Hepatitis Monthly
Volume:7 Issue: 1, Winter 2007

Since hepatitis A virus is a contagious viral infection, crowded military quarters are a fertile ground for the spread of this disease. This study sought to evaluate immunity against hepatitis A virus among Iranian military draftees so as to determine whether or not universal vaccination for the armed forces is necessary. This cross-sectional study randomly selected 800 army draftees in Tehran, the capital city of Iran in 2006. Demographic data, namely age, occupation before call-up, education, and time of in-service, were collected. Five ml of blood was taken from all the subjects; the blood samples were then centrifuged and their serum was examined by the Elisa test with a broad test of Abbott-hepatitis A virus AB META-AXSYM system for total hepatitis A virus antibody. The data were subsequently analyzed with SPSS software, t-test, and Mann-Whitney''s test. P<0.05 was considered significant. All the 800 soldiers were male with a mean age of 19±1SD years, and 702 (88%) of them were holders of a high school diploma with the rest being school dropouts. 781(97.63%) of the subjects had anti-hepatitis A virus antibody while the other 19 (2.37%) did not. That 97.63% of the army draftees recruited into our study were immune to hepatitis A virus is an indication that vaccination for hepatitis A is not necessary for Iranian military conscripts at this juncture.

The GB virus-C (GBV-C) and Hepatitis G virus (HGV), collectively known as GBV-C/HGV and transmitted through blood transfusion and blood components. A co-infection of HGV and HCV is often seen in patients with hemophilia. The paucity of information about rate of GBV-C infection among hemophilic patients in Iran promoted the current study. This study was performed on 80 hemophilic patients from south Khorassan branch of Iranian hemophilia society in Birjand. All 80 serum samples were tested for hepatitis B surface antigen (HBs-Ag), Anti HCV, Anti HIV, and Anti HTLV-1. All sera positive for HCVAb were retested by recombinant immunoblot assay as a complementary test. Also,Serum HCV-RNA, HCV genotyping and HGV-RNA were detected. The prevalence of HGV-RNA was 5% (4 of 80). The prevalence of Anti HCV positive was 26.3% (21 of 80) and HCV- RNA was detected in 80% (17 of 21) of these patients. Co infection of HGV with HCV was 5%. HBsAg and Anti HIV were negative in all of our patients. Anti HTLV-1 was detected in one patient (1.25%). HGV and HCV are prevalent in South Khorassan hemophilic patients. Prevalence of HGV infection is less than HCV but it is more prevalent than HBV, HIV and HTLV-1 infection.

In this study, the effect of infections and inflammation developed during hepatitis B vaccination program on antibody response in hemodialysis (HD) patients was evaluated. In total, 94 patients who had hepatitis B surface antigen (HBsAg) (-), antibody to hepatitis B surface (antiHBs) (-), antibody against hepatitis B core immunoglobulin G (antiHBcIgG) (-) (Group A) and who were previously vaccinated but having antibody titer levels lower than 10 mIU/mL (Group B), on maintenance HD program were included in this study. In group A, 40 |μ|g intramuscular vaccine on 0, 1, 2 and 6 months and in group B, 40 μ|g of intramuscular booster dose vaccine were administered. Antibody titer of 10 mIU/mL was considered as positive. Group A was then divided into two subgroups with respect to antibody response (Group A1 and Group A2). Eighty-one patients completed the study (Group A; n=64, mean age=42.3±11.4 years; Group B: n=17, mean age=53.6±10.6 years). In Group A, antibody response was positive in 82.8% (Group A1), negative in 17.2% (Group A2) and it was positive in 100% of Group B. Inflammatory parameters, nutritional and demographic features were found similarly in all groups. Throughout the study, infections developed most frequently in Group A. We concluded that acute infections and inflammations developed in patients vaccinated according to vaccination schedule recommended for HBV prophylaxis during HD treatment does not affect antibody response and acute phase reactants are not indicators for negative antibody response.

