Prevalence of HHV-8 Infection in Albanian Adults and Association with HBV and HCV

To estimate the prevalence of human herpesvirus type 8 (HHV-8) in Albania and its correlation with HBV and HCV, we tested 196 serum samples collected from apparently healthy adults (i.e., 154 women and 42 men). We found 20% anti-HHV-8 antibodies, about 10% HbsAg-positive, and 67% anti-HBc antibodies; anti-HCV antibody prevalence was 3%. It remains to be determined whether HHV-8 infection and HCV infection have common modes of transmission.

Effects of hepatitis B virus infection on human sperm chromosomes

AIM: To evaluate the level of sperm chromosome aberrations in male patients with hepatitis B, and to directly detect whether there are HBV DNA integrations in sperm chromosomes of hepatitis B patients.

METHODS: Sperm chromosomes of 14 tested subjects (5 healthy controls, 9 patients with HBV infection, including 1 with acute hepatitis B, 2 with chronic active hepatitis B, 4 with chronic persistent hepatitis B, 2 chronic HBsAg carriers with no clinical symptoms) were prepared using interspecific in vitro fertilization between zona-free golden hamster ova and human spermatozoa, and the frequencies of aberration spermatozoa were compared between subjects of HBV infection and controls. Fluorescence in situ hybridization (FISH) to sperm chromosome spreads was carried out with biotin-labeled full length HBV DNA probe to detect the specific HBV DNA sequences in the sperm chromosomes.

RESULTS: The total frequency of sperm chromosome aberrations in HBV infection group (14.8%, 33/223) was significantly higher than that in the control group (4.3%, 5/116). Moreover, the sperm chromosomes in HBV infection patients commonly presented stickiness, clumping, failure to staining, etc, which would affect the analysis of sperm chromosomes. Specific fluorescent signal spots for HBV DNA were seen in sperm chromosomes of one patient with chronic persistent hepatitis. In 9 (9/42) sperm chromosome complements containing fluorescent signal spots, one presented 5 obvious FISH spots, others presented 2 to 4 signals. There was significant difference of fluorescence intensity among the signal spots. The distribution of signal sites among chromosomes was random.

CONCLUSION: HBV infection can bring about mutagenic effects on sperm chromosomes. Integrations of viral DNA into sperm chromosomes which are multisites and nonspecific, can further increase the instability of sperm chromosomes. This study suggested that HBV infection can create extensively hereditary effects by alteration genetic constituent and/or induction chromosome aberrations, as well as the possibility of vertical transmission of HBV via the germ line to the next generation.

[Patients with HBV, HCV and HIV antigens--medical management, surgical procedures, equipment sterilization principles]

The purpose of the study was to present information about clinical treatment of HIV, HBV and HCV infection seropositive patients. We present indications and principles for hospitalization, conventional and surgical treatment and sterilization methods.

Association between serum aspartate transaminase and homocysteine levels in hemodialysis patients

BACKGROUND

Hyperhomocysteinemia is a common metabolic abnormality in patients undergoing hemodialysis (HD). An impairment of remethylation of homocysteine (Hcy) is seen in these patients but cannot account completely for hyperhomocysteinemia. Homocysteine is derived from transmethylation of methionine that can be metabolized through transamination pathway alternatively. However, the significance of transamination in the metabolism of Hcy in HD patients is not studied.

METHODS

A total of 145 patients undergoing HD for more than 3 months were enrolled in the study. Vitamins B were not prescribed routinely to these patients. Among them, 49 patients had positive test results for hepatitis B surface antigen or antihepatitis C virus antibody. Serum Hcy, folic acid, vitamin B12, pyridoxal 5' -phosphate, methionine, and transaminase were measured, and parameters of dialysis adequacy were calculated. Multiple linear regression model was used to analyze the factors determining Hcy levels.

