Hepatitis Monthly
Volume:18 Issue: 1, Jan 2018

Hepatitis B Virus (HBV) is one of the most serious infectious diseases and represents a major global health issue worldwide. It can be transmitted vertically and horizontally through contact with infected blood or body fluids. More attention to HBV infection in pregnancy is needed due to high risk of chronicity when transmitted to infants during delivery.
A comprehensive review of the HBV prevalence rate in pregnant females taking into account different geographical areas and socio-economic status is still lacking. This would be of crucial importance for HBV prevention and control programs. As such, this systematic review and meta-analysis was conducted focusing on HBV prevalence rate in pregnant females from different parts of the world.
Different electronic databases, including Embase, PubMed/MEDLINE, Scopus, and ISI/Web of Science were searched from January 1st 2000 to July 31st 2016, using relevant keywords, such as “prevalence” or “seroprevalence” or “epidemiology” and “pregnancy” or “pregnant” or “antenatal” in combination with “hepatitis B virus” or “HBV” with no language restrictions. The study protocol of this systematic review was deposited at the “International Prospective Register of Systematic Reviews” and registered as CRD42016041985.
After scrutinizing all the extant scholarly literature from 2000 to 2016, this study found 222 relevant articles. The overall HBV prevalence rate in pregnant females worldwide was estimated using a random-effect model, giving a value of 3% (95% confidence interval or CI 2% - 4%). Heterogeneity between studies was significantly high (I2 = 99.9%, P This suggests that despite the recent scientific advancements and the clinical progress that has occurred in anti-viral therapy, HBV still represents a major issue worldwide, especially in underdeveloped countries. The key strategies for preventing transmission from pregnant females to their fetuses are through early birth dose and infant vaccination, as well as by the use of hepatitis B immunoglobulin (HBIG) and the screening and diagnosis of mothers at high risk and the subsequent use of anti-viral agents during pregnancy in order to reduce maternal DNA concentrations down to undetectable concentrations. Health authorities should effectively implement these approaches to better control HBV in pregnancy.

Hepatitis B virus (HBV) has a high mutation rate due to its unusual replication strategy leading to the production of a large number of virions with single and double mutations. The mutations, in turn, are associated with the development of drug resistance to nucleos(t)ide analogs (NUCs) in patients before and during NUCs therapy.
The current study aimed at investigating the molecular characterization of HBV in Turkish patients with chronic hepatitis B (CHB) infection.
Polymerase chain reaction (PCR) amplification and direct sequencing procedures were used to analyze mutations. The detected drug resistance mutations were divided into the nucleos(t)ide analogs primary, partial, and compensatory resistance groups. The amino acid substitutions of hepatitis B surface antigen (HBsAg) were categorized into antiviral drug - associated potential vaccine - escape mutations (ADAPVEMs) and typical HBsAg amino acid substitutions, which included hepatitis B hyperimmunoglobulin (HBIg) - selected escape mutation, vaccine escape mutation, hepatitis B misdiagnosis, and immune - selected amino acid substitutions.
The number of patients included in the study was 528 out of which 271 (51.3%) were treatment - naive and 351 (66.3%) were hepatitis B e antigen (HBeAg) - negative. Moreover, 325 (61.6%) were males with a mean age of 38 years (range: 18 - 69). Primary, partial, and compensatory resistance to NUCs was reported in 174 (32.9%) patients. Six different ADAPVEM motifs were determined in both treatment - naive and treatment - experienced patients, namely, sF161L/rtI169X, sE164D/rtV173L, sL172L/rtA181T, sL173F/rtA181V, sS195M/rtM204V, and sS196L/rtM204I. The prevalence of ADAPVEMs and typical HBsAg escape mutations was 5.3% (n = 28) and 34.8% (n = 184), respectively.
The analysis of drug resistance should constitute a fundamental part of the follow - up period of patients with CHB undergone treatment with NUCs. The surveillance of development of drug resistance mutations, while receiving treatment for hepatitis B is of paramount importance to monitor and control the emerging resistance.

Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality among thalassemic patients. New treatments based on direct-acting antivirals (DAAs) are highly effective and well-tolerated by patients; nonetheless, they have not been studied in thalassemic populations. In this study, we evaluated the safety and efficacy of these treatments in a cohort of Sardinian thalassemic patients with chronic HCV infection.
We consecutively recruited thalassemic patients with HCV infection, who were eligible for DAA therapy at 3 liver units. Different drug combinations, depending on HCV genotype and hepatic disease severity, were used according to the current guidelines. Sustained virological response was assessed at 12 weeks posttreatment. Data regarding the side effects and transfusion requirements were also collected.
We recruited 49 patients, including 29 males (59.2%), with the mean age of 43 years (genotype 1, 55.1%). Twenty-one (42.9%) patients had a history of interferon-based treatment. Cirrhosis was detected in 28 (57.1%) patients; only 1 patient had ascites and hypoalbuminemia (Child-Pugh B7). On the other hand, 35 (71.4%) patients received a sofosbuvir-based regimen. Ribavirin treatment was reported in 26 (53.1%) cases. All the patients were followed-up for at least 12 weeks after therapy, and sustained virological response was observed in 98% of the patients. No treatment discontinuation was required due to adverse events. The most common side effects included fatigue (24.5%), headache (10.2%), and anaemia (77%), requiring further blood transfusion in patients receiving ribavirin.
This prospective study showed that DAAs are safe and effective agents in thalassemic patients with advanced liver fibrosis, regardless of previous antiviral treatment responses.

Liver cancer is a highly lethal cancer with 5 year survival rate of about 18%. This cancer is a leading cause of death in many countries. As there is not a comprehensive population base study on liver cancer mortality rates by cause in national and provincial level in Iran. We aimed to estimate the liver cancer mortality rate, its patterns, and temporal trends during 26 years by sex, age, geographical distribution, and cause.
We used the Iranian death registration system (DRS), in addition to demographic and statistical methods, to address the incompleteness and misclassification and uncertainty of death registration system to estimate annual liver cancer mortality rate. Direct age standardized approach was applied using Iran national population 2015 as a standard population to facilitate the comparison between the provinces.
Liver cancer age standardized mortality rate in Iran increased by more than four times from 1.18 (95% uncertainty interval; 0.86 to 1.61) deaths per 100,000 person in 1990 to 5.66 (95% uncertainty interval; 4.20 to 7.63) deaths per 100,000 person in 2015. Male to female age adjusted mortality ratio changed from 0.87 to 1.82 during the 26 years of the study. With increasing age, liver cancer mortality rate increased in both sex and all provinces. At provincial level, the province with highest mortality rate have 2.96 times greater rate compare to the lowest. Generally, about 71% of mortality at national level is due to hepatitis B and C infection.
In order to reduce liver cancer mortality rate, it is recommended to control main risk factors including chronic hepatitis infections. Because of the growing rate of mortality from liver cancer, augmenting life expectancy, and increasing number of the elderly in Iran, policy makers are more expected to adopt measures including hepatitis B vaccination or hepatitis C treatment.

The current international multicentre open-label, uncontrolled, real-world retrospective study aimed at evaluating the effectiveness and safety of ombitasvir / paritaprevir / ritonavir dasabuvir ± ribavirin (3D therapy) in treatment-naive and treatment-experienced hepatitis C virus (HCV) genotype 1-infected (GT1) patients.
Adult patients with chronic HCV GT1 infection, scheduled for 3D therapy according to therapeutic guidelines, were eligible. Demographic and clinical data were collected retrospectively by reviewing individuals health records. The primary effectiveness endpoint was the sustained virological response at 12 weeks following the end of treatment (SVR12).
The participants in the current study consisted of 134 patients with HCV GT1 infection, including 10 liver transplant recipients. SVR12 was achieved in 120 (96.8%) non-transplant and all liver transplant patients (100%). Significant improvement in liver function tests were observed. Among 4 treatment failures, 2 patients were non-responders and 2 patients relapsed. OBV/PTV/r DSV ± RBV regimen was well tolerated in most patients with treatment discontinuation due to adverse events in 3 patients. The most frequent adverse events were asthenia (25.8%), fatigue (16.1%), skin pruritus (12.9%), and dyspepsia (11.3%).
The current real-life study demonstrated the effectiveness and safety of OBV/PTV/r DSV ± RBV in patients with HCV GT1, including patients with cirrhosis, a liver transplant recipient and the one who failed previous antiviral therapies.

The recent use of new direct-acting drugs (DAAs) in the treatment of chronic hepatitis C needs to be evaluated in HBV/HCV coinfected patients.
Here, we report the case of a 47-year-old female patient with HBV/HCV coinfection who experienced HBV reactivation during treatment with daclatasvir (DCV) and sofosbuvir (SOF). In addition to the DAAs, Entecavir (ETV) was added to the combined regimen with improvement in ALT levels.
Both HBV and HCV treatment could be implemented effectively in case of reactivation of HBV during anti-HCV treatment with DAAs. Close monitoring of HBV DNA and ALT levels are highly recommended during DAAs drug therapy for HCV in patients with HBV/HCV dual infection.