Top PDF Immunopathogenesis of Hepatitis B Virus Infection and Related Complications

Immunopathogenesis of Hepatitis B Virus Infection and Related Complications

Immunopathogenesis of Hepatitis B Virus Infection and Related Complications

Chronic hepatitis B (CHB) is a serious consequence of hepatitis B virus (HBV), which infects and replicates in the liver. It is characterised by prolonged hepatitis B surface antigen seropositivity; this can lead to both cirrhosis and hepatocellular carcinoma (HCC). The infection begins when HBV binds its only known functional receptor, sodium taurocholate cotransporting polypeptide (NTCP), which was identified recently. The discovery of NTCP was a significant breakthrough in the field of HBV research, and has facilitated the establishment of a susceptible hepatoma cell line model for studying the mechanisms underlying HBV pathogenesis. Following productive HBV infection, both cellular and humoral immune cells and molecules, such as T cells and chemokines, are activated to resolve infection by destroying HBV-infected hepatocytes. However, host immunity to HBV is not always protective, most likely due to immune evasion mechanisms employed by HBV. These mechanisms may result in viral persistence, accumulation of mutations, and aberrant epigenetic alterations that lead to HCC. Here we highlight our current understanding of the HBV replication cycle, immunopathogenesis, and related mechanisms underlying the progression of CHB to advanced liver disease, along with the attendant complications.
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Correlation of Liver Enzymes and Liver Histology in Chronic Hepatitis B Virus Infection

Correlation of Liver Enzymes and Liver Histology in Chronic Hepatitis B Virus Infection

There is no doubt that high ALT levels have a high prevalence of signiicant histology [9,19]. In our study, not only the entire group but even the subgroup analysis proved the direct correla- tion of ALT levels with histological severity. However, 38.8% of patients with normal ALT who were formerly considered to be immune-tolerant and assumed to have mild liver disease also had histologically signiicant disease. Similarly, in a study evaluating 71 HBV infected children, besides a signiicant cor- relation between ALT level and inlammation, 5% of ALT nor- mal patients were found to have HAI≥9 [17]. Also, recent adult studies demonstrated 18-37% signiicant inlammation and 24-34% signiicant ibrosis (≥2) even in patients with normal ALT levels [9,20]. Therefore, traditionally deined ALT levels can underestimate chronic liver disease. Based on these emerging data, some authors recommended liver biopsy over age 40 even in normal ALT levels [20]. We also may suggest considering liver biopsy in chronic HBV infected children with currently normal deined ALT levels. However, liver biopsy has some undesir- able procedural risks such as bleeding. To avoid over-biopsying we advise using the newly-deined upper limits for liver biopsy decision. There may also be value in some non-invasive tests relecting liver injury such as transient elastography [21]. But these test needs to be further validated.
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Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus

Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus

From a cost-effectiveness perspective, China will benefit from the use of LAM or LdT antiviral strategies to prevent HBV transmission. Indeed, Chinese hepatologists in tertiary hospitals have been prescribing these agents to pregnant women with chronic HBV infection for several years (Li et al., 2003; Zhang & Wang, 2009). However, pregnant infected women are more likely to visit the obstetrics clinic first, and may not seek consultation from hepatologists. The recent guideline from the Chinese Society of Obstetrics and Gynecology recommends against antiviral treatment as prophylaxis of perinatal transmission of HBV (Chinese Society of Gynaecology and Obstetrics, 2013). A survey of Chinese obstetricians showed that only 11.7% agree with antiviral treatment during pregnancy (Hu et al., 2013). Delayed update of evidence and differences in research interest between obstetricians and hepatologists may contribute to the above knowledge and practices among gynaecology staff. The findings presented in this study highlight the critical need to further summarize the clinical evidence and evaluate the cost-effectiveness of antiviral treatment to prevent perinatal transmission of HBV.
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Detection Of Hepatitis B Virus DNA In Moroccan Patients With Epithelial Ovarian Carcinoma EOC By Polymerase Chain Reaction

