Trend of 25-hydroxycholesterol and 27-hydroxycholesterol plasma levels in patients affected by active chronic hepatitis B virus infection and inactive carriers

Hepatitis B virus (HBV) infection is a global health problem with different immunological phases and therapeutic approaches. The serological condition of inactive carrier (IC) was recently well defined as a clinical and virological stable status, in which specific treatment is usually deferred, while the active chronic hepatitis B (CHB) condition requires an immediate treatment strategy. Recently, a possible broad antiviral effect of oxysterols, in particular 25-hydroxycholesterol (25OHC) and 27-hydroxycholesterol (27OHC), was observed, as most likely linked to the positive modulation of innate immunity, but no clear evidence is available about their possible role in chronic HBV infection. Thus, we examined the relationship between the plasma levels of oxysterols and the disease condition of 40 HBV patients, without treatment at the start of the study. Of these, 33 were ICs and 7 were active CHB subjects. A marked reduction of 25OHC and 27OHC plasma levels was detectable in all active CHB recruited patients, while the plasma values observed in ICs all remained within the physiological range. No difference was observed between the two groups of patients with regard to the plasma levels of 24-hydroxycholesterol (24OHC). Further, the plasma level of 27OHC ≥ 140 μg/L was shown to be predictive of an inactive carrier status. This cohort study points to 27OHC as a good candidate biomarker to differentiate active and inactive CHB status. An increasing bulk of research reports is supporting the very likely contribution of this oxysterol to the immunological control of chronic hepatitis B.

Hepatitis B Virus: From Diagnosis to Treatment

Hepatitis B infection is still a global concern progressing as acute-chronic hepatitis, severe liver failure, and death. The infection is most widely transmitted from the infected mother to a child, with infected blood and body fluids. Pregnant women, adolescents, and all adults at high risk of chronic infection are recommended to be screened for hepatitis B infection. The initial analysis includes serological tests that allow differentiation of acute and chronic hepatitis. Molecular assays performed provide detection and quantification of viral DNA, genotyping, drug resistance, and precore/core mutation analysis to confirm infection and monitor disease progression in chronic hepatitis B patients. All patients with chronic hepatitis B should be treated with antiviral medications and regularly monitored for efficient treatment. The current treatment is based on nucleos(t)ide analogs and pegylated interferons that save lives by decreasing liver cancer death, liver transplant, slow or reverse the progression of liver disease as well as the virus infectivity.

Evaluation of HBV, HCV, and HIV seroprevalence in patients with plasma cell disorders

Hepatitis B (HBV) and hepatitis C (HCV) viruses are hepatotropic and lymphotropic viruses that can proliferate either in lymphocytes and monocytes or hepatocytes.The aim of this study was to evaluate the seroprevalence of HBV, HCV, and human immunodeficiency virus (HIV) in patients with plasma cell disorders. We also aimed to compare patients with plasma cell disorders and chronic lymphocytic leukemia (CLL) in terms of HBV, HCV, and HIV seropositivity.This is a retrospective study. The patients who had patient file in the Multiple Myeloma Outpatient Unit of our hospital and were followed in our outpatient unit between January 1, 2012 and September 15, 2019, with diagnoses of either of the plasma cell disorders were included in the study. In addition, 272 CLL patients who were admitted to the Leukemia Outpatient Unit of our hospital were also enrolled in the study. The 2 disease groups were compared in terms of HBV, HCV, and HIV seropositivity.A statistically significant relationship was found between disease groups according to hepatitis B surface antigen (P < .05). Hepatitis B positivity were found to be more common in CLL patients. There was also a statistically significant relationship between the disease groups in terms of hepatitis B e antigen positivity (P = .001).We found that hepatitis B surface antigen positivity rate in CLL patients was higher than in patients with plasma cell disorders. Seroprevalence of HBV, HCV, and HIV was found to be very low in patients with plasma cell disorders.

Analysis of clinical characteristics and S gene sequences in chronic asymptomatic HBV carriers with low-level HBsAg

BACKGROUND

During the natural hepatitis B virus (HBV) infection process, some infected subjects are characterized by a sustained low serum HBV surface antigen (HBsAg) expression level. Most members in this population are chronic asymptomatic HBV carriers (ASCs). To elucidate the mechanism underlying low-level HBsAg expression in ASCs, we sequenced the HBV S gene in these patients to reveal specific sequence characteristics.

METHODS

Overall, 1308 cases of chronic ASCs were grouped according to their HBsAg serum expression levels (10 IU/mL). The clinical characteristics of the population were analysed in detail. The HBV S gene was sequenced from 276 ASC cases with low-level HBsAg expression. Additionally, 100 of 1032 ASC cases with high-level HBsAg expression were randomly selected for HBV S gene sequencing based on age matching according to the low-level HBsAg group. A comparative analysis was conducted with the HBV S gene sequences from ASCs with low HBsAg expression and the HBV reference S gene sequences from ASCs with high HBsAg expression.

RESULTS

The population with low-level HBsAg expression displayed the following primary clinical characteristics: mostly chronic asymptomatic HBV carriers, older age (mean age 55.09 years), HBsAg/anti-HBe/anti-HBc (core) positivity as the main serological pattern (97.1%), low HBV DNA replication (1.32 ± 1.60 log₁₀ IU/mL), a low HBV-DNA positive rate (45.65%) and primarily genotype B (82.54%) and serotype adw (84.13%). The comparative analysis of the HBV S gene sequences from ASCs with low-level HBsAg showed significant mutations (including co-mutations) on both sides of the main hydrophilic region (MHR).

CONCLUSION

Significant mutations in multiple regions and at multiple sites (including co-mutations) on both sides of the MHR may be one cause of the low HBsAg expression level in this population.

Automated Diagnosis of Hepatitis B Using Multilayer Mamdani Fuzzy Inference System

In this research, a new multilayered mamdani fuzzy inference system (Ml-MFIS) is proposed to diagnose hepatitis B. The proposed automated diagnosis of hepatitis B using multilayer mamdani fuzzy inference system (ADHB-ML-MFIS) expert system can classify the different stages of hepatitis B such as no hepatitis, acute HBV, or chronic HBV. The expert system has two input variables at layer I and seven input variables at layer II. At layer I, input variables are ALT and AST that detect the output condition of the liver to be normal or to have hepatitis or infection and/or other problems. The further input variables at layer II are HBsAg, anti-HBsAg, anti-HBcAg, anti-HBcAg-IgM, HBeAg, anti-HBeAg, and HBV-DNA that determine the output condition of hepatitis such as no hepatitis, acute hepatitis, or chronic hepatitis and other reasons that arise due to enzyme vaccination or due to previous hepatitis infection. This paper presents an analysis of the results accurately using the proposed ADHB-ML-MFIS expert system to model the complex hepatitis B processes with the medical expert opinion that is collected from the Pathology Department of Shalamar Hospital, Lahore, Pakistan. The overall accuracy of the proposed ADHB-ML-MFIS expert system is 92.2%.

