Hepatitis Research and Treatment http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Spectrum of Histomorphologic Findings in Liver in Patients with SLE: A Review Mon, 21 Jul 2014 11:05:15 +0000 http://www.hindawi.com/journals/heprt/2014/562979/ Collagen vascular diseases (CVDs) like systemic lupus erythematosus (SLE), rheumatoid arthritis, Sjogren syndrome (SS), and scleroderma are immunologically mediated disorders that typically have multisystem involvement. Although clinically significant liver involvement is rare, liver enzyme abnormalities are common in these patients. The reported prevalence of hepatic involvement in SLE, histopathologic findings, and its significance is very variable in the existing literature. It is important to be familiar with the causes of hepatic involvement in SLE along with histomorphological features which aid in distinguishing hepatitis of SLE from other hepatic causes as they would alter the patient management and disease course. Histopathology of liver in SLE shows a wide morphological spectrum commonly due to a coexisting pathology. Drug induced hepatitis, viral etiology, and autoimmune overlap should be excluded before attributing the changes to SLE itself. Common histopathologic findings in SLE include fatty liver, portal inflammation, and vascular changes like hemangioma, congestion, nodular regenerative hyperplasia, arteritis, and abnormal vessels in portal tracts. Shrruti Grover, Archana Rastogi, Jyotsna Singh, Apurba Rajbongshi, and Chhagan Bihari Copyright © 2014 Shrruti Grover et al. All rights reserved. Prevalence of Hepatitis C Virus Genotypes in District Bannu, Khyber Pakhtunkhwa, Pakistan Mon, 30 Jun 2014 07:28:12 +0000 http://www.hindawi.com/journals/heprt/2014/165826/ Determination of an individual’s hepatitis C virus (HCV) genotypes prior to antiviral therapy has become increasingly important for the clinical management and prognosis of HCV infection. Therefore, this study was conducted to investigate the prevalence of HCV genotypes in HCV infected patients of district Bannu in Khyber Pakhtunkhwa region of Pakistan. Serum samples of 117 seropositive patients were screened for HCV-RNA by using reverse transcriptase-nested polymerase chain reaction (RT-nested PCR) and then PCR positive samples were subjected to HCV genotyping. Out of 117 seropositive samples, 110 samples were found positive by PCR analysis. Genotype 3a was the most prevalent one detected in 38% of patients, followed by genotype 3b in 21% of patients, and then genotype 2a in 12% of patients. However 21% of HCV-PCR positive samples could not be genotyped by method used in this study. Genotype 3a was the most prevalent genotype in patients of all age groups and its prevalence was found high among patients with increasing age (>34 years). Moreover, genotypes 3a and 3b were found to be the most prevalent genotypes in patients with history of shaving by barbers, receiving multiple injections, and dental procedures. In conclusion there is need of further investigation of genotypes of HCV by using more sensitive assays and considering large sample size in district Bannu. Shamim Saleha, Anwar Kamal, Farman Ullah, Nasar Khan, Asif Mahmood, and Sanaullah Khan Copyright © 2014 Shamim Saleha et al. All rights reserved. MHC Class I Presented T Cell Epitopes as Potential Antigens for Therapeutic Vaccine against HBV Chronic Infection Mon, 26 May 2014 07:24:52 +0000 http://www.hindawi.com/journals/heprt/2014/860562/ Approximately 370 million people worldwide are chronically infected with hepatitis B virus (HBV). Despite the success of the prophylactic HBV vaccine, no therapeutic vaccine or other immunotherapy modality is available for treatment of chronically infected individuals. Clearance of HBV depends on robust, sustained CD8+ T activity; however, the limited numbers of therapeutic vaccines tested have not induced such a response. Most of these vaccines have relied on peptide prediction algorithms to identify MHC-I epitopes or characterization of T cell responses during acute infection. Here, we took an immunoproteomic approach to characterize MHC-I restricted epitopes from cells chronically infected with HBV and therefore more likely to represent the true targets of CD8+ T cells during chronic infection. In this study, we identified eight novel MHC-I restricted epitopes derived from a broad range of HBV proteins that were capable of activating CD8+ T cells. Furthermore, five of the eight epitopes were able to bind HLA-A2 and A24 alleles and activated HBV specific T cell responses. These epitopes also have potential as new tools to characterize T cell immunity in chronic HBV infection and may serve as candidate antigens for a therapeutic vaccine against HBV infection. Joseph D. Comber, Aykan Karabudak, Vivekananda Shetty, James S. Testa, Xiaofang Huang, and Ramila Philip Copyright © 2014 Joseph D. Comber et al. All rights reserved. Histological and Clinical Characteristics of Patients with Chronic Hepatitis C and Persistently Normal Alanine Aminotransferase Levels Wed, 07 May 2014 00:00:00 +0000 http://www.hindawi.com/journals/heprt/2014/760943/ Patients with chronic hepatitis C virus (HCV) infection and persistently normal alanine aminotransferase (PNALT) are generally described to have mild liver disease. The aim of this study was to compare clinical and histological features in HCV-infected patients with PNALT and elevated ALT. Patients presenting to the University of Illinois Medical Center, Chicago, who had biopsy proven HCV, an ALT measurement at the time of liver biopsy, at least one additional ALT measurement over the next 12 months, and liver biopsy slides available for review were identified. PNALT was defined as ALT ≤ 30 on at least 2 different occasions over 12 months. Of 1200 patients with HCV, 243 met the study criteria. 