Hepatitis Monthly
Volume:8 Issue: 1, Winter 2008

The relative frequency of hepatitis C virus (HCV) genotypes and differences of HCV genotype distribution in relation to transmission mode, age and acquisition time of infection were investigated among 758 high- risk patients: 118 were under dialysis (DP), 109 intravenous drug users (IDU), 317 hepatologic (HP) and 214 |β β|- thalassemic patients (β βTM). A total of 478 anti-HCV (Enzyme Immunoassay EIA) positive sera were further examined for HCV-RNA (Transcription Mediated Assay-TMA), HCV genotype (Line Probe Assay-LiPA) and hepatitis C viral load (branched DNA- bDNA). With the exception of IDU group, patients were contaminated before 1990 after blood transfusion or other nosocomial treatment. For IDU, who were significantly younger individuals than DP and HP, HCV infection occurred the ast decade after IV drug use. The overall distribution of HCV genotypes 1, 2, 3 and 4 was 38.6%, 8.4%, 40.7%, and 12.4%, respectively. With the exception of IDU group in which genotype 3 was by far the most common, genotype 1 predominated in all patients examined. Results reveal a difference of HCV genotype distribution among patients of high risk groups in our area, as a sequel of epidemiologic changes in HCV transmission. IDU group may be also responsible for a new hepatitis C epidemic and may constitute the new significant reservoir in the future. This transition may require new prevention protocols and therapeutic strategies.

Hepatitis B virus (HBV) is a major cause of both acute and chronic liver disease. It is estimated that there are 350 million carriers of the virus in the world, and a high proportion will develop serious liver disease, including hepatocellular carcinoma. The aim of this study was cloning and expression hepatitis B surface antigen (HBsAg) gene to design a DNA vaccine. In this study, we amplified the HBsAg gene from Iranian patients. The gene was cloned in pGEMEX-1 expression vector and recombinant plasmid was transformed in to JM109 E. coli strain and induced by IPTG. We amplified, cloned and expressed hepatitis B virus surface antigen successfully and expressed protein was serologically assayed using gel diffusion and western blot analysis. Gene was sequenced and submitted to GenBank. The cloned HBsAg gene is ready for using in experimental DNA vaccine animal study. There are some mutations on this recombinant protein (T45D, Y206C and S207R) which will affect on folding and function of recombinant protein.

Hepatitis C virus (HCV) infection represents a major problem of public health with 170 million chronically infected individuals worldwide. It has been reported that HCV core protein plays an important role in disease pathogenesis and cancerogenesis. The objectives of this study are to understand the gene expression changes in L02 human hepatocyte induced by HCV core protein and provide information about the pathogenesis and cancerogenesis. To determine the effect of core protein on gene expression in hepatocytes, suppression subtractive hybridization technique and semi-quantitative reverse transcription polymerase chain reaction were used to identify over-expressed genes in L02-Core cells that express HCV core protein in a stable fashion. Thirty-four known genes, which were differentially expressed between the two cells, were identified successfully. Most of the differentially expressed genes were mainly involved in cell migration, cell proliferation and signal transduction. In L02-Core cells, the over-expression level of extracellular matrix metalloproteinase inducer is highest, suggesting that HCV core protein contributes to the migration of liver tumor cells. These findings can explain the role of core protein in disease pathogenesis and cancerogenesis, and suggest that the core protein may be a potential cause of induction of hepatocellular carcinoma invasion.

Hepatitis B virus (HBV) infection has a high incidence among injection drug users (IDUs). Several important behavioral risk factors influence transmission of HBV in this group. However, consensus has not been achieved on many of them. The aim of this investigation was to assess the prevalence and risk factors for HBV in IDUs. This cross-sectional study was carried out between 2001 and 2002 in Tehran. IDUs included people who were being treated for drug abuse and those in the prison. Physician-completed risk factor questionnaires and blood samples (5 ml) for serologic HBV markers (ELISA) were used. Risk factors were evaluated in binary logistic regression (LR) model (forward) procedure for possible association with odds of past or current HBV infection. The evaluated risk factors were age, gender, sexual behavior, shared syringe use, duration of addiction, imprisonment, tattooing, past history of surgery, dental procedures, blood transfusion, jaundice, type of illicit drug use and level of education. This study sample was comprised of 518 IDUs (89.6% males), including 386 (74.5%) prisoners. Antibody against HBV core antigen (HBcAb) was detected in 61.2% (n=317). The prevalence of hepatitis B surface antigen (HBsAg) was 3.7% (n=19). Among HBsAg positive patients, HBeAg was positive in 12 individuals (63.2%). In comparison with seronegative IDUs for HBcAb and/or HBsAg, the odds of using shared syringes, male sex and past history of bisexual relationship were 1.5 (P<0.05), 1.9 (P<0.05) and 2.4 (P<0.01), respectively. These results suggest that seroprevalence of hepatitis B is high but chronic carrier state is not frequent in IDUs. Imprisonment, male sex and having past history of bisexual relationship are independent risk factors for past or current hepatitis B infection.

