort and the data from The 1000 Genome Project. Subjects and Methods 300 HCC and 300 healthy blood samples were prospectively collected with informed consent. All patients had been diagnosed with primary HCC and underwent partial hepatectomy. Clinical information including sex, age, tumor stage and survival outcomes were collected prospectively. Genomic DNA were extracted from blood samples and SNPs were examined. SNP allele frequencies in different populations were obtained from The 1000 Genomes Browser by NCBI. Results Twelve ABCB5 genetic variants were within the coding regions, with one splicing variant, one stop codon change, while 2 were synonymous and 8 were non-synonymous changes. In particular, allele frequencies of rs2074000 observed in healthy local cohorts (C: 0.517 vs A: 0.483) were comparable to East Asian, while the genetic variation was absent in European in 1000 Genomes Project (CHB - C: 0.534 vs A: 0.466; CHS - C: 0.548 vs A: 0.452; GBR - C: 1.000 vs A: 0.000; CEU - C: 1.000 vs A: 0.000; P<0.001). Similarly, allele frequencies of rs17143187 in healthy local cohorts (G: 0.518 vs C: 0.482) were comparable to East Asian (CHB - G: 0.539 vs C: 0.461; CHS - G: 0.567 vs C: 0.433), while it was absent among European (GBR and CEU - G: 1.000 vs C: 0.000) (P<0.001). Data from our local HCC cohorts further demonstrated that rs2074000 and rs17143187 were independent protective factors in overall survival (Cox HR; rs2074000: 0.676, 95% CI: 0.49-0.93, P=0.017; rs17143187: 0.709, 95% CI: 0.51-0.98, P=0.038). These ABCB5 genetic variants were associated with early tumor stage (OR; rs2074000: 0.351, 95% CI: 0.21-0.59, P<0.001; rs17143187: 0.382, 95% CI: 0.22-0.65, P<0.001) and solitary tumor nodule (OR; rs2074000: 0.507, 95% CI: 0.30-0.86, P=0.012; rs17143187: 0.517, 95% CI: 0.30-0.88, P=0.015). Conclusions ABCB5 genetic variants rs2074000 and rs17143187 mainly prevalent in East Asian predicted better overall survival among HCC patients. ABCB5 is crucial in tumor-initiating cells in melanoma. ABCB5 rs2074000 (non-synonymous SNP, Gln to Lys, classified as damaging by SIFT score) and rs17143187 (splicing variant) both predicted to confer non-functional proteins, thus partly explain the protective effects. Further functional studies are warranted to comprehend the underlying mechanisms. Citation Format: Chun Philip Yeung, Ching Ning Charing Chong, Tan To Cheung, Kelvin Kwok Chai Ng, Paul Bo San Lai, Siu Tim Cheung. Asian prevalent ABCB5 genetic variants rs2074000 and rs17143187 predicts overall survival and clinical outcomes in hepatocellular carcinoma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 807.

Prevalence of Hepatitis B and C virus infection and their co-relation with hematological and hepatic parameters in subjects undergoing Premarital Screening in the Jazan Region, Kingdom of Saudi Arabia.

Objective:Hepatitis is a serious health concern with a high rate of mortality and morbidity world over. Saudi Arabia also has its course of the disease incidence. The data on the prevalence of the disease is still limiting. This study aimed to estimate the prevalence of hepatitis B virus [HBV] and hepatitis C virus [HCV] infection in the Jazan region and study its effects on hematological and hepatic parameters.Methods:This cross-sectional study was conducted at premarital screening centre located in King Fahd Central Hospital, Jazan, Kingdom of Saudi Arabia. A total of 7,826, Saudi couples undertaking premarital screening from Jazan region, were enrolled in the study and screened between January 2014 and June 2015 for hepatitis B virus and hepatitis C virus. Complete blood counts and hepatic profile were carried out for individuals who were Hepatitis B and or C virus positive.Results:A higher prevalence of hepatitis virus infection in male participants [HBV 1.9%; HCV 0.4%] than in females [HBV 1.43%; HCV 0.2%] was seen. The neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios were significantly decreased among HBV- and HCV-infected patients. The concentration of hepatic enzymes showed a statistically significant increase in seropositive individuals. The levels of albumin were significantly decreased in individuals with hepatitis B and C when compared with the control groupConclusions:The study concludes that the prevalence of HBV infection among Saudi subjects in Jazan was higher than the prevalence of HCV infection, and both HBV and HCV were higher in men than in women.