Detection Of Hepatitis B Virus DNA In Moroccan Patients With Epithelial Ovarian Carcinoma EOC By Polymerase Chain Reaction

development of liver cancer. However, several studies have shown that HBV may replicate in other extrahepatic cells [5] . Some studies revealed that the virus has extensive reservoirs of extrahepatic replication [5b] . HBV proteins and nucleic acids have been found in a number of non-hepatic tissues including lymph nodes, spleen, bonemarrow, kidney, colon, stomach, periadrenal ganglia, skin, thyroid, pancreas, testis, ovaries, brain, heart and lung tissue [6] . Other studies have failed to prove the presence of extrahepatic HVB, making controversial results in this context. We tried to analyze the presence of Hepatitis B Virus infection in women with epithelial ovarian carcinoma attending to oncology department of Ibn Rochd University hospital.
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Comparison of clinical manifestations and outcomes between hepatitis B virus- and hepatitis C virus-related hepatocellular carcinoma: analysis of a nationwide cohort.

Comparison of clinical manifestations and outcomes between hepatitis B virus- and hepatitis C virus-related hepatocellular carcinoma: analysis of a nationwide cohort.

In AJCC/mUICC stage IV tumor, survival was significantly worse in HBV-related HCC. These findings are consistent with the study of Cantarini et al., which reported that HBV-related HCC is more aggressive than HCV-related HCC, especially for HCC diagnosed at an advanced stage [27]. Whether or not viral etiology should be considered in treatment decision is also an important issue. Indeed, several previous studies have tried to assess whether viral etiology is a significant factor determining treatment outcome, and found that viral etiology was not an independent factor for determining outcomes of HCC who underwent resection [28,29], ablation [30], or TACE [31]. In this study, we also found that viral etiology is not an independent factor associated with survival for patients who received therapy. Even in AJCC/mUICC stage IV tumor, survival was not significantly different when patients received treatment (Table 4). Therefore, although viral etiology should be considered in estimation of patient prognosis, it may have little impact on choosing therapeutic modality.
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HIV-1 Infection in intravenous drug abusers with clinical manifestations of hepatitis

HIV-1 Infection in intravenous drug abusers with clinical manifestations of hepatitis

At present there are many reports of hepati- tis B virus, non-A non-B hepatitis, and asymptomatic HIV infection in groups of drug addicts, and also reports of [r]

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Rev. Soc. Bras. Med. Trop.  vol.47 número5

Rev. Soc. Bras. Med. Trop. vol.47 número5

Introduction : Hepatitis B virus (HBV) and human immunodefi ciency virus (HIV) infections are two of the world’s most important infectious diseases. Our objective was to determine the hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) prevalences among adult HIV-infected patients and identify the associations between socio-demographic variables and these HBV infection markers. Methods : This study was performed from October 2012 to March 2013. Three hundred HIV-seropositive patients were monitored by the Clinical Analysis Laboratory of Professor Polydoro Ernani de São Thiago University Hospital, Santa Catarina, Brazil. The blood tests included HBsAg, anti-HBc immunoglobulin M (IgM) and total anti-HBc. Patients reported their HIV viral loads and CD 4 + T-cell counts using a questionnaire designed to collect socio-
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Clinical and  aspects of Hepatitis B virus and Hepatitis C virus in FortalezaCeará

Clinical and aspects of Hepatitis B virus and Hepatitis C virus in FortalezaCeará

The brown color was reported in 77.5% of valid cases. It is noteworthy that in all cases, only 261 were subject to appropriate analysis, as they con- tained enough data to draw a profile of people affected by the disease. In all variable, there was a large number of cases in which the possible way of transmission is ignored, with highlight to the ex- posure category related to sex with 586 ignored cases (75.2%); followed by the category three or more partners, 482 (61.9%); transplantation, 473 (60.7%); hemodialysis, 467 (59.9%); transfusion, 454 (58.3%); IDU, 450 (57.8%) and tattoo, 458 (58.8%).
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There is no difference in hepatic fibrosis rates of patients infected with hepatitis C virus and those co-infected with HIV

There is no difference in hepatic fibrosis rates of patients infected with hepatitis C virus and those co-infected with HIV

