Serological Markers Of HBV Infection Research Articles

Serological profile of hepatitis B virus infection among traditional birth attendants and the attending pregnant women in Ibadan, Nigeria

ABSTRACT Although a sizable number of pregnant women patronize Traditional Birth Attendants (TBAs) for deliveries in Nigeria, efforts to prevent or reduce the risk of HBV transmission are not targeted at the TBAs and the pregnant women patronizing them. This may be linked to the dearth of information on the serological profiles of HBV among this cohort. We, therefore, show the serological profiles of HBV among the cohort. One hundred and seventy pregnant women and 91 TBAs participated in this study between May and July 2019. Serological markers of HBV infection were assayed using ELISA. A prevalence of, 8.0% (95% CI: 5.0% − 11.5%) for HBsAg, 0.8% (95% CI: 0.0% − 1.9%) for HBeAg, 2.7% (95% CI: 0.8% − 5.0%) for HBcIgM, 26.1% (95% CI: 20.7% − 31.4%) for anti-HBs, 21.5% (95% CI: 16.5% − 25.4%) for anti-HBe and 67.0% (95% CI: 60.9% – 72.8%) for anti-HBc was found indicating a high percentage of carriers. Although 32 (12.3%) of the entire participants claimed to be fully vaccinated, serological evidence was only detected in 4 (12.5%). The high percentage of carriers and low evidence of vaccination necessitate intensified efforts to ensure that adequate interventions are made available and accessible to the TBAs and the pregnant women patronizing them (including newborn babies).

Baseline serum hepatitis B core antibody level predicts HBeAg seroconversion in patients with HBeAg-positive chronic hepatitis B after antiviral treatment

Antibody to hepatitis B core antigen (anti-HBc) is one of the most classical serological markers of HBV infection. This study aimed to investigate the association of serum anti-HBc and HBeAg seroconversion in patients with HBeAg-positive chronic hepatitis B (CHB) after antiviral treatment. Two hundred and seventeen HBeAg-positive CHB patients treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) for 48 weeks were retrospectively enrolled. Serological response (SR) is defined as HBeAg seroconversion at 48 weeks of antiviral treatment. Serum anti-HBc level was measured using the Abbott ARCHITECT assay. After 48 weeks of antiviral treatment, twenty-two (10.1 %) patients achieved SR. Baseline level of serum anti-HBc in the SR patients (11.8 S/CO) was significantly higher than patients with non-SR (9.6 S/CO, P < 0.001). The median anti-HBc level was significantly declined after 48 weeks of antiviral therapy (9.9 vs. 8.9 S/CO, P < 0.001). Multivariate logistic regression analysis showed baseline of serum anti-HBc was an independent predictor of SR (odds ratio [OR]: 1.462, 95 % confidence interval [CI] 1.170–1.825, P = 0.001). The area under receiver operating characteristic curve (AUROC) of baseline anti-HBc level for predicting SR was 0.781 with the cut-off of 11.1 S/CO, with a sensitivity of 77.27 % and a specificity of 72.82 %.Our findings highlighted that baseline serum anti-HBc level is a promising indictor for predicting HBeAg seroconversion in HBeAg-positive CHB patients after antiviral treatment.

Serological markers of Hepatitis B virus infection among Health Care Workers in Accra, Ghana

