Hepatitis Monthly
Volume:18 Issue: 2, Feb 2018

Cytomegalovirus (CMV) and Human Herpes Virus-6 (HHV-6) activation after liver transplantation have been associated with increased graft rejection and adverse outcomes. This study aimed at investigating the development and timing of CMV infection after liver transplantation and its relation to post-transplantation HHV-6 activation.
Patients undergoing liver transplantation were enrolled, regardless of their age, place of residence, or their liver failure etiology. Blood samples were collected at baseline and every week for a period of 12 weeks and were tested for anti-CMV IgG and anti-HHV-6 IgG, CMV pp65 antigenemia, as well as CMV and HHV-6 DNA using the Polymerase Chain Reaction (PCR) method.
Among 46 liver transplant recipients, 17 (36.9%) developed CMV infection within 3 months after transplantation. Before transplantation, 42 (91.3%) and 41 (89.1%) recipients were seropositive for CMV and HHV-6, respectively. Fifty percent of patients were positive for CMV antigenemia, among which 73.9% became symptomatic for CMV infection. Half of the patients had positive test results for CMV PCR with a significant relationship between the CMV viral load and the development of symptomatic CMV infection (P = 0.001). Twenty-five (54.3%) patients had positive test results for HHV-6 PCR with a significant relationship between HHV-6 positivity and the development of clinical presentation (P = 0.002). The average post-transplantation time to HHV-6 and CMV activation was 19.4 ± 86.5 and 28.4 ± 60.5 days, respectively, with a linear relationship in the regression analysis.
The HHV-6 infection, either as primary infection or reactivation, leads to an increased risk of CMV infection and symptomatic disease after liver transplantation. Activation of HHV-6 precedes the CMV activation in time.

Hepatitis C infection is a major health problem around the world. It exhibits high genetic diversity, characterized by regional variations in genotype distribution. It seems that the hepatitis C virus genotypes are differently distributed between distinct geographical regions and also associated with different clinical outcomes and response to antiviral therapy.
The current study was performed to identify the distribution of HCV genotypes among chronic patients, who were HCV positive in Rasht, Capital City of Guilan Province, and Northern Part of Iran.
Patients and The cross sectional study was carried out from June 2014 to February 2015. A total of 83 patients with anti-HCV-positive specimens were enrolled. Detection of HCV-RNA by Real Time-Polymerase Chain Reaction (RT-PCR) was performed from anti-HCV positive specimens, and HCV genotypes among plasma samples from RNA-HCV positive patients were then investigated using type-specific primers.
The mean age of patients was 49.6 ± 11.2 years (range: 19 to 62). Hepatitis C virus RNA was detected in 81 out of 83 patients with positive HCV antibodies. The HCV G1a was identified as the most abundant HCV subtype 42 (51.8 %). Furthermore, HCV G3a was observed in 23 (28.4%) patients followed by G2a, in 6 (7.4%), and G1b in 10 (12.4%). The frequency of HCV genotypes in males was higher than females. G1a was the most frequent genotype in patients over 40 years of age and also G3a was the most frequent in patients under 40 years old, yet this difference was not significant.
The current results indicate that G1a is the most prevalent genotype in in the study region. Also, the study gives greater evidence of the role of gender between different HCV genotypes in Rasht. Therefore, it is essential to determine the predominant subtypes of HCV in each region of Iran.

The serum hepatitis B virus (HBV) RNA is suggested as a potential new biomarker of HBV infection. However, it is not fully understood.
The current study aimed at characterizing serum HBV RNA in patients with untreated chronic hepatitis B (CHB) and genotype B and C HBV infection.
A large cohort of 483 patients with hepatitis B e antigen (HBeAg)-positive and -negative was performed. The routine serum biomarkers of HBV infection were tested. HBV genotyping was carried out by direct sequencing. Serum HBV RNA levels were quantified using a method described in the authors’ previous study (lower limit of detection: 66.7 IU/mL).
Serum HBV RNA was detected in 92.5% (394/426) of the patients with HBeAg-positive and 31.6% (18/57) of HBeAg-negative ones; a positive association was observed between HBeAg and HBV RNA statuses in the subjects. Alanine aminotransferase (ALT), HBV DNA, and genotype were the independent predictors in patients with HBeAg-positive CHB (P = 0.024, 0.001 and 0.014, respectively), while it was HBV DNA in the negative ones (P = 0.000) for serum HBV RNA detectability. Serum HBV RNA was positively correlated with ALT, aspartate transaminase (AST) and HBV DNA, regardless of HBeAg status, and with hepatitis B surface antigen (HBsAg) in HBeAg-positive ones (P Serum HBV RNA may be affected by HBeAg status, serum HBV DNA, HBsAg levels, HBV genotype, ALT, and AST levels. There might be some similarities between the characteristics of serum HBV RNA, and serum HBV DNA and HBsAg, regardless of its distinctive features. The roles of serum HBV RNA in viral replication, infection, survival, disease progression, and antiviral responses need to be investigated in further studied.

Non-alcoholic fatty liver disease (NAFLD) is considered as the most common chronic liver disease, which can contribute to some clinical conditions varying from simple steatosis to hepatic cirrhosis. Consequently, the early diagnosis of NAFLD is vital. The present study aimed at investigating the ability of FLI (fatty liver index) in predicting NAFLD.
A total of 212 individuals over the age of 18 years (103 males and 109 females) were recruited from those admitted to a gastrointestinal clinic in Mashhad, northeastern Iran. Anthropometric parameters were measured and blood samples were collected. Hepatic steatosis and fibrosis were identified by FibroScan. FLI from body mass index, waist circumference (WC), triglyceride, and gamma glutamyltransferase data were calculated. Logistic regression was applied to establish a relationship among FLI, hepatic steatosis, and fibrosis. The sensitivity and specificity of FLI and its optimal cut-off point were detected by receiver operating characteristic analysis.
The mean age of the participants was 39.26 ± 14.18 years. FLI was significantly associated with NAFLD (OR = 1.062, 95%CI: 1.042 - 1.082, P Fatty liver index (FLI) is a suitable and simple predictor for liver steatosis. However, performance of FLI in predicting NAFLD is not more effective than WC. Although FLI is a predictor for liver steatosis, it has a positive association with liver fibrosis and can perhaps predict liver fibrosis too.

This study aimed at creating a new predictive model of significant fibrosis in chronic hepatitis B using direct and indirect parameters and comparing this model with other noninvasive models for its validation in clinical settings.
Patients (n = 81), according to the ISHAK score, were classified as mild and significant fibrosis. Serum matrix metalloproteinase-2, tissue inhibitor of metalloproteinase-2, beta-nerve growth factor levels, and indirect parameters were analyzed. To evaluate the presence of significant hepatic fibrosis, well-known conventional models were also evaluated. The cut-off values of each model were determined using receiver operating characteristic curves to distinguish patients with mild and significant fibrosis.
Significant hepatic fibrosis index-1 was constructed using the following equation: (matrix metalloproteinase-2 × age × prothrombin time × direct bilirubin) / (albumin × platelet). The sensitivity and specificity for significant hepatic fibrosis index-1 were 73.3% and 95.6%, respectively. Area under the curve of significant hepatic fibrosis index-1 was 0.895 (P Significant hepatic fibrosis index-1 employs a new marker; matrix metalloproteinase-2 along with routine parameters had the best diagnostic performance for significant fibrosis in patients with chronic hepatitis B. Using significant hepatic fibrosis index-1 or even significant hepatic fibrosis index-2 might be an alternative approach in place of liver biopsy to predict significant fibrosis in chronic hepatitis B cohort.