Seroprevalence of hepatitis B and C infection among Nigerian subjects with chronic kidney disease

Background and Objective: The prevalence of hepatitis virus infection in subjects with chronic kidney disease (CKD) has important implications for the etiology of kidney disease, infection safety in hemodialysis, and increases challenges in management consideration. The aim of this study was to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among our patients with CKD before the commencement of dialysis. Methods: All CKD patients (n = 1388) dialyzed between January 1996 and December 2012 were enrolled into the study. Demographic data and etiology of CKD were extracted from case records. Patients were screened for HBV and HCV at initiation of dialysis. Hepatitis B surface antigen (HBsAg), HCV antibodies were measured using specific enzyme-linked immunoassay kits (Bio Rad Monalisa HBsAg ULTRA kit, Marnes–la-Coquette, France; HCV Dia.Pro Diagnostics Milano Italy, respectively). All subjects with HIV infection were excluded from the study. Results: The studied group comprised 511 (36.8%) females; the mean age of the patients was 46.1 ± 15.3 years. Eighty-three (6.0%) patients were HBsAg positive, whereas 16 (1.2%) were HCV antibody positive. No difference was observed in gender occurrence. Patients with chronic glomerulonephritis (GN) were significantly more likely to be HBsAg positive (9%) compared with those with hypertension (5.5%) or diabetes (5.3%) (P = 0.015). Conclusion: The prevalence of HBV in CKD patients was high, whereas HCV was low. HBV was significantly associated with chronic GN. Routine screening of all patients with CKD and before hemodialysis for HBV should be mandatory, especially in HBV endemic regions of the world.

HEPATITIS VIRUS INFECTION IN REPEATEDLY TRANSFUSED THALASSEMIA PATIENTS

Patients of thalassemia who are conventionally treated by a regular transfusion regimen, are at a risk of developing transfusion transmitted infections, including hepatitis. The present study was conducted to evaluate the prevalence of hepatitis virus infection in repeated transfused thalassemia patients. A total of 83 patients of thalassemia who had received at least 10 transfusions were tested for HBs Ag, anti HBs and anti-HCV using ELISA. Amongst these patients, HBs Ag, anti HBs and anti HBC were detected in 1.2%, 26.5% and 12% patients respectively. the prevalence of HBV and HCV infection were in agreement with the findings in other study.

Safety of rilpivirine plus nucleoside reverse-transcriptase inhibitors in HIV-infected Taiwanese with a higher prevalence of hepatitis virus infection.