The present study has limitations, the most relevant of which is possibly related to the model used to calculate the FPR in HCV-infected and in HCV/HIV-co-infected patients. Ideally, in the calculation of fibrosis progression, consecu- tive biopsies should be performed with a long interval be- tween them in patients untreated for HCV, which would be ethically unacceptable. The present model, described else- where (3), permits the evaluation of the cumulative effect of fibrosis progression according to the duration of infection. Although previously validated, this model may be criticized since it considers the patient to have no fibrosis at the time of HCV infection. The accuracy of the calculation of the esti- mated length of infection can also be criticized, as it is based on patient history. In order to adequately analyze the dura- tion of HCV infection, the population evaluated here in- cluded only patients with a history of blood transfusion or intravenous drug users, since in this population contamina- tion generally occurs during the first transfusion or in the first year of intravenous drug use in as many as 90% of cases (38). Although not an ideal method, this estimate using a single biopsy remains a useful tool in the study of the natural history of chronic hepatitis C. Besides, the groups presented some differences related to epidemiological aspects that possibly influenced the results when comparative analyses were performed.
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Evaluation of hepatitis B surface antigen and hepatitis B virus-DNA results in postmortem plasma specimens

Evaluation of hepatitis B surface antigen and hepatitis B virus-DNA results in postmortem plasma specimens

Postmortem serological tests are conducted to determine whether the cause of death is a viral infection or not, as well as to screen organ transplants for the presence of viral infections before performing transplantation surgery [7,8-11] . Studies have shown that there is a significant difference in postmortem samples obtained at the 6th hour and those obtained at the 16th hour following death. It has been reported that the postmortem samples for serological tests should be obtained within 24 h of death [5,12] . In our study, most of the cases had undergone autopsy on the day of death or on the day following death, and therefore, most of the blood samples used for serological tests were obtained between 12 and 24 h after death (n=836, 95%).
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Comparison of seropositivity of HCV between oral lichen planus and healthy control group in Hamedan province (west of Iran)

Comparison of seropositivity of HCV between oral lichen planus and healthy control group in Hamedan province (west of Iran)

Chronic hepatitis C is often asymptomatic and is usually discovered accidentally. Extrahepatic involvement includes; thyroiditis, delayed skin porphyria, cryoglobulinemia, and glomerulonephritis, especially membranoproliferative glomerulonephritis, sicca syndrome, thrombocytopenia, lichen planus [8,9], diabetes mellitus and lymphoproliferative disorders [10]. The first association between oral lichen planus and hepatitis C virus was reported in 1991 [11] and since then, several articles about the relationship between hepatitis C virus in oral lichen planus have been published [12-17]. Most cases of HCV associated with oral lichen planus have been obtained from studies in the Mediterranean area, whereas in countries like Egypt and Nigeria that have the highest prevalence of HCV, a significant difference has not been reported [13,18]. Therefore, some researchers have suggested that there cannot be explained any relationship between oral lichen planus and HCV only based on the increased incidence in the general population [19] and some workers believe that this controversy is related to different geographical areas [20]. Overall, the relationship between oral lichen planus with HCV infection still remains disputed. Recently, the emphasis on being disputed and the need for more studies based on an accurate methodology without selection bias and the possible confounding factors such as age have risen [21].This study was designed in the West region of Iran considering the importance of relationship between hepatitis C viruses in oral lichen planus .
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Naturally occurring mutations in large surface genes related to occult infection of hepatitis B virus genotype C.

Naturally occurring mutations in large surface genes related to occult infection of hepatitis B virus genotype C.

