فهرست مطالب

Hepatitis Monthly
Volume:12 Issue: 6, Jun 2012

  • تاریخ انتشار: 1391/05/23
  • تعداد عناوین: 11
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  • Roberta Dambrosio, Alessio Aghemo Page 361
    Antiviral treatment of chronic hepatitis C virus (HCV) is aimed at the persistent eradication of the virus, the so-called sustained virological response (SVR), with the aim ultimately being to prevent the development of liver-related complications and improve patients’ survival. Patients with HCV-related compensated cirrhosis are the group most likely to benefit from viral clearance, as several retrospective studies have shown liver complications rates to be positively modified by the achievement of a SVR. Whether these benefits rely on viral clearance or on the histological improvements seen following successful interferon (IFn)-based therapies has recently been a matter for debate, as studies have shown cirrhosis to regress in some patients with a SVR. Whatever the mechanisms, cirrhosis has the uncanny ability to be both a dominant indication for therapy, as well as one of the strongest baseline factors associated with reduced efficacy of any IFn-based regimen. This has led to the development of alternative treatment strategies, such as low dose pegylated IFn (PegIFn) monotherapy, that unfortunately has proven to be of limited efficacy. For this reason regimens able to clear the virus without relying on the broad antiviral effect of IFN are eagerly awaited.
    Keywords: Hepatitis C, Liver Cirrhosis, Virology
  • Cristin Constantin Vere, Costin Teodor Streba, Liliana Streba, Ion Rogoveanu Page 369
  • Seyed Vahid Tabatabaei, Seyed Moayed Alavian, Maryam Keshvari, Bita Behnava, Seyyed Mohammad Miri, Pegah Karimi Elizee, Farhad Zamani, Sedigheh Amini Kafiabad, Ahmad Gharehbaghian, Bashir Hajibeigy, Kamran Bagheri Lankarani Page 372
    Background
    Treatment guidelines contraindicate ribavirin for treatment of hepatitis C virus (HCV) infection in thalassemia major patients. Nevertheless, the current evidence suggests that ribavirin might be tolerated by these patients.
    Objectives
    Despite this evidence, low dose ribavirin combination therapy has not been compared with peg interferon monotherapy in these patients so far.Patients and
    Methods
    Two hundred eighty thalassemia patients with detectable HCV-RNA PCR (≥ 50 IU/mL) and liver histology consistent with chronic HCV infection were self-assigned to receive peg interferon alfa-2a (n = 81) monotherapy or its combination therapy with ribavirin, 600-800 mg QD, according to hemoglobin levels (n = 199). Treatment experienced patients were eligible for this study.
    Results
    Sustained virological response (SVR) was significantly higher in patients who received ribavirin (51 % vs. 38 % P = 0.02). In multivariate regression, OR of ribavirin for prediction of SVR was 2.2 (95 % CI 1.24-3.91). The SVR was significantly higher in the ribavirin group in subgroups of patients with more than 24 years of age, elevated ALT, ferritin < 2006 ng/mL, previous treatment failure, genotype 1, positive history of splenectomy, fibrosis score of 0-4 HAI and viral load < 600,000 IU/mL. Treatment discontinuations due to the safety concerns were comparable between the treatment groups (6.5 and 8 %). Furthermore, transfusion intervals were almost halved in patients who received low dose ribavirin.
    Conclusions
    According to the present study, adult thalassemia patients with HCV infection can be treated successfully with low dose ribavirin. Hence, we strongly advise combination therapy in thalassemia patients with aforementioned clinical characteristics. Moreover, ribavirin does not seem to be beneficial in thalassemia patients below 18 years of age.
    Keywords: Beta, Thalassemia, Hepacivirus, Ribavirin, Peginterferon Alfa, 2a
  • Marcello Campagna, Andrea Siddu, Angelo Meloni, Claudia Basciu, Luigi Ferrai, Alessandro Pettinau, Cristiana Cardia, Giuseppina Masia, Rosa Cristina Coppola Page 382
    Background
    Continuous assessment of hepatitis A virus (HAV) seroepidemiology is a useful tool to control the risk of infection.