RESULTS

All patients had higher Hcy levels (40.3 +/- 28.3 micromol/L) than the upper limit of reference range 15 micromole/L. The levels of vitamin B(12) were all higher than 160 pg/mL (118 pmol/L). Only 9 patients had serum folic acid lower than 3 ng/mL (6.8 nmol/L). The predialysis Hcy levels were correlated with age, HD duration, folic acid, vitamin B12, and aspartate transaminase (AST) levels among all patients or the subgroup of hepatitis noncarriers with linear multiple regression analysis. In hepatitis carriers, AST levels were not associated with Hcy. A cutoff value of AST less than 14 U/L predicted a predialysis Hcy level higher than 27 micromol/L in noncarriers, with a sensitivity of 83.9% and a specificity of 50.2%.

CONCLUSION

In addition to vitamin B12 and folic acid, the serum AST levels correlated inversely with predialytic Hcy levels independently in hepatitis noncarrier HD patients. The results suggest that transamination may play an important role in the development of hyperhomocysteinemia when impaired transmethylation is encountered in uremic patients.

Prevention of de novo hepatitis B infection in liver allograft recipients with previous hepatitis B infection or hepatitis B vaccination

OBJECTIVES

To assess de novo hepatitis B virus (HBV) transmission from liver donors with HBV serum markers (HBM) to their recipients and the need for HBV vaccination before liver transplantation.

METHODS

A total of 108 orthotopic liver transplantations for nonviral disease and the risk of developing de novo hepatitis B based on HBMs before transplantation have been studied. Of the 108 patients, 94 met the study criteria and were divided into two groups: 27 who had HBMs before transplantation (from past infection or by previous vaccination) and 67 who had no HBM. Development of de novo hepatitis B was determined by analytical, serological, and histological parameters.

RESULTS

No case (0%) of de novo hepatitis B was detected in the pretransplantation HBM group, whereas there were 10 cases (14.5%) in the other group (p < 0.005).

CONCLUSIONS

The presence of pretransplantation HBM in liver transplant recipients protects these patients against the development of de novo hepatitis B. This is especially important considering that there is a high prevalence of donors with positive hepatitis B core antibody (especially in some countries), and that these donors transmit HBV infection to recipients without HBM in a significant number of cases. Thus, vaccination against HBV in patients who are candidates for liver transplantation is fundamental to avoid cases of de novo hepatitis B.

Prevalence of hepatitis B and hepatitis C in blood donors and high risk groups in Hajjah, Yemen Republic

OBJECTIVE

To determine the prevalence of hepatitis B antigen and anti-hepatitis C virus (HCV) antibodies in blood donors, hospital employees, patients suspected to have liver disease, and hemodialysis patients.

METHODS

This study was conducted from April 1997 through to September 1999 as a hospital based study in Hajjah, Republic of Yemen. All healthy blood donors, hospital employees, suspected hepatitis patients and patients in the hemodialysis unit were included in this study. The hepatitis B antigen (HbsAg) measured in IMX system (Abott) using the monoclonal anti-HBs assays. The Hepatitis C screened by the same system using HCV version 3.0 [Third generation (Recombinant HCr43, c200, c100-3, NS5)].

RESULTS

The screened blood donors for HbsAg and HCV were 7868 and 2434 with a prevalence of 9.8% for hepatitis B antigen and 1.1% for anti-hepatitis C virus. Two hundred of the hospital employees were screened with a prevalence rate of 1.5% and 0.5% for hepatitis antigen and anti-hepatitis C virus. The patients referred selectively for testing the hepatitis B antigen and anti-hepatitis C virus were 1229 and 749, the prevalence rate of HbsAg was 14.9% and 8.8% for anti-HCV, double infection (both hepatitis B virus and HCV) recorded in 8 patients forming 3.2% of the positives (in 0.4% of the total).

CONCLUSION

The prevalence was high in Hajjah governorate, Republic of Yemen in both the healthy blood donors and in the risky groups except the hospital employees.

[Long-term prospective study of hepatitis B virus carriers using clinical laboratory and morphological analyses]

AIM

Analysis of long-term outcomes of carriage of hepatitis B virus surface antigen (HBsAg).