Introduction: The prevalence of HBV among the Ghanaian population is high and also occupational exposures to blood and body fluids that could potentially result in HBV infection is also high among HCWs. However the distribution of serological markers of HBV infection among Health care workers remains largely unknown. The aim of the study was to describe the distribution of HBV serological markers among the Ghanaian HCWs.&#x0D; Methods: A hospital based cross sectional survey involving 363 HCWs drawn from five health institutions selected through stratified random sampling procedure was undertaken. A structured pretested questionnaire was the research instrument that was utilized to collect data from health care workers who also gave 5mls of venous blood to be evaluated qualitatively for the presence of five serological markers of HBV. Enzyme Linked Immunosorbent Assay (ELISA) procedure was subsequently undertaken to detect IgM HBcAb. Data were analyzed using SPSS version 20.0.&#x0D; Results: The predominant HBV maker among the population was Anti-HBs; 57.4% (195/340) and the least was HBeAg; 1.5% (5/340). One third (123/340) of the HCWs were naïve to HBV. Lifetime exposure to HBV (Anti-HBc) prevalence was 8.2% (28/340) (95% CI= 5.0%-11). &#x0D; Conclusions: Even though Anti-HBs is the predominant antibody marker identified among the population of HCWs evaluated, one third of the participants still remain susceptible to HBV infection. Protective measures need to be instituted to prevent new infections among HCWs who are currently naïve to the virus. Sanitary workers or orderlies need to be given special consideration in HBV prevention campaigns.&#x0D;

Occult Hepatitis B Virus Infection Among Hemodialysis Patients in Fakous General Hospital

Background: Occult HBV infection (OBI) is defined as the presence of a small amount of HBV in patients with negative serum for hepatitis B surface antigen (HBs Ag). The serum HBV DNA level in these patients is generally lower than 104 copies/mL, there is a high prevalence of OBI in patients with chronic hepatitis C, HCC cryptogenic liver disease, and HIV. Objectives: Assessment of prevalence of Occult Hepatitis B Virus infection among hemodialysis patients in Fakous General Hospital. Patients and Methods: A total of 40 patients with end-stage renal disease undergoing regular HD (for at least 6 months underwent a complete physical examination. Serum samples were collected between before hemodialysis and then stored at -80C° until tested. Serological markers of HBV infection (HBsAg, anti-HBs, anti-HBc) were determined using standard third generation commercially available enzyme immunoassays). Results: The 40 patients who have been included in this study had a minimum age of 25 years and a maximum age of 78 years. The number of females was 25 with a percentage of 62.5% and the percentage of males was about 37.5% (15 males). 22 patients (55%) had negative sera for anti-HCV antibody and a percentage of 37% and 63% for the distribution of females and males, respectively. 18 patients (45%) had positive sera for anti-HCV antibody and 37% of them were females and 63% of them were males. Conclusions: OBI infection is a relatively common infection (37.5%) among chronic hemodialysis patients in the dialysis unit of Fakous general hospital.

Occult Hepatitis B Virus Infection in Maintenance Hemodialysis Patients: Prevalence and Mutations in "a" Determinant.

Background: Occult hepatitis B virus infection (OBI) is defined as undetectable serum hepatitis B surface antigen (HBsAg) with detectable HBV-DNA in the serum or liver. Patients with maintenance hemodialysis (MHD) are at a high risk of OBI. The prevalence of OBI in MHD patients in China is not well evaluated. In this study, we aim to assess the prevalence of OBI in MHD patients in Sichuan Province, Southwest of China and investigate the mutations in the “a” determinant of HBsAg.Methods: A total of 330 patients undergoing MHD at Sichuan Provincial People's Hospital were enrolled. Serum samples were collected for ELISA assay to test the serological markers of HBV infection, real-time PCR assay to identify the presence of HBV-DNA, and nested PCR plus sequencing analysis to investigate the gene mutations.Results: In a total of 330 MHD patients, we found that the prevalence of OBI was 4.2% (7/165) in the test group, 2.1% (7/330) in the overall dialysis cohort. After a follow-up study of 7 MHD patients with OBI for 2 years, 2 (isolated HBcAb+) of them were still detectable for HBV-DNA. By sequencing analysis, we revealed mutations at the “a” determinant of HBsAg, including Q129R, T131N, M133S, F134L and D144E. The Q129R and M133S mutations were first reported.Conclusions: Our study clarifies the prevalence of OBI in MHD patients in Sichuan Province(4.2% in the test group, 2.1% in the overall dialysis cohort), and demonstrate the mutations of Q129R and M133S in the “a” determinant of HBsAg for the first time.

Occult HBV infection may negatively impact on drug survival in patients with rheumatoid arthritis on treatment with a first biologic drug. An appraisal from the Biologic Apulian Registry (BIOPURE).

