Long-term persistence of seroprotection by hepatitis B vaccination in healthcare workers of southern Italy

BACKGROUND

The impact of hepatitis B virus (HBV) vaccination campaigns on HBV epidemiology needs to be evaluated, in order to assess the long-term immunity offered by vaccines against HBV.

OBJECTIVES

To evaluate the current status of anti-HBV vaccine coverage among healthcare workers (HCWs) in Southern Italy, and to determine the long-term persistence of antibodies to hepatitis B surface antigens (anti-HBs) in such a cohort of subjects.

PATIENTS AND METHODS

A longitudinal, retrospective seroepidemiological survey was conducted among 451 HCWs, who were working at or visiting, the Occupational Health Department of a city hospital, in Catania, Italy, between January 1976 and December 2010.

RESULTS

At the 30-year follow-up (mean follow-up 10.15 ± 5.96 years, range 0.74-30), 261 HCWs had detectable anti-HBs titers indicating a persistence of seroprotection of 89.4% (out of 292 anti-HBs positive results, three months after vaccination). An inadequate vaccination schedule was the strongest predictor of antibody loss during follow-up (OR = 8.37 95% CI: 5.41-12.95, P < 0.001). A Kaplan-Maier survival curve revealed that the persistence of anti-HBs 30 years after vaccination, was 92.2% for high responders, while it was only 27.3% for low responders (P = 0.001).

CONCLUSIONS

A good level of seroprotection persisted in 57.9% of the subjects after 30 years. Factors related to this immunization status confirmed the importance of vaccinating HCWs early in their careers and ensuring an adequate vaccination schedule. However, with particular reference to the low rate of hepatitis B vaccine coverage among HCWs in Southern Italy, the implementation of a new educational intervention as part of an active vaccination program is needed.

Five-year review of HIV-hepatitis B virus (HBV) co-infected patients in a New York City AIDS center

A retrospective review of 4,721 human immunodeficiency virus (HIV)-infected patients, followed at St. Luke's Roosevelt Hospital Center, New York City, was conducted from January 1, 2005 to December 31, 2009. HIV-Hepatitis B virus (HBV) co-infection rate was 218/4,721, 4.6%. Among co-infected patients, 19 patients (19/218, 8.7%) died; 13 patients (13/19, 68.4%) died from non-acquired immune deficiency syndrome (AIDS) defining including 2 patients with liver failure. More non-survivors (5 patients, 5/19, 26.3%) had liver cirrhosis than those who survived (8 patients, 8/199, 4.0%; P = 0.002). There were more patients with positive HBV e antigen (HBeAg) among non-survivors, (12 patients, 12/19, 63.2%) than among survivors (74 patients, 74/199, 37.2%; P = 0.047). HIV-HBV co-infection is associated with increased overall mortality. Therefore, use of dual active antiretrovirals, particularly, tenofovir (TDF) based regimen for optimal suppression of HIV-HBV and immune restoration with prevention of high risk behaviors may contribute to improved outcomes.

Prevalence and Risk Factors of HIV, Syphilis, Hepatitis B and C Among Female Prisoners in Isfahan, Iran

BACKGROUND

Female prisoners are at risk of acquiring sexually transmitted infections (STIs). There has been no previous study regarding the epidemiological status of STIs among female prisoners in Isfahan, central Iran.

OBJECTIVES

The aim of this study was to investigate the prevalence and risk factors of the aforementioned infections among women incarcerated in the central prison, Isfahan, to determine appropriate prevention measures.

PATIENTS AND METHODS

In a cross-sectional study, all of the 163 women incarcerated in the central prison, Isfahan in 2009, were voluntarily enrolled by the census method. After completing a checklist consisting of demographic, social, and risk factors, a 5ml blood sample was taken from each individual. The sera were analyzed for markers of the hepatitis B virus (HBV; HBsAg, HBsAb, HBcAb), hepatitis C virus (HCV; HCV antibodies), human immunodeficiency virus (HIV; HIV antibodies), and syphilis (RPR). Confirmatory tests were performed on HCV antibody-positive cases.

RESULTS

The mean age of the participants in the study was 34.54 ± 11.2 years old, 94.3% of these women were Iranian, and many of them had only a primary level of education. The prevalence of HBsAg, HBcAb, HBsAb, and HCV antibodies were; 1.2%, 7.4%, 12.9% and 7.4% respectively. No positive RPR or HIV antibodies were detected.

