Hepatitis Monthly
Volume:17 Issue: 7, Jul 2017

Context: Hepatitis E virus (HEV) is well-known to be transmitted by the fecal-oral route. In addition, several studies in Europe and Asia had reported potential HEV transmission associated with blood transfusion, but this route is still uncertain.
The aim of this study was to estimate the anti-HEV IgG seroprevalence among blood donors around the world using the Bayesian-based methods.
Evidence Acquisition: A systematic review was performed using the PubMed/Medline, Scopus, Web of Science and Cochrane Library databases using the terms “prevalence”, “hepatitis E” and “blood donors”. Studies with a timeframe from inception to March 2016, in Roman characters, that had outcomes of interest such as prevalence of IgG antibodies were included. The estimation of anti-HEV IgG (presented as the event rate and 95% confidence intervals, CI) was performed using a Bayesian-based random effect model using the Comprehensive Meta-Analysis software, version 2. Pairwise meta-analyses and chi-square tests were used to assess significant differences between different sexes and ages.
Results and Of the retrieved studies, 71 met the inclusion criteria, comprising a total of 113 316 blood donors. The prevalence rate was statistically significant in males and over 40 years old donors (P

Context: The immunogenicity of the hepatitis B virus vaccine is reduced in patients with renal failure compared with the non-uraemic population. A variety of approaches have been suggested to improve the immune response in uraemic population including an increase in dose of the hepatitis B vaccine.
To compare the efficacy and safety of hepatitis B vaccine schedules based on greater versus standard doses of HB vaccine in patients with chronic kidney disease stages 3 - 5.
Evidence Acquisition: We carried out a systematic review of the medical literature with a meta-analysis of randomized trials comparing seroprotection rates after greater vs. standard doses of the HB vaccine. The odds ratio to obtain seroprotection among patients who received greater (study group) vs. standard (control group) doses was the end-point of interest. We used a random-effects approach, as described by DerSimonian and Laird, with heterogeneity and subgroup analyses.
We retrieved 11 clinical trials (n = 870 unique patients); 2 (n = 141 patients) and 8 studies (n = 689) included CKD patients on pre-dialysis and dialysis stage, respectively. Three trials (n = 368 patients) employed plasma-derived vaccine; 8 (n = 502) adopted recombinant vaccine. Aggregation of study results (n = 10 studies) showed that the seroprotection rate (short-term follow-up) towards HB virus was higher among patients receiving greater than standard doses of vaccine [pooled OR, 2.10, 95% confidence intervals, 1.15 - 3.82]. The P-value was 0.0001 for our test to study heterogeneity. The seroprotection rate towards HBV was much greater in the subset of trials (n = 2) based on plasma-derived vaccine (OR, 3.78; 95% CI, 2.35; 6.07), and no heterogeneity was found (NS). In the subset of RCTs (n = 8 studies), the seroprotection rate was higher among patients receiving greater doses of vaccine towards HBV, OR, 2.01 (95% CI, 0.92; 4.39), with significant heterogeneity (P = 0.002). Tolerance was satisfactory and no dropouts due to side effects were reported.
Vaccine schedules based on greater than standard doses of HB vaccine offer higher immunogenicity in patients with chronic kidney disease. These results support the current recommendations to give higher doses of HBV vaccine to susceptible dialysis population in order to increase the sero-protection rate. Further research is needed to assess whether these findings apply to HB vaccines provided with novel adjuvants.

Studies on the association between visfatin and nonalcoholic fatty liver disease (NAFLD) have contradictory results and the role of this adipokine in NAFLD pathogenesis has remained unclear. In vitro studies indicate that visfatin expression could be regulated by sex hormones. Testosterone down-regulates visfatin expression in pre-adipocytes and estrogen increases its expression in adipocytes.
This study aimed at exploring whether the association between serum visfatin and markers of hepatic injury is the same for both genders in patients with NAFLD.
In this cross-sectional study, 62 consecutive patients (32 males and 30 females) with NAFLD were recruited. Fasting serum visfatin, caspase-cleaved cytokeratin 18 (cCK18), total soluble cytokeratin 18 (CK18), liver enzymes (AST and ALT), insulin, and lipid-glucose profile was measured. Anthropometric measurements, fibroscan and assessment of dietary intake and physical activity level, were performed for each participant. Two independent sample t tests, chi-square test, univariate, and multiple linear regression (to adjust for confounding factors) were used to analyze the data.
In males, serum visfatin had a significant positive association with serum Aspartate Aminotransferase (AST) (B = 0.47, P = 0.009), alanine aminotransferase (ALT) (B = 0.40, P = 0.035), CK18 (B = 0.50, P = 0.008), and cCK18 (B = 0.47, P = 0.012). In females, serum visfatin only had a weak association with CK18 (B = 0.37, P = 0.045). Instead, higher body mass index (BMI) was significantly associated with increased serum CK18 (B = 0.44, P = 0.02), cCK18 (B = 0.42, P = 0.02), controlled attenuation parameter (CAP) (B = 0.39, P = 0.049), and liver stiffness measurement (LSM) (B = 0.40, P = 0.03) in females. Higher waist to hip ratio was also significantly related to serum AST (B = 0.37, P = 0.04), ALT (B = 0.50, P = 0.02), CK18 (B = 0.41, P = 0.03), cCK18 (B = 0.37, P = 0.04), and CAP (B = 0.39, P = 0.04) in this group. In this study, females were significantly older (47.83 ± 81.10 vs 39.84 ± 12.10, P = 0.008) and had higher BMI (32.31 ± 4.56 vs 29.42 ± 4.89, P = 0.02) compared to males, thus the associations were adjusted for age, BMI, and other confounders.
Interpretation of serum visfatin level in relation to hepatic injury was probably gender-dependent in NAFLD. While its increased serum level could be an indicator for more hepatic injury in males, this was not the case in females. Body Mass Index and waist to hip ratio were stronger predictors for hepatic injury in females.

