Hepatitis Monthly
Volume:8 Issue: 2, Spring 2008

Hepatitis B virus (HBV) infection is significantly higher in Asian American Pacific Islanders (AAPIs) than in the general U.S. population. People chronically infected with HBV not only have the potential for developing cirrhosis and primary hepatocellular carcinoma, but also are potential sources for infecting others. Therefore, early diagnosis of HBV infection can reduce the risk of further transmission of the virus through education and vaccination of high-risk groups. The aim of this study was to screen for current and past HBV infection in this high-risk group. A community-based participatory study was conducted between 2004 and 2007. A total of 609 Korean Americans (KA) completed HBV blood screening tests in seven Korean churches in Colorado. Current HBV infection (HBsAg), past HBV infection (anti-HBc positive), and HBV susceptibility were measured. Demographic information, including HBV vaccination history on these groups, was obtained. Korean Americans had an almost ten times higher incidence of current (4%) and past HBV infection (41%) than the general U.S population. Older individuals had a higher incidence of past HBV infection and lower immunization rate. The risk of lifetime HBV infection was less among participants younger than 30 (OR: 0.07; 95% CI: 0.02-0.21) and those who self-reported HBV vaccination (OR: 0.12; 95% CI: 0.05-0.29). Variables associated with immunity due to vaccination (anti-HBc negative but positive to anti-HBs) were, age under 30 (OR: 13.86; 95% CI: 4.68-41.05), and self-reported vaccination (OR: 8.06; 95% CI: 3.43-18.92). Our study findings confirm the high prevalence of HBV infection among AAPIs, specifically among AAPIs in regions where AAPIs constitute a small proportion of residents. Given the high incidence of HBV infection among these community-dwelling KA, and that the majority of HBV-infected participants were unaware of their condition, focused HBV screening should be conducted to uncover individuals with HBV

Determination of the genotypes and subtypes of hepatitis B virus (HBV) provides epidemiological data, which can contribute further to vaccination and antiviral treatment strategies, diagnostic development, and prediction of the disease course. The aim of this study was to describe the molecular characterization and phylogenetic analysis of 60 HBV S-region isolated from native Iranian patients with chronic HBV infection HBV-positive sera were collected from Iranian patients with hepatitis B infection in Tehran Hepatitis Center. HBV-DNA was extracted and the partial HBV S ORF (677bp) were chosen for amplification and sequencing. By comparing the sequences of HBV isolated from Iranian patients with 50 complete sequences of HBV retrieved from the GenBank database, representing all other existing genotypes, the sequences of all 60 patients were consistent with that of genotype D. All HBV isolates from Iranian patients were clustered in genotype D branch with high bootstrap values. Sixty HBV isolates from Iranian patients with chronic hepatitis B represent homogenous genotypic diversity. These sequences of Iranian HBV genomes may contribute to the information on the genetic diversity of HBV worldwide.

To exploring which camel milk proteins, have the ability to inhibit and/or blocking the hepatitis C virus (HCV) entry and replication inside the cells system. Using human peripheral blood mononuclear cells (PBMCs) and hepG2 cells system, three experiments were setup: 1) cells treated with amylase or lactoferrin then infected with HCV; 2) HCV treated with amylase or lactoferrin then used to infect the cells; and 3) HCV infected cells were treated with amylase or lactoferrin. RNA was extracted, RT-PCR and nested PCR were run, in addition to immune-staining the cells to localize the viral molecule within the cells foci. Camel milk-amylase and lactoferrin were in vitro tested the ability to inhibit the HCV entry and replication inside the human peripheral blood and hepG2. Amylase could not able to inhibit nor blocking the viral replication. However, lactoferrin demonstrate a clear ability to inhibit the viral entry into both cells system when pre-interact with the virus, but fault to protect the cells before infection. The virus replication inside the cells was completely blocked only when the infected cells were treated with lactoferrin. Camel lactoferrin was demonstrated a remarked in vitro ability to completely inhibit the HCV entry into PBMC, hepG2 and replication inside those cells system