CONCLUSIONS

A significant relationship was seen between the HCV antibody, drug injection and illegal sex in the women, and also between HBc-Ab and drug injection. Regular screening, educational programs, and facilitation of access to suitable treatment care should be widely implemented in the prison population. Testing for immunity against HBV should be considered on admission, and afterwards vaccination of all prisoners and an appropriate preventative approach should be applied.

Seroprevalence of Hepatitis Viruses B, C, D and HIV Infection Among Hemodialysis Patients in Kerman Province, South-East Iran

BACKGROUND

The prevalence of hepatitis viruses in hemodialysis patients has been reported to be much greater than in the general population. Attention to local data, effectively guides health planners so that they can control infections and prevent nosocomial transmissions.

OBJECTIVES

This cross sectional study was carried out to determine the prevalence of hepatitis B (HBV), hepatitis C (HCV), and hepatitis D (HDV) viruses, as well as the human immunodeficiency virus (HIV) in dialysis centers in the Kerman Province, in the southeast of Iran.

PATIENTS AND METHODS

All hemodialysis patients (n = 228) in 7 centers were enrolled in the study. Hepatitis B surface antigens (HBsAg), HCV antibodies (Ab), HDV Ab and HIV Ab were measured using specific enzyme linked immunoassay kits (ULTRA kit, bioMérieux, France) and confirmed by a qualitative PCR assay.

RESULTS

The studied group was comprised of 92 (40.4%) females and 136 (59.6%) males. The mean age of the patients was 51 ± 9.5 years and the duration of hemodialysis was 39.7 ± 7.9 months. Positive HBsAg was found in 7% of cases, HCV Ab in 7%, and patients with both viruses were detected in 1.7% cases. HIV Ab and HDV Ab were negative in all cases. Out of the other risk factors, frequency of blood transfusions was significantly correlated with positive HCV Ab (P < 0.008).

CONCLUSIONS

Prevalence of HBV and HCV in hemodialysis patients was moderate to low in the Kerman Province, as in other parts of the country. Strict adherence to protective measures could lead to even lower rates.

The influence of human leukocyte antigen and IL-10 gene polymorphisms on hepatitis B virus outcome

CONTEXT

The clinical outcome of hepatitis B virus (HBV) infection is variable, ranging from spontaneous recovery to an inactive carrier state, chronic hepatitis, occult HBV infection, liver cirrhosis, or hepatocellular carcinoma.

EVIDENCE ACQUISITION

This variable pattern and clinical outcomes of the infection were mainly determined by virological and host genetic factors. Since the most of host genetic factors associated with HBV infection have currently focused on human leukocyte antigen (HLA) associations and interleukin (IL)-10 gene polymorphisms, this review focuses on the recent progresses in these issues to provide prognostic markers for the outcome of HBV infection.

RESULTS

A study on serum levels of IL-10 in occult HBV infected patients reported that the higher level of IL-10 production may suppress function of the immune system against HBV in patients with occult HBV infection. IL-10 promoter polymorphism at position -592 is associated with susceptibility to occult HBV infection.

CONCLUSIONS

Findings of this study suggest that the host HLA polymorphism is an important factor in determining outcome of HBV infection but regarding IL-10 gene promoter polymorphisms, we are still have a long way to achieve a definite conclusion.

Prevalence of hepatitis d virus infection among hepatitis B virus infected patients in qom province, center of iran

BACKGROUND

Hepatitis D virus (HDV) is a defective RNA virus that depends on the hepatitis B surface antigen (HBsAg) of hepatitis B virus for its replication, developing exclusively in patients with acute or chronic hepatitis B. There are little data regarding the routes of HDV transmission in Iran. The risk factors for HDV infection in Iran are blood transfusion, surgery, family history, Hejamat wet cupping (traditional phlebotomy), tattooing, war injury, dental interventions, and endoscopy.

OBJECTIVES

We performed this study to determine the prevalence of hepatitis D in the general population of Qom province and the potential risk factors for acquiring HDV.

PATIENTS AND METHODS

This cross-sectional study collected 3690 samples from 7 rural clusters and 116 urban clusters. HBs antigen was measured, and if the test was positive, anti-HDV was measured. Ten teams, each consisting of 2 trained members, were assigned to conduct the sampling and administer the questionnaires. The data were analyzed using SPSS.