Hepatitis B virus (HBV) infection remains one of the major infectious threats to human health. Since the implementation of highly sensitive HBV nucleic acid testing, occult HBV infection (OBI) has been detected. Occult HBV infection is characterized by a positive HBV DNA test with undetectable HBsAg (Hepatits B surface antigen). The prevalence of OBI varies significantly between geographic areas, genotypes, and population depending on the sensitivity of the detection assays used.
This project aimed at determining the prevalence of OBI in blood donors from a major blood donor center in Beirut, Lebanon through testing for 4 HBV markers (HBsAg, anti-HBs, anti-HBc and HBV DNA).
A total of 7437 blood donors were first tested for anti-HBc marker between August 2013 and March 2015; samples positive for anti-HBc were tested for other serological markers and HBV genome. DNA was extracted from 500 μL of plasma and tested for HBV DNA using Artus HBV TM PCR Kit assay. All anti-HBc positive samples were tested by nested PCR, targeting the S gene.
This study revealed a 4.6% prevalence of anti-HBc positive blood donors (341/7437). Among anti-HBc positive blood donors, 21 were HBsAg positive (6.2%) and 75% were positive for anti-HBs. The occurrence of occult hepatitis B virus in healthy seropositive blood donors during a 20 month period was very low; only 1 Syrian blood donor (n = 1/341, 0.3%) was HBsAg negative, HBV DNA-positive with anti-HBs level > 1000 mIU/mL.
Our study indicates that HBV DNA is present in a small percentage of HBsAg negative, anti-HBc reactive units. Lebanon has developed its own blood screening strategy, which is to screen for anti-HBc in addition to HBsAg. This is based on HBV prevalence and cost-effectiveness of testing methods. The disadvantage of not implementing nucleic acid testing (NAT) is missing rare blood units from donors in the window period.

The current study aimed at evaluating the association between metabolic syndrome (MeS) in patients with hepatitis C virus (HCV) liver cirrhosis (compensated, genotype, 1b) and changes after sustained viral response (SVR) following a 12-week therapy with paritaprevir, ritonavir, ombitasvir, dasabuvir, and ribavirin (PrOD).
The current multicenter retrospective study included 809 patients diagnosed with compensated HCV cirrhosis (child class A), all 1b genotype treated for 12 weeks with direct acting antiviral agents - PrOD - regimen (according to the protocol practiced in Romania) and achieved SVR. The parameters of MeS (according to the definition of the International Diabetes Federation) were collected from medical records before and 12 weeks after the treatment. The results were collected in a central database and analyzed with SPSS 18.0. Statistical analysis used both descriptive and analytical methods with a significance level of 95% (CI 95%).
Out of the 809 patients, 105 (13%) demonstrated 3 out of the 5 criteria for MeS. Based on the MeS criteria, the commonest parameters were abnormal glycaemia (54.1%), followed by visceral obesity (38.6%), raised triglycerides (26.1%), high blood pressure (12.1%), and a low high-density lipoprotein (HDL)-cholesterol (4.6%). The re-assessment of MeS parameters after SVR showed favourable changes, which were statistically significant: a siginficanttly lower serum triglyeride level (182.32 vs. 153.50 mg/dL, P = 0.001), lower systolic arterial blood pressure (130.57 vs. 124.85 mmHg; P = 0.001), lower diastolic arterial blood pressure (80.26 vs. 78.42 mmHg; P = 0.001) and lower glyceamic levels (130.06 vs. 120.71 mg/dL; P = 0.001), as well as a significant rise in HDL-cholesterol levels (48.61 vs. 50.50 mg/dL; P = 0.003). Abdominal circumference was the only parameter, which did not change after SVR. Following the changes sustained after SVR, 26.7% of the patients no longer fulfilled the minimum 3 criteria for MeS. No correlation was observed between the presence of MeS and the risk of severe adverse events, but it was noted that 37.5% of the patients who decompensated, 66.7% of the ones who developed hepatocarcinoma and 100% of the ones that died of abnormal glycaemic levels.
Hyperglycemia, and not MeS, is associated with HCV compensated liver cirrhosis genotype 1b, and is a risk factor for severe adverse events. The attainment of SVR through PrOD regimen results in short-term improvements in MeS parameters.

HCV has very diverse genotypes in nature, divided into variable number of subtypes. Due to epidemiologically divergent subtypes, it shows diverse geographical distributions, which makes it difficult to treat. This disease plays havoc with underdeveloped and developing countries due to scarcity of data and poor awareness among common people. Therefore, this study aimed to evaluate the geographical distribution of HCV genotypes and RNA viral load along with hemato-biochemical analysis of HCV patients in underdeveloped and neglected areas of Punjab province, Pakistan.
Out of 1115 samples, 583 (52.3%) from males and 532 (47.7%) from females were declared as HCV RNA positive samples. In all the three regions, genotype 3 (46.3%) was found to be the most frequent genotype in both genders followed by genotype 2 (28.9%), genotype 1 (12.5%), genotype 4 (2.2%), genotype 5 (1.8%), genotype 6 (1.2%), untypeable genotypes (5.2%), and mixed genotypes (2.41%). Most of the patients had viral load less than 600,000 IU/mL.
HCV genotype 3a is the most prevalent genotype in various regions of Punjab. Effective HCV awareness programs and novel therapeutic measures should be enforced to combat against HCV infection. Moreover, geographical distribution and mapping of HCV in Pakistan should be studied to develop better control strategies against HCV infection.