[Epidemiology and clinical manifestations of viral hepatitis]

HBV Viral Load and Liver Enzyme Levels May Be Associated with the Wild MBL2 AA Genotype

The present study investigated the frequencies of rs1800450 (MBL ^⁎B, G>A), rs1800451 (MBL ^⁎C, G>A), and rs5030737 (MBL ^⁎D, C>T) polymorphisms in exon 1 of the MBL2 gene among patients with chronic viral hepatitis. Blood samples from patients infected with hepatitis B virus (HBV; n = 65), hepatitis C virus (HCV; n = 92), and a noninfected control group (n = 300) were investigated. The presence of polymorphisms was detected using a real-time polymerase chain reaction to correlate with liver disease pathogenesis and fibrosis staging according to the Metavir classification. The genotypic and allelic frequencies showed no significant differences between the groups, but patients with active HBV and the wild AA genotype presented a positive correlation between increased transaminase and HBV DNA levels and the presence of mild to moderate fibrosis. Patients with HCV and the wild AA genotype presented mild inflammation and higher HCV RNA levels, although the same association was not observed for the fibrosis scores. The results suggest that the mutations in exon 1 of the MBL2 gene do not contribute directly to the clinical and laboratory features of HCV and HBV infections, but further studies should be performed to confirm whether the wild AA genotype has indirect effect on disease progression.

NGF and P75NTR gene expression is associated with the hepatic fibrosis stage due to viral and non-viral causes

This study evaluated the relative mRNA expression levels of nerve growth factor (NGF) and the p75 neurothrophin receptor (p75^NTR) in different histological stages of human liver disease. Fifty-one liver biopsy specimens obtained from patients with hepatitis B virus (n = 6), hepatitis C virus (n = 28), and non-viral hepatitis – (n = 9) and standard histological liver (n = 8) as controls (CT) were subjected to qPCR and histopathological exams. Our data revealed a significant difference in the NGF expression levels between the three patient groups and the Control group. p75^NTR expression levels in the HCV and NVH groups were higher than those observed in the HBV and Control groups. In cases of liver cirrhosis, higher p75^NTR mRNA expression was observed, whereas NGF was expressed at higher levels in patients with hepatic fibrosis. NGF expression was lower in the F1 liver fibrosis stage, and p75^NTR receptor expression continuously and proportionately increased compared to the increase in the degree of fibrosis and was significantly higher in livers in fibrosis stages 3 and 4. The hepatic levels of NGF and p75^NTR were decreased and increased, respectively, relative to the stage of inflammatory activity. A positive correlation between p75^NTR and NGF gene expression was observed in livers with mild to moderate fibrosis, though not in cases of severe fibrosis and cirrhosis.

Resistance mutations are rare among protease inhibitor treatment-naive hepatitis C genotype-1 patients with or without HIV coinfection

BACKGROUND

HCV has a high replication rate and a lack of proofreading activity, leading to a greatly diverse viral population. This diversity may lead to emergence of resistant strains in direct-acting antiviral therapy. The frequency of naturally occurring HCV protease inhibitor (PI) mutations has been addressed in many countries, but there are few data on the prevalence of these mutations in Brazilian patients.

METHODS

We evaluated the sequence of HCV NS3 protease gene in 247 patients (135 HCV-monoinfected and 112 HIV-HCV-coinfected patients). HCV RNA was extracted from plasma and a fragment of 765 base pairs from the NS3 region was amplified and sequenced with Sanger-based technology.

RESULTS

HIV-HCV-coinfected patients were more likely to be older than 40 years and have an HCV subtype-1a infection. Overall, 21.9% of patients had at least one amino acid substitution in the NS3 region; 14 patients (5.7%) harboured at least one resistance mutation (T54S, V55A, Q80R) and the Q80K mutation was not found in our case series. There was no difference between monoinfected and coinfected patients regarding the frequency of natural polymorphisms and resistance mutations.

CONCLUSIONS

Baseline HCV NS3 amino acid substitutions identified herein are considered mostly natural polymorphisms with no clinical impact on PI-based therapy. The identified resistance mutations may be associated with low-level resistance to PIs in vitro. Q80K substitution seems to be a rare event in Brazil. HIV coinfection was not associated with a greater frequency of such substitutions in the studied sample.

Association between histological findings, aminotransferase levels and viral genotype in chronic hepatitis C infection

INTRODUCTION

The genomic heterogeneity of hepatitis C virus (HCV) influences liver disorders. This study aimed to determine the prevalence of HCV genotypes and to investigate the influence of these genotypes on disease progression.