RESULTS

Forty-eight subjects (1.3%) suffered from hepatitis B, and 1 HBsAg-positive case had HDV infection. The prevalence of hepatitis D infection in Qom Province was 0.03%. The prevalence of hepatitis D infection in HBsAg-positive cases was 2%. Our anti-HDV-positive case had a history of tattooing, surgery, and dental surgery. There was no significant relationship between tattooing, surgery history, or dental surgery and hepatitis D infection.

CONCLUSIONS

The prevalence of hepatitis D in Qom is the the lowest in Iran, similar to a study in Babol (north of Iran).

A cross-sectional study on anti hepatitis B immune status in vaccinated healthcare workers in the west pomeranian region of poland

BACKGROUND

Hepatitis B vaccination, recommended for medical staff, has a non-response rate of 5% to 32%. In Poland, there is no standardized postvaccination protocol to verify immunity.

OBJECTIVES

To determine the fraction of those who have been vaccinated against HBV (with a complete course followed/not followed by a booster) but not checked for serological evidence of hepatitis B immunity and to detect anti-HBs levels in this group by anonymous cross-sectional sero-survey.

PATIENTS AND METHODS

Surgical/gynecological staff from 16 randomly selected hospitals in West Pomerania, Poland, were surveyed between July 2010-January 2011. EIA system version 3.0 was used to detect anti-HBs.

RESULTS

Of 488 participants (439 females, median age 42 years) who were previously vaccinated (1-21 years ago), anti-HBs status was not determined after HBV vaccination in 361 individuals (74.0%; 95% CI: 69.9-77.7%), 5% (18/361) of whom had an anti-HBs titer of 0.0 mIU/ml (12/18 who were given booster doses developed anti-HBs > 10 mIU/ml) and 7.2% (26/361) of whom had an anti-HBs titer of 0.1-10 mIU/ml. The multivariate logistic regression model revealed that working in a teaching hospital was associated with lower odds of not being checked for anti-HBs after HBV vaccination (OR 0.22, 95% CI: 0.14-0.35; P = 0.0001).

CONCLUSIONS

The lack of a strict post-HBV vaccination policy to confirm immunity results in the majority of surgical/gynecological staff not checking their anti-HBs levels after HBV immunization. It is unknown whether the absence of current serological evidence of hepatitis B immunity can be attributed to non-response, the waning of vaccine-induced immunity, or preserved anamnestic response. The lack of a booster vaccination response in a fraction of subjects suggests that they are non-responders. Strict post-vaccination testing to document immunity remains the key practice to detect non-responders among medical staff.

Effect and Predictive Elements for 52 Weeks' Telbivudine Treatment on Naïve HBeAg positive Chronic Hepatitis B

BACKGROUND

Antiviral treatment with nucleoside analogs has been used for chronic hepatitis B (CHB). Each kind of nucleoside analog has its own characteristics and suitability for patients. Telbivudine (LdT, brand name: Sebivo, Beijing Novartis Pharma Ltd) is the newest nucleoside analog, with strong and rapid viral suppression. However, its resistance rate is relatively high during long-term application, due to low genetic barriers to resistance. So, it is necessary to increase the effect and reduce resistance with effective management, according to baseline factors and early on-treatment responses.

OBJECTIVES

To reveal possible predictive factors of the effect of telbivudine (LdT) treatment on naïve HBeAg-positive chronic hepatitis B (CHB) patients to optimize treatment.

PATIENTS AND METHODS

A total 71 naïve chronic hepatitis B (CHB) patients who met the inclusion criteria were enrolled. All patients were treated with LdT 600 mg Qd for at least 52 weeks. Multiple logistic regression analyses were done to investigate the predictive values of baseline factors and responses at Week 24.

RESULTS

The reduction in hepatitis virus B (HBV) DNA level was 6.44 ± 2.38 lg copies/mL at Week 52 compared with baseline. The complete virus response (CVR), biochemical response (BR), serological response (SR), and drug resistance (DR) were 61.99%, 77.46%, 35.21%, and 8.45% respectively. By multiple regression analysis, baseline alanine aminotransferase (ALT) levels significantly affected CVR (P = 0.024, OR = 1.008), and baseline ALT and baseline HBV DNA levels were independent compact factors of SR (P = 0.012, OR = 1.007; P = 0.001, OR = 0.423). The differences in CVR, SR, and DR in patients with ALT > 120 Iu/mL compared with patients with ALT ≤ 120 Iu/mL were statistically significant. The differences in SR in patients with HBV DNA > 107 copies/mL compared with patients with HBV DNA ≤ 107 copies/mL were statistically significant. Additionally, CVR, BR, and SR were differed significantly between patients with HBV DNA lower than 300 copies/mL at Week 24 and patients with HBV DNA higher than 300 copies/mL (P = 0.000, P = 0.0016, and P = 0.000, respectively).