We performed a retrospective analysis to evaluate the survival on first line biologic drug of rheumatoid arthritis (RA) patients with potential occult HBV infection (pOBI). We analysed longitudinal data of 486 consecutive RA patients starting a first biological drug in a time frame from 1st January 2008 to 31st December 2014. Demographic and disease related characteristics were collected at baseline and at the last observation visit. Baseline serological markers of HBV infection and causes of treatment discontinuation were also recorded. Primary endpoint was the influence of pOBI on drug survival, estimated by Kaplan-Meier life table analysis. Estimates hazard ratios (HRs) of drug discontinuation, adjusted for disease characteristics, biological drug class and HBcAb status were computed by Cox-regression models. The retention rate was significantly lower in pOBI positive patients (58.2%) when compared to pOBI negative ones (67.8%) and this data was confirmed also when only discontinuation due to ineffectiveness was considered (pOBI positive 66.4% vs pOBI negative 75.3%, long rank 7.93, p=0.005). Cox regression models showed a significant association between HBcAb-neg (HR 0.58, 0.41-0.84), higher ESR-DAS28 at baseline (HR 1.07, 1.03-1.11) or RF/ACPA-neg (HR 1.46, 1.04-2.06) and drug discontinuation. Occult HBV infection seems to influence negatively the effectiveness of biological therapies in RA patients.

A cross-sectional serosurvey on hepatitis B vaccination uptake among adult patients from GP practices in a region of South-West Poland.

BackgroundHepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination is widely recommended for those not covered by the national immunisation program. Objective: To assess the coverage and influencing determinants of HBV vaccination among adult patients attending GP clinics as well as to establish serological status in terms of HBV infection.MethodsPatients who were seen consecutively in March 2013 at four randomly selected GP practices located in Zgorzelec county, in south-western part of Poland, were invited to participate and complete questionnaires on socio-demographic data and other factors related to vaccination. A pilot study was done in one urban GP practice in the city of Gryfino (Gryfino county), the results have been included in the study. Patients’ immunisation status was assessed basing on vaccination cards and anti-HBs titer with the use of third-generation testing methods. In addition, serum samples were assayed for anti-HBc total.ResultsResponse rate: 99.3 %. Of 410 participants (66.1 % females, median age 56 years), 55.4 % (95%CI:50.5-60.1 %) were previously vaccinated; in those 11.5 % took 2 doses, 66.1 % - 3 doses,18.1 % – 4 doses. Elective surgery was the main reason (57.7 %) for HBV immunization, 4.8 % - were vaccinated due to recommendations by GPs. The multivariable logistic regression model revealed that living in a city (OR 2.11), and having a surgery in the past (OR 2.73) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6 % (95%CI:9.3 %-19,5 %), and 7.2 % (95%CI:4.4-11.8 %) among those vaccinated.ConclusionsLow HBV immunization coverage among adult patients from GP clinics and the presence of serological markers of HBV infection among both - those unvaccinated and vaccinated call for comprehensive preventative measures against infection, including greater involvement of family doctors. Although interventions should cover the whole population, inhabitants living in the rural areas should be a group of special interest. Preoperative immunization for HBV seems to be an efficient public health tool to increase the vaccination uptake.

