Hepatitis Monthly
Volume:7 Issue: 3, Summer 2007

Hepatitis E virus (HEV) is recognized as a common cause of epidemic and sporadic viral hepatitis. HEV outbreaks have been documented in some military forces in the world. The aim of this study was to evaluate anti-HEV antibody in Iranian soldiers. In a cross-sectional study, 800 soldiers were selected by simple random sampling in Tehran, Iran in 2006. A questionnaire of demographic data was completed and blood samples were obtained for anti-HEV IgG & IgM antibody. Data were analyzed using student t-test and chi-square using SPSS 12. All soldiers were male and their mean age was 19 ± 1.2. Education level in 553 (69.1%) of them was high school diploma or higher. Anti-HEV IgG antibody was positive in only 9 (1.1%) of them and IgM was negative in all soldiers. Approximately 98% of soldiers were at risk for HEV infection and before discovering an effective vaccine, preparation of healthy drinking water and personal hygiene education should be considered for prevention of hepatitis E infection.

Superinfection with HEV in patients with chronic liver disease (CLD) can cause severe hepatic decompensation leading to increased morbidity and mortality. This study aimed to determine seroprevalence of HEV infection among CLD patients compared to blood donors from Azerbaijan, north-west of Iran. CLD patients and a group of age matched blood donors with normal liver function tests were evaluated for the presence of anti-HEV IgG antibody in their sera for evidence of hepatitis E. The risk factors were estimated. The mean age of CLD patients was 48 years (range: 10-87). 27.5% of patients were HEV IgG-positive. Among the controls 19.7% were positive for anti-HEV IgG. By multivariate analysis, there was no association between positive anti-HEV IgG and etiology of chronic liver disease, gender, literacy, accommodation, and number of family members in patients or controls. Mean age of patients infected with HEV in both groups was significantly more than the seronegative ones. We found high seroprevalence of HEV-antibody among blood donors and CLD patients in our study, so we recommend more attention to hygiene of food and water. In addition, such patients should be informed about the potential risks and simple ways to prevent the disease in their regular life and travels. This issue must be concerned in cases of "acute on chronic" hepatitis in CLD patients.

Insulin resistance appears to be a major factor involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). In this pilot study, we examined the effect of pioglitazone, an insulin-sensitizing agent, on patients with NAFLD and NASH. The medical records of patients referred to our clinic over a 48-month period were reviewed, and individuals with a clinical diagnosis of NAFLD or NASH, who were overweight (BMI|"|25) with chronic elevated liver enzymes were included in this study. The patients were either treated with pioglitazone or advised to start a weight-reduction diet and exercise, in a non-blinded random method based on the treating physicians'' discretion. Thirty-four patients'' charts were retrospectively analyzed. Nineteen patients were treated with pioglitazone and 15 patients were advised to start a weight reduction diet and exercise. There were significant improvements in mean ALT and AST in the pioglitazone group at the end of treatment when compared to pretreatment values and to the diet/exercise group. There were no significant changes in the lipid profiles, body mass index or fasting glucose levels between baseline and at the end of the therapy in either group. There were no adverse side effects, including hypoglycemia, in patients treated with pioglitazone. Preliminary results using pioglitazone in patients with NAFLD or NASH are promising. However, larger prospective studies are further needed to validate the results of our study and to examine histological response.

Viral hepatitis represents one of the most significant public health challenges. The institutionalization itself is an important factor influencing the risk and frequency of exposure and further spread of HBV and HCV infections. This study was carried out to determine the frequency of HBV and HCV serological markers in residents of Guilan nursing home. Demographic data and history of exposure to known risk factors were collected by interview and through medical records available at the nursing home; clinical information was obtained via examination. All residents were screened for markers of HBV and HCV. HBsAg or HCVAb positive cases were examined for HBeAg, HBcAb, and HCV-RNA, respectively; and complementary tests including AST, ALT, ALP, bilirubin, serum albumin, and prothrombin time (PT) were done. 383 residents of Guilan nursing home including 243 females (63.4%) with mean age of 58.4±21.9 years were investigated. The average duration of residency was 6.0±5.7 years. Nine cases (2.3%) including 6 males (4.2% of all males) were anti-HCVAb positive. Out of these 9 cases, 5 individuals were HCV-RNA positive. All of these 5 cases were male. The average duration of residency in HCV positive cases was 1.5±1.8 years in comparison with 6.1±5.8 years in negative cases. There was a significant reverse relationship between residency duration and HCV positivity in logistic regression. Residency in nursing home is not an important risk factor for viral hepatitis transmissions. However; we recommend precise and complete viral hepatitis screening on admission to nursing home and HBV vaccination for HBV negative cases.