CONCLUSIONS

There were more responders among naïve HBeAg-positive chronic hepatitis B patients with lower HBV DNA levels (especially lower than 107 copies/mL) and higher ALT values (especially higher than 120 Iu/mL at baseline) to LdT treatment. Adjustments for treatment strategy should be considered if HBV DNA > 300 copies/mL at Week 24 is observed.

Frequency and mutation patterns of resistance in patients with chronic hepatitis B infection treated with nucleos(t)ide analogs in add-on and switch strategies

BACKGROUND

Treatment for chronic hepatitis B (CHB) has improved over the last 10 years mainly due to the development of effective oral antiviral agents [nucleoside/nucleotide analogs (NUCs)].

OBJECTIVES

The aim of the present study is to identify the frequency and major patterns of resistance to the hepatitis B virus (HBV) in a Turkish population of CHB patients treated with NUCs using add-on and switch therapy strategies.

PATIENTS AND METHODS

The investigation involved a total of 194 patients (88 were treated using add-on therapy, and 106 were treated using switch therapy). We analyzed the HBV polymerase gene by amplification and direct sequencing procedures.

RESULTS

Primary drug-resistance mutations were detected in 84 patients (43%; 42 in add-on therapy, and 42 in switch therapy) taking lamivudine (LAM), 10 patients (5%; 6 in add-on therapy, and 4 in switch therapy) taking entecavir (ETV), and 16 patients (8%; 8 in add-on therapy, and 8 in switch therapy) taking adefovir (ADV). The most common LAM and ETV resistance mutations were rtM204I/V, rtL180M and rtT184A/I/S, respectively, while rtA181T/V and rtN236T substitutions were the most frequently observed ADV resistance mutations.

CONCLUSIONS

Patients with CHB who developed NUC resistance were managed using 2 different rescue strategies. The frequency and mutation pattern of resistance were similar in patients treated with add-on and switch strategies. These findings may be helpful in the management of rescue strategies in LAM-resistant patients.

Transfusion transmitted infections - a retrospective analysis from the National Blood Transfusion Service in Eritrea

BACKGROUND

The emergence of transfusion transmitted infection (TTI) especially HIV/AIDS has created a huge obstacle in ensuring blood safety. To assess the situation in Eritrea, we carried out a retrospective study of 29,501 blood donors for the prevalence of TTI's i.e. HIV, HBV, HCV and Syphilis.

METHODS

The study population included all donors who donated blood from January 2006 to November 2009. The data was collected from the National Blood Transfusion Services (NTBS) of Eritrea and includes category of donor and result for TTI markers.

RESULTS

A total of 29,501 units of blood were collected from 23,385(79%) voluntary blood donors and the rest 6,116(21%) units were collected from family replacement donors. The over all prevalence of TTI's were 3.8% with 3.5% in voluntary blood donors and 5.1% in family replacement donors. The sero-prevalence for TTI markers were 0.18% HIV, 2.58% HBV, 0.57% HCV and 0.49% Syphilis.

CONCLUSION

In conclusion, even if the TTI prevalence rate among Eritrean blood donors is low, ensuring blood safety has a long way to go.

Antiviral therapy in patients co-infected with hepatitis B virus and human immunodeficiency virus

The rapid spread of human immunodeficiency virus (HIV) in China has made hepatitis B virus (HBV)/HIV co-infection become a common clinical condition. HBV/HIV co-infection substantially alters the natural course of HBV or HIV mono-infection as well as their management. Therapy for HBV infection in HIV-co-infected patients is based on whether or not there is an indication for anti-HIV therapy. In patients with no indication for anti-HIV therapy, interferon-α(IFN-α) or adefovir dipivoxil (ADV) is recommended. In patients with an indication of anti-HIV therapy, a backbone of highly active anti-retroviral therapy should include tenofovir disoproxil fumarate (TDF) in combination with lamivudine (LAM) or emtricitabine (FTC). Switching to or adding ETV/ADV is recommended in patients who develop LAM/FTC resistance. LdT has no activity against HIV and is therefore not recommended for anti-HBV therapy in patients with HBV/HIV co-infection.