Blunt wires in oral and maxillofacial surgery

he use of wires in maxillofacial surgery is simple, quick, conomical, and minimally invasive.1 However, the sharp nds can lead to a higher than normal number of wire-stick njuries (Fig. 1) with the potential risk of virus-associated iseases and infections such as hepatitis B (HBV), hepatiis C (HCV), and human immunodeficiency viruses (HIV).2 homas et al. reported that anti-HCV was found in 2.0% of ral surgeons, and serological markers of HBV infection in 1.2%.3 Most percutaneous injuries sustained by medical practiioners occur with sharp needles. Over the last 2 decades, dvances in the prevention of accidental needlestick injuries uring operation have included the development of needles ith blunt, tapering points, and this suggests that the use f blunt wires would also reduce the risk of percutaneous njuries (Fig. 1).4 Surgical wires are made of surgical stainless steel, and for edical purposes are delivered as a round bar. The sharp, ut ends can be blunted on a grinding disc but this is timeonsuming and has a high risk of injury. Another method is o cut and blunt the wires using a laser-beam welding system. aser-beam welding, which has high power density (around MW/cm2), can result in the rapid heating and cooling of mall zones. Cutting is done manually with a neodymiumoped yttrium aluminium garnet (Nd:YAG) Dentaurum laser Dentaurum, JP Winkelstroeter KG, Ispringen, Germany) for anual use. The workpiece is positioned under the stereomicroscope f the device. After a short exposure (0.5–20 ms), the wire elts to form beads at the ends (Fig. 2). The wires are held in

Prevalence, risk factors and genotypes of hepatitis B infection among HIV-infected patients in the State of MS, Central Brazil

ObjectivesA cross-sectional study on prevalence of HBV and HDV infection, risk factors and genotype distribution of HBV infection was conducted among 848 HIV-infected patients in Mato Grosso do Sul, Central Brazil. MethodsSerum samples of 848 participants were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and hepatitis surface antibody (anti-HBs). HBsAg positive samples were tested for anti-HBc IgM, HBeAg, anti-HBe, anti-HCV, and total anti-HDV. HBsAg and anti-HBc positive were subjected to DNA extraction. Viral DNA was amplified by semi-nested PCR for the regions pre-S/S and then purified and genotyped/subgenotyped by direct sequencing. Student's t-test, chi-square test and Fisher's exact test were used to compare variables and to evaluate association between HBV positivity (defined as anti-HBc and/or HBsAg positivity) and risk factors. ResultsAmong the 848 HIV infected patients investigated 222 had serological markers of HBV infection. The prevalence rate of HIV-HBV coinfection was 2.5% (21/848; 95% CI: 1.4–3.5%); 484 (57.1%) patients were susceptible for HBV infection. There were no cases of anti-HDV positive and only one (0.1%) anti-HCV-positive case among the HIV-HBV coinfected patients. Male gender, increasing age, family history of hepatitis, use of illicit drug, and homosexual activity were independent factors associated with HBV exposure. The phylogenetic analysis based on the S gene region revealed the presence of genotypes D (76.9%), F (15.4%) and A (7.7%) in the study sample. ConclusionThis study demonstrates the low prevalence of HIV-HBV infection and also highlights the need for early vaccination against HBV as well as testing for HBV, HCV and HDV in all HIV-infected individuals.

Occult Hepatitis B Infection in the Immigrant Population of Sicily, Italy

In Italy, about 7% of the resident population is represented by immigrants originating from geographic regions at high endemicity for hepatitis B virus infection. This study aims to assess the prevalence of occult HBV infection (OBI) including the identification of HBV-genotypes in a population of immigrants serologically negative for hepatitis B surface antigen (HBsAg). Between May 2006 and May 2010, 339 immigrants were tested for markers of HBV, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. HBV-DNA was tested by using nested-PCR assays on three different genetic region. HBV-DNA was detected in plasma samples of 11/339 (3.2%) patients. Most of them had no serological markers of HBV infection, 3/58 (5.2%) were anti-HBc-alone, and 4/13 (30.8%) were anti-HIV positive. HIV positivity was the only factor independently associated with the higher probability of observing OBI (OR=16.5, p<0.001). No HCV co-infected patients were found. Genotype D was detected in 9/11 (81.8%) OBI cases, while the remaining two (18.2%) were classified as genotype E. Although OBI was found at lower rate than expected among immigrants from highly endemic countries, anti-HBc alone positivity was confirmed as a sentinel marker of occult HBV infection. Nevertheless, a marked heterogeneity of HBV markers was found among HBV-DNA positive subjects. Our finding evidenced the predominance of HBV-genotype D viral strains among OBI cases, also in those from geographical areas where overt HBV infections are mainly sustained by viral genotypes other than D.