    Objectives
    This study aimed to evaluate the changing patterns of anti-HAV seroprevalence in a population,which isgenerally considered to be anarea ofhigh endemicity.Patients and
    Methods
    Overall, the results of 3349 sera collected during the period 2005-2008 from patients attending the University Hospital of Cagliari, Italy were studied; their mean age was 52.7 years, (s + 16.22). Patients with liver disease were excluded from the study. Age specific seroprevalence results were compared with those observed in similar previous studies carried out in the same area.
    Results
    The overall prevalence of anti-HAV was 74.6% with consistently lower values in subjects younger than 40 years (17.5%; P < 0.0001) particularly in those under 30 years of age (8.9%, CI 5.8-11.9). A significant declining trend in age specific seroprevalence has been foundin people under 30 years;61% in 1988, 33% in 1995 and 8.9% in 2005-2008.
    Conclusions
    Our findings show that a significant decline inherd immunity has occurred in the last 20 years as a consequence of lower HAV circulation due to improvementsin socio-economical and hygienic conditions. Adolescents and young adults are becoming increasingly susceptible to HAV infections, as recent outbreaks of acute HAV hepatitis have occurred. Persistent environmental monitoring and the implementation of prevention measures must be considered in order to contain the risk related to this epidemiological shift.
    Keywords: Hepatitis A, Epidemiology, Immunity, Herd, Preventive Measures
  • Chen Dong, Xing Dai, Jiuhong Liang, Min Dong, Jihong Meng Page 386
    Background
    Hepatitis E is a common infection in China, but few studies have been carried out to compare regional and ethnic factors in its prevalence.
    Objectives
    To characterize the seroprevalence of anti-HEV IgM and IgG in the general population of 11 Chinese provinces and in the people from different ethnic minorities.
    Materials And Methods
    Sera from 14208 people including 723 people from four ethnic minorities were screened for anti-HEV IgM and IgG by enzyme-linked immunosorbent assay (ELISA). For the anti-HEV IgM positive samples, reverse transcription-polymerase chain reaction (RT-PCR) was carried out for the detection of HEV RNA.
    Results
    The overall prevalence of anti-HEV IgG was 19.7%. The highest rate was 35.7% in Guizhou, while the lowest rate was 5.5% in Shanxi. Significantly higher rates were found among males compared to females in Hebei and Hunan province, and among females compared to males in Chongqing and Shannxi. In Guizhou, the prevalence rates among the Buyi, Miao, Shui and Han ethnic groups were 41.8%, 32.0%, 37.5% and 34.7%, respectively, which were not significantly different. The results also showed that the anti-HEV IgG detection rates increased with age for each ethnic group. Additionally, four samples were tested positive for anti-HEV IgM but HEV RNA was not detectable.
    Conclusions
    HEV prevalence varies considerably among Chinese provinces. Thus, prevention and control programs including vaccination could be specifically targeted to people living in regions with relatively higher prevalences. 2012;12(6): 386-90. DOI: 10.5812/hepatmon.6194.
    Keywords: Hepatitis E Seroprevalence_China
  • Elham Torbati, Mojgan Bandehpour, Parviz Pakzad, Nariman Mosaffa, Ameneh Koochaki, Bahram Kazemi Page 391
    Background
    Hepatitis infection represents one of the important causes of morbidity and mortality in developing countries, however there is not any effective vaccine against hepatitis C which is one of the significant problems in vaccine project.
    Objectives
    The aim of the present study is to evaluate the role of HCV core protein in inducing IFN-Gamma secretion and TCL activities as a vaccine in Balb/C mice.
    Material And Methods
    Our previous cloned plasmid (HCV Core gene into pETDuet-1) applied for protein expression in bacteria. The expressed and purified recombinant protein together with Freund’s adjuvant was injected to 15 Balb/c mice. The total IgG and IgG2a of immunized mice sera were evaluated after a week. Two weeks after booster injection, we studied the proliferation and IFNγ secretion of spleens, inguinal and popliteal lymph nodes lymphocytes by ELISA and ELISPOT.
    Results
    The FSFC (Frequency of spot forming cells) of secreting cells of immunized mice with HCV/Core protein and sera IgG2a were considerably higher than the control groups.
    Conclusions
    The core protein together with proper adjuvant can be a candidate vaccine against of HCV infectionBalb/C Mice. Hepat Mon. 2012;12(6): 391-397. DOI: 10.5812/hepatmon.6141.