Public cleansing workers, especially public garbage collectors are probably at risk for hepatitis B virus (HBV) and/or hepatitis A virus (HAV) infections. This study was designed to assess risky behaviors, occupational risk and seroprevalence of HBV and HAV infections in this group. 354 public cleansing workers of Bangkok Metropolis (185 cleaners and 169 garbage collectors) were randomly selected by multi-stage sampling. The subjects were interviewed and their blood pecimens were collected to investigate HBV seromarkers (HBsAg, anti-HBs and anti-HBc) and anti-HAV by voluntary participation. Out of 354 workers, 22.6% had tattoos, 15.8% had a history of regular alcohol consumption, and 6.8% had a history of extramarital sex without using condoms in a previous year. Public garbage collectors had relatively higher percentage than public cleaners. Also, public garbage collectors had significantly higher percentage of occupational risks including a history of contact with blood, a history of contact with used condom, syringe or needle, and a history of needle stick or sharp puncture than public cleaners (P= 0.0018, 0.0067 & 0.0012, respectively). Results from blood screening revealed 49.4% of HBV seropositivity, 5.9% of HBsAg, 37.3% of anti-HBs, 6.2% of anti-HBc only, and 85% of anti-HAV antibody. Public garbage collectors had significantly higher HBV seropositivity than public cleaners (P=0.0058), while there was no statistical significance in anti-HAV positivity between groups. Risk factors for HBV seropositiveness after multivariate analysis were occupation (adjusted OR=1.76, P=0.0027), a history of contact with used condom, syringe or needle (adjusted OR=3.02, P<0.0001), and a history of needle stick or sharp puncture (adjusted OR=4.21, P<0.0001). This study supported public cleansing workers; especially public garbage collectors were at risk for HBV and/or HAV infections. The risk reduction programs including a 100% condom use, life skills education, hygienic practice, use of safer equipment for collecting garbage, and HBV vaccination should be provided for this group.

Viruses might be one of the causes that trigger systemic lupus erythematosus (SLE). Steroidtherapy may influence the natural history of virus infections. Reports on the association between SLE and hepatitis C virus (HCV) infection are scarce. We conducted a study to investigate the prevalence and clinical significance of HCV infection in patients with SLE. In a prospective study (2003-2005) we evaluated the prevalence and clinical significance of chronic HCV infection in patients who met the diagnostic criteria of the American College of Rheumatology for SLE. The blood samples of 124 patients were tested for HCV antibodies by an enzyme-linked immunosorbent assay (ELISA). Anti-HCV reactive samples were retested for confirmation by Abbott MATRIX Immunoblot assays and also for HCV-RNA detection by the polymerase chain reaction (PCR). The control group consisted of first time blood donors referred to the regional blood transfusion organization. Six of 124 (4.8%) patients were seropositive for anti-HCV by ELISA; of these only 3 cases (2.4%) were positive by PCR. Both ELISA and the Immunoblot assays may be falsely positive for ongoing HCV infection in patients with SLE. A 2.4% prevalence of active HCV infection was found in patients with SLE, which did not differ significantly from the prevalence of HCV in the general population (less than 1%). In the few positive cases, we observed no adverse influence of this infection on the clinical features of the systemic lupus erythematosus. Our results do not support the participation of HCV infection in the pathogenesis of SLE.

Liver fibrosis occurs as the response of chronic liver injury. In the past, it was thought as irreversible but now is recognized as a dynamic process with possibility of significant resolution. Regardless of the cause, the response to liver injury includes collapse of hepatic lobules, formation of fibrous septae, and hepatocyte regeneration with nodular formation. Conventional biochemical and serological tests have no significant value for assessment of liver fibrosis and liver biopsy specimen is still the "gold standard" for staging of liver diseases. The incessant progress in production of new pharmaceuticals creates an enormous need for non-invasive diagnostics of liver fibrosis. The lack of appropriate non-invasive tools is currently the main limitation for monitoring of disease progression, predicting clinical outcomes and evaluating therapeutic effects. At this time, two groups of diagnostic tools are used for non-invasive assessment of liver fibrosis: imaging techniques and biologically-based markers. Some of them like transient elastogarphy are very promising and others like biologically based markers are helpful but cannot serve as independent markers of liver fibrosis. Therefore, experimental and clinical hepatology of the next decade have a great challenge to find a more accurate, reproducible and non-invasive technique for hepatic fibrosis assessment.