Total and covalently closed circular DNA detection in liver tissue of long-term survivors transplanted for HBV-related cirrhosis

Background Life-long prophylaxis against HBV recurrence is recommended in patients transplanted for HBV-related disease. The risk of HBV reactivation is due to persistence of covalently closed circular (ccc) DNA in hepatocytes. Whether cccDNA persists in livers of long-term transplant survivors who received conventional prophylaxis is unknown. Aim To investigate the presence of intrahepatic total and cccDNA in transplanted patients with no evidence of biochemical markers of HBV recurrence. Methods Intrahepatic total and cccDNA were assessed using sensitive nested and real-time PCR from 44 HBsAg-positive patients (75% male; mean age 55.2 ± 8.9 years) who had undetectable serum HBV-DNA at transplant. The mean follow-up after transplant was 88.3 months (range, 18–159). Results One patient underwent HBV recurrence after transplant and was the only who tested positive for both intrahepatic total HBV-DNA and cccDNA. Of the 43 patients negative for all serological markers of HBV infection, only 2 tested positive for intrahepatic total HBV-DNA, but none for cccDNA. Conclusions Most patients with undetectable HBV-DNA at transplant, who received conventional HBV prophylaxis, have no evidence of intrahepatic total HBV-DNA and cccDNA. cccDNA should be considered a new additional diagnostic tool, also to identify patients at low risk of HBV recurrence after liver transplantation.

Hepatitis B prophylaxis in HIV-infected patients

The risk of infection with hepatitis B virus is higher in HIV-infected patients due to shared risk factors. Unfortunately, the efficacy of immunisation against HBV in this group is much worse than in general population. Especially patients with low CD4 cell count and high HIV viral load present with lower rate of response. Therefore the use of double vaccine doses or prolongation of the vaccination schedule is recommended in those whose post-vaccination anti-HBs titers are less than 10 mIU/ml. It is uncertain how to manage the patients with “isolated” anti-HBc, where other serological markers of HBV infection are negative. Some recommend vaccination in these patients as well. It is advisable to measure HBV DNA in patients with “isolated” anti-HBc, as a part of them may present with occult hepatitis B.

Clinical significance of isolated anti-HBc positivity in cases of chronic liver disease in New Delhi, India

Background:The presence of anti-HBc IgG in the absence of HBsAg is usually indicative of a past self-limiting HBV infection. But it is frequently associated with co-infection with HCV which can worsen the existing status of chronic liver disease (CLD).Objectives:The present study was planned to evaluate the significance of isolated HBc IgG positivity in patients of CLD and look for the presence of HCV co-infection in such patients.Methods:Clinical profiles and biochemical tests were done for all the 77 CLD cases included in the study. Blood samples were taken from these patients and tested by the commercially available EIA for the presence of HBsAg, anti-HBc IgG, anti-HBs and anti-HCV. HBV DNA was detected by amplifying the surface region in all the cases.Results:Isolated anti-HBc IgG positivity defined as the presence of anti-HBc IgG in absence of any other serological markers of HBV infection was detected in 28 patients. Out of 64 patients positive for anti-HBc IgG 36 had the markers of HBV, either HBsAg, HBV DNA or anti-HBs alone or in combination. There was a significant association between isolated anti-HBc IgG positivity and HCV co-infection.Conclusion:Anti-HBc IgG should be tested in all patients with CLD as it is frequently the only marker of HBV infection in such patients and they should be monitored closely as such patients can develop CLD. Presence of co-infection with HCV should be actively searched for in such patients.

The Frequency of Serological Markers of HBV Infection in Asymptomatic Pakistani Patients

The Frequency of Serological Markers of HBV Infection in Asymptomatic Pakistani Patients

Natural and iatrogenic variation in hepatitis B virus.