Persistent infection with hepatitis C virus (HCV) leads to liver cirrhosis (LC) and often to liverm cancer. Mannose binding lectin (MBL) is a C-type serum lectin, which plays an important role in innate immunity by activating the classical complement pathway. Variants of the MBL have been shown to be associated with low serum concentrations of the protein and to predispose to bacterial, fungal and viral infections. This study was undertaken to investigate the association between polymorphisms of MBL gene and hepatitis C virus infection. We determined genotypes of two promoters and three exon 1 SNPs in mbl2 by SSP-PSR and grouped these genotypes according to related amount of functional MBL production in 100 patients infected with hepatitis C virus and 100 healthy blood donors in Iranian population. MBL gene mutations were determined by means of polymerase chain reaction and restriction fragment length polymorphism analyses. genotypes XA/O or O/O were significantly more frequent among patients infected with hepatitis C virus, where YA/YA genotype was more common among donors. Frequency of alleles X, Y, H and L did not have a significant difference between the two groups as well as alleles HYA, LYA nor LXA. MBL may be one of the factors that influence the course of HCV infection. Additional study on subjects at a high risk for infection with hepatitis C may clarify the role of carriage for the variant allele of mbl2 in a life-long risk of infection.

To determine the levels of zinc, copper, iron, albumin and zinc to copper ratio in sera of patients in different stages of cirrhosis and to find possible correlation between trace elements and anthropometrics measurements with liver cirrhosis presence and progression. This cross-sectional analytic study was carried out on sixty continuous patients with liver cirrhosis referred to hepatology clinic, Tabriz University of Medical Sciences. The mean of daily calorie and protein intake was determined by Nutrition III software and compared to recommended dietary allowances (RDA), body composition was determined by bioelectrical impedance analysis (BIA) and serum Zn, Cu and Fe levels were determined by atomic absorption spectrophotometery and albumin level of serum was measured by calorimetric method. Among sixty studied patients, 39 were male and 21 were female. 53.8% of male patients were in Child-Pugh class B while 23.8% of female patients were in Child-Pugh class B. The mean energy and protein intake of all patients was lower than RDA values and there was no significant correlation between the mean of protein and energy intake with severity of liver cirrhosis. The serum levels of Zn, Albumin and Zn/Cu ratio in patients with Child-Pugh class B were significantly lower than those with Child-Pugh class A. In general, these results suggested that changes in liver cell pathology compounded by functional impairment may alter the metabolism of trace metals, in particular, zinc.

All chronic hemodialysis patients for hepatitis B infection have to be tested and vaccinated against HBV infection routinely. A descriptive study was designed in 47 hemodialysis patients. After a blood sample was taken for serologic status, three doses (0, 1, 6 month) of hepatitis B vaccine were administered. Repeated titers were obtained one month after the last vaccination and analyzed by ELISA. 39 patients (83%) became immune with protective levels of HBs antibody. There was not a significant correlation between sex, age, smoking, underlying diseases, weight, duration of dialysis and positive HBs antibody after vaccination. Hmodialysis patients need follow-up testing.

Hepatitis B virus (HBV) can cause acute and chronic hepatitis in humans, with the latter possibly leading to liver cirrhosis and hepatocellular carcinoma. The clinical course of HBV infection is critically dependent on genetic and immune features of the host as well as on virological factors. In situations of immune suppression, e.g. in patients after organ transplantation with chronic HBV infection, severe progression of liver disease can occur, due to direct effects of immunosuppressive regimens on HBV''s hepatotoxicity or replication and due to the selection of HBV mutants. HBV variants are commonly found in chronically infected patients because of the lack of proofreading capacity of the HBV reverse transcriptase. Examples of relevant HBV mutations include precore or basal core promoter mutants with increased replication capacity, escape mutants with alterations in the ''a-determinant'' immune epitope, core gene deletions after renal transplantation, antiviral drug resistant strains and accumulation of complex HBV variants after long-term immune suppression. In this review, we present the virological background of HBV genetic variability, discuss frequent mutations observed in transplanted patients and address the effects of HBV genetic variability on the clinical outcome in solid organ transplant recipients