Precore and core promoter mutations of the hepatitis B virus gene in chronic genotype C-infected children

The precore (G1896A) and core promoter (A1762T, G1764A) mutations of the hepatitis B virus gene are known to be associated with changes in immunologic phase or the progression to complicated liver disease in adults. We analyzed these mutations in chronically HBV-infected children. Serum was collected from 37 children with chronic HBV infection from March 2005 to September 2008. HBV DNA extraction and nested PCR were followed by sequencing of the PCR products. The children were 6.7 ± 4.6 yr old. All of 37 children had HBV genotype C. Of the cohort, 31 (83.8%) were HBeAg-positive and 6 (16.2%) were HBeAg-negative; the former group comprised 18 (48.6%) who were in the immune-tolerance phase (ITP) and 13 (35.2%) in the immune-clearance phase (ICP). Most of the patients had HBV DNA levels of > 1.0 × 10(8) copies/mL. In the ITP group, only 1 (5.5%) had core promoter mutations, and none had the precore mutation. In the ICP group, only 2 (15.4%) had core promoter mutations; the remaining 6 patients had HBV DNA levels of < 2.0 × 10(3) copies/mL and no core promoter/precore mutations. The very low incidence of the precore/core promoter gene mutation, in children, suggests that these mutations may be the result of life-long chronic HBV infection.

Expression and purification of a functional human hepatitis B virus polymerase

AIM: To identify a method for efficient large-scale purification of functional hepatitis B virus polymerase (HBV-Pol) without addition of cellular factors.

METHODS: Full-length HBV-Pol (843 amino acids) tagged with 5’ end Polyhistidine was expressed at a high level in an Escherichia coli (E. coli) system. Sodium dodecyl sulfate lysis buffer was utilized to dissolve insoluble HBV-Pol, and Ni-NTA resin affinity chromatography was utilized for HBV-Pol purification. Most recombinant HBV-Pol was eluted with 100 mmol/L imidazole in the presence of NP-40, a weak detergent that keeps HBV-Pol in solution. A reducing agent was utilized throughout the purification steps to keep soluble HBV-Pol from redundant disulfide bond formation.

RESULTS: The large-scale production of functional intact human HBV-Pol was achieved in an E. coli expression system. Purified HBV-Pol showed stable reverse transcriptase activity and DNA polymerase activity. The purified protein was of high purity and had stable reverse transcriptase activity.

CONCLUSION: Large-scale production of HBV-Pol in pure form should facilitate crystallization and detailed analysis of the structure and mechanism of HBV-Pol. Ability of this purification approach to obtain human HBV-Pol in an enzymatically active form should be helpful for development of drugs for treatment of chronic hepatitis B.

Influence of transforming growth factor-beta1 gene polymorphism at codon 10 on the development of cirrhosis in chronic hepatitis B virus carriers

Transforming growth factor (TGF)-beta1 is a key cytokine producing extracellular matrix. We evaluated the effect of TGF-beta1 gene polymorphism at codon 10 on the development of cirrhosis in patients with chronic hepatitis B. One hundred seventy eight patients with chronic hepatitis (CH, n=57) or liver cirrhosis (LC, n=121), who had HBsAg and were over 50 yr old, were enrolled. The genotypes were determined by single strand conformation polymorphism. There were no significant differences in age and sex ratio between CH and LC groups. HBeAg positivity and detection rate of HBV DNA were higher in LC than in CH groups (P=0.055 and P=0.003, respectively). There were three types of TGF-beta1 gene polymorphism at codon 10: proline homozygous (P/P), proline/leucine heterozygous (P/L), and leucine homozygous (L/L) genotype. In CH group, the proportions of P/P, P/L, and L/L genotype were 32%, 51%, and 17%, respectively. In LC group, the proportions of those genotypes were 20%, 47%, and 33%, respectively. The L/L genotype was presented more frequently in LC than in CH groups (P=0.017). Multivariate logistic regression analysis confirms that detectable HBV DNA (odds ratio [OR]: 3.037, 95% confidence interval [CI]: 1.504-6.133, P=0.002) and L/L genotype (OR: 3.408, 95% CI: 1.279-9.085, P=0.014) are risk factors for cirrhosis.

The effectiveness of nucleoside analogues in chronic hepatitis B patients unresponsive to interferon therapy: our clinical trials for one year

BACKGROUND AND AIMS

We aimed to evaluate the effectiveness of nucleoside analogues such as Lamivudine, Adefovir,Entacavir, and Tenofovir in patients with chronic hepatitis B who failed to respond to interferon therapy and relapsed.

