Seroprevalence and Risk Factors for Hepatitis B in an Adult Population: The First Report from Birjand, South Khorasan, Iran

Prevalence and assessment of the associated risk factors of hepatitis B and C infections in the low socioeconomic communities

Aim: This study determined the prevalence and risk factors associated with hepatitis B and C among the low socioeconomic population. Materials & methods: A total of 1004 participants were screened for hepatitis B/C infection and risk factors from six different localities of Islamabad, Pakistan Results: The prevalence rate of hepatitis B and C was 1 and 4%, respectively. Chi-square test showed hepatitis B/C infection was related with marital status, hepatitis B vaccination, blood recipients and family income. Multivariable analysis showed hepatitis B vaccination, exposure to therapeutic injections, dental visits, exposure to HCV patients and age of participants were independently associated with hepatitis C infection. Conclusion: The risk of hepatitis B/C infection is multifactorial and the population needs to be vaccinated at a larger scale to avoid outbreaks.

Prevalence of Hepatitis B and C Infections and Associated Risk Factors in Pars Cohort Study, Southern Iran

BACKGROUND

Hepatitis B and C virus (HBV and HCV) infections rank among the most frequent infectious diseases with a rising worldwide burden. However, their epidemiology and risk factors are understudied in many regions, including Iran.

METHODS

This study was conducted as part of the Pars Cohort Study (PCS) in Valashahr district, Fars province (2012-2014). Participants received venipuncture for HBsAg and HCV antibody, followed by Polymerase Chain Reaction (PCR) testing. All infected people and their comparison groups completed a risk assessment questionnaire.

RESULTS

Overall, 9,269 people participated in the study; the majority were women and of Fars ethnicity. Prevalence of HBsAg and HCV antibody was 2.3% (n = 215) and 0.3% (n = 26), from whom 23% (n = 47) and 13% (n = 3) had indications for treatment, respectively. During follow-up, among HBsAg-positive individuals who were not on treatment, 62% tested negative for HBsAg, and in 2% HBV DNA had risen to treatment levels. Risk factors for HBV infection were illiteracy [OR = 3.43, 95% CI = 1.1, 10.3], and Turk ethnicity compared to Fars [OR = 1.58, 95% CI = 1.1, 2.3]. History of blood transfusion [OR = 2.00, 95% CI = 1.1, 3.5] and history of drug use [OR = 2.85, 95% CI = 1.1, 7.4] were associated with HCV infection, after adjustment.

CONCLUSION

Further epidemiological studies are needed to identify at-risk populations in different regions. Preventive interventions, including educational programs and transfusion safety strategies, are crucial for reducing the hepatitis burden.

IL-10 -1082 A/G (rs1800896) Polymorphism is Effective in Clearing Hepatitis B Virus Infection

Background: Hepatitis B Virus (HBV) is a universal health challenge all around the world. Several factors like viral load, genetic characteristics, age, sex, and immune status contribute to variable clinical outcomes of HBV infection. The sequels of HBV infection vary remarkably among persons ranging from the spontaneous deletion of infection to persistent infection. Objective: The present study aimed to evaluate the association of single nucleotide polymorphisms IL10-1082 with HBV clearance. Methods: Sixty subjects with Chronic Hepatitis B (CHB) infection and 60 subjects who spontaneously recovered HBV were enrolled in the study. The IL-10-1082 polymorphisms were determined by Polymerase Chain Reaction with Restriction Fragment Length Polymorphism (PCR–RFLP). Results: The clearance of HBV infection demonstrated a significant association with IL-10-1082 polymorphisms in the GG genotype (P = 0.03), while there was no association with other genotypes. Reduced risk of chronic hepatitis B infection was associated with IL-10-1082 GG (OR: 2.33, 95% CI: 1.07 - 5.09). Besides, IL-10-1082 A/G alleles did not differ clearly between the two study groups (P = 0.07) Conclusions: The IL-10-1082 polymorphisms may be associated with a reduced risk of CHB infection and recovery after HBV infection.