In this study, we investigated mutation patterns related to occult infections of HBV genotype C, focusing on the S ORF from HBsAg-negative Korean subjects. A total of five major character- istic features are noteworthy in terms of mutation patterns related to occult infections from our HBsAg-negative cohort. First, two deletion types in preS1 and preS2, both of which are reported to be associated with liver disease progression in chronic patients, including HCC [7,8,31,32], were significantly implicated in more than half of the occult subjects (53.7%, 22/41 subjects). This finding strongly supports the previous notion that HBV variants related to occult infection can contribute to the progression of HCC or cirrhosis [32–34]. Furthermore, HBV mutations in occult infection may be due to de novo infection in patients with advanced liver disease rather than the accumulation of indepen- dent mutations in individuals. Our data also showed that these two types of deletions existed in an exclusive manner, suggesting that the simultaneous generation of both deletions may have a lethal effect on the viral life cycle. Of the preS1 deletions, the deletions in the preS1 start codon leading to 11 amino acid truncations of Table 2. Comparison of the prevalence of deletion, mutation rates, and substitutions in the preS1, preS2, S and overlapped P regions between the occult subjects and HBV carriers in this study.
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Prevalence of Hepatitis B and C virus infection among alcoholic individuals: importance of screening and vaccination

Prevalence of Hepatitis B and C virus infection among alcoholic individuals: importance of screening and vaccination

Serum samples were tested for HBsAg (HBsAg One, RADIM, Pomezia, Italy), total anti-HBc (Diasorin, Italy), anti-HBs (Diasorin, Italy), and anti-HCV (HCVab, Radim, Pomezia, Italy) using EIA following the manufacturer’s information. Anti-HCV reactive samples were submitted to real time PCR (Cobas Taqman HCV 2.0, Roche, USA), and samples with detectable HCV RNA were also genotyped by INNOLIPA (Versant HCV Genotype Assay – LiPA, Bayer, Germany).

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Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

Acute exacerbation of chronic hepatitis B virus infection in renal transplant patients

Among the 35 patients with exacerbation, 10/35 were not treated with lamivudine. Spontaneous resolution of the bio- chemical abnormalities without loss of liver function was observed in 9/10 not treated patients and one patient died with liver failure. According to lamivudine use, in only 9% (3/35) of the patients the drug was used as preemptive/prophylactic therapy. Treatment with lamivudine after onset of exacerba- tion was administered to 22/35 patients, with clinical response in 18/22. The mean time to ALT normalization was 8.8 months in these patients. When lamivudine was given at the time of exacerbation, no difference in mortality due to hepatic insuf- ficiency was observed between treated and untreated patients (9% vs. 10%; p = 0.69).
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Low occurrence of occult hepatitis B virus infection and high frequency of hepatitis C virus genotype 3 in hepatocellular carcinoma in Brazil

Low occurrence of occult hepatitis B virus infection and high frequency of hepatitis C virus genotype 3 in hepatocellular carcinoma in Brazil

The frequency of diagnosis depends on the relative sensitivity of both HBsAg and HBV DNA assays as well as on the prevalence of HBV infection in the population (20). In Brazil, HBV prevalence is variable, since this is a large country with high cultural, ethnic and social diversity. Most Brazilian regions show intermediate endemicity ranging from 1 to 2% in studies with healthy populations and blood donors. The Southwest region of Paraná State and some indigenous populations of the Amazon Basin (North re- gion) show HBsAg rates around 8% (high endemicity) (21). HBV seroprevalence is higher among males than females and HBV is two times more frequent in low socio-economic level populations (21).
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Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: a nationwide survey.

Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: a nationwide survey.

Needlestick and sharps injuries (NSIs) present the greatest occupational risk for transmission of blood-borne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). It is estimated that more than 600,000 NSIs occur annually in the United States, and almost half of these events are unreported [1]. The occurrence of NSIs in Taiwan is reported to be 1.3 per person per year and is significantly higher than in other Asian countries [2–4]. These injuries may cause potentially fatal infections with blood-borne pathogens and are a serious occupational safety concern for healthcare workers. The risk of infection due to NSIs ranges from as high as 40% for HBV and 3%,10% for HCV, to as low as 0.2%,0.5% for HIV [5–8]. In Taiwan, healthcare workers face even greater risks because HBV is highly endemic with 15%,20% of the general population having the hepatitis B surface antigen (HBsAg), and the number of HIV
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Occult HBV Infection Reactivation in Non-Hodgkin’s Lymphoma: An Update on Prevalence and Management

Occult HBV Infection Reactivation in Non-Hodgkin’s Lymphoma: An Update on Prevalence and Management