Association between hepatitis B virus infection and chronic kidney disease: A cross-sectional study from 3 million population aged 20 to 49 years in rural China

Hepatitis B virus (HBV) infection can lead to different types of chronic kidney diseases (CKD) in clinical practice. However, HBV infection has been observed to have no significant association with CKD indicators in some epidemiological surveys. This research aims to estimate CKD prevalence in HBV infection population and clarify the relationship between HBV infection status and CKD.The participants aged 20 to 49 years were selected by multistage random sampling from January 1, 2010 to December 31, 2012 across 31 provinces and regions in rural China. The data was collected by standard questionnaire and physical check-up. Status of HBV infection was diagnosed as immune tolerant phase, hepatitis B envelope antigen -positive chronic HBV infection, inactive HBV carrier, hepatitis B envelope antigen -negative chronic HBV infection and resolved HBV infection based on serological markers, and the level of hepatic function, respectively.In total, 2,969,502 subjects were included in the study. In population aged 20 to 49 years in rural China, prevalence of HBV infection was 12.17%. Prevalence of proteinuria, hematuria, estimated glomerular filtration rate less than 60 mL/min/1.73m and CKD was 0.94%(95% CI = 0.91-0.97%) vs. 0.65%(95% CI = 0.64-0.66%), 1.92%(95% CI = 1.87-1.96%) vs. 1.19% (95% CI = 1.18-1.21%), 1.02%(95% CI = 0.99-1.06%) vs. 0.77% (95% CI = 0.76-0.78%), and 3.85%(95% CI = 3.78-3.91%) vs. 2.60%(95% CI = 2.58-2.62%) in population with HBV infection and without infection, respectively. Prevalence of CKD and indicators was higher in population in every status of HBV infection than in population without infection, respectively (all P < 0·0001). Every HBV infection status was a risk factor for CKD.CKD prevalence was higher in population in every status of HBV infection than without infection. HBV infection was a risk factor for CKD in population aged 20 to 49 years in rural China.

Dynamics of hepatitis B virus serum markers in an acute hepatitis B patient in the incubation phase

Patients with acute hepatitis B (AHB) usually present after developing symptoms; therefore, the temporal kinetics of viral markers during the incubation period have not been documented clearly. We describe an AHB infection before the onset of hepatitis, throughout the course of the disease and without anti-viral therapy. The patient initially visited our hospital for immunization against HBV and was found to be positive for viral markers: 0.0 IU/mL of anti-HBs, 0.06 S/CO of anti-HBc and 2.93 IU/mL of HBsAg. During the 14 days after his first visit, HBsAg, HBV DNA, HBe antigen and HBV core-related antigen, but not anti-HBc or anti-HBs, levels increased. On day 22, he developed acute hepatitis. The period of logarithmic viral replication was estimated to be 7.0 days. HBV genomic sequencing and phylogenetic analysis indicated transmission from the patient's wife. Although sexual intercourse could not be ruled, another possible route of transmission was the unusual occurrence of kissing his wife when she had macroscopic bleeding after tooth brushing, 2 months before his positive HBsAg result; the day of the episode being consistent with the calculated HBV replication velocity. This study reveals the temporal kinetics of viral markers during the incubation period of AHB.

[A recombinant adenovirus vector carrying murine interleukin-21 gene controls chronic HBV infection in mice]

OBJECTIVE

To investigate the effect of an adenovirus vector containing murine interleukin-21 gene (Ad-GFP-mIL-21) in virus clearance and on the production of HBV-specific antibodies in mice with persistent HBV infection.

METHODS

ELISA and Western blot analysis were used to detect the expression of mIL-21 in the supernatant and cytoplasm of cultured HepG2.2.15 cells after infection by Ad-GFP-mIL-21. Mouse models of chronic HBV infection established by in vivo transduction with rAAV8-1.3HBV were divided into 3 groups for treatment 12 weeks later with injection of Ad-GFP-mIL-21, GFP recombinant adenovirus or PBS via the tail vein. Serum levels of HBsAg, HBsAb, HBcAb, and mIL-21 in the mice were detected using ELISA, and the expression of Ad-GFP-mIL-21 in the organs was observed by fluorescent microscopy at different time points after the injection.

RESULTS

Ad-GFP-mIL-21 was capable of infecting HepG2.2.15 cells in vitro, and the levels of mIL-21 in the supernatant were correlated with the titers of adenovirus administered and the infection time. In the mice with persistent HBV infection, green fluorescence expression was observed almost exclusively in the liver on day 4 after injection of Ad-GFP-mIL21, and serum levels of IL-21 increased significantly compared with the level before treatment (P<0.05). Although HBsAb was undetectable in both Ad-GFP-mIL21-injected and control mice on day 13, a significantly higher serum level of HBcAb was detected in the mice with Ad-GFP-mIL21 injection (P<0.05).

CONCLUSION

Ad-GFP-mIL-21 can efficiently express mIL-21 in mice with chronic HBV infection to downregulate serum levels of HBsAg and promote HBcAb production, suggesting its efficacy in controlling chronic HBV infection.

Clinical features of treatment-naive patients with hepatitis B virus infection: A community-based survey from high- and intermediate-hepatitis B endemicity regions in Southeast China

The aim of study was to investigate the clinical features of treatment-naive patients in 2 regions with high- and intermediate-hepatitis B endemicity level in Southeast China and provide the baseline data for monitoring health or planning therapy.This study included 8207 cases of treatment-naive patients with hepatitis B virus (HBV) infection from Yuhuan (YH, high-hepatitis B endemicity region) and Shaoxing (SX, intermediate-hepatitis B endemicity region) during 2014-2015. Clinical data were collected from the patients. Blood samples were kept for detecting hepatitis B surface antigen, hepatitis B envelope antigen (HBeAg), hepatitis B envelope antibody, hepatitis B surface antibody, hepatitis B core antibody, liver function, HBV deoxyribonucleic acid, and alpha-fetoprotein. All persons underwent B ultrasound to exclude liver cirrhosis or cancer.Of all 8207 HBsAg-positive patients, 52.9% patients were in the low-replication (LR) stage and 30.3% in the HBeAg-negative chronic hepatitis B (ENH) stage; 8.8% cases were in the ENH stage with elevated alanine aminotransferase (ALT). More male than female patients were in immune clearance (IC) or ENH stages with elevated ALT (10.4% vs 4.8%, 12.1% vs 5.3%, respectively, P < .05). The percentage of patients in IC and immune tolerant (IT) stages declined with increasing age, whereas the percentages of ENH with elevated ALT stage were highest in 40 to 60 years.The percentage of patients in IT and IC stages was higher in YH than in SX (9.4% vs 3.8%, 9.9% vs 4.2%, respectively, P < .05). More patients had HBVDNA≥10 IU/mL in YH than in SX (24.6% vs 16.0%, P < .05), and more male than female patients had HBVDNA≥10 IU/mL(24.5% vs 17.9%, P < .05).Clinical features varied in treatment-naive patients with HBV infection between different genders and regions. More attention should be paid to the surveillance and therapy of patients in YH especially male patients for the prevention and prognosis of hepatitis B.

