Hepatitis Monthly
Volume:6 Issue: 2, Autumn 2006

Persistent infection with hepatitis C virus leads to liver cirrhosis and often to liver cancer. Mannose binding lectin is a C-type serum lectin, which plays an important role in innate immunity by activating the classical complement pathway. Variants of the mannose binding lectin have been shown to be associated with low serum concentrations of the protein and to predispose the subjects to bacterial, fungal and viral infections. This study was undertaken to investigate the association between hepatitis C virus infection and polymorphisms of mannose binding lectin gene. We assessed the single nucleotide polymorphism of mannose binding lectin in exon 1, at codon 52, codon 54 and codon 57 in 100 patients infected with hepatitis C virus and 100 controls in Iranian population. Mannose binding lectin gene mutations were determined by means of polymerase chain reaction and restriction fragment length polymorphism analyses. The occurrence of the codon 54 mutation was significantly higher in patients (OR 3.53, CI 95%: 1.94-6.44, p<0.005). No significant difference in the frequency of codon 52 and 57 mutations was observed between patient and control groups. Mannose binding lectin may be one of the factors that influence the course of HCV infection. Our results suggest that heterozygous carriage of the variant allele of codon 54 of mannose binding lectin is associated with hepatitis C virus infection in our cases. This may not be true about codons 52 and 57 mutations.

Because of the importance of hepatitis and the prevalence of contamination with hepatitis virus, a survey of the students'' knowledge about viral hepatitis was conducted in Shiraz University of Medical Sciences. This is a descriptive study performed in cross-sectional method. Ten percent of the students enrolled in different courses were selected by stratified sampling method. A structured questionnaire was designed to obtain information about their knowledge of hepatitis. The mean scores were 41.3±20.2 and 61±34.5 of 100 regarding knowledge about hepatitis and prevention of the disease, respectively. Students had more information about hepatitis prevention than about other aspects of the disease such as mode of transmission and symptoms. There were statistically significant differences between the knowledge of hepatitis by age, semester and educational degree (P<0.001). This study showed no significant association between knowledge of hepatitis and sex, job, parents'' education and the place of residence (P>0.05). This study showed that students'' knowledge of hepatitis was very weak. Their knowledge with respect to the prevention of the disease was higher than other aspects.

An important way to prevent hepatitis B infection is vaccination especially among high-risk populations including healthcare workers. Unfortunately, immunologic response to the vaccine is not perfect. Multiple different factors such as gender, age, body mass index (BMI), smoking and underlying diseases can influence the immunologic response. So, this study was conducted to evaluate the post-vaccination immunologic response of medical students of Guilan University of Medical Sciences (GUMS). In this cross-sectional study, GUMS medical students who had received complete vaccine series at zero, one, and six months were enrolled. Their demographic data and the factors which could probably alternate the immunologic response were collected by interview. The anti-HBs Ab titer was evaluated by Enzyme-Linked-Immunoassay (ELISA). Appropriate immunologic response was supposed to be HBsAb >=10 mIU/ml. The collected data were analyzed using SPSS 10.00.P value <0.05 was considered significant. We evaluated 233 students with mean age of 24.9¡4.5 years. 74.7% were female. 4.9% did not respond properly to vaccination. Females'' immunologic responses were significantly higher than males'' (P=0.001). Responsiveness was significantly lower in smokers than non-smokers (P=0.02). Mean age in inappropriate and appropriate responder groups were 28.67¡5.4 and 24.77|¡|4.4 years, respectively (P=0.004). 95.1% of students had a protective level of anti-HBsAb (>10 mIU/ml). Since health-care staffs including medical students are a high risk group to be contaminated with HBV, it is preferable to be evaluated for anti-HBs titer 1-3 months after full three-dose vaccination especially when these factors are present; in this way the false sense of being immunized among them may be decreased.

Thrombocytopenia is a relatively common extrahepatic manifestation of hepatitis c,even in the absence of cirrhosis.Also, thrombocytopenia has been reported in chronic HBV infection. The aims of present study were to evaluate the prevalence of thrombocytopenia in chronic HCV and HBV infection in the absence of cirrhosis and to assess the relationship between HBV and HCV infection and frequency of thrombocytopenia. 438 patients (219 patients with chronic active hepatitis B and 123 inactive carriers of HBV and 96 patients with chronic HCV infection) were enrolled in this study. Thrombocytopenia was defined as platelet counts below 150,000/µl. The prevalence of thrombocytopenia was 17.7% in patients with chronic active hepatitis B and 10.6% in HBV inactive carriers, 13.3% in patients with chronic hepatitis C and 5.3% in control group. The prevalence of thrombocytopenia in chronic hepatitis B and C was significantly more than control group. These results in Iran, with 2-3 million people with chronic HBV infection and around 400,000 with chronic HCV infection shows that HBV and HCV infections, even in the absence of cirrhosis, may be two causes of thrombocytopenia.

Coinfection eventuality of HIV and HBV infection and having common transmission ways has turned Hepatitis B into a major health concern among HIV positive cases. The increasing number of HIV infected patients and their relevant problems, especially opportunistic infections, demands for Hepatitis B vaccination. This study, therefore was conducted to evaluate the immune response against hepatitis B vaccine and related factors among HIV positive cases and probable approaches to improve its level. In this cross -sectional study, 169 HIV positive cases who were Kermanshah''s Behavioral Disease Counseling Center''s clients, with negative HBsAg and HBcAb, were vaccinated against hepatitis B virus with a 20µg of recombinant HBsAg at 0-1-6 month schedule in deltoid region. A month after the last shot, their HBsAg titer was measured. Titers higher than 10 Iu/ml were considered as a suitable immune response. Data included in this study were: age, gender, CD4 count, antiretroviral treatment history, hepatitis C coinfection and injecting drug abuse. Then these data were analyzed through X2 test. Among 169 under study cases, immune response was overally 52.7% and this rate was 51.9% for males and 66.7% for females (P=0.313). Immune response was 54.3%, 44.3%, 45.3% in CD4 count>500, 200-499, and <200/mm3 respectively (P=0.039). In cases with and without antiretroviral treatment the immune response was 81.8% and 50.6%, respectively (P=0.045%). In this study the CD4 count and history of antiretroviral therapy correlation with immune response level was significant, but other factors like age, HCV co-infection, drug abusing, and gender were ineffective factors in immune response to HBV vaccine. Therefore, early vaccination among cases with higher CD4 count and cases under antiretroviral treatment seems necessary.

The hepatitis C virus (HCV) is a small, enveloped, single-stranded positive sense RNA virus with a diameter of about 50 nm belonging to the Hepacivirus genus of the family Flaviviridae. The HCV genome is translated to produce a single protein of around 3011 amino acids. This "polyprotein" is then proteolytically processed by viral and cellular proteases to produce structural (core protein, envelope glycoproteins E1 and E2, ARFP/F protein, p7) and nonstructural (NS2-3 autoprotease, NS3-4A, NS4B, NS5A, NS5B) proteins. Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors worldwide, with increasing incidence. It is estimated that approximately 300-400 thousands of people in the IRAN and 4 million in the United States are persistently infected. It is important for tumor control to identify the factors that predispose patients to death. A large number of molecular factors have been shown to associate with the invasiveness of HCC, and have potential prognostic significance.