Introduction Combination antiretroviral therapy (cART) containing rilpivirine plus 2 NRTIs are effective antiretroviral (ARV) regimens for ARV-naive HIV-infected patients who had baseline plasma HIV RNA load (PVL) <5 log10 copies/mL and as switch therapy for those with viral suppression. In this study, we aimed to assess the short-term safety of rilpivirine-containing regimens among HIV-infected patients who initiated or switched to rilpivirine plus two NRTIs in Taiwan.Materials and Methods Between January and June 2014, medical records of all HIV-infected patients who initiated or switched to rilpivirine plus two NRTIs, during the follow-up were reviewed to assess the tolerance and adverse effects. Using a standardized data collection form, we recorded data of PVL and CD4 count, serologies for hepatitis B and C virus (HBV and HCV, respectively), haemogram, aminotransferases, bilirubin and serum creatinine before starting rilpivirine-containing regimens at four weeks and every 12 weeks thereafter.Results During the study period, medical records of 246 patients initiated their first ARV therapy with rilpivirine-containing regimens (n=90) or switched to rilpivirine-containing regimen from other regimens (156). Of the 246 patients, 73.4% were men who have sex with men and 9.1% and 25.6% tested positive for HBsAg and anti-HCV antibody, respectively. Baseline CD4 was 395 cells/mm3 (range, 2-1581) and PVL, 2.76 log10 copies/mL (range, <1.3>7.0 log10 copies/mL). As of 10 July, 23 patients (9.3%) stopped rilpivirine-containing regimens due to gastrointestinal upset (n=4), skin rash (2), depression (2), poor sleep (3), anaemia (4, all being with zidovudine/lamivudine), nail hyperpigmentation (1), presence of transmitted drug resistance (4), and elevated aminotransferase levels (1). The proportion of the patients with aminotransferases of fivefold or higher than the upper limit of normal (ULN) was 1.7% and 1.5% for AST and ALT, respectively, before starting rilpivirine-containing regimens; the respective value was 1.4% and 2.4% after 12 weeks of cART.Conclusions Rilpivirine-containing regimens were generally well tolerated and less than 10% of the patients had to stop rilpivirine due to various reasons. Despite a higher prevalence of chronic HBV or HCV infection, rilpivirine-containing regimens did not cause significant changes of aminotransferases from baseline.

Laparoscopic liver resection: 5-year experience at a single center

Background Hepatocellular carcinoma (HCC) is a common cancer, especially in the Association of Southeast Asian Nations (ASEAN) region, where the prevalence of hepatitis virus infection is high. Liver resection is a potentially curative and popular therapy for HCC. Laparoscopic surgery using minimally invasive techniques potentially brings benefits to patients who need liver resection for HCC. This study aimed to evaluate the effectiveness, safety, and benefits of laparoscopic liver resection for HCC with long-term follow-up evaluation.MethodsThis cohort study with 5-year results of total laparoscopic hepatectomy for HCC was conducted in one center. Patients with HCC were selected for laparoscopic liver resection by the same team. The operation also was performed by one team of surgeons. The follow-up protocol was similar to that for open surgery. The patients were scheduled to return for examination every 2 months after the operation. The data for the patients were collected and analyzed using SPSS software.ResultsFrom January 2008 to December 2012, 173 enrolled patients with HCC underwent laparoscopic liver resection. The male-to-female ratio was 3:1. The mean age of the patients was 56 years (range 16–83 years). The follow-up period for 130 patients was 21.6 ± 16.0 months (range 0–60 months). The mean tumor size was 3.73 cm (range 2–10 cm). The stages of HCC according to the Barcelona Clinic Liver Cancer (BCLC) categorization were as follows: 0 (6 %), A1 (59.5 %), A2 (6.9 %), A4 (2.9 %), and B (27.2 %). Four patients required conversion to other techniques (2.3 %) because of the potential for major bleeding and tumor perforation. The types of resection were resection of one segment (segments 2, 3, 4, 5, 6, 7, and 8; 43.8 %), resection of two segments (posterior sector, anterior sector, segments 5 and 6, and left lateral sector; 47.9 %), resection of three segments (left and central liver; 4.7 %), and four segments (right liver; 3.6 %). The mean operation time was 112 ± 56 min (range 30–345 min), and the median blood loss was 100 ml (range 20–1,200 ml). The mean hospital stay was 6.5 ± 2.0 days (range, 3–19 days). No perioperative mortality occurred. The overall survival rates were 94.2 % at 1 year, 87 % at 2 years, 72.9 % at 3 years, 72.9 % at 4 years, and 72.9 % at 5 years. The mean overall survival time was 49.7 ± 2.1 months (range 45.5–53.9 months). The disease-free survival rates were 79.1 % at 1 year, 60 % at 2 years, 57 % at 3 years, 52 % at 4 years, and 26.3 % at 5 years. The mean disease-free survival time was 38.9 ± 2.6 months (range 33.9–44.0 months).ConclusionLaparoscopic liver resection for HCC is feasible, safe, and effective, with good oncologic results. Major and anatomic hepatectomy are possible with improved skill and experience. Laparoscopic liver resection is a promising treatment option with minimally invasive benefits for HCC patients.