Fitting logistic regression models to assess vitamin D deficiency with clinical parameters in chronic hepatitis B patients

Statistical models provide a quantitative structure with which clinicians can evaluate their hypotheses to explain patterns in observed data and generate forecasts. In contrast, vitamin D is an important immune modulator that plays an emerging role in liver diseases such as chronic hepatitis B (CHB). Therefore, we quantified 25(OH)D₃ serum levels in 292 CHB patients tested for their association with clinical parameters. Of 292 patients, 69 (63%), 95 (47%), and 39 (19%) had severe vitamin D deficiency (25(OH)D₃ < 10 ng/mL), vitamin D insufficiency (25(OH)D₃10 and < 20 ng/mL), or adequate vitamin D serum levels (25(OH)D₃ 20 ng/mL), respectively. In both univariate and multivariate analyses, zinc serum level was a strong predictor of low 25(OH)D₃ serum levels (P < 0.001). Results of fitted models showed that lower vitamin D levels were significantly associated with: younger age, lower uric acid levels, HBeAg-positive status, lower calcium levels (p < 0.05). Vitamin D deficiency (<20 ng/ml) or severe deficiency (<10 ng/ml) was observed more frequently among HBV patients (52%). Vitamin D deficiency was observed in most CHB patients. Generally, our results recommend that substitution of vitamin D can be a substitution method in the treatment of patients with HBV-associated disorders.

Epidemiologic profile of viral hepatitis B and C in North of Iran: results from PERSIAN Guilan Cohort Study (PGCS)

OBJECTIVE

Hepatitis B (HB) and C (HC) are two severe viral infectious diseases with a deleterious impact on global health. This study aimed to evaluate the prevalence of HB and HC in the Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study using immunological and molecular methods.

RESULTS

The blood samples were obtained from 10,520 enrolled participants. Complete biochemical and hematological tests, as well as urine analysis, were assessed. The presence of HBsAg, anti-HBs, anti-HBc, and anti-HCV antibodies for all participant and HBeAg and anti-HBe antibodies for HB-positive patients were evaluated. Moreover, HB genomic DNA and HC genomic RNA were extracted from serum samples of HB-positive patients. The real-time PCR assay was employed to quantify the gene copies of hepatitis B and C viruses. HC genotyping was also performed. The prevalence of HB and HC was 0.24% (95% CI 0.16-0.35) and 0.11% (95% CI 0.06-0.19), respectively. Rural participants were significantly more HB-positive than the urban people (P = 0.045), while males were significantly more HC-positive than the females (P = 0.013). The prevalence of HB and HC in this area were lower than those of other geographical locations of Iran, which may be due to different lifestyles or other unknown reasons.

Seroepidemiology and Risk Factors of Hepatitis B Virus Infection: A Population-Based Azar Cohort Study

BACKGROUND

Hepatitis B is a major global health problem. It can cause chronic infections and put people at high risk of death from cirrhosis and hepatocellular carcinoma. The aim of this study was to report the epidemiological features of hepatitis B virus (HBV) infection and risk factors based on the data from Azar Cohort.

METHODS

The population of this study comprised the people in the age range of 35-70 yr from Azar cohort, East Azerbaijan Province, Iran between 2015 and 2016. Based on cluster sampling, 4,949 people were selected and invited to complete the questionnaire and perform the tests. Blood samples were analyzed for serum HBV markers (HBsAg, HBsAb and HBcAb) by ELFA method. The data were analyzed using SPSS statistical software.

RESULTS

The mean (SD) age of the participants was 49.15 ± 9.02 years. The frequency rates of HBsAg, HBsAb and HBcAb were estimated as 1.03%, 16.9% and 24.95%, respectively. There was statistically significant association between family history of hepatitis (P<0.001) and jaundice history (P<0.001) with the presence of HBsAg. There was also a positive correlation between marital status (P=0.002), history of hospitalization (P<0.001), smoking (P=0.001), dental procedures (P<0.001), foreign travels (P=0.005), occupation status (P=0.002) and the presence of HBcAb.