MATERIAL AND METHODS

Complete clinical, device, serological and partial morphological examinations of patients with latent form of HBV infection were performed 16-22 years after the infection with HBV.

RESULTS

Progression to chronic viral hepatitis (morphologically--hepatitis B) with a trend to annular hepatic tissue rearrangement was stated in all the examinees. Despite the development of chronic hepatitis, serological profile and PCR indicated HBV elimination.

CONCLUSION

All patients with latent HBV infection need regular observation because in the absence of symptoms worsening of clinico-biochemical and morphological indices takes place. Therefore, these patients should receive specific antiviral therapy.

Hepatitis B virus genotypes and clinical manifestation among hepatitis B carriers in Thailand

BACKGROUND

Hepatitis B virus (HBV) genotypes have distinct geographic distributions. The aim of the present study was to evaluate the distribution of HBV genotypes and their clinical relevance in Thailand.

METHODS

Hepatitis B virus genotypes among 107 hepatitis B carriers residing in Thailand were evaluated using serologic and genetic methods. They were clinically classified into asymptomatic carriers with normal serum alanine transaminase (ALT) levels and patients with chronic liver disease, such as those with chronic hepatitis (CH), liver cirrhosis (LC) and hepatocellular carcinoma (HCC).

RESULTS

Hepatitis B virus genotype distribution among the 107 patients was 25.2% for genotype B, 72.0% for genotype C and 2.8% for genotype D. The serum ALT levels, HBV-DNA and hepatitis B e antigen positivity were significantly higher in carriers infected with genotype C HBV than in those infected with genotype B (P < 0.05). The proportion of genotype B HBV was higher in asymptomatic carriers than in patients with CH and those who developed liver disease, such as LC and HCC (45.5, 16.9 and 25.0%, respectively; P < 0.05). In contrast, the proportion of genotype C HBV was higher in patients who developed liver disease and CH than in asymptomatic carriers (68.7, 83.0 and 50.0%, respectively; P < 0.05). Phylogenetic analysis based on entire genome sequences revealed three HBV isolates, which were classified into a subgroup of genotype C in isolates from South-East Asian countries.

CONCLUSIONS

Genotypes B and C are the predominant types among hepatitis B carriers residing in Thailand and those genotypes influence the clinical manifestation in carriers with chronic hepatitis B infection.

Expression of bile duct-type cytokeratin in hepatocellular carcinoma in patients with hepatitis C virus and prior hepatitis B virus infection

The clinicopathologic findings in patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) positive for biliary markers, those related to the hepatic progenitor cells, were investigated. Cytokeratin (CK) 19 was reactive for HCCs only in patients with prior hepatitis B virus (HBV) infection. The proportions of patients with prior HBV infection and poorly differentiated HCC were significantly higher among those with CK 19-positive HCC than among those with CK 19-negative HCC. Some HCCs develop from the hepatic progenitor cells in patients with HCV infection and prior HBV infection, which may affect the clinicopathologic findings of HCV-related HCCs.

Impact of hepatitis B and C on graft loss and mortality of patients after kidney transplantation

BACKGROUND

Mortality or graft loss after renal transplantation might be influenced by hepatitis virus infection.

METHODS

Sera from time of transplantation of 927 renal transplant recipients were tested for hepatitis C (HCV) and hepatitis B virus (HBV) in order to investigate the impact of hepatitis virus infection on graft loss and mortality over an observation period of 20 yr.

RESULTS

One hundred and twenty three of 927 patients were HCV positive, 30 patients HBV positive and seven patients HBV and HCV positive. The observation period was 9.2 +/- 4.4 yr. Mortality was significantly higher in patients with hepatitis B (p = 0.0005), as well as in patients with concomitant B and C hepatitis (p < 0.0001) and in those who acquired HCV infection after transplantation (n = 30, p = 0.0192) compared with non-infected patients. Patients with replicating HBV infection (HBeAg positive) had the worst prognosis (p < 0.0001). In the multivariate analysis the presence of HBeAg (p < 0.0001), patients' age (p < 0.0001) and HCV infection after transplantation (p = 0.0453) were predictors for death. Graft survival was significantly shorter in patients with concomitant hepatitis B and C (p = 0.0087) as well as in HBeAg positive patients (p = 0.002). HCV infection or HBs antigenemia did not have a significant impact on graft survival compared with non-infected patients.