13% (32/243) of patients had PNALT while 87% (211/243) had elevated ALT. Significantly more patients with PNALT had advanced fibrosis (F3 and F4) compared to those with elevated ALT (). There was no significant difference in the histology activity index score as well as mean inflammatory score between the two groups. In conclusion, in a well-characterized cohort of patients at a tertiary medical center, PNALT did not distinguish patients with mild liver disease. Bakht Roshan and Grace Guzman Copyright © 2014 Bakht Roshan and Grace Guzman. All rights reserved. Transplacental Transfer of Hepatitis B Neutralizing Antibody during Pregnancy in an Animal Model: Implications for Newborn and Maternal Health Thu, 27 Mar 2014 11:25:09 +0000 http://www.hindawi.com/journals/heprt/2014/159206/ Despite the success of postexposure prophylaxis (PEP) of the newborn in preventing mother-to-child transmission of hepatitis B virus), in non-US clinical trials, administering hepatitis B immune globulin (HBIG) to mothers at the end of pregnancy (in addition to passive-active PEP of the newborn) only partially improved outcomes. That is, a significant percentage of newborns became infected during their first year of life. We used a relevant animal model for human IgG transplacental transfer to study dose, time and subclass dependence of HBV neutralizing antibody (nAb) maternal, and fetal levels at the end of pregnancy. Pregnant guinea pigs received 50 or 100 IU/kg HBIGIV 2–5 days before delivery. Human total IgG, IgG subclasses, and nAb in mothers and their litters were measured. In vitro analyses of guinea pig Fc neonatal receptor binding to HBIGIV, as well as to all human IgG subclasses, were also performed. Our study showed that nAb transferred transplacentally from the pregnant guinea pigs to their litters; no transfer occurred during parturition. The amount of the transferred nAb was dose and time dependent. Thus, selection of an efficacious dose in the clinic is important: microdosing may be underdosing, particularly in cases of high viraemia. Li Ma, Malgorzata G. Norton, Iftekhar Mahmood, Zhong Zhao, Lilin Zhong, Pei Zhang, and Evi B. Struble Copyright © 2014 Li Ma et al. All rights reserved. Prevalence and Seroincidence of Hepatitis B and Hepatitis C Infection in High Risk People Who Inject Drugs in China and Thailand Thu, 27 Mar 2014 07:16:14 +0000 http://www.hindawi.com/journals/heprt/2014/296958/ We determined the prevalence and incidence of HBV and HCV infection in people who inject drugs (PWIDs) at high risk for HIV in China and Thailand and determined the association of HBV and HCV incidence with urine opiate test results and with short-term versus long-term buprenorphine-naloxone (B-N) treatment use in a randomized clinical trial (HPTN 058). 13.8% of 1049 PWIDs in China and 13.9% of 201 PWIDs in Thailand were HBsAg positive at baseline. Among HBsAg negative participants, the HBsAg incidence rate was 2.7/100 person years in China and 0/100 person years in Thailand. 81.9% of 1049 PWIDs in China and 59.7% of 201 in Thailand were HCV antibody positive at baseline. The HCV confirmed seroincidence rate among HCV antibody negative PWIDs was 22/100 person years in China and 4.6/100 person years in Thailand. Incident HBsAg was not significantly different in the short-term versus long-term B-N arm in China or Thailand. Participants with positive opiate results in at least 75% of their urines during the time period were at increased risk of incident HBsAg (HR = 5.22; 95% CI, 1.08 to 25.22; ) in China, but not incident HCV conversion in China or Thailand. J. Brooks Jackson, Liu Wei, Fu Liping, Apinun Aramrattana, David D. Celentano, Louise Walshe, Yi Xing, Paul Richardson, Ma Jun, Geetha Beauchamp, Deborah Donnell, Yuhua Ruan, Liying Ma, David Metzger, and Yiming Shao Copyright © 2014 J. Brooks Jackson et al. All rights reserved. Hepatitis B Vaccination and Screening Awareness in Primary Care Practitioners Thu, 06 Mar 2014 07:29:40 +0000 http://www.hindawi.com/journals/heprt/2014/373212/ Introduction. The goals of Healthy People US 2020 have called for increased screening and vaccination of high-risk groups for Hepatitis B (HBV). Methods. We performed a survey of 400 randomly chosen primary care practitioners (PCPs) in Wisconsin to assess their knowledge, attitudes, and practices regarding screening and vaccination for HBV. Results. Screening rates of patients at risk of sexual transmission were low, with 61% of respondents stating that they screen patients who had more than 1 sex partner in 6 months and 86% screening patients with a history of sex with prostitutes. Screening rate for persons with a history of intravenous drug use was 94%. Children of immigrants were screened by 65%, persons on hemodialysis by 73%, and prison inmates by 69%. Screening increased with provider experience with HBV. Deficiencies in vaccination rates mirrored screening practices. Major barriers to screening were cost, someone else’s responsibility, time constraints, or lack of knowledge. Conclusions. Without improved education and practices of PCPs about HBV screening and vaccination, the goals of healthy people 2020 regarding HBV will not be met. Barriers to screening and vaccination need to be addressed. Cost-effectiveness of alternative strategies such as universal vaccination under the age of 50 should be explored. Adnan Said and Janice H. Jou Copyright © 2014 Adnan Said and Janice H. Jou. All rights reserved. Involvement of Differential Relationship between HCV Replication and Hepatic PRR Signaling Gene Expression in Responsiveness to IFN-Based Therapy Sun, 29 Dec 2013 16:00:55 +0000 http://www.hindawi.com/journals/heprt/2013/917261/ Aim. To gain an insight into the effect of HCV replication-associated interference with the IFN system on hepatic mRNA expression involved in IFN production. Methods. Relative mRNA expression of TLR3/RIG-I signaling genes involved in