CONCLUSION

The frequency of hepatitis B in Azar Cohort was 1.03% which is a lower rate compared with other reports from Iran. The association of the population studied and the increase of public awareness in this area can probably prevent this disease.

Hepatitis B virus infection among people who use drugs in Iran: a systematic review, meta-analysis, and trend analysis

Background

People who use drugs (PWUD) are considered as one of the main at-risk populations for Hepatitis B virus (HBV) infection. We conducted a systematic review on the prevalence of HBV infection among PWUD in Iran.

Methods

Consistent with PRISMA guideline, international (Medline, Web of Science, Scopus, and Embase) and national (Scientific Information Database) databases were searched using a comprehensive search strategy up to September 2019. The retrieved records were reviewed, and experts were contacted for unpublished studies. Studies on Iranian PWUD reporting HBV surface Antigen (HBsAg) prevalence among people who inject drugs (PWID) and non-injecting PWUD were included. HBsAg prevalence was pooled for PWID and non-injecting PWUD and for other subgroups using random-effects model meta-analysis. The trend of HBV prevalence over time was investigated using meta-regression analysis.

Results

Overall, 35 studies reported data on HBV infection among PWID (33 studies) and non-injecting PWUD (11 studies). The pooled prevalence of HBsAg among PWID was 4.8% (95% CI 3.7–6.2). The only risk factor significantly associated with the odds of positive HBsAg in PWID was the previous history of imprisonment (OR 1.72, 95% CI 1.29–2.30, p value = 0.000). The pooled estimate of HBsAg among non-injecting PWUD was 2.9% (95% CI 2.5–3.2). Time trend analyses showed significant decrease in HBV prevalence among PWID reaching from 8.2% (95% CI 3.9–16.5) in 2004–2006 to 3.1% (95% CI 2.3–4.1) in 2016 and later (b = -0.07; p value = 0.05). No significant trend was detected for non-injecting PWUD.

Conclusion

The prevalence of HBV infection among non-injecting PWUD and even PWID was not considerably higher than the Iranian general population. This might be the result of extensive harm reduction interventions in Iran. However, it seems that there are subgroups of PWID, who do not adequately benefit from existing harm reduction interventions. Future programs should more specifically target these high-risk groups.

The Prevalence of Hepatitis B, Hepatitis C and Human Immunodeficiency Viral Infections Among a Large Population of Afghans

Background: Viral infections are a public health problem. Objectives: We would like to evaluate the seroprevalence of hepatitis B, C, and human immunodeficiency virus infections (HIV) in a large sample of the Afghanistan population in Kabul. Methods: In total, 196516 Afghani citizens went to Fateme-al-Zahra clinic to perform obligatory checkup for traveling to Iran. The serum samples were primarily checked by rapid tests for HBV, HCV, and HIV, and in case of positive results, a commercial ELISA kit used as the confirmatory test. Results: Out of 196516 participants, 153763(78%) were men and 42753 (22%) were women. The seroprevalence of HBV, HCV, and HIV infections was 1.23% (2430), 0.13% (265) and 0.018% (16), respectively. The prevalence of HCV and HIV was significantly higher in males than females (m/f: 0.097%/0.037% vs. m/f: 0.008%/0%, respectively; P < 0.05). The simultaneous co-infection of HBV-HCV and HBV-HIV was 0.004% and 0.0005 %, respectively. Conclusions: This study showed a low prevalence of HBV, HCV, and HIV among the study group. Considering the selection bias, sensitivity, and specificity of rapid tests, the real prevalence expected to be quite higher. Proper strategies to improve the social awareness and implement preventive vaccination for HBV can decrease the incidence of these infections.