CONCLUSION

HCV infection after transplantation is associated with a high mortality whereas chronic HCV infection before trans plantation does not have a significant impact on mortality. Patients with replicating HBV infection or concomitant HBV and HCV infection have a high risk of graft loss and mortality.

A 1-year trial of lamivudine for chronic hepatitis B in children

We carried out a 1-year trial to evaluate the efficacy and tolerability of lamivudine, an oral nucleoside analogue, in a small group of children with vertically acquired chronic hepatitis B. Patients were assessed for serum alanine aminotransferase (ALT) and serum hepatitis B virus (HBV) DNA at baseline and every 4 weeks thereafter, and for hepatitis B s antigen, hepatitis B e antigen and their antibodies every 12 weeks. Analysis of HBV mutation was undertaken at entry and on the occasion of the last positive control of HBV DNA. Lamivudine suppressed serum HBV DNA to undetectable levels in all treated patients within 24 weeks. Serum ALT levels returned to normal values within 36 weeks. Therapy was well tolerated, and although nausea and vomiting were reported in one child, it was not necessary to stop treatment. A new observation was that, contrary to previous data, seroconversion appeared to occur earlier in children with lower ALT levels at baseline.

[Hepatitis B virus infection: diagnosis, clinical sequelae, therapy and prevention]

This article gives an overview on the clinical epidemiology of hepatitis B in Switzerland. It considers structure of the hepatitis B virus, serologic diagnosis of hepatitis B and its prevention and treatment. The main conclusions are as follows: 1. Hepatitis B prophylaxis is available. Juveniles should be vaccinated before taking up sexual activity. Pregnant women should be tested and their offspring immunised actively and passively when there is evidence of infection. 2. In cases of acute hepatitis B contact persons should be tested and vaccinated where appropriate. Treatment is not indicated. 3. For the treatment of chronic hepatitis B interferons and lamivudine are currently available. Advantages and shortfalls of the different forms of treatment are discussed.

Lamivudine treatment for reverse seroconversion of hepatitis B 4 years after allogeneic bone marrow transplantation

Reverse seroconversion of hepatitis B virus (HBV) after allogeneic BMT is rare. We present a case of HBV reactivation late after allogeneic BMT which responded well to lamivudine therapy. A 35-year-old woman with CML received an allogeneic BMT. Before BMT, the patient had immunity to HBV, with serum antibodies against hepatitis B surface antigen (HBsAb), and the donor was completely negative for HBV. Four years after BMT, acute hepatitis occurred with a detectable level of HBV-DNA. Lamivudine rapidly reduced transaminase and bilirubin levels, and serum HBV-DNA decreased to negative. Retrospective analysis revealed that there had been a gradual decrease in serum HBsAb titers after BMT. Administration of lamivudine immediately after HBV replication may be more effective than vaccination of hepatitis B surface antigen-negative donors before BMT.

Short report: hepatitis b infection and severe Plasmodium falciparum malaria in Vietnamese adults

We investigated the prevalence of infection with hepatitis B virus among adult Vietnamese patients hospitalized for severe Plasmodiumfalciparum malaria. Sera from patients admitted with severe malaria in Ho Chi Minh City, Vietnam, between May 1991 and January 1996 were assayed for hepatitis B surface antigen (HB(s)Ag) by a commercial enzyme-linked immunosorbent assay kit. The overall prevalence of HB(s)Ag was 23.77% (77 of 324). This was higher than reported estimates of prevalence in the general catchment population for the study hospital (mean, 9.8%; range, 9-16%). No association was found between risk of death caused by severe malaria and HB(s)Ag. Patients admitted with cerebral malaria had a slightly greater risk of registering positive for HB(s)Ag (relative risk, 1.28; 95% confidence interval, 1.04-1.58) relative to other manifestations of severe malaria. Chronic infection with hepatitis B virus may be a risk factor for severe malaria.