MATERIALS AND METHODS

We followed a total of 73 patients with hepatitis B in the hepatitis outpatient clinic in our hospital. The patients subsequently received nucleoside analogues therapy and their treatment data were evaluated retrospectively. The biochemical and virological response rates were evaluated at 3 and 12 months, and we compared these results with the results of treatment-naive patients.

RESULTS

There were 29 (39.7%) HbeAg-positive and 44 (60.3%) HbeAg-negative patients, and their mean age was 35.8 (±13.4) years. Of these patients, 33, 18, 13 and 9 received Entacavir, Tenofovir, Lamivudine, and Adefovir treatment,respectively. In HbeAg-negative patients, at 3 months the biochemical and virological response (early response) rates were observed to be 91% and 98%), and at 12 months the two rates were 93% and 73%, respectively. In HbeAg-positive patients, the biochemical and virological response rates at 3 months were 83% and 97%, and the rates at 12 months were 90% and 48%, respectively.

CONCLUSIONS

In CHB therapy with treatment-resistent patients, nucleoside analogues may be preferable. There are disadvantages to nucleoside analogues, such as a risk of developing resistance during therapy, reduced HBeAg seroconversion compared to interferons, and the therapy's ambiguous duration. In our study, in HbeAg-negative patients who received nucleoside analogues, a lower biochemical response rate was detected in patients with 1 year of Lamivudine therapy compared to other therapies. For HbeAg-positive patients, the virological response rate was higher in 1 year of Tenofovir therapy than with other therapies.

Are hepatitis B virus and celiac disease linked?

BACKGROUND AND AIMS

It has been hypothesized that nonintestinal inflammatory diseases such as hepatitis B virus (HBV) and hepatitis C virus (HCV) may trigger immunologic gluten intolerance in susceptible people. This hypothesis suggests a possible epidemiological link between these two diseases, although this assumption is still a matter of debate.

METHODS

We conducted a retrospective study to assess the prevalence of celiac disease in HBV carrier patients who had been infected in childhood.

RESULTS

None of the HBV carrier patients had immunoglobulin A antiendomysium and immunoglobulin A anti-tissue transglutaminase, but 6 patients and 1 recovered subject had immunoglobulin A antigliadin and/or immunoglobulin G antigliadin. Moreover, no patient treated with interferon therapy showed any serological marker of celiac disease.

CONCLUSIONS

Due to the small sample size, we cannot claim that there is no association between celiac disease (CD) and HBV, although in our study we did not find any CD patients. A sample size that is more representative of the prevalence of CD in Italy would better support the establishment of any possible connection between CD and HBV.

Prevalence and clinical significance of hepatitis B Basal core promoter and precore gene mutations in southern Iranian patients

BACKGROUND AND AIMS

To investigate the prevalence and pattern of PC and BCP mutations and their clinical significance in patients with genotype D chronic hepatitis B infection in the Fars province of southern Iran.

MATERIALS AND METHODS

From January 2007 to March 2008, we evaluated 44 patients with chronic hepatitis B infection who were referred to our hepatology clinics affiliated with the Shiraz University of Medical Science. All Patients were HBeAg Negative and HBeAb positive. Basal core promoter and precore mutations in these patients were evaluated with clinical phenotype and laboratory tests.

RESULTS

The mean age of the patients was 37.21 ± 10.54 years. Twenty-seven patients (61.4%) had no mutations, whereas 17 patients (38.6%) had mutations in the precore or basal core promoter regions or both. The mean serum ALT level in mutation-free patients was 59.74 ± 55.86 IUL, whereas patients with PC and BCP mutations had a mean serum ALT level of 71.35 ± 59.49 IUL. The mean serum AST level in patients with mutations was higher than for patients without mutations (59.53 ± 41.35 IUL vs. 40.65 ± 25.21 IUL, respectively). There was no statistically significant difference between the mutation and mutation-free groups in terms of age, sex, and liver enzyme levels (P > 0.05). Fourteen of the 44 patients (31.8%) had mutations in the precore region (G 1896A). 17 patients (38.6%) had mutations in basal core promoter region.

CONCLUSION

This study revealed a high prevalence of precore and basal core promoter mutations in southern Iran. Although no statistically significant difference was noted in liver enzymes, patients with mutations had higher liver enzymes in comparison with mutation-free patients.