Invader Assisted Enzyme-Linked Immunosorbent Assay for Colorimetric Detection of Disease Biomarkers Using Oligonucleotide Probe-Modified Gold Nanoparticles

We successfully developed an invader assisted ELISA assay (iaELISA) for sensitive detection of disease biomarkers. The method includes three key steps as follows; biotinylated detection antibody was at first used to capture targeted antigen by sandwich ELISA. The biotinylated oligonucleotide was then attached to detection antibody via streptavidin. Finally, the cascade invader reactions were employed to amplify the biotinylated oligonucleotide specific to the antigen so that detection of the antigen was transformed into signal amplification of the antigen-specific DNA. To achieve colorimetric detection, oligonucleotide probe and modified gold nanoparticles (AuNPs) were coupled with the invader assay. Utilization of the hairpin probes in the invader reaction brought about free AuNPs, resulting in the positive read-out (red color). On the other hand, aggregation of the AuNPs occurred when the hairpin probes were not utilized in the reaction. This method was successfully used to detect as low as 2.4 x 10(-11) g/mL of HBsAg by both naked eye and spectrophotometer. This sensitivity was about 100 times higher than that of conventional ELISA method. The method was also used to assay 16 serum specimens from HBV-infected patients and 8 serum specimens from HBV-negative donors and results were in good agreement with those obtained from the conventional ELISA. As the invader assay is sensitive to one base sequence, a good specificity was also obtained by detecting other antigens like hepatitis A virus (HAV) and BSA. The method has therefore much potential for ultrasensitive and cost-effective detection of targeted proteins that have clinical importance.

Hepatitis B virus infection in Indonesia

Approximately 240 million people are chronically infected with hepatitis B virus (HBV), 75% of whom reside in Asia. Approximately 600000 of infected patients die each year due to HBV-related diseases or hepatocellular carcinoma (HCC). The endemicity of hepatitis surface antigen in Indonesia is intermediate to high with a geographical difference. The risk of HBV infection is high in hemodialysis (HD) patients, men having sex with men, and health care workers. Occult HBV infection has been detected in various groups such as blood donors, HD patients, and HIV-infected individuals and children. The most common HBV subgenotype in Indonesia is B3 followed by C1. Various novel subgenotypes of HBV have been identified throughout Indonesia, with the novel HBV subgenotypes C6-C16 and D6 being successfully isolated. Although a number of HBV subgenotypes have been discovered in Indonesia, genotype-related pathogenicity has not yet been elucidated in detail. Therefore, genotype-related differences in the prognosis of liver disease and their effects on treatments need to be determined. A previous study conducted in Indonesia revealed that hepatic steatosis was associated with disease progression. Pre-S2 mutations and mutations at C1638T and T1753V in HBV/B3 have been associated with advanced liver diseases including HCC. However, drug resistance to lamivudine, which is prominent in Indonesia, remains obscure. Although the number of studies on HBV in Indonesia has been increasing, adequate databases on HBV infection are limited. We herein provided an overview of the epidemiology and clinical characteristics of HBV infection in Indonesia.

Age as a predictor of significant fibrosis features in HBeAg-negative chronic hepatitis B virus infection with persistently normal alanine aminotransferase

BACKGROUND

Although alanine aminotransferase (ALT) levels reflect the degree of liver damage, not all patients with chronic hepatitis B virus (HBV) infection exhibit persistently elevated ALT levels. In the present study, we aimed to comprehensively evaluate the characteristics of histological abnormalities in a large population of Chinese patients with chronic HBV and persistently normal ALT levels.

METHODS

In total, 2303 consecutive patients who underwent liver biopsy were screened. Of these patients, 273 were categorized as having persistently normal ALT levels (PNALT), whereas 618 were categorized as having persistently or intermittently elevated ALT levels (PIALT). All these patients had at least three ALT values recorded in the year prior to the baseline liver biopsy.

RESULTS

Significant necroinflammation was observed in 9.7% (11/113) patients with PNALT, 23.3% (42/180) patients with PIALT (ALT 1-2× upper limit of normal [ULN]), and 27.8% (42/151) patients with PIALT (ALT > 2× ULN), whereas significant fibrosis was observed in 8.8% (10/113) patients with PNALT, 27.8% (42/151) patients with PIALT (ALT 1-2× ULN), and 21.2% (32/151) patients with PIALT (ALT > 2× ULN). Multiple logistic regression analysis indicated that age parameters were associated with significant histological abnormalities in patients with PNALT. The area under the curve showed that age was associated with significant fibrosis characteristics in patients with hepatitis B extracellular antigen (HBeAg)-negative PNALT.

CONCLUSION

Significant histological abnormalities are not often observed in Chinese patients with PNALT. Interestingly, age appears to be a predictor of significant fibrosis in patients with HBeAg-negative PNALT.

Relationship between level of hepatitis B virus DNA and liver disease: a population-based study of hepatitis B e antigen-negative persons with hepatitis B

BACKGROUND & AIMS

There is little information on the proportion of persons with chronic hepatitis B virus (HBV) infection with active hepatitis. We aimed to determine the proportion of persons with hepatitis B e antigen-negative chronic HBV infection who develop immune-active HBV infection over time and the relationship between demographic and viral factors on severity of disease on liver biopsy.

METHODS

We performed a longitudinal population-based cohort study of 754 Alaska Native patients with chronic HBV infection. Levels of alanine aminotransferase (ALT) were measured every 6 months, and levels of HBV DNA were measured at study entry and whenever ALT levels exceeded the upper limit of normal (ULN). Immune-active chronic HBV infection was defined as levels of ALT ≥ 30 U/L in men and >20 U/L in women and levels of HBV DNA >2000 IU/mL at 1 or more time points from 2001-2008. Liver biopsies were scored by using the modified histology activity index score of Knodell and the Ishak fibrosis score.