The management of chronic hepatitis B infection

Chronic hepatitis B infection is frequently diagnosed within the genitourinary clinic setting with sexual transmission the commonest route of acquisition in the United Kingdom. Only 3--5% of adults who contract acute hepatitis B will progress to chronic infection, and these individuals can be identified by the presence of hepatitis B surface antigen (HBsAg) in the bloodstream 6 months after infection. Individuals at highest risk of long-term complications such as cirrhosis and hepatocellular carcinoma, carry HBeAg and have high levels of circulating hepatitis B virus (HBV) deoxyribonucleic acid (DNA). Therapy should be targeted towards this group of patients. Two forms of therapy are now licensed for use in chronic hepatitis B infection: interferon-alpha and lamivudine. Seroconversion occurs in 30--40% of patients treated with interferon and treatment is often limited by toxicity. Lamivudine is well tolerated with seroconversion rates of 15--20% at one year, rising with increasing duration of therapy. Long-term monotherapy is limited however by the development of resistance mutations and combination nucleoside therapy is likely to become the treatment of choice in the future. Patients with chronic hepatitis B should be counselled regarding transmission, partner vaccination and alcohol intake and co-infection with other hepatitis viruses should be excluded.

Secreted virus-encoded proteins reflect murine cytomegalovirus productivity in organs

Mouse infection with murine cytomegalovirus (MCMV) is an established model for studying human cytomegalovirus infection. In this study, the relationship was analyzed between MCMV activity in organs of infected mice and the presence of infectious virus (viremia), viral genomes (DNAemia), or secreted virus-encoded proteins in the blood. For the latter, 2 recombinant viruses were constructed that encode for the hepatitis B virus surface antigen and the secreted alkaline phosphatase, respectively, as secreted marker proteins. The secreted markers correlated better with the infection in organs than DNAemia and viremia. The marker protein assays can serve as practical and sensitive tools for longitudinal monitoring of MCMV infection in individual mice.

Relationship between hepatitis C virus infection and schistosomal liver disease: not simply an additive effect

BACKGROUND

To study the association, clinical significance, and impact of hepatitis C virus (HCV) co-infection in patients with schistosomal liver disease (SLD).

METHODS

A total of 240 patients with chronic liver diseases encountered consecutively were enrolled in the study. Fifty volunteer blood donors were enrolled as controls. HCV antibody determination (enzyme-linked immunosorbent assay), qualitative and quantitative HCV RNA assay (reverse transcriptase polymerase chain reaction), and HCV genotyping (line probe assay) were performed.

RESULTS

Twenty-eight patients had SLD alone, 60 had both SLD and chronic hepatitis C (CH-C), 120 had CH-C alone, and 32 had other liver diseases. The positivity rates for HCV antibody (76% vs 20%; P < 0.001) and HCV RNA (59% vs 10%; P < 0.001) were significantly higher in the patients with SLD (n = 88) than in the volunteer blood donors (n = 50). Complications of liver cirrhosis were more common in patients with concomitant SLD and CH-C than in those with either SLD or CH-C alone. The mean levels of alanine aminotransferase (77 +/- 42 vs 93 +/- 55 IU/l; P = 0.049) and HCV RNA concentrations (3.5 +/- 1.0 vs 4.2 +/- 1.0 log copy/ml; P < 0.001) were significantly lower in patients with concomitant SLD and CH-C than in those with CH-C alone. HCV genotype 4 predominated in both these groups (93% and 98%).

CONCLUSIONS

SLD in Egypt is significantly associated with HCV infection, with the predominance of genotype 4. Concurrent HCV infection and SLD result in much more severe liver disease than that seen with either disease alone. However, the activity of HCV infection seems to be partially suppressed in patients with SLD.

