End of treatment response in patients treated for hepatitis c virus with standard interferon and ribavirin based on viral load

To determine the End-of-Treatment-Response [ETR] to standard interferon and ribavirin based regimen in patients of chronic hepatitis C and to compare the ETR response in low and high viral load groups. Descriptive study. Virology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, from March 2012 to May 2013. Patients with chronic hepatitis C virus infection were included in the study. Pre-treatment viral load was determined by RoboGene Quantification kit. Based on viral load, the 400 patients were divided into two equal groups of low viral load [< 800,000 IU/ml] and high viral load [> 800,000 IU/ml]. The patients were treated with standard interferon alpha [3 million units subcutaneously thrice weekly] and ribavirin [10.6 mg/kg body weight] for 6 months. ETR was measured using Sacace Biotechnologies Qualitative kit. Chi-square test was used to compare the ETR in the two viral load groups. P-value < 0.05 was considered as significant. Out of 400 patients, 206 [51.5%] were males and 194 [48.5%] were females. Two hundred seventy [67.5%] patients achieved ETR and 130 [35.5%] failed to do so. In low viral load group, 145 [72.5%] patients achieved and 55 [27.5%] patients did not achieve ETR. In high viral load group, 123 [61.5%] patients achieved and 77 [38.5%] did not achieve ETR. The difference in ETR between low and high viral load groups was statistically significant [p=0.019]. End-of-treatment-response in patients treated for hepatitis C virus with standard interferon and ribavirin was greater in patients with low viral load as compared to patients with high viral load

Molecular and serological assessment of chronic HBV carriers and additional burden of applying updated guidelines in Pakistan

To assess the additional burden of the patients eligible for treatment, based on recommendations on viral load, in the light of 2009 version of AASLD guidelines, as compared to 2004 guidelines and to determine the frequency of HBeAg in chronic HBV carriers. Descriptive cross-sectional study. Virology Department, Armed Forces Institute of Pathology, Rawalpindi, from November 2010 to January 2012. Persons with chronic HBV infection, reporting for HBV DNA PCR test, were included in the study and blood samples were collected. HBV DNA load was determined by Real Time PCR. HBsAg and HBeAg were tested by ELISA. Out of the 801 subjects positive for HBsAg, 74 [9.24%] were positive for HBeAg. Out of them, 113 [14.1%] had HBV DNA load > 100,000 copies/ml and were eligible for treatment according to AASLD 2004 guidelines. Forty one [5.1%] had HBV load between 10,000 and 100,000 copies/ml, and were additionally eligible for treatment as per AASLD 2009 guidelines. The 5.1% of 4.5 million estimated HBV carries in Pakistan comes to 229500. There was a low HBeAg positivity and HBV DNA positivity in our chronic HBV infected persons. Moreover, there is an increase of 229500 potential candidates for HBV treatment in Pakistan based on viral load testing, according to the AASLD 2009 guidelines when compared with 2004 guidelines. The increase in the number of candidates for treatment may require an additional expenditure of tens of billions of rupees

Frequency of hepatitis B and C in young asymptomatic males

To understand the latest trends of hepatitis B and C viruses frequency by detecting Hepatitis B surface antigen and hepatitis C antibodies in young asymptomatic males. Descriptive study. This study has been carried out at the Department of Pathology Combined Military Hospital, Risalpur and Department of Virology, Armed Forces Institute of Pathology, Rawalpindi from 1st March 2010 to 30th September 2010. One thousand and forty two physically fit candidates between 17 to 23 years of age, reporting to Engineer Centre Risalpur, from Punjab and Khyber Pakhtunkhwa for induction in Armed Forces, were enrolled in the study by non-probability convenience sampling. They were screened for HBsAg and anti HCV by Immuno-chromatographic rapid test devices, at Pathology Department Combined Military Hospital Risalpur. All positive samples were confirmed from Department of Virology, Armed Forces Institute of Pathology Rawalpindi by Enzyme Linked Immuno-sorbent assay. Out of 1042 study subjects, screened during the period, 31 [2.97%] were found to be positive for HBsAg and 16 [1.53%] for anti HCV. As per available information, 876 study subjects belonged to rural areas and 166 belonged to urban areas. Mean age was 20 +/- 1.4 years and range was 17 to 23 years. Province wise 987 individuals belonged to Punjab, out of which 30 cases [3.0%] were positive for HBsAg and 15 cases [1.5%] were positive for anti HCV, which indicates that the predominant part of the study subjects were from Punjab and their positivity percentage is almost same as given in the study, whereas 55 individuals belonged to Khyber Pakhtunkhwa. Frequency of Hepatitis B and C in asymptomatic young males of Punjab is 3% and 1.5% respectively and that for Khyber Pakhtunkhwa is 1.8% for both viruses

Seropositivity of hepatitis delta virus in patients with chronic Hepatitis B virus infection

To determine the frequency of hepatitis delta virus [HDV] seropositivity in patients with chronic Hepatitis B Virus [HBV] infection at Armed Forces Institute of Pathology [AFIP], Rawalpindi. Study design: Cross-sectional study. The study was conducted at department of Virology, AFIP, Rawalpindi. A total of 227 serum samples were collected at AFIP, Rawalpindi, from patients with chronic hepatitis B virus [HBV] infection along with a short history regarding the age, sex and socioeconomic status. Enzyme Linked Immundsorbent Assay [ELISA] for detection of HDV Immunoglobulin G [IgG] and Immunoglobulin M [IgM] antibodies was performed on all the collected serum samples. A total of 30 [13.2%] patients out of 227, were found positive for IgG. The mean age of the patients was 35.8 +/- 10.7 years. Seropositivity of HDV-IgG was 12.8% [25/195] in males and 15.6% [5/32] in females. 11.8% [6/51] of patients from higher socioeconomic group and 13.6% [24/176] in lower socioeconomic group were positive for HDV-IgG [p=0.728%]. Our study shows that 13.2% of chronic hepatitis B virus infected patients at AFIP, Rawalpindi, were positive for HDV IgG. HDV seropositivity was not affected by demographic variables-such as age, gender and socioeconomic status of patients