Hepatitis C virus (HCV) infection is a worldwide problem in health. The seroprevalence of HCV infection is estimated to be 3%. There is considerable geographic and temporal variation in the incidence and prevalence of HCV infection. The researchers conducted the literature search using the electronic database MEDLINE (1966 to January 2008), EMBASE (1980 to October 2007), OVID (1966 to October 2007) and Google (for local websites and medical journals). The following keywords were used: ''Hepatitis C'', ''Epidemiology'', ''Iran'', and ''Pakistan''. HCV infection in Pakistan is more common than in Iran. The most common modes of transmission in Pakistan consist of: IVDs, unsafe injections, transfusion, tattooing and sharing by barbers and in Iran consists of: IVDs, getting wounded in war, extramarital sexual contact and tattooing. The hepatitis C infection is an emerging disease in both countries and requires more governmental support. This article reviews the literature available so far on the epidemiology and potential risks of transmission of HCV and makes recommendations for implementing strategies for the prevention of such transmission in our region.

Nosocomial transmission of blood-borne pathogens is common in a dialysis setting. Hepatitis C virus (HCV) infection is a common problem that increases morbidity and mortality in hemodialysis patients. Blood transfusion and the duration of hemodialysis are the most important factors in HCV transmission. The aim of the study was to determine the incidence rate of HCV antibody in hemodialysis patients and its association with some factors. In this descriptive-analytical study, HCV antibody was measured in 93 hemodialysis patients in all hospitals affiliated to Golestan University of Medical Sciences. Standard infection prevention measures in hospital settings and dialysis units were performed including serologic testing for HCV antibody for every new patient in the dialysis unit as well as routine testing of all patients. Negative cases of hepatitis C antibody (confirmed with ELISA 2nd generation and RIBA II Immunoblot methods) were selected and followed for 18 months. Some predisposing factors such as transfusion, duration of hemodialysis, medical procedures including surgery, transplantation, invasive odontology, suspicious sexual contact, diagnostic or therapeutic manipulation, tattooing, and IV drug abuse, were registered and considered. Other rare procedures like acupuncture, manicure and pedicure, blood brotherhood rituals, perinatal riskfactors, common circumcision rituals and history of abortion were also considered. We used a tight control policy through the separation of the rooms within the unit, specific hemodialysis apparatus for suspicious patients and a separate staff caring for the patients. We maintained a low rate of staff turnover in dialysis units and tried to control hepatitis B viral infection. Marital status and living area were significantly related to HCV antibody positivity. It means that more HCV antibody positive cases were observed in married people in urban areas. History of tattooing, medical procedures including surgery, transplantation, invasive odontology and IV drug usage were not significantly related to HCV antibody status. During the follow up, three cases (4.3%) converted to positive. There was a relationship between numbers of hemodialysis per week and HCV antibody positivity (P<0.001). Tight control of transmission routes and severe isolation policy in this study explains an almost ideal decrease in incidence rate of HCV antibody positivity. We suggest periodical screening programs (at least every 6 months) for blood samples that remain in the dialysis apparatus and all procedures used for hemodialysis in these specific patients to achieve a better infection control.

Hepatitis B is one of the common diseases in the world and in Iran, caused by hepatitis B virus (HBV). This virus is transmitted by various ways including dentistry procedures and this may discourage dentists to admit hepatitis B surface antigen (HBsAg) positive patients leading to hide the disease by the patients and increased transmission risk. During a cross-sectional descriptive study, 50 dentistry centers were chosen among dentistry centers of Tehran in various regions by cluster sampling. Two HBsAg positive medical students went to these centers and announced about their diseases and requested for dentistry. Samples (dentists and secretaries) did not have any information about the research. They studied and examined reaction of dentists and their secretaries as well as admission rate. Among 50 centers, 16 did not admit patients (5 cases by secretary and 11 cases by dentist) and 16 centers admitted them as the last patient (last appointment) and totally 32 cases met unfriendly. Among different regions of Tehran, the highest rate of non-admission was observed in the south (60%) and the lowest rate in the north (P<0.01). Charity centers and private centers had the most and the least non-admission rate, respectively, and the difference was significant (P<0.01). There were 16 non-admission cases among general dentists but there was not any rejection in specialists. The higher rate of non-admission and unfriendly behavior in southern district of Tehran and military and charity centers may be related to the lack of awareness and proper communication between patient and dentist. It highlights the necessity of more educational workshop to promote dentists knowledge about HBV, encourage them to use disposable tools for the patients, more accurate supervision on centers by the ministry of health and finally to assume all patients as HBsAg positive.