Hepatitis Monthly
Volume:9 Issue: 1, Winter 2009

Hepatitis B is the most frequent cause of chronic hepatitis and cirrhosis in Iran. To establish better preventive strategies, updating data on prevalence rates are needed. This study was conducted to determine the seroprevalence of hepatitis B virus (HBV) in Isfahan province, Central Iran, in 2006. In a cross-sectional study in 2006, 816 subjects over 6 years old were selected through a systematic multi-stage cluster sampling from 32 urban and 9 rural areas of Isfahan province. Demographic data, HBV risk factors and blood samples were collected and hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) were measured by enzyme-linked immunosorbent assay (ELISA) method. Chi-square test and Odds Ratio (95% CIs) and multistage logistic regression analysis were used for statistical analysis. A P<0.05 was considered statistically significant. The subjects of this study included 428 females (52.5%) and 388 males (47.5%). Of the 816 participants, 10 (1.3%) were positive for HBsAg, 98 (12.1%) for isolated HBsAb, 22 (2.9%) for isolated HBcAb and 11 (1.3%) for both HBsAb and HBcAb. The HBsAg seropositive rate ranged from 0 in 6-9-year-old to 1.9% in 40-49-year-old age groups. HBsAb and HBcAb were more frequently observed in 6-9-year-old and ≥50-year-old age groups, respectively. No subject vaccinated for HBV was found positive for HBsAg or HBcAb (age group 6-9 years old). According to the status of education, the highest HBcAb positivity rate was in non-educated group (P<0.001). There were no independent risk factors for any of HBV markers. Isfahan province seems to have a low prevalence of HBV infection. However, as low HBcAb and HBsAb prevalence rates were seen in non-vaccinated at-risk age groups, improving the coverage of vaccination for HBV seems necessary.

Many previous studies have used cross-sectional approaches to measure associations between injecting drug users'' (IDUs'') characteristics and hepatitis C virus (HCV) status, and identified independent predictors of antibody to HCV (anti-HCV) positivity including duration of injecting, needle-sharing history and prior imprisonment. Although HCV transmission between IDUs occurs primarily through blood transfer during close physical interactions, the contribution of social network data to prediction of HCV status has not been previously assessed. 215 injecting drug users and their injecting network members were recruited in Melbourne, Australia between July 2005 and August 2006. Logistic regression was used to analyze behavioral and social network data for predictors of HCV exposure. IDUs'' HCV exposure status was independently associated with the age of first injection of their injecting network members (adjusted OR = 2.82, P=0.019) and the HCV exposure status of those network members (adjusted OR = 6.17, P<0.001), in addition to several ''traditional'' behavioral and lifetime variables. Patterns of exposure to the hepatitis C virus are influenced by the characteristics of members of IDUs'' social networks. HCV RNA and/or antibody testing are an important part of any HCV prevention strategy for IDUs; increased availability of testing and sharing HCV status information within social networks would enable more IDUs to avoid infection.

To determine changes (trends) in infection rates of hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis in Iranian blood donor population. Specimens of 1,004,889 volunteer blood donors in Tehran blood transfusion service from 2003 to 2005 were screened for HBsAg, anti-HCV, anti-HIV1/2, and VDRL (venereal disease research laboratory) reactivity in a cross-sectional survey. Reactive samples were verified using a recognized confirmatory test which consisted of a second independent HBsAg enzyme immunoassay (EIA), and neutralization assay; an additional independent anti-HCV EIA and HCV-RIBA assay; a second independent anti-HIV1/2 test, and HIV Western blot; and a confirmatory fluorescent Treponemal antibody absorbed (FTA-ABS) test, respectively. The seroprevalence of HBsAg, anti-HCV, HIV Ab1/2, and VDRL was 0.9%, 2.1%, 0.2%, and 0.04%, respectively, in all blood donors. Prevalence of confirmed positivity was 0.6%, for HBsAg, 0.1%, for HCV RNA, 0.004%, for HIV western blot and 0.004% for FTA-ABS. Between 2003 to 2005, a decreasing trend was observed in HBsAg frequency. HCV frequency decreased in 2005 compared to 2003. The trend of HIV infection frequency had no increasing or decreasing pattern, and was relatively stable while the trend of syphilis infection frequency increased. Although the frequency of transfusion-transmitted infections is low, it is still far from ideal in the volunteer blood donors. Reduction of trends of infections could be achieved through more scrutiny in donor selection, improved sensitivity of serological tests, and re-evaluation of infection routes in donors.

HBV infection is common in Bangladesh. However, the characteristics of young patients incidentally detected with HBeAg-negative chronic hepatitis B is yet to be studied in this country. We did percutaneous liver biopsies in 36 patients with chronic hepatitis B (CHB) aged between 8 and 20 years. They were all HBeAg-negative with persistently normal or raised serum ALT values. 56% of patients had significant necro-inflammation. Significant fibrosis was seen in 17.6% of patients. Serum ALT was raised in 38.2%. A high HBV DNA load was observed only in 26.5% of patients. HBeAg-negative CHB is assumed not to be present in the age group studied, since this is the age group that represents immunotolerance to CHB. Immunotolerant CHB patients are positive for HBeAg, have normal ALT with high HBV DNA load. However, our study not only documented that HBeAg-negative CHB is common in our young population, but the data were also in contrary to what was expected in such age group of CHB patients. HBeAg-negative CHB is an entity that can be seen in young population and a significant percentage of such patients may have considerable hepatic involvement.