Occult hepatitis B virus infection (OBI) is characterised by the persistence of hepatitis B virus (HBV) genome in the liver, without any evidence of overt infection: without HBV surface antigen (HBsAg) and HBV DNA detectable in the serum, or fugacious spots of very low levels of viraemia. OBI, a possible phase in the natural history of chronic hepatitis B, is mainly due to the strong suppression of viral replication by host’s immunity. Although every condition inducing a strong immunosuppression may cause an OBI reactivation, onco-haematological patients, particularly those afected by non-Hodgkin’s lymphoma (NHL), are at the highest risk of this occurrence. This is mostly due to the primary involvement of the immune system that characterises these diseases, and the strong immunosuppressive treatments used for their cure. OBI reactivation represents a life-threatening risk, because of the possible development of an overt acute hepatitis that may lead to hepatic failure. Prophylaxis with lamivudine can prevent OBI reactivation and, when it occurs, the prompt administration of an antiviral therapy with nucleos(t)ide analogues can stop it. Currently, no valid serological tests for occult HBV detection are available, in this way every HBsAg-negative patient undergoing treatment for NHL is to be considered at risk of a ‘probable OBI reactivation’. The estimation of the real extent of this occurrence in a NHL setting is a diicult challenge, mostly due to the diiculty of obtaining a deinitive diagnosis (which involves the availability of a liver biopsy performed before its development) and the high variability of the literature reports on this issue. In fact, the data concerning this prevalence range from 2.3-27.7% among the diferent papers, according to diferent study designs, diferent diagnostic criteria, diferent study populations, and diferent geographical areas of origin of the patients. The aim of this review is to browse the available knowledge about occult HBV infection amongst NHL patients, focusing on the prevalence of OBI reactivations, their identiication, and their management.
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High prevalence of occult hepatitis B virus genotype H infection among children with clinical hepatitis in west Mexico

High prevalence of occult hepatitis B virus genotype H infection among children with clinical hepatitis in west Mexico

The prevalence of HBV infection among 215 children with clinical hepatitis was 11.2% after testing for HBV DNA. These data are consistent with the fact that OBI is common among the adult Mexican population (Roman et al. 2010, Garcia-Montalvo & Ventura-Zapata 2011, Panduro et al. 2013). In this study, the data support the notion that HBV infection is underestimated when viral DNA is not evaluated. This is particularly relevant be- cause Mexico is classified as a low-prevalence region for HBV infection, but only by serological testing (HBsAg) (Panduro et al. 2011). Within the HBV DNA+ group, 70% (17/24) had less than six months of symptoms based only on clinical criteria. However, the serological, biochemi- cal and molecular findings suggest that these patients were diagnosed at a late phase of an acute HBV infection, concordant with the reduced levels of serum HBV DNA
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Rev. Saúde Pública  vol.51

Rev. Saúde Pública vol.51

In conclusion, the prevalence of HBV and HCV infection is low among FSW in Goiânia, Central Brazil. However, we have found a high frequency of FSW susceptible to HBV older than 30 years, in addition to the identiied risk factors observed, which indicate that preventive interventions are needed for both sexual and drug-related behaviors, and more eforts should be made to vaccinate FSW against hepatitis B, mainly those older than 30 years. Finally, this study also demonstrates social vulnerabilities to sexually transmitted infections among these women, and potential for increased transmission of STI. hese indings provide a starting point to address target interventions to prevent STI, including viral hepatitis B, in this high-risk population.
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Viral hepatitis in female sex workers using the Respondent-Driven Sampling

Viral hepatitis in female sex workers using the Respondent-Driven Sampling

In conclusion, the prevalence of HBV and HCV infection is low among FSW in Goiânia, Central Brazil. However, we have found a high frequency of FSW susceptible to HBV older than 30 years, in addition to the identified risk factors observed, which indicate that preventive interventions are needed for both sexual and drug-related behaviors, and more efforts should be made to vaccinate FSW against hepatitis B, mainly those older than 30 years. Finally, this study also demonstrates social vulnerabilities to sexually transmitted infections among these women, and potential for increased transmission of STI. These findings provide a starting point to address target interventions to prevent STI, including viral hepatitis B, in this high-risk population.
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