Hepatitis B virus (HBV) displays a distinct hepatotropism and a narrow host range in vivo. However, very little is known about the interaction of HBV with its host cells, mainly because of difficulties in the development of suitable tissue culture system. We present here confirmatory evidence of a putative role of annexin-V in HBV infection. HBV from both human sera and from culture supernatants from HepG2 2.15 cells were used to infect FTO9.1 cells (a rat hepatoma cell line transfected with a construct containing human annexin-V). Cells and culture supernatants were assayed at various times post-infection by immunofluorescent microscopy (HBcAg staining in nucleus), and by HBV cccDNA-specific PCR. Supernatants from these initially infected cells were then used to infect fresh FTO9.1 cells with a similar outcome to primary infection. Core and surface gene PCRs were positive on days 2, 5 and following transfer experiments. cccDNA-specific PCR confirmed internalisation of the virus into the nucleus. HBcAg fluorescence showed nuclear staining on days 2, 5 and following transfer experiments. Addition of recombinant annexin-V and DMSO to the cell culture medium resulted in a greater efficiency of infection. Later washes were negative for HBV-DNA, ruling out contamination of the cells by external HBV particles. This cell line does appear to be useful in the study of the early stages of HBV infection, but requires further evaluation.

Chronic HBV and HCV infections are known as important underlying causes of hepatocellular carcinoma (HCC). Their prevalence in Iran are estimated to be 1.7-5% and 0.5-1%, respectively. We investigated the prevalence of HCC in chronic carriers of HBV and HCV via alpha-feto protein (AFP) measurement and ultrasonography as well as pathological assessments. In this cross-sectional study, HBV and HCV positive cases were determined from documents in blood banks since 1985. From 1064 aviable cases, 514 were randomly selected and followed up for two consecutive years. For all patients, AFP testing and sonography were done after reconfirmation of chronicity. Cases with nodules or mass in sonography and AFP levels above 20 ng/ml were considered suspicious for HCC and after rechecking were referred for liver biopsy. Finally, HCC was confirmed pathologically. The mean subjects'' age was 35.19±13.16 years and hepatitis duration was 6.12±5.66 years. Twenty-nine (5.7%) had elevated AFP and 18 (3.5%) had nodules in sonogram. In 16 (3.13%) cases, HCC was detected pathologically. Risk of HCC was correlated with age >40 years, cirrhosis and hepatitis duration (P<0.001). There was no correlation between the risk of HCC and the type of hepatitis, HBeAg positivity, sex and ALT levels. Early screening for HCC using AFP and sonography can be useful for HCC detection in HCV and HBV chronic carriers.

Hepatitis C virus (HCV) is a major public health problem and is the most common liver disease among hemodialysis (HD) patients. The seroprevalence of HCV infection among HD ranged from 1.9% to 80% in reports published since 1999. The main risk factor for HCV acquisition in HD patients seems the length of time on HD. Phylogenetic analysis of HCV viral isolates has suggested nosocomial patient-to-patient transmission of HCV infection among HD patients. Lack of strict adherence to universal precautions by staff and sharing of articles such as multidose drugs might be the main mode of nosocomial HCV spread among HD patients. Currently, there are several dilemmas on the management of these patients: should HCV-RNA testing be included in the routine screening of HD population for HCV infection?; does periodic serum alanine aminotransferase testing have a role in screening HD patients for HCV infection?; can dialysis really ''save'' the liver of HCV-infected HD patients?; should HCV-infected subjects be isolated and dialyzed by segregated machines?; is there any difference in treating HD and non-HD HCV-infected subjects? This article gathers the present evidence to address these issues and to demonstrate the current worldwide magnitude of HCV in HD population.