Hepatitis B is a disease of public health importance in Iran. We conducted this study to determine the epidemiology, clinical presentations of hepatitis B infection in Khuzestan province, Southwest of Iran. A cross-sectional study was conducted on hepatitis B virus (HBV) positive individuals referred to the Ahwaz Jondishapour University Hospitals (AJSUH) and Hepatitis Clinic from February 2002 to May 2007. Based on a specially-designed protocol, standard commercially-available tests and physical examinations were performed. All subjects were evaluated using a face-to-face questionnaire about demographic aspects. The analysis included data on past medical history, physical examination and periodic evaluation clinically and serologically. 1264 patients infected with hepatitis B virus participated in the study. The patients consisted of 874 male and 390 female patients with the age range of 8-72 years. The most frequent age group was 20-40 years (56.4%). Anti-delta antibodies were observed in 4.7% of the carriers (59⁄1264), anti hepatitis C virus (anti-HCV) antibodies in 0.9% (12⁄1095) and anti human immunodeficiency virus (anti-HIV) antibodies in 0.1% (1⁄1095) of active carriers, respectively. Of 1264 patients infected with hepatitis B virus, 71 (5.6%) were also hepatitis B e antigen (HBeAg) positive, no difference in female to male ratio was observed between HBeAg-positive and HBeAg-negative patients with chronic hepatitis B. The family history of hepatitis, dental procedures and a history of transfusion are important risk factors for HBV infection in our area. More careful screening and preventive measures, strict attention to asepsis, evaluation of risk factors, and improvements in certain lifestyle patterns and customs in this area may be essential to prevent transmission of the infection.

A growing pile of evidence supports the notion that pulmonary involvement is one of the extrahepatic manifestations of chronic hepatitis C virus (HCV) infection. The objective of this study was to determine the prevalence of HCV infection in patients with chronic obstructive pulmonary disease (COPD), and vice versa. Two cross-sectional studies were performed: 1. A prevalence study of HCV infection among patients with COPD; 2. A prevalence study of COPD among patients with chronic HCV infection. COPD was diagnosed according to ATS/ERS guidelines. The prevalence of HCV infection in COPD group was compared with the result of a previous study which determined the prevalence of HCV infection in general population. Prevalence of COPD in patients with chronic HCV infection was also compared to those with chronic hepatitis B virus (HBV) infection. The study included 108 patients with COPD, 68 patients with chronic HCV infection, and 60 patients with chronic HBV infection. HCV infection was observed in 8.3% of patients with COPD, and 1.2% of the control subjects (P= 0.000). The prevalence of COPD among patients with chronic HCV and HBV infection was 17.6%, and 5%, respectively (P=0.03). Comparing COPD-positive and -negative chronic HCV patients for risk factors for COPD revealed that only the mean age was higher in COPD-positive patients (60.8±9.1 years vs. 46.5±11.5 years, P=0.000). In multivariate analysis, age was found to be the only independent predictor of COPD in HCV group. Patients with COPD have increased prevalence of HCV infection, and patients with HCV infection, have increased prevalence of COPD. COPD may be an extrahepatic disease associated with HCV infection.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are significant health problems, as they can lead to chronic active hepatitis, liver cirrhosis, and hepatic carcinoma. Factors associated with HBV propagation include blood and derivates transfusion, duration and frequency of hemodialysis, equipment contamination and contact among patients as well as between them and health-care workers. Transmission of HCV through dialysis units has shown a progressive increase worldwide, ranging from 5% in some western countries to 70% in some developing countries. The aim of this study was to determine the prevalence of HBV and HCV infections in hemodialysis patients of Rasht (center of Guilan province, North of Iran). A cross-sectional analysis was performed on 163 chronic (>6 months) hemodialysis patients. Patients from the hemodialysis unit of Rasht were interviewed. The following data was collected: name, age, gender, occupation, duration of dialysis and cause of End Stage Renal Disease. Blood samples were collected and screened for HBsAg and anti-HCV antibodies by a third-generation enzyme-linked immunosorbent assay (ELISA). Qualitative HCV determination in ELISA positive cases (after two tests) was performed by QIAGEN OneStep RT-PCR kit (assay sensitivity 100 copies/mL). Five patients were HBsAg positive (3.06%) and 30 were anti HCV antibody positive by ELISA (18.40%). HCV positivity was confirmed by PCR in 17(10.42%) patients. All patients had a minimum of two to a maximum of three dialysis sessions per week. Mean age in HBsAg positive cases was 47.3 years and all of them were male. Duration of dialysis was 8-12 years in all five HBsAg positive patients. Mean age in HCV positive patients was 42.3 years. 66% of HCV positive patients were male and 33.33% of them were female. Duration of dialysis was 0-4 years in 33.33 % of HCV positive patients, 4-8 years in 26.66% of cases, 8-12 years in 20% and 12-16 years in 20% of them. This project suggests that hepatitis C infection has a high prevalence in dialysis patients and Anti-HCV Ab test should be performed before scheduling them. Although some references refuse to suggest isolation of dialysis settings for this group of patients, strategies such as closed control of services given to these patients such as blood transfusion and also training the personnel of hemodialysis units for infection prevention seems to be necessary.