Hepatitis virus infection in children with chronic liver disease

Background: Hepatitis B and Hepatitis C viral infections are important causes of chronic liver disease (CLD) in patients. Prevalence of hepatitis virus infections among children with chronic liver disease is not known from this region. Objectives: To know the prevalence of HBV,HCV,HAV and HEV infection among children of CLD attending Nehru Hospital, PGIMER, Chandigarh. Methods: Two hundred and seventy children (174 males and 96 females, mean age ± SD: 6.38 yrs ± 3.92) of CLD between July 2008 to December 2012 were included in the study. Patient features, routine investigations including abdominal USG were recorded. 2 ml blood was collected and serum samples were stored at -20°C.These were tested for HBsAg, anti HCV, anti HAV IgM and anti HEV IgM by ELISA. All samples were uniformly tested for these four parameters using same standards. Results: One hundred and sixty five patients (61.1%) out of 270 children with CLD were non-reactive for HBsAg, anti HCV, anti HAV IgM and anti HEV IgM. These patients were of EHPVO with or without ascites, auto-immune hepatitis and Wilson's disease.73 patients (27.03%) of CLD were reactive for HBsAg including 4 patients with HAV co-infection (anti HAV IgM reactive). Seventeen patients (6.29%) of CLD had HCV infection including one with HAV co-infection. 16 patients (5.92%) of CLD had HAV infection whilst 3 patients (1.11%) of CLD were suffering from HEV infection. Conclusion: Approximately 27% children with chronic liver disease were having hepatitis B infection followed by 6.29% children with HCV infection. Approximately 6% children of CLD had Hepatitis A infection and 1.1% children had acquired Hepatitis E infection through feco-oral route. Prophylactic vaccination against HBV and HAV infection needs to be intensified in children with chronic liver disease.

肝炎ウイルス検査の受診状況等に関する聞き取り調査報告

肝炎ウイルス検査の受診状況等に関する聞き取り調査報告

Aflatoxin and PAH exposure biomarkers in a U.S. population with a high incidence of hepatocellular carcinoma

The incidence of hepatocellular carcinoma (HCC) is significantly elevated in a Hispanic community in Bexar County, Texas. Chronic exposure to dietary aflatoxins (AFs) is a major risk factor for HCC; increased risk has been linked to polycyclic aromatic hydrocarbon (PAH) co-exposure and hepatitis virus infection. The aims of this study were to assess AF and PAH exposures, investigate dietary factors that may contribute to increased AF exposure, and determine the prevalence of hepatitis virus infection in Bexar Co. Blood and urine samples were collected from 184 volunteers for biomarker analyses and hepatitis screening. Serum AFB 1-lysine adduct, urinary AFM 1 and 1-hydroxypyrene (1-OHP) levels were measured using high-performance liquid chromatography. The average AFB 1-lysine adduct level detected in 20.6% of serums was 3.84 ± 3.11 pg/mg albumin (range 1.01–16.57 pg/mg). AFM 1 was detected in 11.7% of urines, averaging 223.85 ± 250.56 pg/mg creatinine (range 1.89–935.49 pg/mg). AFM 1 detection was associated with increased consumption of corn tortillas (p = 0.009), nuts (p = 0.033) and rice (p = 0.037). A significant difference was observed between mean 1-OHP values of non-smokers (0.07 ± 0.13) and smokers (0.80 ± 0.68) μmol/mol creatinine (p < 0.01). A high hepatitis C virus positivity rate (7.1%) was observed. Findings suggest that the incidence and level of AF and PAH exposure were less than those observed in a high-risk population; however, participants consuming higher amounts of foods prone to AF contamination may be more vulnerable to exposure and interactions with other environmental/biological factors (i.e., HCV).

Viral Hepatitis in Indonesia: Past, Present, and Future.