IFN-β production was correlated with positive- and negative-strand HCV RNAs in pretreatment liver tissues responsive and nonresponsive to peginterferon and ribavirin for chronic hepatitis C genotype 1. Treatment response was analyzed for per protocol population at weeks 12 () and 24 () and at 24 weeks aftertreatment (). Results. HCV replication had no relation to the expression of TLR3, RIG-I, TRIF, IPS-1, IRF3, and IFN-β mRNAs in responders. In striking contrast, positive- and/or negative-strand HCV showed positive correlations with TLR3, RIG-I, TRIF, IPS-1, and IRF3 mRNAs in week-12 nonresponders; with RIG-I, TRIF, IPS-1, and IRF3 mRNAs in week-24 nonresponders; and with TLR3, RIG-I, and IRF3 mRNAs in posttreatment nonresponders. Thus mRNA expression of TLR3/RIG-I signaling genes was increased in relation to viral replication in nonresponders. Conclusions. The findings in IFN nonresponders may imply a host feedback response to severe impairment of the IFN system associated with HCV replication. Nobukazu Yuki, Shinji Matsumoto, Michio Kato, and Toshikazu Yamaguchi Copyright © 2013 Nobukazu Yuki et al. All rights reserved. Predictors of Health-Related Quality of Life in Outpatients with Cirrhosis: Results from a Prospective Cohort Sun, 22 Dec 2013 11:04:20 +0000 http://www.hindawi.com/journals/heprt/2013/479639/ Background. Cirrhosis may lead to a poor health-related quality of life (HRQOL), which should be taken into consideration when addressing the cirrhotic outpatient. Methods. Prospective cohort study evaluating predictors of HRQOL in outpatients with cirrhosis. Patients with overt hepatic encephalopathy at baseline were excluded. HRQOL was evaluated at baseline using the six point Chronic Liver Disease Questionnaire. Predictors of low quality of life scores (<4 points) and mortality were analyzed using multivariable logistic regression. Results. In total, 92 patients were included (mean age 61 years, 59% male). Nineteen patients died (mean duration of follow-up 20 months). The mean Child-Pugh score was 6.9. Twenty percent had a poor HRQOL judged by the Chronic Liver Disease Questionnaire score and 45% had covert hepatic encephalopathy. The only predictors of poor HRQOL were the Child-Pugh score (), nonalcoholic etiology of cirrhosis (), and body mass index (). The body mass index predicted poor HRQOL independently of the presence of ascites and albumin level. Conclusions. The body mass index was associated with a low HRQOL. This suggests that malnutrition may be an important target in the management of patients with cirrhosis. Maja Thiele, Gro Askgaard, Hans B. Timm, Ole Hamberg, and Lise L. Gluud Copyright © 2013 Maja Thiele et al. All rights reserved. Transforming Growth Factor-β1 Gene Polymorphism (T29C) in Egyptian Patients with Hepatitis B Virus Infection: A Preliminary Study Wed, 18 Dec 2013 09:34:51 +0000 http://www.hindawi.com/journals/heprt/2013/293274/ The interindividual variations in the capacity of transforming growth factor-β1 (TGF-β1) production have been ascribed to genetic polymorphisms in TGF-β1 gene. As pathogenesis of HBV has a genetic background, this preliminary study was designed to assess the impact of TGF-β1 (T29C) on the susceptibility of Egyptians to HBV infection. Genotyping was performed using single stranded polymorphism-polymerase chain reaction (SSP-PCR) in 65 Egyptian hepatitis B patients and 50 healthy controls. TGF-β1 plasma levels were measured using Enzyme-linked immunosorbent assay (ELISA). The frequency of CC genotype was significantly higher () in HBV patients compared to controls. On the contrary, TC genotype did not show significant difference in both groups. TT genotype was significantly higher () in controls than HBV patients. Our current preliminary data revealed that the frequency of the genotypes in the controls were within Hardy-Weinberg equilibrium (HWE) while the patients group was out of HWE (). TGF-β1 was significantly (; ) deceased in the sera of patients as compared to normal subjects. Depending on our preliminary work, CC genotype may act as a host genetic factor in the susceptibility to HBV infection in Egyptians. Taken together, the current data pointed to the importance of polymorphism of TGF-β1 gene (T29C) in HBV infection. Roba M. Talaat, Mahmoud F. Dondeti, Soha Z. El-Shenawy, and Omaima A. Khamiss Copyright © 2013 Roba M. Talaat et al. All rights reserved. Circulating Cytokines and Histological Liver Damage in Chronic Hepatitis B Infection Thu, 31 Oct 2013 09:17:22 +0000 http://www.hindawi.com/journals/heprt/2013/757246/ Each phase of hepatitis B infection stimulates distinct viral kinetics and host immune responses resulting in liver damage and hepatic fibrosis. Our objective has been to correlate host inflammatory immune response including circulating Th1 and Th2 cytokines in patients with chronic hepatitis B infection with liver histopathology. Sixty-four patients with chronic hepatitis B without previous treatment were recruited. The liver histology and histological activity index were assessed for various degrees of necroinflammation and hepatic fibrosis. We determined circulating levels of the Th1 and Th2 cytokines. Forty-six males and 18 females at a median age of 34.5 years were studied. HBeAg was present in 28/64 (43.75%) of the patients. In patients negative for HBeAg, IL-10 and IFN-gamma were significantly correlated with degrees of necroinflammation (, , resp.; ). Moreover, TNF-alpha was significantly correlated with degrees of fibrosis (; ), and IL-10 and TNF-alpha were significantly correlated with significant fibrosis (, , resp.; ). These correlations were found in the HBeAg negative group as opposed to the HBeAg positive group. In HBeAg negative patients, circulating cytokines IL-10 and IFN-gamma were correlated with degrees of necroinflammation, whereas IL-10 and TNF-alpha were correlated with significant