RESULTS

Of the study participants, 186 (25%) met the criteria for immune-active HBV, 56% of these initially and 44% later during follow up. Of the 38 patients with liver biopsy results, only 1 of 16 with ALT levels consistently below twice the ULN and 1 of 19 with HBV DNA between 2000 and 20,000 IU/mL, vs 12 of 22 (55%) with ALT > twice ULN (P = .002) and 11 of 18 (61%) with 1 or more measurements of HBV DNA >20,000 IU/mL (P < .001), had moderate or severe hepatitis or fibrosis.

CONCLUSIONS

In a cohort of Alaska Natives with chronic HBV infection, 25% met criteria for immune-active HBV. There is a low probability of advanced fibrosis if levels of HBV DNA never exceed 20,000 IU/mL.

Purpura with ulcerative skin lesions and mixed cryoglobulinemia in a quiescent hepatitis B virus carrier

Mixed cryoglobulinemia is occasionally seen in patients with hepatitis B virus (HBV) infection. This report presents the case of a quiescent HBV carrier who had type II mixed cryoglobulinemia, protracted purpura, ulcerative skin lesions and advanced chronic kidney disease. The cutaneous manifestations of the patient improved along with a decrease in the serum cryoglobulin and HBV-deoxyribonucleic acid levels following the initiation of oral entecavir in combination with plasmapheresis. However, the patient ultimately required prednisolone due to the limited benefits of these treatments. We also discuss various concerns regarding steroid treatment in patients with mixed cryoglobulinemia complicated by HBV infection.

[Diagnosis of chronic hepatitis B infection]

BACKGROUND

Infection with the hepatitis B virus can lead to chronic liver inflammation with the risk of developing cirrhosis and cancer of the liver. Increased knowledge and improved treatment of chronic hepatitis B infection in recent years mean that virological tests are increasingly used to ascertain the course of illness, status and response to treatment by the individual patient. The purpose is therefore to provide an updated overview of available diagnostics.

METHOD

The article builds on a selection of original and review articles identified through a search in Medline, as well as experience of microbiological diagnostics from the national reference laboratory for the hepatitis virus in Norway.

RESULTS

Detection of virus proteins and antibodies to these, as well as virus quantification and characterisation, form an important part of the assessment of hepatitis B infection, including confirmation of the chronic phase of the illness.

INTERPRETATION

Proper diagnosis is based on a broad selection of different serological and virological markers. Genotype and certain mutations may affect the course of illness and the response to treatment. To prevent further transmission and offer effective treatment, it is important to identify chronic carriers, but also persons who have previously been infected with hepatitis B virus with risk of reactivation.

Diagnostic significance of hepatitis B viral antigens in patients with glomerulonephritis-associated hepatitis B virus infection

Hepatitis B viral infection can lead to hepatitis B virus-associated glomerulonephritis, a clinically significant subtype of secondary nephritis. In the present study, we examined the presence of PreS1/S2 antigen in renal tissues by use of immunohistochemistry and investigated the use of PreS1/S2 and 2 HBV serum antigens, HBe-Ag and HBs-Ag, in the diagnosis. We assessed the presence of these 3 antigens in patients with confirmed hepatitis B virus-associated glomerulonephritis (n = 22) and patients without this disease (n = 19). Our results indicate that the combined use of PreS1/S2-Ag and serum HBe-Ag in the diagnosis of hepatitis B virus-associated glomerulonephritis had good positive predictive value (0.89), modest negative predictive value (0.77), and substantial agreement based on Cohen's kappa coefficient (κ = 0.660, P < 0.001). We suggest that our results be considered in the development of more definitive diagnostic criteria for hepatitis B virus-associated glomerulonephritis.

Elevation of B-type natriuretic peptide level in asymptomatic hepatitis B virus-positive patients is not associated with abnormalities of cardiac function

OBJECTIVES

To compare B-type natriuretic peptide (BNP) and echocardiographic parameters in patients with hepatitis B virus (HBV) and healthy control subjects.

SUBJECTS AND METHODS

52 consecutive patients with HBV and 47 healthy controls were examined. All subjects underwent transthoracic echocardiography after a complete medical history and laboratory examination including BNP, C-reactive protein (CRP) and high-sensitivity CRP (hsCRP).

RESULTS

Demographic characteristics were similar in patients with HBV and the control group. No significant difference was found in conventional Doppler and tissue Doppler parameters between the two groups. BNP levels were significantly higher in patients with HBV [6.5 ng/l (range 0.5-85.2)] than controls [4.3 ng/l (range 0.5-18.3)], p = 0.039. hsCRP [3.25 mg/l (0.02-40.2) vs. 0.5 mg/l (0.02-8.0)] levels were significantly higher in patients with HBV than control subjects (p < 0.001).

CONCLUSION

Patients with HBV had higher BNP, CRP, and hsCRP levels than controls. Echocardiographic findings were similar in both groups. This slight BNP elevation in HBV patients may be related to chronic inflammation due to HBV.

The prevalence of HBV infection in the cohort of IDPs of war against terrorism in Malakand Division of Northern Pakistan

BACKGROUND

Hepatitis B is an important public health problem in the Pakistani population and is the major cause of chronic hepatitis, cirrhosis, fibrosis and hepatocellular carcinoma. High prevalence of HBV infections has been observed especially in areas of low economic status. In spite of effective immunization programs, no significant change has been observed in the epidemiology of HBV in the rural areas of Pakistan (~67.5% of the total population) mainly due to lack of interest from government authorities and poor hygienic measures. The current study was aimed at estimating the prevalence and risk factors associated with HBV infection within internally displaced persons (IDPs) due to war against terrorism in the Malakand Division of Northern Pakistan.

METHODS

Blood samples from 950 IDPs suspected with HBV infection (including both males and females) were collected and processed with commercial ELISA kits for HBsAg, Anti HBs, HBeAg, Anti HBe antibodies. The samples positive by ELISA were confirmed for HBV DNA by real-time PCR analysis.

RESULTS

The overall prevalence of HBV observed was 21.05% of which 78.5% were males and 21.5% were females. Most confirmed HBV patients belong to the Malakand and Dir (lower) district. High-risk of infection was found in the older subjects 29.13% (46-60 years), while a lower incidence (11.97%) was observed in children aged <15 years. Lack of awareness, socioecomic conditions, sexual activities and sharing of razor blades, syringes and tattooing needles were the most common risk factors of HBV infection observed during the cohort of patients.