ABSTRACTSince Indonesia is a huge archipelago country, the prevalence of hepatitis virus infection highly varies among islands. In average the prevalence of clinical hepatitis in Indonesia was 0.6% in the year 2007. Of 82 clinical acute hepatitis patients treated in hospitals in several cities, acute hepatitis A accounted for 28.0%, acute hepatitis B 13.4%, and acute hepatitis C 1.2%; 35.4% patients were infected by unknown etiology. In 1980s, the prevalence of anti-HAV in the age group 10- to 14-years was almost 100% in smaller towns and 45 to 60% in big cities. About 30 years later, anti-HAV prevalence decreased to around 13% in the same smaller town. Outbreaks of hepatitis A were reported between 2006 and 2009 in several cities in Java island. The prevalence of HBsAg in the islands other than Java island (8.5%) was significantly higher than in Java island (4.9%). In 1,409 viremic subjects, 4 genotypes of HBV were found, i.e., genotype B (60%), followed by genotype C (33%), genotype D (7%), and genotype A (0.3%). In contrast, the prevalence of hepatitis C was much higher in Java island compared to other islands. In blood donors in Java island, the prevalence of anti-HCV and HCV RNA were 1.5 and 1.1% respectively, while in other islands, the prevalence were only 0.7 and 0.2% respectively. Hepatitis D was very rare in Indonesia, and so was hepatitis E. Outbreaks of hepatitis E were reported between 1989 and 1993 in West Kalimantan. Afterward, the incidence of hepatitis E was reported sporadically.How to cite this articleMulyanto. Viral Hepatitis in Indonesia: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):65-69.

Seroprevalence of Hepatitis B and C Genotypes Among Young Apparently Healthy Females of Karachi-Pakistan

Introduction: Although the prevalence of hepatitis virus infections in Pakistan is still unknown, limited data indicate that the exposure rate to HBV is 35–38% with 4% being carriers and 32% having anti-HBV surface antibodies through natural conversion [1,2,3]. Studies in Pakistan have shown that the prevalence rate of HCV is 4.8–14% for, and that it is continuously increasing. Hence there is an urgent need to create awareness about the prevalence of both hepatitis B and C, and to develop preventive measures aimed at minimizing the prevalence of these diseases in the country. Study Design: Prospective, descriptive study. The study took place from March 2002 till October 2006 at two university campuses in Karachi. Materials and methods: A total of 4000 healthy female students were screened for HBs Ag, anti-HBs antibodies and anti-HCV antibodies by rapid immunochromatography, ELISA and PCR. Results: A total of 3820 volunteers (95.5%) were negative by all three methods, 181 (4.5%) tested positive for HB surface antigen and 20 (0.5%) were positive for anti HB surface antibodies; 208 volunteers (5.2%) were positive for HCV. Double infection with HBV and HCV was found in only one patient (0.025%). Out of 180 HBs antigen positive samples 151 (83.89%) were genotype D, 28 (15.56%) showed mixed infection with genotypes B and D, and one patient (0.56%) showed mixed infection with genotypes C and D. Out of 208 samples positive for HCV antibodies, 107 (51.44%) were genotype 3a, 50 (24.04%) were mix of genotype 3a and 3b, 33 (15.87%) were genotype 3b, 10 (4.81%) were genotype 1b while, 8 (3.84%) samples could not be typed. Conclusion: Although the presence of these pathogenic viruses was not very high in our young healthy female population, it is still a matter of concern to control the unregulated spread of these deadly infections by promoting increased awareness and regular immunization programs in the community. Local manufacturing of vaccines and related products may reduce these infections.

Seroprevalence of hepatitis B and C genotypes among young apparently healthy females of karachi-pakistan.