Although hepatotropic viruses such as hepatitis B virus (HBV) and hepatitis C virus (HCV) are well-identified viral agents for the development of hepatitis, infection with some other viruses may lead to varying degrees of liver injury. Moreover, the hepatic pathogenicity of a few viral agents still remains to be determined. In recent years, viral agents such as TTV and SEN virus with possible hepatic pathogenicity have been introduced. SEN virus has been reported with different rates of prevalence in high-risk groups such as dialysis patients, and low-risk groups such as blood donors. Identification of the SEN virus as a possible etiological agent of parenteral transmission hepatitis led to a major concern about the possibility of its role in liver diseases in hemodialysis patients as well as in renal transplant patients. This manuscript provides an updated integrative review on SEN virus from virological aspect as well as epidemiologic and diagnostic medicine. Moreover, its role in liver diseases considering the co-infection with other hepatotropic viruses has also been reviewed.

Hepatitis E virus is a major cause of outbreaks and sporadic cases of viral hepatitis in developing countries. Literature search using the Medline (1966 to July 2008), EMBASE/Excerpta Medica (1980 to July 2008), OVID (1966 to July 2008), Google Scholar (for Local websites and medical journals), SID, websites of Iranian universities and IranMedex was done. The prevalence of hepatitis E infection in Iranian general population is increasing significantly with age. The prevalence in Iran is less than Pakistan. Consumption of contaminated water is an important mean for the spread of this enteric transmissible disease. Pigs and animals have a low role in HEV infection in our region. Primary prevention of HEV infection is the cornerstone of HEV control in our region and purely depends upon the improvement of the sanitary conditions of the society, provision of sanitary water, proper disposal of waste, and avoidance of contamination of food.

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are major public health problems worldwide. This study attempted to analyze the relationship between positive antibodies to HCV (anti-HCV) and antibodies to HIV (anti-HIV) in Thai selected groups. A retrospective analysis of subject profiles including: demographic parameters, the main risk behavior and results of anti-HCV and anti-HIV tests perfomed on 165 injecting drug users (IDUs), 400 sexually transmitted disease (STD) patients, and 2,529 of the general population (2,167 blood donors and 362 premarital check-up individuals) was carried out. History profile analysis showed high positive rate of anti-HCV in IDUs with and without anti-HIV (90.14% vs. 87.23%). In STD patients, the precentages were 13% and 5.67% respectively, and those in the general population were 22.22% and 2.55%, respectively. Results revealed significant relationships between positive anti-HCV and anti- HIV in STD patients (P=0.0283; relative risk=2.29) and the general population (P< 0.0001; relative risk=8.72), but no significance was observed in IDU patients (P=0.7392; relative risk=1.03). There were significant relationships between anti-HCV and anti-HIV among STD patients and the general population, however none was observed in the IDU group.

Vasculitis is a common extrahepatic manifestation of chronic hepatitis C virus infection and could be either associatedwith cryoglobulinemia or not.The mechanism of peripheral neuropathy seems to be vasculitic in both cryoglobulinemic and non-cryoglobulinemic patients. Antiviral therapy with peginterferon and ribavirin usually improves symptoms of virus-induced neuropathy. Herein, we reported on a rare case of hard mononeuritis multiplex triggered by antiviral therapy in a patient without neurological symptoms before the treatment.

Hepatitis B virus (HBV) infection is a global health problem, with more than 350 million people chronically infected worldwide. Previous studies revealed that ayw2 is the predominant subtype in Iran. There are also some reports other HBV subtypes including ayw1, ayw3 and ayw4 which are widespread subtypes of genotype D. In this study, we reported on an exceptional and extremely rare subtype of HBV genotype D in an Iranian patient chronically infected with HBV who was also co-infected with hepatitis delta virus (HDV). The HBV and HDV genotypes and sub-genotypes were determined by polymerase chain reaction (PCR) followed by direct sequencing and phylogenetic analysis. The HBV subtype was determined from the amino acid sequence of the region of viral genome encoding the hepatitis B surface antigen (HBsAg). Phylogenetic analysis based on the HBV S gene revealed that the patient was infected with HBV genotype D and sub-genotype D1. Further amino acid mapping on the amino acid of the HBV S gene sequence showed that the our patient who was chronically infected with HBV was infected by an unusual subtype "ayr" of the virus which is not typical for the genotype D of HBV. HDV phylogenetic analysis also revealed that the patient was co-infected with HDV clade1. The results indicated the presence of the uncommon subtype "ayr" of HBV genotype D in Iran. This may show that the virus is going further evolution by changing its genome, though the importance of this atypical subtype in genotype D of HBV is still not clear and needs longitudinal studies.