Analysis Of Risk Factors For Nonalcoholic Fatty-Liver Disease In Hepatitis B Virus Infection: A Case-Control Study

Background

Nonalcoholic fatty-liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Although NAFLD has been studied extensively, potential risk factors for NAFLD among chronic hepatitis B (CHB) patients and their comparison with healthy individuals have remained understudied in Iran. As such, we examined the association between HBV infection and the development of NAFLD in two groups.

Methods

A case-control study was done on 376 CHB patients and 447 healthy subjects randomly selected from Birjand, South Khorasan province, Iran. We used logistic regression to estimate adjusted ORs with 95% CIs for incidence of NAFLD. Potential risk factors for NAFLD were evaluated while adjusting for age, sex, marital status, and educational level. Also, χ ² was used to compare demographic characteristics between the two groups.

Results

A total of 373 CHB patients (mean age 40.1±12.9 years) versus 447 individuals in the control group (mean age 39.8±13.9 years) were included in this study (p=0.337). Liver characteristics were found to be significantly different in CHB and healthy groups (p<0.05). According to the results obtained from logistic regression, the adjusted OR (95% CI) for NAFLD incidence of comparing HBsAg-positive to HBsAg-negative participants was 0.62 (0.45-0.84).

Conclusion

The results suggested that HBsAg seropositivity was associated with lower risk of developing NAFLD. This study also revealed that mild cases of fatty liver in carriers of hepatitis B are more common than in healthy subjects. However, moderate and severe cases of this condition are more common in healthy people than in hepatitis B carriers.

Serological and biochemical study of hepatitis B patients, a report from the southeast of Iran

Aim: Clinical importance of HBeAg and HBeAb positivity was assessed in 309 patients with chronic HBV infection. Patients & methods: Clinical, biochemical and serological data were extracted from medical archives over a 10-year period (2004–2014). Results: HBeAg and HBeAb were positive in 46 (14.8%) and 221 (71.5%), respectively. Persistent elevation of AST and ALT enzymes were seen in 73 (21.2%) and 98 (30.1%) of the patients, respectively. HBeAb positivity rendered a significant protective effect against the elevated enzyme levels (odds ratio = 0.03; 95% CI: 0.003–000.3; p = 0.006 for AST, and odds ratio = 0.05; 95% CI: 0.007–000.4; p = 0.007 for ALT). Conclusion: Immune reaction against HbeAg in the course of chronic HBV infection rendered a protective factor against hepatic enzymes elevation.

Is an endoscopic examination associated with transfusion-transmissible infections? A systematic review and meta-analysis

BACKGROUND

The purpose of a donor medical questionnaire is to identify the blood donor's history relative to the current known blood-safety risks. A temporary deferral from blood donation after an endoscopic examination is enforced because of the reusable nature of the endoscope and close contact with the inner body. The objective of this systematic review was to find the best available evidence on the association between an endoscopic examination and the risk of transfusion-transmissible infections.

METHODS

Studies from five databases investigating the link between an endoscopic examination and transfusion-transmissible infections (hepatitis B virus, hepatitis C virus, human immunodeficiency virus infection, Treponema pallidum) were retained and assessed independently by two reviewers. The association between endoscopy and transfusion-transmissible infections was identified by conducting meta-analyses and calculating pooled effect measures (odds ratios and 95% confidence intervals). The Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to assess the quality of evidence.

RESULTS

We identified 7571 references and finally included 29 observational studies. A significant association between an endoscopic examination and hepatitis B virus infection (pooled odds ratio [OR], 2.21; 95% confidence interval [CI], 1.26-3.86; p = 0.005) or hepatitis C virus infection (pooled OR 1.76, 95% CI, 1.45-2.14; p < 0.00001) was found. The level of evidence was considered as "very low" due to the type of study design (i.e., observational) and indirect study populations (i.e., no blood donor populations).

CONCLUSION

An endoscopic examination is associated with an increased hepatitis B virus or hepatitis C virus infection risk. Further high-quality trials are required to formulate stronger evidence-based recommendations on endoscopic examination as a blood donor deferral criterion.