fibrosis. Kittiyod Poovorawan, Pisit Tangkijvanich, Chintana Chirathaworn, Naruemon Wisedopas, Sombat Treeprasertsuk, Piyawat Komolmit, and Yong Poovorawan Copyright © 2013 Kittiyod Poovorawan et al. All rights reserved. Parvovirus B19 Associated Hepatitis Tue, 22 Oct 2013 15:09:59 +0000 http://www.hindawi.com/journals/heprt/2013/472027/ Parvovirus B19 infection can present with myriads of clinical diseases and syndromes; liver manifestations and hepatitis are examples of them. Parvovirus B19 hepatitis associated aplastic anemia and its coinfection with other hepatotropic viruses are relatively underrecognized, and there is sufficient evidence in the literature suggesting that B19 infections can cause a spectrum of liver diseases from elevation of transaminases to acute hepatitis to fulminant liver failure and even chronic hepatitis. It can also cause fatal macrophage activation syndrome and fibrosing cholestatic hepatitis. Parvovirus B19 is an erythrovirus that can only be replicate in pronormoblasts and hepatocytes, and other cells which have globosides and glycosphingolipids in their membrane can also be affected by direct virus injury due to nonstructural protein 1 persistence and indirectly by immune mediated injury. The virus infection is suspected in bone marrow aspiration in cases with sudden drop of hemoglobin and onset of transient aplastic anemia in immunosuppressed or immunocompetent patients and is confirmed either by IgM and IgG positive serology, PCR analysis, and in situ hybridization in biopsy specimens or by application of both. There is no specific treatment for parvovirus B19 related liver diseases, but triple therapy regimen may be effective consisting of immunoglobulin, dehydrohydrocortisone, and cyclosporine. Chhagan Bihari, Archana Rastogi, Priyanka Saxena, Devraj Rangegowda, Ashok Chowdhury, Nalini Gupta, and Shiv Kumar Sarin Copyright © 2013 Chhagan Bihari et al. All rights reserved. Measuring the Response of Extrahepatic Symptoms and Quality of Life to Antiviral Treatment in Patients with Hepatitis C Mon, 07 Oct 2013 17:16:53 +0000 http://www.hindawi.com/journals/heprt/2013/910519/ Background. HCV infection is associated with musculoskeletal manifestations such as chronic widespread pain, sicca syndrome, polyarthritis, and a reduced HRQOL. Little data is available on the effect of treatment on these manifestations. This study measured changes in extrahepatic symptoms and HRQOL before and after antiviral treatment in a large UK patient cohort. Methods. 118 patients completed HQLQ and rheumatological questionnaires before and after treatment with pegylated interferon-α and ribavirin, with specific regard to chronic widespread pain, sicca syndrome, and sustained virological response. Results. There was significant improvement in HQLQ domains of physical functioning, physical disability, social functioning, limitations and health distress due to hepatitis, and general health. There was significant deterioration in domains of positive well-being, health distress, and mental health. There was a significant decline prevalence of CWP (26.3% versus 15.3%, ). Sicca syndrome prevalence fell insignificantly (12.7% versus 11%). SVR was associated positively with all HRQOL changes and significantly with CWP remission. Conclusions. HCV antivirals significantly improve poor HRQOL scores and CWP. Before treatment, both were common, coassociated, and unaccounted for through mixed cryoglobulinemia alone. Although a role of the hepatitis C virus in CWP cannot be deduced by these results, symptomatic improvement via antiviral treatment exists for this subset of patients. David Isaacs, Nader Abdelaziz, Majella Keller, Jeremy Tibble, and Inam Haq Copyright © 2013 David Isaacs et al. All rights reserved. Elevation in Serum Concentration of Bone-Specific Alkaline Phosphatase without Elevation in Serum Creatinine Concentration Secondary to Adefovir Dipivoxil Therapy in Chronic Hepatitis B Virus Infection Mon, 09 Sep 2013 18:03:11 +0000 http://www.hindawi.com/journals/heprt/2013/739247/ Of 168 patients with chronic hepatitis B virus (HBV) infection-related liver disease, 20 patients who had received 100 mg of lamivudine plus 10 mg/day of adefovir dipivoxil (ADV) (ADV group) and 124 patients who had received 0.5 mg/day of entecavir or 100 mg/day of lamivudine (non-ADV group) for >1 year were enrolled. For comparative analyses, 19 well-matched pairs were obtained from the groups by propensity scores. At the time of enrollment, serum creatinine and phosphate concentrations were similar between the ADV and non-ADV groups; however, urinary phosphate () and serum bone-specific alkaline phosphatase (BAP) () concentrations were significantly higher in the ADV group than in the non-ADV group. Serum BAP was significantly higher at the time of enrollment than before ADV administration in the ADV group (), although there was no significant change in serum BAP concentration in the non-ADV group. There was a significant positive correlation between the period of ADV therapy and ΔBAP (, ). Serum BAP concentration increased before increase in serum creatinine concentration and was useful for early detection of adverse events and for developing adequate measures for continuing ADV for chronic HBV infection-related liver disease. Hiroshi Abe, Nobuyoshi Seki, Tomonori Sugita, Yuta Aida, Haruya Ishiguro, Tamihiro Miyazaki, Munenori Itagaki, Satoshi Sutoh, and Yoshio Aizawa Copyright © 2013 Hiroshi Abe et al. All rights reserved. Tryptophan-Kynurenine Metabolism and Insulin Resistance in Hepatitis C Patients Wed, 04 Sep 2013 14:13:36 +0000 http://www.hindawi.com/journals/heprt/2013/149247/ Chronic hepatitis C virus (HCV) infection is associated with 50% incidence of insulin resistance (IR) that is fourfold higher than that in non-HCV population. IR impairs the outcome of antiviral treatment. The