METHODS

Blood samples and liver biopsies were collected from HCV-seropositive patients for serological analysis, biochemical marker measurements, HCV genotyping and histopathological evaluation.

RESULTS

Hepatitis C virus-ribonucleic acid (HCV-RNA) was detected in 107 patients (90.6% with genotype 1 and 9.4% with genotype 3). Patients infected with genotype 1 exhibited higher mean necroinflammatory activity and fibrosis.

CONCLUSIONS

HCV genotype 1 was the most prevalent and was associated with greater liver dysfunction.

The modulation of apoptosis by oncogenic viruses

Transforming viruses can change a normal cell into a cancer cell during their normal life cycle. Persistent infections with these viruses have been recognized to cause some types of cancer. These viruses have been implicated in the modulation of various biological processes, such as proliferation, differentiation and apoptosis. The study of infections caused by oncogenic viruses had helped in our understanding of several mechanisms that regulate cell growth, as well as the molecular alterations leading to cancer. Therefore, transforming viruses provide models of study that have enabled the advances in cancer research. Viruses with transforming abilities, include different members of the Human Papillomavirus (HPV) family, Hepatitis C virus (HCV), Human T-cell Leukemia virus (HTLV-1), Epstein Barr virus (EBV) and Kaposi’s Sarcoma Herpesvirus (KSHV).

Apoptosis, or programmed cell death, is a tightly regulated process that plays an important role in development and homeostasis. Additionally, it functions as an antiviral defense mechanism. The deregulation of apoptosis has been implicated in the etiology of diverse diseases, including cancer. Oncogenic viruses employ different mechanisms to inhibit the apoptotic process, allowing the propagation of infected and damaged cells. During this process, some viral proteins are able to evade the immune system, while others can directly interact with the caspases involved in apoptotic signaling. In some instances, viral proteins can also promote apoptosis, which may be necessary for an accurate regulation of the initial stages of infection.

Evaluation of Knowledge and Practice of Hairdressers in Women's Beauty Salons in Isfahan About Hepatitis B, Hepatitis C, and AIDS in 2010 and 2011

BACKGROUND

Blood-borne viruses such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) have some common epidemiological characteristics, and have infected millions of people throughout the world. Patients infected by acute hepatitis or HIV infections may not be aware of the disease, and thereby cause transmission to others. During haircut, shave, or pedicure, barbers may accidentally expose to their clients' blood, transmit their own infection to them, or transmit the infection from one client to another. Thus the beauty salon staff has a potential role in expansion of infections.

OBJECTIVES

As being barbers and barbering are risk factors to some infectious diseases, determining the role of knowledge and awareness of barbers and hairdressers about topics related to AIDS, and hepatitis B and C is important.

PATIENTS AND METHODS

This cross-sectional descriptive study was performed in 2010-2011 on 281 women's beauty salons located in eleven urban districts of Isfahan town. A multistage cluster sampling was performed and knowledge assessment questionnaire accompanied by practice checklist regarding hepatitis B and C, and AIDS were completed by trained interviewers. Knowledge and practice scores were determined in 0-20 and 0-10 scales, respectively. The content validity of questionnaire was confirmed by three expert opinions and the test-retest reliability of the questionnaire was determined to be 0.83 in a pilot study on 30 participants. Data were analyzed using Pearson's correlation coefficient and one-way ANOVA test by SPSS software, version 18.

RESULTS

In the study, 281 hairdressers participated. There was a statistically significant relationship between education level and knowledge score of hairdressers (P < 0.001). We found a statistically significant relationship between knowledge level and job history of hairdressers according to the Pearson's correlation coefficient (P = 0.004). The results did not show any statistically significant relationship between education level and practice scores (P = 0.5). Furthermore, the job history of hairdressers and their practice score did not show a significant relationship (P = 0.77).

CONCLUSIONS

We obtained promising results about the knowledge and practice levels of staffs of women's beauty salons in Isfahan about AIDS, and hepatitis B and C. The target group exhibited an intermediate level of knowledge about the diseases because of important role of barbers in virus transmission; we should provide the best control, evaluation, and continuous teaching programs.

Evaluation of knowledge and practice of hairdressers in men's beauty salons in Isfahan about hepatitis B, hepatitis C, and AIDS in 2010 and 2011

BACKGROUND

Blood-borne viruses such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) have infected millions of people worldwide. During haircut or shaving, barbers may accidentally expose to their clients' blood, transmit their own infection to them, or transmit the infection from one client to another. So the knowledge of barbers toward topics related to AIDS, hepatitis B, and C are of great importance.