CONCLUSION

The present study, revealed for the first time a high degree of prevalence of HBV infection in rural areas of Northern Pakistan. The noticed prevalence is gender- and age-dependent that might be due to their high exposures to the common risk factors. To avoid the transmission of HBV infection proper awareness about the possible risk factors and extension of immunization to the rural areas are recommended.

Hepatitis B and hepatitis C virus in Thai blood donors

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of transfusion-transmitted infection (TTI). In Thailand, the prevalence of HBV infection in new blood donors has decreased gradually from 7.1% in 1988 to 2.6% in 2009. This drastic decline in HBV prevalence is mostly the result of an effective expanded program on immunization (EPI) against HBV; the current coverage rate with HBV vaccine in newborns is more than 98% nation-wide. The prevalence of HCV infection, has decreased at a slower rate due to lack of HCV vaccination. The use of healthy volunteer blood donors and nucleic acid amplification technology (NAT) has also contributed to the steady decrease in rates of HBV and HCV infections. We summarize the current status of the EPI program for preventing HBV and the current strategy of HBV and HCV screening in new blood donors.

Infectious disease screening of blood specimens collected post-mortem provides comparable results to pre-mortem specimens

Serology assays for standard screening are optimised for use with sera collected from living adults and children. Because of potential changes in the vascular compartments after death, methods used for screening sera from cadaveric organ donors need to be validated before testing these specimens. Serum was separated from blood collected from cadaveric donors within 24 h of death and biochemical parameters measured to detect dilution of protein and haemolysis. In order to demonstrate if any inhibitors that might interfere with the assays were present, pre and post-mortem specimens were spiked with aliquots of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), human T-cell Lymphotropic Virus (HTLV) and T. pallidum-positive sera. Comparison of serum from living subjects with serum obtained post-mortem showed that while the concentration of total protein decreased, concentrations of albumin, immunoglobulin G (IgG) and immunoglobulin M (IgM) remained unchanged. The degree of haemolysis, as measured by free haemoglobin, was within the limits accepted for the Architect analyser. Spiking of pre- and post-mortem specimens with aliquots of HIV, HCV, HBV, HTLV and T. pallidum-positive sera showed no statistical difference in the signal between pre-mortem and post-mortem results when tested on the Abbott Architect analyser. Positive results were obtained in each of a further nine subjects who had tested positive for HIV (n=1), HCV (n=8), HBV (n=1) on pre-mortem serological testing. These findings suggest that the sensitivity of the Abbott Architect serological screening tests is not significantly affected in specimens collected within 24 h of the cessation of life.

Grupo Colaborativo En Hepatitis B. [Clinical practice guideline for diagnosis and treatment of chronic hepatitis virus hepatitis B. Grupo Colaborativo en Hepatitis B]

This guide sets out the technical criteria for the diagnosis and treatment of chronic hepatitis secondary to viral hepatitis B. The guide intend to reduce the morbidity and mortality of this disease. The Guide give practical definitions to help understand the terminology, describe epidemiology, risk factors, and clinical aspects and the diagnosis of chronic hepatitis B. Finally the guide give recommendations for the management including special circumstances such as patients with cirrhosis, patients coinfected with HIV or coinfected with hepatitis C. The recommendations of the guide become the national guide for the management of chronic hepatitis B

Incomplete protection against hepatitis B among remote Aboriginal adolescents despite full vaccination in infancy

The objective of this study was to determine long-term immunity to hepatitis B virus (HBV) in a cohort of adolescents who received plasma-derived HBV vaccine in 1989 and 1990 in a remote Australian Aboriginal community. This was done using a serological survey; primary outcome measures were cut-off titres of HBsAb, and the presence of HBcAb and/or HBsAg. Of 37 adolescents in the cohort, 4 (11%) had evidence of active infection, one with abnormal liver enzymes, 7 (19%) had evidence of past infection, 15 (41%) were HBsAb positive in low titre and 11 (30%) were classed as immune. It was concluded that there was relatively poor long-term serological immunity to HBV vaccination in this group; a finding which is in keeping with similar studies in Indigenous and remote populations elsewhere. This finding raises the concern that a significant proportion of Aboriginal adolescents in other remote communities (vaccinated in 1989 and 1990) were not adequately protected by the vaccine. If so, there will be an unexpected burden of chronic HBV infection in these settings and a substantial group who are non-immune, despite having received complete HBV vaccination courses as infants. The authors recommend followup serosurveys in remote Aboriginal communities to identify people with low HBsAb titres, especially those without an adequate anamnestic response to another dose of HBV vaccine. In addition, community-based active surveillance programs will be required to detect people with chronic HBV infection and provide access to monitoring and appropriate treatment.

Management and treatment of chronic hepatitis B virus infection in HIV positive and negative patients: the EPIB 2008 study

BACKGROUND & AIMS

To compare the management and the virological and serological efficacy of treatments for chronic hepatitis B (CHB) in HIV positive and negative patients.

METHODS

Two hundred and forty-six HIV positive and 205 HIV negative consecutive patients with past or present CHB, seen in October 2008 in participating departments, were included in a multicenter study. All the data were retrospectively collected from the first visit to October 2008 through a standardized questionnaire.

RESULTS

Compared to HIV negative patients, HIV positive patients more often presented positive HBeAg (46.4% vs. 32.8%, p=0.01), HBV genotype A (54.8% vs. 17.1%, p<0.0001), co-infection with HCV (12.4% vs. 5.9%, p=0.0002) or HDV (12.6% vs. 2.9%, p=0.04). HIV positive patients were more often on HBV therapy (92.7% vs. 57.1%, p<0.0001), leading to undetectable serum HBV DNA levels (71.0% vs. 44.1%, p<0.0001). In HIV positive patients, multivariate analysis showed that older age, lower initial HBV DNA levels, and longer time on HBV therapy significantly correlated with undetectable HBV DNA. No difference in efficacy was observed between tenofovir used alone or in combination. HBsAg (but not HBe) loss was more often observed in HIV positive patients, sometimes followed by HBsAg re-appearance after withdrawal of HBV treatment. Excluding the 37 HBV-HCV-co-infected patients, the last clinical presentation and liver fibrosis scores were similar in HIV positive and negative patients.

CONCLUSIONS

The assessment of CHB and the efficacy of HBV therapy have improved in HIV positive patients. HIV infection did not have a negative impact on the likelihood of HBV therapeutic success.