IntroductionAlthough the prevalence of hepatitis virus infections in Pakistan is still unknown, limited data indicate that the exposure rate to HBV is 35-38% with 4% being carriers and 32% having anti-HBV surface antibodies through natural conversion [1, 2, 3]. Studies in Pakistan have shown that the prevalence rate of HCV is 4.8-14% for, and that it is continuously increasing. Hence there is an urgent need to create awareness about the prevalence of both hepatitis B and C, and to develop preventive measures aimed at minimizing the prevalence of these diseases in the country.Study DesignProspective, descriptive study. The study took place from March 2002 till October 2006 at two university campuses in Karachi.Materials and methodsA total of 4000 healthy female students were screened for HBs Ag, anti-HBs antibodies and anti-HCV antibodies by rapid immunochromatography, ELISA and PCR.ResultsA total of 3820 volunteers (95.5%) were negative by all three methods, 181 (4.5%) tested positive for HB surface antigen and 20 (0.5%) were positive for anti HB surface antibodies; 208 volunteers (5.2%) were positive for HCV. Double infection with HBV and HCV was found in only one patient (0.025%). Out of 180 HBs antigen positive samples 151 (83.89%) were genotype D, 28 (15.56%) showed mixed infection with genotypes B and D, and one patient (0.56%) showed mixed infection with genotypes C and D. Out of 208 samples positive for HCV antibodies, 107 (51.44%) were genotype 3a, 50 (24.04%) were mix of genotype 3a and 3b, 33 (15.87%) were genotype 3b, 10 (4.81%) were genotype 1b while, 8 (3.84%) samples could not be typed.ConclusionAlthough the presence of these pathogenic viruses was not very high in our young healthy female population, it is still a matter of concern to control the unregulated spread of these deadly infections by promoting increased awareness and regular immunization programs in the community. Local manufacturing of vaccines and related products may reduce these infections.

Type 2 diabetes and hepatocellular carcinoma: A cohort study in high prevalence area of hepatitis virus infection

This study aimed to elucidate the relationship of type 2 diabetes, other known risk factors, and primary hepatocellular carcinoma (HCC) in countries with a high prevalence of hepatitis infection. We followed a prospective cohort of 54,979 subjects who participated in the Keelung Community-Based Integrated Screening program between 1999 and 2002. A total of 5,732 subjects with type 2 diabetes cases were identified at enrollment on the basis of fasting blood glucose level, and a total of 138 confirmed HCC cases were identified either through two-stage liver cancer screening or linkage with the National Cancer Registry. The independent effect of type 2 diabetes on the incidence of HCC and the interaction between type 2 diabetes and hepatitis infection or lipids profile were assessed using the Cox proportional hazards regression model. After controlling for age, sex, hepatitis B virus (HBV), hepatitis C virus (HCV), smoking, and alcohol consumption, the association between type 2 diabetes and incidence of HCC (excluding 33 prevalent cases identified at enrollment) was modified by HCV status and cholesterol level. The associations were only statistically significant (adjusted hazard ratio [HR] = 2.08 [1.03-4.18]) for being HCV negative and for having hypercholesterolemia (adjusted HR = 2.81 [1.20-6.55]). These statistically significant findings remained even excluding cases of diabetes newly diagnosed at enrollment. In conclusion, in an area with a high prevalence of hepatitis virus infection, type 2 diabetes increases the risk of developing HCC in those who are HCV negative or have a high level of total cholesterol.

Hepatitis B and C virus co-infections in human immunodeficiency virus positive North Indian patients

To determine the prevalence of hepatitis B and C virus infections in human immunodeficiency virus (HIV) -positive patients at a tertiary care hospital in New Delhi, India. Serum samples from 451 HIV positive patients were analyzed for HBsAg and HCV antibodies during three years (Jan 2003-Dec 2005). The control group comprised of apparently healthy bone-marrow and renal donors. The study population comprised essentially of heterosexually transmitted HIV infection. The prevalence rate of HBsAg in this population was 5.3% as compared to 1.4% in apparently healthy donors (P < 0.001). Though prevalence of HCV co-infection (2.43%) was lower than HBV in this group of HIV positive patients, the prevalence was significantly higher (P < 0.05) than controls (0.7%). Triple infection of HIV, HBV and HCV was not detected in any patient. Our study shows a significantly high prevalence of hepatitis virus infections in HIV infected patients. Hepatitis viruses in HIV may lead to faster progression to liver cirrhosis and a higher risk of antiretroviral therapy induced hepatotoxicity. Therefore, it would be advisable to detect hepatitis virus co-infections in these patients at the earliest.

