Hepatitis Monthly
Volume:12 Issue: 2, Feb 2012

Hepatitis C virus (HCV) infection causes chronic hepatitis, which frequently leads to hepatic ibrosis and hepatocellular carcinoma (HCC). Alanine aminotransferase (ALT) is a iomarker of hepatocyte injury and is associated with the progression of hepatic fibrosis. dvanced hepatic fibrosis also predisposes HCV carriers to a risk of HCC. In contrast,some cases with persistent HCV infection have normal ALT levels that persist for a long ime, and these HCV carriers have no or mild hepatitis and hepatic fibrosis. These HCV arriers are defined as persistent normal ALT (PnALT) cases and their risk of HCC is low ompared to HCV carriers with abnormal ALT. However, there are various definitions of normal ALT and PnALT, and advanced hepatic fibrosis may be missed without a liver biopsy. n addition, there is also a risk of ALT elevation in HCV carriers with PnALT, which ncreases the risk of progression to hepatic fibrosis and HCC. Most HCV carriers with nALT have asymptomatic or nonspecific symptoms. HCV carriers with PnALT are also onsidered to be responsive to interferon-based treatment. Thus, assessment of hepatic ibrosis is important in HCV carriers, and the eradication of HCV infection is more likely n HCV carriers with evidence of hepatic fibrosis, regardless of their ALT levels.

Context: On the strength of epidemiological data,biological studies, and clinical findings, hepatitis C virus appears to be involved in the pathogenesis of a proportion of patients with non-Hodgkin lymphoma and cryoglobulinemia. The aim of this paper is to review the published literature focused on the current knowledge concerning hepatitis C virus and its potential role in the production of non-Hodgkin lymphoma and cryoglobulinemia in susceptible individuals.Evidence Acquisition: In this review, databases such as pubMed, embase, ISI, and Iranian databases including Iranmedex, and SID were searched. The results of this review indicate that HCV infection may be a likely cause of various B cell dysregulation disorders such as non-Hodgkin lymphoma and cryoglobulinemia. Based on current findings, it has been hypothesized that NHL and cryoglobulinemia in HCV infection may have an immune-mediated pathogenesis. In HCV infected patients, we showed an elevated risk of these two diseases. These finding suggested a possible role for chronic hepatitis C in the pathogenesis of NHL and cryoglobulinemia.

Data on the natural history and long term follow up of patients with autoimmune hepatitis who refer for regular medical attention is limited. We aimed to evaluate the clinical presentation and the natural history of a large cohort of type I AIH from Iran. Between 1997 and 2008, 102 patients were included in the study. Patients were diagnosed using the international autoimmune hepatitis group criteria and were followed up for an average of 60 months. Clinical and biochemical data were gathered from all patients at both the beginning and end of follow-up. Liver biopsy was done for all of the patients before, and for 28 patients after treatment. Biochemical remission was achieved in 80 (79.4%) cases among whom, 53 (66.5%) attained cure with almost normal liver histology and/or liver function test and sonography. The remaining 27 (33.5%) patients also achieved clinical and biochemical remission, but developed compensated cirrhosis as well. Relapse was seen in 24 patients (32.5%) after remission. From 22 (21.6%) subjects with ultimate treatment failure, 6 underwent orthotopic liver transplantation and 3 died from liver failure while in transplant list. Sixteen 16 (72.7%) of 22 patients who did not respond to therapy were non-compliant with medications and had irregular follow up. Ten year survival for all cohort was 96%. Long term Survival in AIH patients is very good. Prompt diagnosis and appropriate first line and salvage therapy with close follow-up will make liver transplantation rarely necessary for treatment of this disease in future.