molecular mechanisms of IR in HCV are not entirely clear. Experimental and clinical data suggested that hepatitis C virus per se is diabetogenic. However, presence of HCV alone does not affect IR. It was proposed that IR is mediated by proinflammatory cytokines, mainly by TNF-alpha. TNF-alpha potentiates interferon-gamma-induced transcriptional activation of indoleamine 2,3-dioxygenase, the rate-limiting enzyme of tryptophan- (TRP-) kynurenine (KYN) metabolism. Upregulation of TRP-KYN metabolism was reported in HCV patients. KYN and some of its derivatives affect insulin signaling pathways. We hypothesized that upregulation of TRP-KYN metabolism might contribute to the development of IR in HCV. To check this suggestion, we evaluated serum concentrations of TRP and KYN and HOMA-IR and HOMA-beta in 60 chronic HCV patients considered for the treatment with IFN-alpha. KYN and TRP concentrations correlated with HOMA-IR and HOMA-beta scores. Our data suggest the involvement of KYN and its metabolites in the development of IR in HCV patients. TRP-KYN metabolism might be a new target for prevention and treatment of IR in HCV patients. G. F. Oxenkrug, W. A. Turski, W. Zgrajka, J. V. Weinstock, and P. Summergrad Copyright © 2013 G. F. Oxenkrug et al. All rights reserved. Interferon-α-Induced Changes to Natural Killer Cells Are Associated with the Treatment Outcomes in Patients with HCV Infections Tue, 13 Aug 2013 08:34:28 +0000 http://www.hindawi.com/journals/heprt/2013/374196/ Aim. We analyzed the pretreatment natural killer (NK) cell functions with the aim of predicting the sustained virological response (SVR) or the interleukin (IL) 28B polymorphism that is strongly associated with the treatment response. Methods. The peripheral NK cells from chronic hepatitis patients with HCV genotype 1 and high virus titers were activated using a Toll-like receptor (TLR) 4 ligand and IFN-α. The cell surface markers were evaluated using a flow cytometric analysis, and IFN-γ production was evaluated using an enzyme-linked immunosorbent assay (ELISA). The genotyping of the polymorphisms in the IL28B gene region (rs8099917) on chromosome 19 was performed on the DNA collected from each patient. Results. The production of IFN-γ was significantly higher in the SVR patients compared with the no-response (NR) patients, whereas the cell surface markers were similar between the SVR and the NR patients. There were no significant differences found in the IL28B genotype distribution associated with the production of IFN-γ. Conclusion. Differences in the NK cell functions were observed between the SVR patients and the NR patients, suggesting that NK cells play a potential role in the treatment response independent of the IL28B genotype. Shinji Shimoda, Kosuke Sumida, Sho Iwasaka, Satomi Hisamoto, Hironori Tanimoto, Hideyuki Nomura, Kazufumi Dohmen, Kazuhiro Takahashi, Akira Kawano, Eiichi Ogawa, Norihiro Furusyo, Koichi Akashi, and Jun Hayashi Copyright © 2013 Shinji Shimoda et al. All rights reserved. Evaluation of the Significance of Pretreatment Liver Biopsy and Baseline Mental Health Disorder Diagnosis on Hepatitis C Treatment Completion Rates at a Veterans Affairs Medical Center Thu, 16 May 2013 12:26:49 +0000 http://www.hindawi.com/journals/heprt/2013/653976/ Objectives. This study was performed to define the overall treatment response rates and treatment completion rates among the population of Hepatitis C infected patients at an urban VA Medical Center. Additionally, we examined whether pretreatment liver biopsy is a positive predictor for treatment completion and if the presence of mental health disorders is a negative predictor for treatment completion. Methods. Retrospective chart review was performed on the 375 patients that were treated for HCV and met the study inclusion parameters between January 1, 2003 and April 1, 2008 at our institution. Clinical data was obtained from the computerized patient record system and was analyzed for respective parameters. Results. Sustained virological response was achieved in 116 (31%) patients. 169 (45%) patients completed a full treatment course. Also, 44% of patients who received a pre-treatment liver biopsy completed treatment versus 46% completion rates for patients who did not receive a pretreatment liver biopsy. Baseline ICD9 diagnosis of a mental health disorder was not associated with higher treatment discontinuation rates. Conclusions. In conclusion, pretreatment liver biopsy was not a positive predictor for treatment completion, and the presence of mental health disorders was not a negative predictor for treatment completion. Joseph Kluck, Rose M. O’Flynn, David E. Kaplan, and Kyong-Mi Chang Copyright © 2013 Joseph Kluck et al. All rights reserved. HD-03/ES: A Herbal Medicine Inhibits Hepatitis B Surface Antigen Secretion in Transfected Human Hepatocarcinoma PLC/PRF/5 Cells Wed, 10 Apr 2013 13:38:09 +0000 http://www.hindawi.com/journals/heprt/2013/125398/ HD-03/ES is a herbal formulation used for the treatment of hepatitis B. However, the molecular mechanism involved in the antihepatitis B (HBV) activity of this drug has not been studied using in vitro models. The effect of HD-03/ES on hepatitis B surface antigen (HBsAg) secretion and its gene expression was studied in transfected human hepatocarcinoma PLC/PRF/5 cells. The anti-HBV activity was tested based on the inhibition of HBsAg secretion into the culture media, as detected by HBsAg-specific antibody-mediated enzyme assay (ELISA) at concentrations ranging from 125 to 1000 μg/mL. The effect of HD-03/ES on HBsAg gene expression was analyzed using semiquantitative multiplex RT-PCR by employing specific primers. The results showed that HD-03/ES suppressed HBsAg production with an IC50 of 380 μg/mL in PLC/PRF/5 cells for a period of 24 h. HD-03/ES downregulated HBsAg gene expression in PLC/PRF/5 cells. In