    Keywords: Hepacivirus, Core protein, Recombinant Proteins
  • Sobia Kanwal, Tariq Mahmood Page 398
    Background
    Global prevalence of Hepatitis C Virus (HCV) infection corresponds to about 130 million HCV positive patients worldwide. The only drug that effectively reduces viral load is interferon-α (IFN-α) and currently combination of IFN and ribavirin is the choice for treatment.
    Objectives
    The present study is aimed to resolve the genotypes based on core gene that might affect the response to interferon therapy. Furthermore an attempt was made to propose a powerful therapeutic approach by designing the siRNA from sequences of the same patients who remain resistant to IFN in this study.Patients and
    Methods
    To achieve the objectives, a sequence analysis was performed in five HCV ELISA positive subjects who have completed IFN treatment. Neighbor Joining (NJ) method was used to study the evolutionary relationship. Atomic models were predicted using online software PROCHECK and i- TASSER.
    Results
    Two new genotypes were reported for the first time namely 4a from suburban region of Rawalpindi and 6e from all over the Pakistan. According to Ramachandran plot, satisfactory atomic model was considered useful for further studies, i.e. to calculate HCV genotypes conservation at structural level, to find out critical binding sites for drugdesigning, or to silence those binding sites by using appropriate siRNA. Single siRNA can be used to inhibit HCV RNA synthesis against genotype 3 and 4, as the predicted siRNA were originated from the same domain in studied HCV core region in both genotypes.
    Conclusions
    We can conclude that any change or mutation in core region might be the cause of HCV strains to resist against IFN therapy. Therefore, further understanding of the complex mechanism involved in disrupting viral response to therapy would facilitate the development of more effective therapeutic regimens. Additionally, a single designed siRNA can be used as an alternative for current therapy against more than one resistant HCV genotypes.
    Keywords: Interferons, Small interfering RNA (siRNA), Hepatitis C
  • Seyed Hossein Aalaei, Andabili, Leila Mehrnoush, Shima Salimi, Mustafa Shafiei, Seyed Moayed Alavian Page 408
    Background
    The assessment of liver fibrosis is an important way for prediction of liver disease progression and patient’s prognosis. Liver stiffness measurement (LSM) is strongly associated with stage of liver diseases. Overestimation of liver fibrosis in heart failure has been reported. We would like to introduce a new leading cause of liver fibrosis overestimation by presentation of two cases.
    Case Presentation
    One case with right lobe hemangioma has an overestimation of liver fibrosis. The result completely changed when Fibroscan was performed in patient’s left lobe. Interestingly, another case with left lobe hemangioma had overestimation of fibrosis in her left lobe but, right lob Fibroscan was normal.
    Conclusions
    We found that liver hemangioma may leads to overestimation of liver stiffness and the correct inspection of liver echogenicity before any interpretation of high liver stiffness is recommended. We suggest that patient with higher level of Fibroscan score repeat it in other sides of the liver. Also, they should be evaluated by sonography for ruling out of possible confounders such as hepatic hemangioma.
    Keywords: Liver, Hemangioma, Fibrosis
  • Alessio Aghemo, Sherrie Bhoori, Stella De Nicola, Vincenzo Mazzaferro, Massimo Colombo Page 411
    Background
    Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) remains a serious problem in the clinical management of post-OLT patients. Recently, two case reports have described successful prevention of HCV liver graft reinfection with intravenous silibinin (SIL) monotherapy in two carriers of genotype 3a and 1a/4 HCV. Based on these findings, we decided to offer such a therapy to a 65 year old woman on the OLT list.
    Case Presentation
    A 65 year old patient with HCV 2a cirrhosis, a previous relapse to PegIFN and Rbv therapy, was listed for OLT due to hepatocellular carcinoma. She started SIL monotherapy 24 hours before OLT. After an initial HCV-RNA decline following surgery, a progressive HCV RNA increase was observed. For this reason, SIL was stopped after 15 days of monotherapy.
    Conclusions
    SIL has multiple anti-HCV mechanisms of action, most of them have been characterized in vitro only. Our case report shows that the antiviral effect of SIL might be HCV genotype dependent, as recently suggested by a study, showing no effect of SIL on the HCV-2a subgenomic replicon model. Our case reinforces the need for controlled studies to assess the efficacy of silibinin therapy in HCV infected patients before it can be broadly used in all clinical settings.
    Keywords: Hepacivirus, Silybin, Liver Transplantation
  • Miriam Liliana Cuarterolo Page 415