MATERIALS AND METHODS

This cross-sectional descriptive study was performed in 2010-2011 in men's beauty salons in Isfahan town. A multistage sampling was performed. The knowledge assessment questionnaire and the checklist of practice regarding hepatitis B, C, and AIDS were completed by trained interviewers.

RESULTS

In our study, 240 hairdressers participated. There was a statistically significant relationship between the education level and knowledge score of the hairdressers (P = 0.048). We found a statistically significant relationship between the knowledge level and the working history of hairdressers according to the Pearson's correlation coefficient (P = 0.02). The results show significant relationship between the education level and the practice scores (P = 0.005). Also the working history of hairdressers and their practice score had a significant relationship (P = 0.005). The results did not show significant relationship between the age of the hairdressers and the practice scores (P = 0.12).

CONCLUSIONS

We obtained promising results about the knowledge and practice levels of the staff of men's beauty shop in Isfahan about AIDS, hepatitis B, and C. However, but because of the important role of barbers in virus transmission, we should provide the best program for control, evaluation, continuous teaching programs.

[Influence of previous hepatitis B virus infection on liver fibrosis in patients with chronic hepatitis C: a retrospective case series evaluation]

INTRODUCTION

Hepatitis C is a major cause of liver disease worldwide. Its evolutionary course is dynamics and may be influenced by several cofactors. Among them, previous hepatitis B virus infection (anti-HBcAg [+] and HBsAg [-]) has been associated with worse histological and therapeutic prognosis. This study had the objective of independently assessing the relationship between previous hepatitis B infection and liver fibrosis in patients with chronic hepatitis C.

METHODS

The medical records of patients chronically infected with the hepatitis C virus who had been seen consecutively during a one-year period at the infectious and parasitic diseases outpatient clinic of HC FMUSP were retrospectively reviewed in relation to epidemiological, clinical and histological data. Analysis on the independence of the previous hepatitis B infection was performed using the statistical model of multivariate logistic regression. Detection of anti-HBcAg was taken to be the independent variable. The outcome was taken to be grade 3 and 4 histopathological abnormality (septa with nodule formation and cirrhosis).

RESULTS

145 subjects were evaluated in this study. 47.2% of them were anti-HBcAg (+). The main risk factor for infection was blood and blood derivative transfusion (35.9%). Findings of anti-HBcAg (+) were not related to advanced liver fibrosis, although piecemeal necrosis has been found frequently in patients with this serological marker.

CONCLUSIONS

Previous hepatitis B infection does not seem to increase the structural liver damage triggered by chronic hepatitis C virus infection, after statistical control for other co-factors capable to impact the natural history of this infection.

Vaccination strategies against hepatitis A in travelers older than 40 years: an economic evaluation

BACKGROUND

In recent years, the number of travelers aged >40 years who acquire hepatitis A while traveling has increased. Therefore, there is a need to review hepatitis A vaccination protocols in travelers. The aims of the study were to assess immunity levels to hepatitis A virus (HAV) in international travelers >40 years and to determine the least costly immunization strategy.

METHODS

A serological examination of HAV antibodies in 427 international travelers aged >40 years traveling endemic zones was carried out. The prevalence of antibodies in each age group was assessed. The costs of two preventive strategies, direct vaccination of all subjects (independent of the immune status) or screening and subsequent vaccination of susceptible subjects were compared. The critical value of prevalence (CVP) (the value at which the costs for the two strategies are equal) was calculated.

RESULTS

Total prevalence of HAV antibodies was 78.9% [95% confidence interval (CI): 74.8-82.5] and was 80.0% (95% CI: 73.8-85.2) in men and 77.9% (95% CI: 71.9-83.2) in women. There was a positive association with age. In the 40 to 49, 50 to 59, 60 to 69, and 70 to 95 years age groups, the prevalence rates were 62.6 (95% CI: 53.8-71.5), 76.8 (95% CI: 70.0-82.7), 91.7 (95% CI: 85.2-95.6), and 97.5% (95% CI: 87.4-99.6), respectively. The CVP was 58.4% using two doses of vaccine.

CONCLUSIONS

The CVP was lower than the prevalence rate found in our international travelers. Therefore, we recommend systematic screening for HAV antibodies before selective vaccination of international travelers aged >40 years traveling to hepatitis A endemic zones.