conclusion, HD-03/ES exhibits strong anti-HBV properties by inhibiting the secretion of hepatitis B surface antigen in PLC/PRF/5 cells, and this action is targeted at the transcription level. Thus, HD-03/ES could be beneficial in the treatment of acute and chronic hepatitis B infections. Sandeep R. Varma, R. Sundaram, S. Gopumadhavan, Satyakumar Vidyashankar, and Pralhad S. Patki Copyright © 2013 Sandeep R. Varma et al. All rights reserved. Postinfantile Giant Cell Hepatitis: An Etiological and Prognostic Perspective Mon, 11 Mar 2013 09:38:45 +0000 http://www.hindawi.com/journals/heprt/2013/601290/ Giant cell hepatitis is common manifestation in pediatric liver diseases, but quite uncommon in adults, only about 100 cases reported in the English literature in the last two decades. Data for the present review were identified by a structured PubMed/MEDLINE search from 1963 to December 2012, using keywords postinfantile giant cell hepatitis (PIGCH), adult giant cell hepatitis, and syncytial giant cell hepatitis in adults and liver. We report a case of postinfantile giant cell hepatitis along with the review related to the etiology and respective outcome, as the literature in the last 20 years suggests. This condition is probably due to idiosyncratic or cytopathic response of individual to various hepatocytic stimuli. It is purely a histomorphological diagnosis and does not establish the etiology. Autoimmune liver diseases are most common etiology, in around 40% of cases, but various viruses, drugs, posttransplant condition, and other causes also have been reported. Prognosis depends upon the etiology. In this paper, we emphasized various causative factors of PIGCH and their respective outcome in patients affected by them. We also highlighted the possible pathogenesis and histopathological spectrum of this entity on the basis of description given in various studies and our limited experience of few cases. Chhagan Bihari, Archana Rastogi, and Shiv Kumar Sarin Copyright © 2013 Chhagan Bihari et al. All rights reserved. Hepatitis Viruses in Heamodialysis Patients: An Added Insult to Injury? Wed, 06 Mar 2013 15:29:37 +0000 http://www.hindawi.com/journals/heprt/2013/860514/ Hepatitis B (HBV) and hepatitis C (HCV) viruses are the most important causes of chronic liver disease in patients with end stage renal disease on hemodialysis. The prevalence of hepatitis infection among hemodialysis patients is high and varies between countries and between dialysis units within a single country. This case-control study was undertaken to estimate the occurrence of HBV and HCV infections in patients undergoing hemodialysis in our tertiary care center. All patients receving hemodialysis at our centre with HCV or HBV infection were included in the study. The total number of patients admitted for hemodialysis during the study period was 1710. Among these, 26 patients were positive for HBV, 19 were positive for HCV, and 2 were positive for both HCV and HBV. Mean age of the infected cases in our study was 48.63 years. Mean duration of dialysis for infected cases was 4.8 years while that of the noninfected controls was 3.18 years. The mean dialysis interval was twice a week. Interventions to reduce the occurrence of these infections are of utmost need to reduce the risk of long-term complications among hemodialysis patients. Kranthi Kosaraju, Sameer Singh Faujdar, Aashima Singh, and Ravindra Prabhu Copyright © 2013 Kranthi Kosaraju et al. All rights reserved. Occult Hepatitis B: Clinical Viewpoint and Management Mon, 04 Mar 2013 18:15:35 +0000 http://www.hindawi.com/journals/heprt/2013/259148/ Occult HBV infection (OBI) is defined as HBV DNA detection in serum or in the liver by sensitive diagnostic tests in HBsAg-negative patients with or without serologic markers of previous viral exposure. OBI seems to be higher among subjects at high risk for HBV infection and with liver disease. OBI can be both a source of virus contamination in blood and organ donations and the reservoir for full blown hepatitis after reactivation. HBV reactivation depends on viral and host factors but these associations have not been analyzed thoroughly. In OBI, it would be best to prevent HBV reactivation which inhibits the development of hepatitis and subsequent mortality. In diverse cases with insufficient data to recommend routine prophylaxis, early identification of virologic reactivation is essential to start antiviral therapy. For retrieving articles regarding OBI, various databases, including OVID, PubMed, Scopus, and ScienceDirect, were used. Mehdi Zobeiri Copyright © 2013 Mehdi Zobeiri. All rights reserved. Seroprevalence and Risk Factors for Hepatitis C Virus Infection among General Population in Central Region of Yemen Tue, 18 Dec 2012 09:19:14 +0000 http://www.hindawi.com/journals/heprt/2012/689726/ Background. Hepatitis C virus (HCV) represents a major worldwide public health problem. Though several studies from Yemen have provided an estimate of the prevalence of this viral infection, there exist only few studies which reflect the status in the general population. Aim. The present study was designed to investigate the prevalence of hepatitis C infection among general population in central region of Yemen. Methods. The study population comprised 2,379 apparently healthy subjects who were screened for hepatitis C antibodies (HCV Abs) status using ELISA quantitative technique. Seroprevalence rate of seropositive subjects was calculated and stratified by age, sex, educational level, and monthly income. Results. The study showed that out of 2,379 subjects, 31 (1.3%) were HCV Abs positive. Higher prevalence of HCV Abs was found among females, 24 (1.01%), than males, 7 (0.29%). The age specific prevalence rose from 00 (0.00%) in subjects aged ≤14 years to a maximum of 9 (0.38%) in subjects aged ≥55 years. The prevalence of HCV Abs was more