わが国における大酒家慢性肝炎の現状

The objectives of this study were to determine whether hepatitis virus affects chronic alcoholic hepatitis. A nationwide survey of hospitals qualified by the Japanese Society of Gastroenterology was conducted to determine the status of alcoholic liver disease (ALD) in-patients since 1998. The prevalence of hepatitis virus infection in each kind of ALD patient was also investigated. Regarding chronic alcoholic hepatitis, we confirmed it was diagnosed by liver biopsy or not. Only 45 in 204 patients were diagnosed by liver biopsy as chronic alcoholic hepatitis. The percentage of chronic alcohol hepatitis patients without viral hepatitis was 24.5%. Hepatitis virus continues to play a crucial role in the pathogenesis of chronic alcohol hepatitis. Patients without liver biopsy were diagnosed by high ALT level in patients with ALD who were not enough for criteria of alcoholic hepatitis. New criteria are required for such patients.

High prevalence of antibodies to hepatitis A and E viruses and viremia of hepatitis B, C, and D viruses among apparently healthy populations in Mongolia.

The prevalence of infection with hepatitis A virus (HAV), HBV, HCV, HDV, and HEV was evaluated in 249 apparently healthy individuals, including 122 inhabitants in Ulaanbaatar, the capital city of Mongolia, and 127 age- and sex-matched members of nomadic tribes who lived around the capital city. Overall, hepatitis B surface antigen (HBsAg) was detected in 24 subjects (10%), of whom 22 (92%) had detectable HBV DNA. Surprisingly, HDV RNA was detectable in 20 (83%) of the 24 HBsAg-positive subjects. HCV-associated antibodies were detected in 41 (16%) and HCV RNA was detected in 36 (14%) subjects, none of whom was coinfected with HBV, indicating that HBV/HCV carriers account for one-fourth of this population. Antibodies to HAV and HEV were detected in 249 (100%) and 28 (11%) subjects, respectively. Of 22 HBV DNA-positive subjects, genotype D was detected in 21 subjects and genotype F was detected in 1 subject. All 20 HDV isolates recovered from HDV RNA-positive subjects segregated into genotype I, but these differed by 2.1 to 11.4% from each other in the 522- to 526-nucleotide sequence. Of 36 HCV RNA-positive samples, 35 (97%) were genotype 1b and 1 was genotype 2a. Reflecting an extremely high prevalence of hepatitis virus infections, there were no appreciable differences in the prevalence of hepatitis virus markers between the two studied populations with distinct living place and lifestyle. A nationwide epidemiological survey of hepatitis viruses should be conducted in an effort to prevent de novo infection with hepatitis viruses in Mongolia.

The surgical approach to HCC: our progress and results in Japan.

Due to the prevalence of hepatitis virus infection, the incidence of hepatocellular carcinoma (HCC) is very high in Japan. Many techniques have been devised by Japanese surgeons to reduce the mortality rate after hepatectomy for HCC: preoperative precise evaluation of hepatic functional reserve, portal venous embolization as preoperative preparation, anatomical and nonanatomical limited resections using intraoperative ultrasonography, and intermittent inflow occlusion during liver transection. Several challenging surgical procedures are also being tried for advanced HCC: HCC with portal and hepatic venous tumor thrombus, multiple and/or recurrent HCC, and HCC in the caudate lobe. As a result, the latest national survey of HCC revealed that operative mortality was 0.9% and the 5-year survival rate after surgery was 52%. Living-donor liver transplantation for adult patients with HCC is another surgical treatment developed in Japan. After the success of adult-to-adult living donor liver transplant using a left liver graft in 1993, a right liver graft, a left liver graft with caudate lobe, and a right lateral sector graft were developed. Indications for reconstructing the middle hepatic vein tributaries in right liver grafts were also proposed. Consequently, in our series of 36 patients with HCC who underwent living-donor liver transplantation, operative mortality was 3%, and the 2-year survival rate was 84%.