[Epidemiologic peculiarities of infections caused by the hepatitis B and C viruses among lung tuberculosis patients]

The article presents the results of serological investigation for presence of specific markers of hepatitis B (HBV) and hepatitis C (HCV) infections in serum samples obtained from 600 patients with acute and chronic forms of lung tuberculosis (LT) and in control group I - 600 healthy adults and in control group II - 796 patients with somatic pathology from multiprofile hospital. It has been established that among LT patients frequency of revealing HBsAg and anti-HCV is statistically steady; similar indicators are among persons from both control groups. The frequency of revealing of these markers among patients with chronic forms of LT is considerably higher than frequency of their revealing in patients with acute forms of LT. At the same time, both infections in patients with LT were often presented in form of subclinical hepatitis, identified by increase in of aminotransferases activity in blood.

[Clinical, virological and epidemiological aspects of acute B hepatitis in the Catania area (Italy)]

Starting from January 1997 we prospectively evaluated all cases of acute hepatitis B admitted to two of the main Infectious Diseases Units in Catania (eastern Sicily). The survey was extended throughout a 10-year period up to December 2007. Between 1997 and 1999 we observed 21 cases of acute hepatitis B; between 2000 and 2002 18 cases; between 2003 and 2005 22 cases and, finally, 37 cases were reported in the period 2006-2007. We found an increase in acute hepatitis B cases among people aged 26 to 44 years (from 38% in 1997-99 to 70% in 2006-07). A progressive decrease in intravenous drug abuse as a risk factor for acute hepatitis B was also observed (from 61% to 14%) together with a parallel increase in cases due to sexual transmission (from 19% to 56%) and outpatient cosmetic surgical procedures. Mean time to serum HBsAg negativization was longer in the last period (2006-07), with 6 cases out of 37 showing HBsAg persistence beyond 12 months from the clinical onset. Furthermore, in 2006-07 there were 12 cases (42%) of acute hepatitis due to HBV genotypes A and F. In our area, a progressive drop of hepatitis B cases due to intravenous drug abuse occurred, whereas heterosexual and iatrogenic cases increased. Cases due to HBV non-D genotypes may well be related to migration from endemic areas towards Sicily.

[Impact of small molecules on intermolecular interactions underlying the ligand technologies in laboratory diagnosis]

Hydrogen peroxide has been found to have a distorting effect on the quality of determination of the serological markers of hepatitis B and C, transglutaminase antibodies: an increase in the percent of false higher (anti-HBsAg, HBeAg, anti-HCV) and false lower (anti-HBeAg) values, and on the results of PCR-based diagnosis (PCR inhibition that was more pronounced especially in low viremia). A possibility of interference of measurement results in the blood metabolite pool should be taken into account in the use of high-technology methods of laboratory analysis. In particular, there may be changes in the detection of immunological and molecular biological methods in hyperpyruvatemia and hyperoxaloacetatemia, with elevated peroxide concentrations during pathological processes.

[Analysis on HBV epidemical trend of people age <20 from rural areas of Zhaodong]

OBJECTIVE

By two times investigation to the HBV infection of people age <20 in rural areas in Zhaodong city, to understand the effects of HepB immunigation through analysing the changes of HBsAg, anti-HBs and anti-HBc infectious markers during 1986-2005.

METHODS

Cross-sectional study was conducted and the surum samples were collected in 1986 and 2005 respectively. HBsAg, anti-HBs and anti-HBc of the sera with SPRIA were tested.

RESULTS

HBsAg average positive rate of the people age <20 decreased from 8.5% in 1986 to 4.4% in 2005 (chi2 = 10.88, P < 0.01). The anti-HBs average positive rate increased to 43.1% in 2005 from 18.3% in 1986 (chi2 = 130.47, P < 0.01). The anti-HBc average positive rate decreased from 39.9% to 15.1% (chi2 = 122.18, P < 0.01).

CONCLUSION

The HBV infectious background of the rural population in Zhaodong city is high and the HBV infection rate decreased obviously after HepB inoculation since 1986, but it is still higher than the state average rate. It indicated that the HBV prevention in this district need to be enforced and improved.

Hepatitis B: diagnosis and treatment

Although an estimated 1 million persons in the United States are chronically infected with hepatitis B virus, the prevalence of hepatitis B has declined since the implementation of a national vaccination program. Hepatitis B virus is transmitted in blood and secretions. Acute infection may cause nonspecific symptoms, such as fatigue, poor appetite, nausea, vomiting, abdominal pain, low-grade fever, jaundice, and dark urine; and clinical signs, such as hepatomegaly and splenomegaly. Fewer than 5 percent of adults acutely infected with hepatitis B virus progress to chronic infection. The diagnosis of hepatitis B virus infection requires the evaluation of the patient's blood for hepatitis B surface antigen, hepatitis B surface antibody, and hepatitis B core antibody. The goals of treatment for chronic hepatitis B virus infection are to reduce inflammation of the liver and to prevent complications by suppressing viral replication. Treatment options include pegylated interferon alfa-2a administered subcutaneously or oral antiviral agents (nucleotide reverse transcriptase inhibitors). Persons with chronic hepatitis B virus infection should be monitored for disease activity with liver enzyme tests and hepatitis B virus DNA levels; considered for liver biopsy; and entered into a surveillance program for hepatocellular carcinoma.

[Detection of peripheral blood HBV-LHBs transactivation function and its relationship with anti-viral efficacy]

OBJECTIVE

Explore the serum of patients with CHB of HBV large envelope protein (HBV-LHBs) trans-activation function and antiviral therapy effect relationship.

METHODS

60 cases of anti-viral treatment of patients with chronic hepatitis B to take every 3 months HBVDNA, HBV-LHBs, as well as detection of hepatitis B immune markers to observe the changes in indexes.

RESULTS

Income group 60 cases of anti-virus group HBVDNA with HBV-LHBs have a higher detection rate of the consistency of the results found no statistical significance (P > 0.05), HBV-LHBs-positive rate and positive rate of HBeAg differences (chi2 = 4.08, P < 0.05). After 24 months of antiviral therapy HBV-LHBs expression always HBVDNA in 29 cases of which occurred 24 months after the negative reaction of the 20 cases, continuous positive were seven cases of non-negative. 60 cases of patients 24 months found no HBsAg seroconversion, four cases of emergence of HBeAg seroconversion.

CONCLUSION

(1) detection of serum HBV-LHBs to reflect the hepatitis B virus replication with HBVDNA good correlation. (2) anti-viral treatment of dynamic observation of the process of HBV-LHBs expression can predict the effectiveness of anti-viral therapy.

