Hepatitis Monthly
Volume:18 Issue: 7, Jul 2018

It is estimated that 10% of people receiving hepatitis B (HB) vaccination fail to produce a protective level of hepatitis B surface antibody (HBsAb). Various methods such as administration of immune-enhancing medications, increasing the dose of vaccine, or changing injection route are implemented to overcome this issue.
In this regard, to the current study aimed at assessing the efficacy of atorvastatin treatment in subjects not responding to HB vaccination and evaluating the possible molecular pathways included in the process.
In the current clinical trial, healthy subjects with HBsAb titers of less than 10 IU/mL after a complete course of HB vaccination were included. Participants were randomly assigned into two groups of case and control. Subjects in the case group received daily atorvastatin (40 mg) tablets for 10 days, while the controls were given identical placebo tablets. On the 5th day all subjects received 1.0 mL intramuscular HB vaccine. Four to eight weeks after vaccination, blood samples were drawn from the participants for laboratory assessments including enzyme-linked immunosorbent assay (ELISA) to measure the level of HBsAb, interleukin (IL)-4, IL-17, interferon (IFN)-γ and transforming growth factor (TGF)-β cytokines, and real-time polymerase chain reaction (PCR) was also used to evaluate the expression of their corresponding genes; T-Bet, RORc, and GATA3.
A total of 30 subjects (five females and 25 males) were included, with 15 participants in each group. There was no significant difference between the two groups considering baseline characteristics of the participants. Final laboratory assessment of HBsAb levels revealed that 12 (80%) subjects from the case and 5 (33.3%) from the control groups produced a protective level of antibodies (P = 0.025). No significant difference was observed in the concentration of IL-4, IL-17, IFN-γ, and TGF-β, and the expression of their corresponding genes between the two groups.
The study showed that short-term atorvastatin administration was associated with an increased level of HBsAb to that of protective levels against HB, but this response was not induced through the assessed immune pathways. Further investigations are required to identify the exact mechanism for this effect of atorvastatin.

In Turkey, newborns have been vaccinated for hepatitis B at birth, one, and six months of age since 1998.
The current study aimed at determining the seroprevalence of hepatitis B in pre- and post-vaccination periods in the population above two years of age in Manisa province during year 2014 and to evaluate the relationship between being vaccinated and infected with some social determinants of health.
A total of 1230 people were randomly selected from the general population over two years of age. The presence of hepatitis B surface antigen (HBsAg), HBs antibody (anti-HBs), and hepatitis B core antibody was detected using commercial kits. The dependent variables were being vaccinated or infected, and the independent variables were gender, age, education level, occupational class, annual per capita equivalent income, perceived income, household density, and place of residence.
The percentage of participants with a seronegative, vaccinated or infected serologic profile was 50.8%, 28.0%, and 21.2%, respectively. Among participants vaccinated in the national immunization program, 0.6% were positive for HBsAg and 75.1% for anti-HBs only, whereas 22% were seronegative. In the vaccinated group, there was a statistically significant association between living in the village (OR: 3.13 %95 CI 1.49 to 6.58) or rural districts (OR 4.46 %95 CI 1.97 to 10.08) during childhood, having low income (OR: 1.78, 95% CI 1.05 to 3.01) and being vaccinated. In the unvaccinated group, people with low income were less likely to be vaccinated (OR = 0.56, 0.34 to 0.91); individuals, who lived in rural districts during childhood were 2.13 times (95% CI 1.01 to 4.51) more likely to be vaccinated for hepatitis B than individuals, who lived in a city or abroad. There was also an association between being male (OR: 1.40, 95% CI 1.03 to 1.92), living in a village (OR: 0.50, 95% CI 0.33 to 0.75) or rural district (OR: 0.64, 95% CI 0.42 to 0.97) during childhood and being infected.
In this study, up-to-date data on the seroepidemiology of hepatitis B was obtained in a sample representing the community. The researchers concluded that routine hepatitis B vaccination initiated 16 years ago induced high levels of immunity in the great majority of the population aged

Tumor necrosis factor-α (TNF-α) is thought to be involved in the development of non-alcoholic fatty liver disease (NAFLD). However, it is still undetermined whether TNF-α is a significant indicator of major adverse hepatic events (MAHE).
A total of 279 participants with TNF-α data were enrolled and assigned into three different groups based on the serum TNF-α level. The severity of NAFLD was evaluated with magnetic resonance imaging to determine liver proton density fat fraction. The association between TNF-α and MAHE as well as the association between TNF-α and all-cause death were evaluated with the risk-djusted Cox Proportional-hazards Model.
Compared with those in the lowest tertile, participants with highest TNF-α level displayed higher serious hepatic events or burden. After a median 3 years follow-up period, participants with highest TNF-α had a higher risk of MAHE (HR 1.74, 95% CI 1.05 - 1.93, P Patients with high level of TNF-α have increased the burden of NAFLD and higher MAHE risk compared to patients with low level of TNF-α.

The outcome of primary sclerosing cholangitis (PSC) after liver transplantation can be affected by recurrent PSC (rPSC) and subsequent graft failure. IgG4-related sclerosing disease is a recently described entity that has a similar morphological appearance to PSC, making the distinction difficult. However, IgG4-related sclerosing cholangitis has an excellent prognosis since it is steroid sensitive, but the impact of IgG4 on rPSC after liver transplant is still unknown.
To determine the association between IgG4 positive immunochemical staining in liver explants and recurrence of primary sclerosing cholangitis post-liver transplantation.
Clinical information on all adult patients who underwent liver transplantation for PSC from 1990 to 2014 at our institution was obtained. IgG4 immunochemical staining was performed on the porta-hepatis region of these patient’s explanted livers. Immunochemical staining was considered to be positive if the score was > 5 cells/high power field (HPF).
Eighty patients met inclusion criteria. IgG4 staining was positive in 21 subjects. Median time for follow-up in the IgG4 positive group was 99.6 months compared to 152.6 months in the IgG4 negative. There were more instances of rPSC in the IgG4 negative group compared to the IgG4 positive group (26% vs. 5%, P The presence of IgG4 positive cells in liver explants of patient’s transplanted for PSC is associated with fewer episodes of and longer time to recurrent PSC. In addition, IgG4 status of the liver explants does not affect graft survival. Presence of IgG4 positive cells may suggest protective effect against recurrence of PSC.

Hepatitis A virus (HAV) is an epidemiological important infectious agent in the world. HAV incidence can be controlled by cognizance of the geographic distribution pattern.
The aim of this study was to evaluate the frequency of HAV infection in Birjand.
A total of 496 healthy individuals (mean age: 39.34 ± 15.47, range: 15 - 70 years, M/F ratio: 0.68) were randomly enrolled in this cross-sectional study. Demographic data were collected and the presence of anti-HAV total antibody was determined by the enzyme linked immunosorbent assay (ELISA).
Overall, the prevalence of positive serum anti-HAV antibody was 92.78%, however, the rate for 15 - 24 years subjects was 69%. There was a significant positive correlation between presence of anti-HAV antibody with age (P The result of this study showed a high prevalence of HAV antibody in most people, except for young adults, which can be an alarming sign for a higher rate of complicated HAV infections in the future and needs a proper strategy.