Although hepatitis B vaccine reliably induces immunity against hepatitis B virus (HBV), the cost of intramuscular (IM) vaccination has limited its use, particularly in many developing countries. Intradermal (ID) vaccination has been proposed as a cost-saving alternative method for administration of hepatitis B vaccine. However, the effectiveness of ID vaccination needs to be assessed in different ethnic groups. From September 2006 to March 2008, 185 healthy anti-HBc-negative medical and nursing students at Zahedan University of Medical Sciences who had no history of vaccination against HBV, smoking or hepatitis were evaluated. They were randomly categorized into two groups. In group I (n=91), low-dose (4 |mg) recombinant hepatitis B vaccine (Euvax B, Korea) was given by intradermal route. In group II (n=94), the standard dose (20 mg) of the vaccine was administered intramuscularly at 0, 1, and 6 months. The groups were followed for a minimum of 7 months after the first vaccine dose and tested for anti-HBs titers by ELISA (Diasorin Bio Medica Kit, Saluugia, Italy). Seroprotective anti-HBs titers (titer >10 mIU/mL) were achieved in 79 (87%) students in group I and in 90 (96%) in group II (P=0.031). The difference was much pronounced when the two groups were compared for achieving an anti-HBs titer >300 mIU/mL (P<0.0001). Although ID administration of 4-mg recombinant hepatitis B vaccine is effective, this route is less effective with lower immune response than the IM vaccination.

To examine factors associated with transition from non-injecting to injecting routes of drug administration and testing antibody positive to hepatitis C virus (HCV) among ethnic Vietnamese heroin users in Melbourne, Australia. In a cross-sectional convenience survey, sample recruited by peer-workers using snowball sampling technique with a finger prick blood collection. Two-hundred ethnic Vietnamese heroin users were recruited and interviews conducted mainly in Footscray, an area of high ethnic Vietnamese residency with a prominent street based drug market. A structured questionnaire was administered. Measures included patterns of drug use, transition from smoking to injecting and vice versa, injection related risk behaviours and HCV sero-status. Ninety-three percent of the sample commenced drug use by non-injecting routes of administration. More than a half had made the transition from smoking to injecting and almost two thirds of participants had ever injected. The factors associated with making this transition included being male and a longer duration of use. Prevalence of exposure to HCV among injectors was over 50%. Factors associated with being HCV positive were longer duration of injecting, sharing injecting equipment and being older. Smoking heroin is a common route of drug administration among heroin users of Vietnamese ethnicity in this study. The transition from smoking to injecting was very common in the sample. The need for targeted harm reduction initiatives is indicated, and these must take into account patterns of heroin use as well as the social context of drug use if we are to work effectively with heroin users of Vietnamese ethnicity.

Ammonia has still essential role in pathogenesis of encephalopathy. It is probable that helicobacter pylori (H. pylori) infection leads to hyperammonemia and aggravates the hepatic encephalopathy via urease activity or its effect on zinc level. This study was aimed to assess the effect of H pylori eradication on hepatic encephalopathy. In a cross-sectional study, 42 cirrhotic patients with encephalopathy were enrolled the study. For evaluation the encephalopathy, flapping tremor, number connection test (NCT) and grade of encephalopathy was determined for all of the patients. The prevalence of H pylori infection was evaluated based on positive serology by ELAISA method (Genesis Kit, UK), and/or rapid urease test (RUT) during endoscopic evaluation. One month later, after treatment, grading of encephalopathy, NCT and flapping tremor was evaluated again and data were analyzed by software SPSS. Serologic evaluation or RUT showed that 30 patients of 42 (71.42%) were positive for H pylori. In comparison between pre and post treatment, grade of encephalopathy and NCT were reduced significantly but alteration in flapping tremor was not statistically significant. Our results indicate that eradication of H pylori may lead to improve the grade of hepatic encephalopathy and NCT.

Emtricitabine is a cytosine nucleoside analog with antiviral activity against both hepatitis B virus (HBV) and human immunodeficiency virus (HIV). It is structurally similar to lamivudine; it differs only by a fluorine at the 5-position of the nucleic acid. This review focuses on the efficacy and tolerability of FTC in the treatment of chronic hepatitis B, both HBeAg and anti-HBe-positive. Relevant literature was identified through searches of MEDLINE (2001-January 2008). The review of literature suggests that the role of emtricitabine as monotherapy may be limited by its structural similarity to lamivudine and the corresponding risk of development of drug resistance; however, some studies seem to evidence an efficacy for emtricitabine in association with other antiviral drugs, as adefovir dipivoxil and clevudine. Other studies are needed to evaluate the efficacy of this new drug in particular in association with other antiviral drugs.