A fully automated immunoassay from whole blood on a disc

A portable, disc-based, and fully automated enzyme-linked immuno-sorbent assay (ELISA) system is developed to test infectious diseases from whole blood. The innovative laser irradiated ferrowax microvalves and centrifugal microfluidics were utilized for the full integration of microbead-based suspension ELISA assays on a disc starting from whole blood. The concentrations of the antigen and the antibody of Hepatitis B virus (HBV), HBsAg and Anti-HBs respectively, were measured using the lab-on-a-disc (LOD). All the necessary reagents are preloaded on the disc and the total process of the plasma separation, incubation with target specific antigen or antibody coated microbeads, multiple steps of washing, enzyme reaction with substrates, and the absorbance detection could be finished within 30 minutes. Compared to the conventional ELISA, the operation time was dramatically reduced from over 2 hours to less than 30 minutes while the limit of detection was kept similar; e.g. the limit of detection of Anti-HBs tests were 8.6 mIU mL(-1) and 10 mIU mL(-1) for the disc-based and the conventional ELISA respectively.

[Pregnant women hepatitis B markers investigation and analysis of intrauterine infection]

OBJECTIVE

To investigate the relationship between the hepatitis B virus (HBV) infection in pregnant women and intrauterine infection in local region.

METHODS

The markers of hepatitis B (HBVM) were determined by time-resolved fluoroimmunoassay and HBV-DNA were determined by FQ-PCR.

RESULTS

A total of 1262 pregnant women were examined the HBVM, 2.6%, 38.2%, 0.9%, 22.6%, 23.1% subjects were identified HBsAg, HBsAb, HBeAg, HBeAb, HBcAb positive respectively. In 33 cases of serum HBsAg-positive pregnant women, HBV-DNA were observed in most of 11 cases of pregnant women with HBeAg-positive and intrauterine infection rates were 6/11. In contrast, 22 cases of pregnant women with HBeAg negative, HBV-DNA were detected lowly-loaded and intrauterine infection rates were 2/22 (P < 0.01). Intrauterine infection rates of HBV in pregnant women with HBsAg-positive were 24.2% (8/33).

CONCLUSION

HBV infective rates in pregnant women in the local region were low. Pregnant women with serum HBeAg positive and HBV-DNA high-loaded were prone to intrauterine infection.

[Spontaneous and treatment-induced virological dynamic in the plasma, PBMC and liver tissue in a patient with chronic HBV and HCV coinfection]

Here it is reported the virological dynamic of HBV and HCV, identified in the plasma, peripheral blood mononuclear cells and tissue liver, in a patient with chronic HBV-HCV coinfection. A treatment with pegylated Interferon plus Ribavirin determined a sustained virological response for HCV in all the three studied compartments, but a reactivation of chronic HBV infection was observed. In fact, while at the first observation HBV-DNA was detectable only in the liver tissue, after antiviral therapy it was detectable in all the three compartments; moreover this HBV reactivation was associated with a hepatic flare. Then, the patient was treated with Entecavir, which has been determining the clearance of HBV from the peripheral compartments (plasma and PBMC) until today.

Hepatitis B immunity in a population of drug and alcohol users

The objective of this study was to determine the level of immunity from Hepatitis B infection in an Australian population of drug and alcohol users, and the validity of self-reported immune status. A cross-sectional survey was employed of drug and alcohol users presenting for treatment, who were clients of De Paul House, a community-based drug and alcohol withdrawal service in Victoria. Outcome measures were: hepatitis B serology and personal reports of hepatitis B immunity. A total of 118 people were enrolled; 22% were injecting drug users and 48% reported past injecting drug use, while 55% were alcohol users; 51% had no general practitioner; 73% of participants were unaware of whether they were protected from hepatitis B infection, while 19.5% believed they were protected. However, serology demonstrated that 52.2% of those who believed they were protected were not immune. Only 21% of participants were immune. This is the first study in an Australian setting since the 1970s to examine the effectiveness of vaccination targeted to this population, and demonstrates low rates of immunity. New strategies are needed to deliver vaccination to this group. These will need to take account of the often chaotic nature of their lives, the poor validity of self-reported immunity, and the lack of primary care links.

[Evaluation of knowledge, attitudes and practices in the health care setting in Morocco with regard to hepatitis B and C]

The purpose of this study was to evaluate practices and knowledge on infectious hazards, to determine the prevalence of viral hepatitis B and C related to occupational blood exposures among health care workers, and to propose a prevention policy. This descriptive epidemiological survey, which is multicentric and cross-cutting, was carried out in 2005 in four Moroccan cities. 1562 health care workers were contacted and 1002 accepted to reply to the questionnaire (64.1%). The mean age was 39.5 +/- 6.8 years and length of service 12.6 +/- 8.3 years. Blood was identified as the product most handled by workers (91.3%), followed by dirty linen and hospital waste. The most frequently used instruments reported were hollow needles (77.9%), followed by lancets. Re-sheathing used needles was practiced by 47.3% of the personnel. Nurses, assistants and support staff have insufficient knowledge on how viral hepatitis B and C is transmitted. Only 47.4% of personnel were adequately vaccinated against hepatitis B. Post-vaccines serology was carried out on only 2.7% of the vaccinated staff. During the last twelve months, 62.8% of the persons were victim to at least one occupational blood exposures of which 8.3% were reported. Universal precautions are not widely known or applied: only 24.4% wore gloves for invasive acts and 63% correctly disinfected their hands. Viral hepatitis B and C hazards in healthcare facilities are not sufficiently taken account. The recent creation of occupational health services in hospital facilities should contribute to improve working conditions, provide for mandatory vaccination of hospital employees against viral hepatitis B, and improve and increase information and education on hazards related to occupational blood exposures for healthcare personnel.

[Natural history of chronic hepatitis B virus infection]

In the last years notable steps have been done towards the understanding of the biology of Hepatitis B Virus (HBV), its natural history and immunopathogenesis, while succesful universal vaccination programs were implemented around the world and important advances in antiviral therapeuthics occurred. Nevertheless, HBV infection remains a public health problem with nearly 350 million carriers worlwide. The natural history of chronic hepatitis B and the spectrum of its clinical forms are complex and variable.We review the natural history of chronic HBV infection describing the early replicative phase and late or non-replicative (inactive carrier) in those patients who adquired the infection during adulthood and the immune tolerant phase, immune clearance and non-replicative in those who acquired the infection in the perinatal period. Emphasis is made in the course of HBeAg negative chronic hepatitis and occult hepatitis B. The complexity of the natural history of hepatitis B depends on viral features, hepatocyte behavior and patient immune response. The intrinsic and extrinsic HBV factors associated with the progression to cirrhosis and hepatocellular carcinoma are also reviewed.