prevalent in illiterate subjects and increased with decreasing monthly income. Conclusion. It was found that variables including age and educational level were significantly associated with HCV Ab positivity and not associated with gender and monthly income. Rajesh N. Gacche and Sadiq K. Al-Mohani Copyright © 2012 Rajesh N. Gacche and Sadiq K. Al-Mohani. All rights reserved. Prevalence of Occult Hepatitis C Virus in Egyptian Patients with Chronic Lymphoproliferative Disorders Wed, 12 Dec 2012 10:47:24 +0000 http://www.hindawi.com/journals/heprt/2012/429784/ Background. Occult hepatitis C virus infection (OCI) was identified as a new form of Hepatitis C virus (HCV), characterized by undetectable HCV antibodies and HCV RNA in serum, while HCV RNA is detectable in liver and peripheral blood cells only. Aim. The aim of this study was to investigate the occurrence of OCI in Egyptian patients with lymphoproliferative disorders (LPDs) and to compare its prevalence with that of HCV in those patients. Subjects and Methods. The current study included 100 subjects, 50 of them were newly diagnosed cases having different lymphoproliferative disorders (patients group), and 50 were apparently healthy volunteers (controls group). HCV antibodies were detected by ELISA, HCV RNA was detected in serum and peripheral blood mononuclear cells (PBMCs) by reverse transcription polymerase chain reaction(RT-PCR), and HCV genotype was detected by INNO-LiPA. Results. OCI was detected in 20% of patients group, compared to only 4% OCI in controls group. HCV was detected in 26% of patients group with a slightly higher prevalence. There was a male predominance in both HCV and OCI. All HCV positive patients were genotype 4. Conclusion. Our data revealed occurrence of occult HCV infection in Egyptian LPD patients at a prevalence of 20% compared to 26% of HCV. Samar Samir Youssef, Aml S. Nasr, Taher El Zanaty, Rasha Sayed El Rawi, and Mervat M. Mattar Copyright © 2012 Samar Samir Youssef et al. All rights reserved. Hepatitis C Virus Core Antigen Test in Monitoring of Dialysis Patients Tue, 04 Dec 2012 18:29:21 +0000 http://www.hindawi.com/journals/heprt/2012/832021/ Hepatitis C virus infection is a persistent worldwide public health concern. The prevalence of HCV infection is much higher in patients on chronic haemodialysis (HD) than in the general population. HCV infection can detrimentally affect patients throughout the spectrum of chronic kidney disease. Despite the control of blood products, hepatitis C virus transmission is still being observed among patients undergoing dialysis. Detection systems for serum HCV antibodies are insensitive in the acute phase because of the long serological window. Direct detection of HCV depends on PCR test but this test is not suitable for routine screening. Recent studies have highlighted the importance of HCV core antigen detection as an alternative to PCR. Few studies exist about the efficacy of HCV core antigen test in dialysis population. We studied the utility of HCV core antigen test in routine monitoring of virological status of dialysis patients. We screened 92 patients on long-term dialysis both by PCR HCV-RNA and HCV core antigen test. The sensitivity of HCVcAg test was 90%, the specificity 100%, the positive predictive power 100%, the negative predictive power 97%, and the accuracy 97%. We think serological detection of HCV core antigen may be an alternative to NAT techniques for routine monitoring of patients on chronic dialysis. Gioacchino Li Cavoli, Carmela Zagarrigo, Onofrio Schillaci, Francesca Servillo, Angelo Tralongo, Mario Coglitore, Filippo Spadaro, Concetta Scimeca, Natalia Li Destri, and Ugo Rotolo Copyright © 2012 Gioacchino Li Cavoli et al. All rights reserved. Hepatitis B Infection in Microbiology Laboratory Workers: Prevalence, Vaccination, and Immunity Status Tue, 04 Dec 2012 12:27:14 +0000 http://www.hindawi.com/journals/heprt/2012/520362/ The risk of contracting HBV by health care workers (HCW) is four-times greater than that of general adult population. Studies have demonstrated that vaccine-induced protection persists at least 11 years. High risk groups such as HCWs should be monitored and receive a booster vaccination if their anti-HBsAb levels decrease below 10 mIU/mL. In view of the above this study was undertaken to assess the HBV vaccination of the HCWs and their immunological response. Seventy-two HCWs of the Department of Microbiology, Maulana Azad Medical College, New Delhi, India, were recruited and blood sample was drawn for serological tests (HBSAg, anti-HCV, anti-HBsAb, anti-HBeAb, and anti-HBcAb). Anti-HBs titers of >10 mIU/mL were considered protective. Thirty-four (47.3%) of the participants were completely vaccinated with three doses. 25 (73.5%) of the participants with complete vaccination had protective anti-HBsAb levels as against 8 (53.3%) of those with incomplete vaccination and 9 (39.1%) of those who were not vaccinated at all. One of our participants was acutely infected while 29 participants were susceptible to infection at the time of the study. All HCWs should receive three doses of the vaccine and be monitored for their immune status after every five years. Boosters should be administered to those who become susceptible. Arun Kumar Jha, Sanjim Chadha, Preena Bhalla, and Sanjeev Saini Copyright © 2012 Arun Kumar Jha et al. All rights reserved. Antioxidant Therapy in Nonalcoholic Steatohepatitis Thu, 22 Nov 2012 15:26:05 +0000 http://www.hindawi.com/journals/heprt/2012/947575/ Nonalcoholic steatohepatitis (NASH) affects up to 3% of the North American population. It occurs as a manifestation of the insulin-resistant state and oxidative stress is thought to be a key component of its pathophysiology. Exercise and diet, which are the mainstay of therapy, are difficult to achieve and maintain with a disappointing long-term compliance