The existence of HBV as quasispecies is thought to be favoured by the infidelity of HBV RT, which would account for the emergence of the many natural mutants with point substitutions. RT infidelity may also underlie the hypermutation phenomenon. Indeed, the oft-reported point mutation in the preC gene that leads to failure of HBeAg synthesis may be driven by a hypermutation-related mechanism. The presence of mutants with deletions and insertions involving single nucleotides and oligonucleotides at specific positions in the genome, and of mutants with deletions of even longer stretches particularly in the C gene, suggests that other mutagenic mechanisms operate. Candidates include slippage during mispairing between template and progeny DNA strand, the action of cellular topoisomerase I, and gene splicing using alternative donor and acceptor sites. Natural substitutions, deletions or insertions involving the Cp/ENII locus in the X gene can significantly alter the extent of viral replicative activity. Similar mutations occurring at other locations of Cp/ENII, and at B-cell epitope sites of the S gene are associated with failure to detect serological markers of HBV infection. HBV variation can also arise from recombination between coinfecting strains. S gene mutations that become evident following HBIG administration and HBV vaccination are all point substitutions, as are mutations in functional RT domains of the P gene after treatment with viral RT-inhibitory drugs. Widespread and long-term use of prophylactic and therapeutic agents may potentially generate serologically occult HBV variants that might become difficult to eradicate.

Prevalence of hepatitis virus infections in Albanian refugees

A sample of 393 Albanian refugees, including both children and adults, was tested for serological HAV, HBV, HDV and HCV markers. A high prevalence of infection with both the hepatitis A and B viruses was found, while HDV and HCV infections were uncommon. The overall prevalence of anti-HAV was 96%; it was very high in children 0-10 years, suggesting that HAV infection is largely acquired during childhood and that poor ambiental conditions influence the spreading of this viral infection. One or more serological markers of HBV infection were found in 295 Albanians (75%), confirming the endemic nature of this virus in the Albanian community. The overall prevalence of HBsAg was 19%, and the carrier rate was higher in males than in females. The high HBsAg prevalence among children suggests that HBV infection is usually acquired in early childhood. The serological data obtained in the Albanian sample examined clearly indicate the urgent need for measures to reduce the incidence of HAV and HBV infections and to avoid the further spread of HDV and HCV infections. Finally, the high prevalence of type B hepatitis indicates the necessity of vaccination against HBV for all risk groups and for all children at birth.

Influence of Padma 28 on patients with chronic active hepatitis B

AbstractThirty‐four patients with chronic active hepatitis B (CAH‐B) were treated with Padma 28, a herbal remedy with immunocorrective properties. The patients were monitored by clinical and biochemical testing, as well as by serological, immunological and histological techniques. After treatment lasting 1 year 26 of 34 patients (76.5%) improved or normalized in biochemical parameters as well as in total T‐cell count (CD3) and CD4/CD8 index. An improvement in histology was seen in 19 patients (55.9%). An influence of Padma 28 on the serological markers of HBV infection was seen in 26 of 34 patients (76.5%). Six patients of 34 eliminated HBsAg (17.6%) and four of them seroconverted to anti‐HBs. Eleven patients eliminated HBeAg and HBV‐DNA, and eight of them seroconverted to anti‐HBe. Eight patients with persistent HBs and HBe‐antigenaemia had a decreased titre of HBsAg and HBeAg. In eight patients (23.5%) no influence of Padma 28 on serological markers of HBV infection was seen throughout the observation period. These observations indicate that treatment with Padma 28 of patients with CAH‐B fulfils two of the most important tasks for drug therapy of the disease, it influences the activity of genes of HBV and stops the progression of liver inflammation.

Complete nucleotide sequence and viral envelope protein expression of a hepatitis B virus DNA derived from a hepatitis B surface antigen-seronegative patient

An HBV strain isolated from a patient lacking conventional serological markers of HBV infection was characterized. The complete nucleotide sequence was determined following PCR amplification. Only 22 nucleotide substitutions were found relative to the reported sequence of the ayw subtype. Five of these point mutations in the preS/S and preC/C genes led to amino acid substitutions and, with one exception, were located in regions coding for antigenic determinants of viral envelope or capsid proteins. Eight amino acid substitutions were located in terminal protein and the spacer domain of the polymerase gene product. Despite these amino acid changes, transient expression of the preS2 and S envelope proteins in eucaryotic cells yielded viral proteins detectable in the culture medium with polyclonal and monoclonal anti-preS2 and -S antibodies. These data conclusively demonstrate persistent infection by HBV in subjects without HBV serological markers. The absence of conventional HBV serological markers is probably due to several factors: a low level of viral replication, some genetic modifications, as well as an abnormal immune response to the virus.