Hepatitis A was ranked first among all of the different types of viral hepatitis in China, which occurred an average of 500,000 cases annually during the 1980's. A live attenuated hepatitis A vaccine was applied in preventing of the disease in 1992, large scale used in vaccination program in 1995, and incorporated in the Expanded Program of Immunization in 2008 in China. The objective of this study was to determine whether, and to what extent, the decline in the incidence of hepatitis A in China was the result of hepatitis A (HA) vaccination. Official documents and longitudinal serological follow-up studies were reviewed to compare the incidence of HA before and after the introduction of the vaccine. National trends in the incidence of HA in China saw rates decrease by 92.7% in 2009, compared to the levels seen in 1992. A mass vaccination program was carried out in 3-18 year old children (Wuhan City, China), and its protective efficacy was 85.4%. In a mass vaccination program of an entire population (Shenshi County, China), the annual HA incidence decreased from 359.7/100,000 to 17.7/100,000 (almost 20.3 times). There was a significant relationship found between vaccine coverage and the incidence of HA, the correlation of the negative regression was significant at the 1% (Kendall rank correlation, significant level P < 0.05). In summary, this study highlights the important role of implementing a vaccination program in decreasing the incidence of HA, and the large protective efficacy of such a strategy, as demonstrated in China.

HIV and HCV infections are basic issues of many health systems. Since HIV and HCV are transmitted similarly, it is common to become infected by them simultaneously. No consensus exists on the effect of HCV infection on the survival of HIV-infected patients. This study aimed to investigate the issue in a relatively large cohort of patients who had a high prevalence of this coinfection in Shiraz (South of Iran).Patients and In this historical cohort study, we evaluated the survival time of 1338 HIV-infected individuals who had been referred to a behavioral consultation center in Shiraz over 10 years (from April 2001 to July 2011). Kaplan-Meier method and log-rank test were used to investigate patient survival and compare their survival curves, respectively. Moreover, Cox proportional hazards model was used to examine the effect of HCV infection on patient survival after control for age, sex, having the injection drug use (IDU) risk factor, CD4 count at baseline, more than a 30% decline in CD4 cell count, and highly active antiretroviral therapy (HAART). In our cohort, 1044 patients (78.03%) were infected by HCV. The median follow-up was 43.48 months (95% CI = 61.18-26.63). The median survival time in HCV-infected and uninfected patients was 163.8 and 194.8 months, respectively (P = 0.039). After controlling for other covariates, HCV infection increased the mortality rate 2.13 times more in HCV-infected patients than HCV -uninfected patients (CI: 95%; 1.1-4.52). HCV infection increases AIDS-related deaths. To control HCV infection and transmission and eliminate HCV, timely diagnosis and treatment and serious harm reduction programs must be implemented.

Hepatitis B is the most common chronic viral infection in humans and the most common cause of death among viral hepatitis. As 70% to 80% of chronic hepatitis cases are caused by HBV in Iran, this virus alone is considered the most important cause of liver diseases and the major cause of mortality arising from viral hepatitis cases in Iran. We planned this study to determine the prevalence of hepatitis B in the general population of Qom, central Iran.Patients and The present study is a cross-sectional study. A total of 3690 samples were collected from 7 rural clusters and 116 urban clusters. Ten teams, each consisting of 2 trained members, were assigned to conduct the sampling and fill the questionnaires. The data were analyzed using SPSS. The prevalence rate of hepatitis B infection in Qom Province was 1.3%. The mean age of the patients with hepatitis B was 44.17 years. The prevalence of hepatitis B was 1.6% in men and 1.1% in women. Moreover, the prevalence of hepatitis B correlated positively with age, tattooing, and literacy level. The prevalence rate of hepatitis B in Qom is 1.3%. It is possible to prevent the disease by increasing public awareness. Further investigation on clinical presentations and a determination of the genotype of the virus are suggested.

Genotype G is the least common of all the hepatitis B virus (HBV) genotypes. The existence of the genotype G strain of HBV was first noted in 2000 and little information is available on its global geographical distribution. Previous studies have demonstrated the dominance of genotype D in patients with HBV infections in Turkey. To report for the first time in Turkey, the case of a 61 year old male patient who developed the HBV genotype G infection.Case report: According to HBV genotyping using phylogenetic analysis and an INNO-LiPA assay, the patient was infected with genotype G and G+A, respectively. The present clinical study suggests that the transmission of an HBV genotype other than genotype D, namely HBV genotype G, is possible in Turkey. Epidemiological and clinical information on genotype G infection is currently limited, and this is most likely due to its low prevalence throughout the world. Therefore, it may be important to determine the epidemiologic and molecular characteristics of the HBV genotype G as it relates to chronic hepatitis, to enable better understanding of its circulation and progression around the world.