[Seroepidemiological profile of hepatitis B infection in staff at hemodialysis units of Goiânia-Goiás, Central Brazil]

In order to investigate the hepatitis B virus (HBV) infection profile in hemodialysis staff (n = 152) of Goiânia,Goiás, blood samples were tested for detection of HBsAg, anti-HBs and anti-HBc markers. An overall HBV infection prevalence of 24.3% (CI 95%: 17.8 - 32) was found. Multivariate analysis of risk factors showed that length of employment, history of occupational exposure and nonuse of protective equipment were significantly associated with HBV seropositivity. Of 40 staff members who were susceptible to this infection, 20 agreed to participate in the vaccination program. After three vaccine doses (Euvax-B), 18 (90%) seroconverted to anti-HBs with titers >/= 10 IU/L. These data suggest the dialytic environmental as a possible source of occupational transmission of HBV, and emphasize the need to evaluate strategies of control and prevention to be followed in these units.

HBs antigen in children with suspicion of HIV infection

In order to evaluate the prevalence rate of HBs antigen in children with a suspicion of HIV infection, 103 children were tested for HBs antigen and HIV. The mean age of the children was 2 years. The prevalence of HBs antigen was 39.8 per cent in children and the HIV ELISA test was positive in 57.7 per cent. A correlation was found between carrier of HBs antigen and HIV ELISA positivity (p = 0.04, RR = 1.46; 1.06 < RR < 2.02). There was a high prevalence of HBs antigen in children with a suspicion of HIV infection. This calls for the promotion of antenal screening for HIV and HBV along with immunization against hepatitis B in newborns in our setting.

Long-term morbidity and mortality in Chinese insurance applicants infected with the hepatitis B virus

BACKGROUND

Worldwide, there are approximately 350 million carriers of the hepatitis B virus (HBV). The protracted course of HBV infection makes it difficult to estimate morbidity and mortality risk in an insured lives population that is chronically infected with HBV because most studies on this topic have been based on older patients with advanced disease who were treated at tertiary centers that specialize in care of patients with liver disease. Data from these reports bias risk estimates toward severe cases and are not appropriate indicators of what might be expected in an insurance context. This article discusses use of a Markov model to estimate long-term morbidity and mortality risk associated with chronic HBV infection in otherwise healthy Chinese insurance applicants.

RESULTS

The model was validated by comparing results to population data published in Taiwan, Hong Kong, Shanghai, Singapore, and Korea. For males, mortality ratios were in the range of 150-175% for underwriting ages 20, 30, and 40 and slightly lower for age 50. For females, mortality ratios were in the range of 125-150% and slightly higher for age 50. Higher mortality ratios in males were related to the fourfold higher hepatocellular carcinoma (HCC) incidence rate. Mortality ratios varied with the extent of the underwriting evaluation. Liver-related morbidity incidence increased with age at underwriting for males and females. HBeAg (hepatitis B "e" antigen)/anti-HBe status was not a major factor for differentiating risk in an insurance context.

CONCLUSION

Morbidity and mortality are within the insurable range for the majority of HBV-infected Chinese applicants. Risk varies with the extent of the underwriting evaluation and the percentage of applicants with significant liver fibrosis or early cirrhosis that are detected during the underwriting process. HBeAg/anti-HBe status is not a major factor for differentiating risk in an insurance context. Morbidity and mortality estimates provided by the model can be generalized to other populations and individuals where HBV infection occurs at birth or during early childhood, although some modification in insurance risk might be required in non-Asian markets.

[Acute hepatitis B virus after chemotherapy for a case with germinoma]

A 28-year old man with HCG-producing germinoma had undergone chemotherapy and radiotherapy. On admission for the fifth session of maintenance chemotherapy, he was found to be positive for hepatitis B (HB)s antigen, but negative for HBs antibody. HBs antigen had been negative during previous admissions. Since liver function was normal, the patient underwent chemotherapy. During myelosuppression after chemotherapy, liver dysfunction developed and acute HB was diagnosed. He fortunately showed seroconversion 2 months after onset. Serum immunological examinations are required for patients receiving chemotherapy.