Hepatitis Monthly
Volume:17 Issue: 8, Aug 2017

Context: Accurate and updated data describing hepatitis B virus (HBV) epidemiology is crucial for development of national policies to control HBV infection in each country. This study was conducted to estimate the prevalence of HBV infection and exposure in Iran, using the available provincial data.
MEDLINE, Web of Science, Scopus, Google Scholar, and Scientific Information Database were searched for studies assessing the prevalence of hepatitis B surface antigen (HBs Ag) or hepatitis B core antibody (anti-HBc Ab) among the general population between 2006 and 2016 in at least one city of Iran. National prevalence was estimated by two methods. Method 1 used only prevalence estimates of provinces with available survey data. In method 2, all provinces were classified based on the risk of HBV infection among blood donors. HBV prevalence in provinces with missing data was extrapolated from the provinces with available data, and with comparable risk of HBV infection among blood donors. In both methods, national prevalence was estimated using pooled provincial prevalence estimates, weighted by the province population size.
Thirteen studies from 12 provinces were included. The prevalence of HBs Ag and anti-HBc Ab varied markedly across provinces. Provincial HBs Ag prevalence ranged from 0.76% to 5.10% (I-square = 91.7%) and provincial anti-HBc Ab prevalence ranged from 4.17% to 36.90% (I-square = 99.3%). Using method 1, the national prevalence of HBs Ag and anti-HBc Ab was estimated as 1.84% (95%CI: 1.61%, 2.09%), and 13.59% (95%CI: 12.92%, 14.29%), respectively. Using method 2, the national prevalence of HBs Ag was estimated as 1.79% (95% uncertainty range: 1.67%, 1.91%), equating to 1,347,000 (1,253,000 - 1,434,000) individuals living with chronic HBV infection in Iran. The prevalence of HBs Ag and anti-HBc Ab was higher among men compared to women.
HBV prevalence in Iran is low, and has decreased over past decades. However, the risk of HBV infection varies across provinces with some provinces having high HBV prevalence. More detailed data of the HBV epidemiology and transmission in provinces where HBV infection is endemic could support designing the appropriate interventions to control HBV epidemics.

Context: Resveratrol is a natural occurring stilbene present in a limited number of dietary food products and beverages. It is assumed that resveratrol has health-promoting effects by lowering low-density lipoprotein (LDL) cholesterol, improving microcirculation, and inhibiting platelet aggregation. Altogether, these beneficial effects lower the risk of cardiovascular disease. The “French paradox” assumes that a diet with moderate consumption of red wine lowers the risk of cancer and cardiovascular disease. Based on its healthful activities, a large number of studies were performed during the last decades investigating potential biological effects of resveratrol on liver homeostasis and its potential application as a hepatoprotective drug.
The current study aimed at discussing the proposed therapeutic attributes of resveratrol on liver health and its postulated mode of activity.
Evidence Acquisition: To conduct the current study, the PubMed full-text archive depository for articles presenting data on resveratrol in liver health and disease was searched.
Out of the 9268 published articles on resveratrol, a total of 742 articles focused on liver. Among them, 352 articles investigated potential therapeutic activities. Although some of the reported in vitro and in vivo benefits of resveratrol were highly encouraging, well-designed clinical studies were missing.
Presently, it is still premature to advise nutritional supplementation of resveratrol to cure hepatic diseases. Moreover, uncritical recommendation to drink wine as a liver health-promoting beverage should be avoided.

The exact number of HBV/HCV co-infected patients is unknown. In many cases of HBV/HCV co-infection, HCV inhibits replication of HBV. After treatment and eradication of the dominant virus, the other one may then become active. The overall dominant effect appears to be hepatitis C over hepatitis B. Therefore, when planning treatment for eradication of HCV, the risk of HBV reactivation should be taken into account. In interferon-based therapies of patients with HBV/HCV co-infection, some cases of HBV reactivation without hepatitis were observed because IFN is effective against both viruses. In contrast, DAA treatment of hepatitis C in HBV/HCV co-infection is not well established. Currently, no clinical trials have been published regarding treatment of HBV/HCV co-infected patients with HCV DAA therapy. There is several research on HCV DAA therapy in HBV/HCV co-infection, which describes cases of HBV reactivation during and after DDA therapy for HCV. Result of the first available studies demonstrated that patients with HBV/HCV co-infection treated with DAA against HCV should be monitored for HBV reactivation during and after DAA treatment, even though HBV may be inactive at the time of treatment initiation.

Context: An exosome is a type of extracellular vesicle with a diameter of 30 - 100 nm and a density of 1.13 - 1.19 g/m. Exosomes exist in almost all body fluids and can be secreted and absorbed by most cells. They deliver information and molecules that participate in intracellular communication, thus contributing to the progression of various diseases, such as liver diseases.
Evidence Acquisition: In this study we collected and summarized the most important and new data available on the role of exosome in liver diseases by the PubMed search. The study data were collected through searching the related keywords then classified and summarized.
In this review, we summarize the research findings regarding the roles of exosomes in liver physiology and pathology, mainly focusing on liver diseases such as viral hepatitis, liver cancer (mostly hepatocellular carcinoma [HCC]), and liver injury caused by other pathogenic factors (alcohol, drugs, hepatotoxins, high-fat diets, parasites, etc.).
These studies revealed the involvement of exosomes in various aspects of liver physiology and pathology and in the progress of liver diseases. More importantly, it offers a promising new direction for disease diagnosis and treatment.