record. There is growing literature on the potential for antioxidant therapy. The recent literature strongly suggests that vitamin E supplementation and other putative free radical scavengers and/or antioxidants are beneficial in improving biochemical and histological parameters in NASH. Said A. Al-Busafi, Mamatha Bhat, Philip Wong, Peter Ghali, and Marc Deschenes Copyright © 2012 Said A. Al-Busafi et al. All rights reserved. Compliance of Healthcare Professionals with Safety Measures for Control of Hepatitis Viruses in Hemodialysis Centers: An Experience from Southeast Iran Thu, 08 Nov 2012 10:22:38 +0000 http://www.hindawi.com/journals/heprt/2012/415841/ Introduction. Noncompliance with the recommended infection control measures by the healthcare professionals (HCPs) plays a major role in transmission of hepatitis B (HBV) and hepatitis C (HCV) viruses in hemodialysis (HD) wards. This study aimed to determine the compliance rate of the HCP with safety measures in the HD wards in southeast Iran. Patients and Methods. A total of 208 patients were enrolled. Adherence of HCPs with standard infection control measures was assessed. Results. Sixty-one HCPs with a mean age of 32.4 ± 11.2 years old were responsible for healthcare services. Compliance with the following items was weak: not sharing medications trolley (29.8%), disinfecting the shared instruments (46.2%), using single use materials for many patients (52.4%), carrying used materials in disposable containers (51.9%), not returning of unused materials to the clean room (55.3%), and adherence to hand washing (58.7%). Periodic monitoring for HBV and HCV was performed on 100% and 69.7% of the patients, respectively. Less than 2/3 of HCPs participated in the retraining courses. Conclusion. Compliance of HCPs with safety measures for viral hepatitis prevention was partly inadequate in HD wards. Emphasis on retraining of HCPs and official supervision would be effective steps in the reduction of viral dissemination. Sodaif Darvish Moghaddam, Mohammad Javad Zahedi, Mahdieh Dalili, and Mostafa Shokoohi Copyright © 2012 Sodaif Darvish Moghaddam et al. All rights reserved. Phylogenetic Analysis of Hepatitis E Virus in Northwest India Wed, 24 Oct 2012 15:14:40 +0000 http://www.hindawi.com/journals/heprt/2012/976434/ Genotyping and subtyping are important to understand epidemiology of the hepatitis E virus so as to improve control measures to prevent transmission of virus in the community. Hence, the aim of the current study was to identify the prevalent HEV genotypes in Rajasthan in acute sporadic hepatitis E cases with varying degree of liver failure. We studied hepatitis E virus (HEV) isolates from hospitalized patients in Rajasthan, western India. In a total of seventeen HEV sequences, six acute viral hepatitis, seven acute liver failure, and 4 acute- on-chronic cases were analyzed. Subtypes 1a and 1c of HEV are prevalent in Northwest India. Nidhi Subhash Chandra, Ramesh Roop Rai, and Bharti Malhotra Copyright © 2012 Nidhi Subhash Chandra et al. All rights reserved. The TNF-α -308 Promoter Gene Polymorphism and Chronic HBV Infection Wed, 24 Oct 2012 09:36:59 +0000 http://www.hindawi.com/journals/heprt/2012/493219/ Background and Aims. TNF-α -308 allele promoter polymorphism has been known to be a potential prognostic factor in patients with chronic HBV infection. We tried to determine how TNF-α -308 allele promoter polymorphism would affect the prognosis in patients with chronic HBV infection. Methods. We searched MEDLINE, EMBASE, and reference lists of relevant review articles related to the association between “TNF-α G-308A promoter polymorphism” with “chronic HBV infection”. We only focused on searching -308 locus in published studies. We reviewed 21 original articles about TNF-α -308 allele polymorphism and its effect on prognosis in patients with chronic HBV infection and discussed the results. Results. conflicting results were observed. The results were divided into 3 groups including neutral, negative, and positive associations between TNF-α -308 allele polymorphism and prognosis in patients with chronic HBV infection. We summarized the primary data as a table. Conclusions. Authors concluded that although there is an upward trend in evidence to claim that there is a positive relation between TNF-α G-308A promoter polymorphisms and resolution of chronic HBV infection, due to many biases and limitations observed in reviewed studies, an organized well-designed study is needed for clarifying the real association. Sirous Tayebi and Ashraf Mohamadkhani Copyright © 2012 Sirous Tayebi and Ashraf Mohamadkhani. All rights reserved. Hepatitis C Virus: A Critical Appraisal of New Approaches to Therapy Mon, 08 Oct 2012 10:04:50 +0000 http://www.hindawi.com/journals/heprt/2012/138302/ The HCV council 2011 convened 11 leading clinicians and researchers in hepatitis C virus from academic medical centers in the United States to provide a forum for the practical and comprehensive evaluation of current data regarding best practices for integrating new direct-acting antiviral agents into existing treatment paradigms. The council investigated 10 clinical practice statements related to HCV treatment that reflect key topical areas. Faculty members reviewed and discussed the data related to each statement, and voted on the nature of the evidence and their level of support for each statement. In this new era of DAAs, a comprehensive and critical analysis of the literature is needed to equip clinicians with the knowledge necessary to design, monitor, and modify treatment regimens in order to optimize patient outcomes. David R. Nelson, Donald M. Jensen, Mark S. Sulkowski, Greg Everson, Michael W. Fried, Stuart C. Gordon, Ira Jacobson, Nancy S. Reau, Kenneth Sherman, Nora Terrault, and David Thomas Copyright © 2012 David R. Nelson et al. All rights reserved.