Porphyria cutanea tarda, hepatic cirrhosis and hepatocellular carcinoma: Three cases

Porphyria cutanea tarda (PCT) is a disorder of haem biosynthesis with characteristic clinical and biochemical features and frequently with associated liver pathology. On review of 48 cases with biochemically and clinically characteristic PCT at the RMH, 3 were found to have hepatocellular carcinoma (HCC) confirmed by histology. Two were of a trabecular pattern while the third was undifferentiated. The HCC developed 4, 9 and 15 years after the onset of cutaneous symptoms of PCT and in one patient coincided with a rapid rise in porphyrin levels. All patients had coexisting cirrhosis of the liver and siderosis. Two gave a history of alcohol abuse while the third had inactive micronodular cirrhosis. All were HBsAg negative but tests for other markers of HBV infection were not done. Stored serum was not available for tests for antibody to hepatitis C virus. All had elevated serum transaminase and alpha-fetoprotein (328, 500 and 20,000 ng/ml) levels. The incidence of HCC in this series of patients with PCT is approximately 6% which compares with the 10% incidence in alcoholic cirrhosis. Kordac reviewed the results of 342 patients with PCT; 65 died over 17 years, and autopsies were done on 36, of whom 63.9% showed cirrhosis and 47.2% had HCC (Neoplasia 1972;19,135-9). An earlier study from the same institution found the occurrence of HCC was 4.5x more frequent in cirrhotic patients with PCT than in cirrhotic patients without PCT (Czech Med 1962;8:290-5). The reason is uncertain and the possibility of HBV infection was not considered. In a study from Dresden of 76 patients with PCT, 19 (25%) had one or more serological markers of HBV infection, and 14 (18%) were positive for HBsAg (Dr Gesundh-Wesen 1983;36:1396-9). Until data regarding HBV and HCV infection in patients with PCT and HCC are available, the role of PCT as a risk factor additional to that conferred by coexisting cirrhosis will remain unsettled. It is to be noted that HCC may overproduce uroporphyrin and cause PCT (Gastroenterology 1970;59:779). Conclusion: It is recommended that patients with PCT should be tested for HBV and HCV infection, assessed for the presence of cirrhosis, and monitored for serum alpha-fetoprotein levels, rapid rises in porphyrin levels without explanation and abrupt changes in LFT’s, and if suspicion arises have liver ultrasound performed.

Non-radioactive spot hybridization test for detection of hepatitis B virus DNA in serum

Summary Detection of HBV DNA by molecular hybridization in serum has been simplified by the use of a non-radioactive reporter molecule (a biotinylated nucleotide) instead of the conventional radioactive marker. A positive hybridization was rapidly visualized by incubation with a streptavidin/alkaline phosphatase conjugate followed by a coloured enzymatic reaction. The presence of HBV DNA was analysed in the sera of 45 patients with either a radioactive or biotinylated probe; 24 % of sera gave discordant results: they were positive only with the non-radioactive method. The great specificity of these two techniques was proven by the lack of positivity with HBsAg-and HBeAg negative sera. Moreover, no background was noticed with 1 y.g of human DNA or unrelated viral DNA. Quantitative comparison of the sensitivity of the two methods could not be achieved because of the low sensitivity of our radioactive protocol. However, results obtained with 143 sera confirmed the value of the non radioactive hybridization spot test when compared with serological markers of HBV infection. Using biotin, molecular hybridization — without loss of specificity — is easily realizable in any routine diagnostic laboratory.