Information on hepatitis B virus (HBV) genotypes in immigrant populations living in Italy is scanty.
The current study aimed at assessing the epidemiological and clinical need to detect HBV genotypes in immigrants with HBV infection.
A multicenter screening was performed in 5 first-level care facilities centers in Southern Italy to identify migrants with HBV infection. Hepatitis B surface antigen (HBsAg)-positive subjects were further investigated at a tertiary unit of infectious diseases.
Of the 1727 investigated immigrants, 170 (9.8%) were HBsAg-positive. These 170 subjects, prevalently males (86.5%), aged 31.0 ± 8.5 years and living in Italy for nearly 2.5 years, prevalently (80%) from sub-Saharan Africa. HBV DNA was detected in 113 (66.5%) and HBV genotypes in 109 subjects: genotype E in 69.9%, genotype A in 16.5%, genotype D in 11.9%, and genotype C in 2.7%. Genotype E was detected in 70 (83.3%) out of 84 migrants from sub-Saharan Africa and in 5 from the other areas. Of these 75, 16% were hepatitis B e antigen (HBeAg)-positive and none circulated anti-hepatitis D virus (HDV); 69.3% were inactive HBV carriers, 22.7% had chronic hepatitis and 8% cirrhosis with multifocal hepatocellular carcinoma (HCC) in 2 patients. Half of the 18 subjects with genotype A, prevalently from sub-Saharan Africa (61%), were inactive HBV carriers, 7 had chronic hepatitis, and 1 had liver cirrhosis. Of the 13 subjects with genotype D, prevalently from Eastern Europe or India-Pakistan subcontinent, 8 were HBV inactive carriers and 5 had chronic hepatitis.
The data indicated the need to extend HBV screening and vaccination programs to all immigrants from areas of intermediate or high HBV endemicity.

As Methotrexate (MTX) may induce liver side effects or damage, evaluating the liver of the consumers of this drug by a noninvasive method, such as FibroScan, may be effective.
The present study aimed at evaluating the progression of liver fibrosis and steatosis using the transient elastography (FibroScan) technique in patients, who are treated with MTX.
One hundred and one patients, who were treated with MTX because of different rheumatologic diagnosis and/or dermatologic disease, were included in the study. Liver stiffness was measured using FibroScan. Hepatic fibrosis was identified by converting the FibroScan results measured in kPa to the Metavir scale. Also, F0-F4 and steatosis were graded.
The assessment of steatosis using FibroScan showed mild, moderate, and severe stenosis in 15.8%, 13.9%, and 26.7%, respectively. With regards to grading of hepatic fibrosis, 67.0% were graded as F0 to F1, 7.0% as F2, 7.0% as F2 to F3, 2.0% as F3, 11.0% as F3 to F4, and 6.0% as F4. A significant association was found between body mass index, waist circumferences, and fibrosis. The association between the severity of hepatic fibrosis and indices of alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), and serum albumin was significant. No relationship was revealed between the severity of hepatic fibrosis and MTX dosage as well as duration of MTX use.
The authors found significant associations between hepatic steatosis and anthropometric parameters, level of albumin, drug dosage higher than 10 mg, and cumulative dosage of MTX. The severity of hepatic fibrosis and steatosis induced by MTX was mainly affected by the patients’ obesity.

Hepatocellular carcinoma is a rare tumor in children, thus, there are not many studies regarding clinicopathologic findings of this tumor and no report regarding this tumor in this age group from Iran.
In this study, we tried to find out the clinicopathologic findings including outcome of hepatocellular carcinoma in the patients under the age of 18.
During the last 10 years (2005 - 2016), we collected all hepatocellular carcinoma cases in the affiliated hospitals of Shiraz University of Medical Sciences (as the largest referral center in the South of Iran and the only center of pediatric liver transplantation in the whole country) from the archives of Pathology department. Next all clinical data were subsequently extracted from the patients’ hospital charts.
We collected 30 cases of hepatocellular carcinoma with the age range of 9 months to 18 years with no significant sex preference. All of the patients, except 3, showed abnormal levels of AFP. The most common underlying cause of liver tumorigenesis was type I tyrosinemia.
Hepatocellular carcinoma in children is a rare tumor and is mostly secondary to an underlying liver disease, which is tyrosinemia in our center. Hepatitis B related hepatocellular carcinoma is rare in our country, which seems to be related to successful early neonatal vaccination against this viral disease. This tumor has a poor outcome in children and without liver transplantation, has a very short survival rate.