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. HCC is associated with multiple risk factors. Although the association between chronic hepatitis B virus (HBV) infection and HCC is well established, the underlying mechanism of HBV-related hepatocarcinogenesis still remains elusive. Viral proteins such as X protein and the truncated middle S protein have been implicated to be tranactivators. Recently, studies are focused on mutations within the HBV genome that may be associated with HCC. Deletions in the 3'' end of preS1 and 5'' terminal of preS2 may emerge during the course of chronic HBV infection which may potentially lead to impairment in immune clearance of these variants. The preS mutant proteins are localized in the endoplasmic reticulum (ER) and have been implicated in the induction of ER stress responses. The ER stress response induces a series of signal transduction pathways and oxidative DNA damage. Furthermore, preS2 mutant protein can upregulate cyclin A expression and induce nodular proliferation of hepatocytes. The findings in this review are important to study the correlation between HCC and preS deletion mutants.

Administration of adefovir dipivoxil (ADV) has been shown to provide an increased rate of hepatitis Be (HBe) seroconversion. It is also effective in the treatment of HIV. Because of its significant nephrotoxicity after 24 weeks of the treatment, this drug is no longer used for management of HIV. However, hepatitis B virus is inhibited with lower doses of ADV. The drug can even be used safely in those with renal impairment. This review provides new aspects of treatment of hepatitis B using ADV, especially in patients with renal dysfunction as well as renal transplant recipients. We showed that ADV can be used as a safe drug in renal transplant recipients.

Chronic and serious outcomes of hepatitis C virus (HCV) infection impose a remarkable economic burden to the health system. The aim of this study was to evaluate the prevalence of HCV infection in the general population of Kermanshah in the year 2006. In this cross-sectional study, 1721 residents from Kermanshah were chosen by systematic and cluster sampling in the year 2006. After interview, serum samples were taken and evaluated for HCV-Ab using ELISA method (3rd generation). Positive samples were confirmed by Western Blot (WB) and PCR if necessary. The prevalence of HCV was 0.87% (male: 1.4% vs. female: 0.3%). There was 88.2% coordination between ELISA and WB results. Statistical relationship was observed between HCV infection and male sex (P<0.018), history of addiction (P<0.0001), shared needle (P<0.0001), unsafe sexual contact (P<0.008), history of blood and blood products transfusion (P<0.0001), tattooing (P<0.0001), history of incarceration (P<0.0001), and hemophilia (P<0.0001). On the other hand, stepwise logistic regression analysis showed that hemophilia, shared needle, IV addiction, transfusion and addiction were the most important risk factors for HCV infection in a descending order. The rate of HCV infection increased in cases with multiple risk factors. We estimate that among 967196 people, who live in Kermanshah, nearly 8400 individuals may have HCV infection and this will be a major problem in the near future. Addicts especially IV drug users and cases with the history of blood and blood products transfusion are high risk groups who need special attention regarding HCV infection.

Cryptogenic cirrhosis is a diagnosis of exclusion. Polymerase chain reaction (PCR) has demonstrated persistent hepatitis B virus (HBV) infection in serum and liver tissue of HBsAg-negative chronic hepatitis, HBsAg-negative cirrhosis, and HBsAg-negative HCC patients. The entity of occult HBV infection is well established. We report two patients with occult HBV related decompensated cirrhosis of liver for the first time from Bangladesh. The first patient is a young male with jaundice and hepato-splenomegaly. The second patient is also a young male with ascites. Both had altered liver function tests. Diagnosis of decompensated cirrhosis of liver was established in both cases and in both the etiology was identified by PCR to be occult HBV infection. In areas with high prevalence of HBV, a diagnosis of "cryptogenic" cirrhosis based on HBsAg testing alone is not adequate. The so called "cryptogenic" but actually occult HBV cirrhotics are suitable candidates for antiviral treatment. Occult HBV infection must be considered in all patients with cryptogenic cirrhosis of liver in areas where HBV infection is prevalent.