KEYWORDS

Hepatitis B, Natural history, liver cirrhosis, hepatocellular carcinoma.

Serum HBsAg changes in HBeAg positive chronic hepatitis B patients with continuous viral load reductions during treatment with adefovir or peg-interferon-alpha-2a

Hepatitis B surface antigen (HBsAg) loss under antiviral therapy is rare in chronic hepatitis B patients and the dynamics of serum HBsAg in these patients are not available. The changes in serum HBsAg following treatment with adefovir (n=31) or peg-interferon-alpha-2a (n=23) were studied in hepatitis B e-antigen (HBeAg) positive chronic hepatitis B patients. Abbott Architect HBsAg assay was used to quantify serum HBsAg. HBsAg levels were significantly decreased during the first 12 weeks of treatment with median change of -397.0 IU/ml and -555.4 IU/ml, respectively for adefovir and peg-interferon-alpha-2a (p=0.005 and 0.001, respectively). Beyond 12 weeks, no further significant HBsAg reductions were found even in patients with sustained viral replication inhibition in either group. Three distinct patterns of HBsAg changes were observed in most patients in both treatment groups: biphasic pattern (rapid HBsAg reduction from baseline to week 12); assurgent pattern (higher HBsAg level at week 12 than at baseline); and wavy pattern (HBsAg reduction from baseline to week 12, followed by relapse at week 24 or week 28). These results might offer insights into the possible mechanism(s) underlying the unusual occurrences of HBsAg loss under antiviral therapy.

A population-based survey of the prevalence of HIV, syphilis, hepatitis B and hepatitis C infections, and associated risk factors among young women in Vitória, Brazil

OBJECTIVE

To estimate the prevalence of HIV, hepatitis B (HBV) and C (HCV), and syphilis infections and associated risk exposures in a population-based sample of young women in Vitória, Brazil.

METHODS

From March to December 2006, a cross-sectional sample of women aged 18-29 years was recruited into a single stage, population-based study. Serological markers of HIV, HBV, HCV, and syphilis infections and associated risk exposures were assessed.

RESULTS

Of 1,200 eligible women, 1,029 (85.8%) enrolled. Median age was 23 (interquartile range 20-26) years; 32.2% had < or = 8 years of education. The survey weighted prevalence estimates were: HIV, 0.6% [(95% CI), 0.1%, 1.1%]; anti-HBc, 4.2% (3.0%, 5.4%); HBsAg, 0.9% (0.4%, 1.6%); anti-HCV, 0.6% (0.1%, 1.1%), and syphilis 1.2% (0.5%, 1.9%). Overall, 6.1% had at least one positive serological marker for any of the tested infections. A majority (87.9%) was sexually active, of whom 12.1% reported a previously diagnosed sexually transmitted infection (STI) and 1.4% a history of commercial sex work. Variables independently associated with any positive serological test included: older age (> or = 25 vs. < 25 years), low monthly income (< or = 4x vs. > 4x minimum wage), previously diagnosed STI, > or = 1 sexual partner, and any illicit drug use.

CONCLUSIONS

These are the first population-based estimates of the prevalence of exposure to these infectious diseases and related risks in young women, a population for whom there is a scarcity of data in Brazil.

[Present situation of hepatitis B in Chile]

BACKGROUND

Hepatitis B virus infection generates carriers and 8% will evolve to a chronic phase.

AIM

To perform a compilation of studies on hepatitis B in Chile and other sources of information to estimate the impact of this disease in our country.

MATERIAL AND METHODS

Published and unpublished evidence about the infection, in the general population and risk groups in our country, was compiled and reviewed critically. Informal interviews with experts, revision of the mandatory notification book of the Ministry of Health and collection of data from laboratories that study hepatitis B virus, were also carried out.

RESULTS

The seroprevalence of chronic carriers in blood donors is nearly O.3%. Among risk groups such as health care personnel, the figure is O.7%, among homosexuals 29%, among HIV positive patients 30%, among sexual workers 2% and among children with chronic hemodialysis, 9%. Prevalence rate according to notified cases in 2004 was 1.8 x 100,000 inhabitants. Detection of viral hepatitis B surface antigen in laboratories occurs in 0.2% of donors and 1.396 of non donors.

CONCLUSIONS

The seroprevalence of hepatitis B virus, the lack of notification, and the introduction of hepatitis B vaccine to our Regular Program of Immunizations, are arguments to develop in Chile a hepatitis B and C surveillance system.

Efficacy of accelerated hepatitis B vaccination program in patients being actively treated for hematologic malignancies

BACKGROUND

The goal of this study was to conduct an accelerated vaccination program and to determine its efficacy in patients susceptible to hepatitis B virus (HBV) receiving chemotherapy because of their hematologic malignancies.

METHODS

Over a one-year period, a total of 327 patients who were diagnosed as having a hematologic malignancy were serologically analyzed in terms of HBV infection. Of those found to be susceptible to HBV infection, a total of 42 patients consisting of 16 females and 26 males were enrolled in the accelerated vaccination program. All the patients were administered a 20-microg yeast-derived recombinant hepatitis B vaccine on days 0, 14, and 28. Anti-HBs titers above 10IU/l at 1 and 3 months after the final dose were accepted as protective.

RESULTS

A total of 146 (44.6%) patients were susceptible to HBV, while 13 (4.0%) were carriers, 28 (8.6%) were vaccinated, and 113 (34.5%) had had a previous HBV infection. A total of 42 patients (16 females and 26 males, mean age 34.5+/-10.9 years) were enrolled in the vaccination program. Overall, 23.8% (10/42) of the patients in the program had developed anti-HBs at one month after the last vaccination.

CONCLUSIONS

Poor results obtained by different vaccination programs suggest the need for alternative strategies to prevent the disease.

[Influence of the treatment of chronic hepatitis B on HBV DNA suppression and prevention of disease progression]

Appropriate treatment for chronic hepatitis B to present disease progression and clinical complications requires an accurate knowledge of the natural history of this disorder. The natural course of chronic HBV infections now perceive as consisting of 4 phases: immune tolerance, immune clearance, inactive carrier state and reactivation. In patients who acquire the disease in early life complications of CHB continue to develop because of the prolonged insidious damage to the liver. Measurement of serum HBV DNA is the most important factor to evaluate disease activity, assess the efficacy of antiviral therapy and predict treatment outcomes. It was shown that higher HBV DNA levels are associated with increased risk of progression to cirrhosis and HCC. Long-term suppression of viral replication to very low levels with nucleoside (nucleotide) analogues has been shown to decrease or delay liver disease progression and even partially reverse preexisting fibrosis and cirrhosis.