Hepatitis B viral load in various categories of chronic hepatitis B carriers

To determine serum hepatitis B virus [HBV] DNA levels by Real-time Polymerase chain reaction [PCR] in different categories of treatment-naive patients with chronic HBV infection in context with Hepatitis B serology and serum Alanine aminotransferase [ALT] levels. Cross-sectional study. A total of 122 chronic hepatitis B carriers, including 79 low grade carriers [Anti-HBe positive HBeAg negative], 40 high grade carriers [HBeAg positive, Anti-HBe negative] and 3 intermediate grade carriers [Both HBeAg and Anti-HBe negative] were evaluated for HBV DNA levels and serum ALT levels. The serum HBV DNA levels of the low grade carriers with normal ALT levels [<40 IU/L] were significantly lower than the low-grade carriers with raised ALT levels [mean viral load 3x10[3] vs. 1.6x10[6] copies/mL; p=0.0003]. The HBV DNA levels of the high grade carriers were significantly higher than those of the low grade carriers with normal ALT levels [mean viral load 6.4x10[7]vs. 3x10[3] copies/mL; p=0.0007] and than those of low grade carriers with raised ALT levels [mean viral load 6.4x10[7] vs. 1.6x10[6] copies/ mL; p=0.03]. The results show that HBV DNA levels vary in different categories of chronic hepatitis B carriers and when evaluated by a sensitive quantitative PCR assay the HBV DNA levels can be used for differentiation between HBeAg-negative chronic hepatitis B and inactive hepatitis B surface antigen carrier state

Hepatitis A virus infection - shifting epidemiology

To determine the age distribution in HAV infection and seasonal variations in the prevalence of acute viral hepatitis caused by hepatitis A virus. A descriptive study. The study was carried out on the patients reporting at Virology Department, Armed Forces Institute of Pathology [AFIP], Rawalpindi, for determination of hepatitis A virus [HAV] IgM antibody, from July 2003 to June 2004. Altogether 626 patients with clinical suspicion of hepatitis A virus infection were referred to AFIP Rawalpindi for this test. Blood samples were collected and sera were separated and transferred to plastic aliquots that were stored at -20oC in a retrievable fashion until utilized in testing. The testing for ant-HAV IgM was carried out with the help of a commercial Enzyme Linked Immunosorbant Assay [ELISA] using reagent kits of DiasSorin [Germany] for HAV IgM antibodies. The HAV IgM positive rate was 40.57% [252/626]. Those tested included the sporadic cases as well as the patients from outbreak in two schools of Nowshera cantonment. The age of patients testing positive for HAV IgM, ranged from 03 to 27 years. There was a statistically significant seasonal difference in rate of positivity in different months of the calendar year. An outbreak of HAV infection was seen in the children of two neighboring schools of a cantonment, in which 44 children in different classes developed clinical jaundice. HAV infection occurs in a significant proportion of young people with a clinical suspicion of HAV infection. There is a changing trend of developing hepatitis A in the age beyond 18 years and in outbreaks, which was not there in our patients previously due to universal immunity found against HAV by the age of 18. It was because of chances of consumption of polluted food

Outbreak of dengue fever in Mangla and Mirpur area

Dengue virus infection has been endemic in Pakistan. An outbreak of febrile illness associated with thrombocytopenia was reported from Mangla and adjoining areas in vicinity of Mangla Dam during July-August 2003. We carried out a serological investigation of the outbreak by serosurveillance. Sera from 52 representative cases were received for viral studies at our institute. Aim of the study was to rule out dengue infection in these cases. Descriptive laboratory based. Department of Virology, Armed Forces Institute of Pathology, Rawalpindi. According to clinical history all the, patients had fever of 3-10 days duration associated with thrombocytopenia. Suspecting Dengue infection, their acute sera were tested for Dengue IgM, by the kit manufactured by Diagnostic Automation Inc., Dengue virus IgM ELISA USA. Among 52 single sera from these cases. Dengue IgM antibodies were detected in 38[73%] cases. Among the sero-positive cases, 7[18.4%] had Vivax malaria. 32[84%] were males with mean age of 34 years and 6[16%] were females with mean age of 27 years. Platelets were below 150,000/micro l in all the cases. Occurrence of Dengue fever in northern Pakistan has been documented and this should now be considered in the differential diagnosis of undiagnosed cases of fever, moreover concomitant malaria infection emphasizes the need for sustainable, community-based mosquito control

Hepatitis B surface antigen; screening in young Pakistani males

Hepatitis B is one of the most common infectious diseases in the world with over 350 million chronic carriers worldwide. In Pakistan, most of the studies have been done in high risk groups such as health care workers, voluntary blood donors etc. Few studies have been reported in general population so far. Therefore, there is dearth of knowledge regarding prevalence of HBV infection in young males seeking employment in various sectors of society. To investigate the prevalence of hepatitis B surface antigen [HBs Ag] in a population-based sample of healthy young males that were drawn from various regions of Pakistan for recruitment. Combined Military Hospital, Attock, from Jan 2001 to Mar 2002. Cross-sectional observational. A total number of 4552 healthy young males who reported for pre-recruitment physical examination, belonging to all the provinces of Pakistan, Northern areas and Azad Kashmir were screened for HBs Ag by immunochromatographic technique. The positive result was confirmed using Enzyme Immunoassay kit. Out of the total of 4552 healthy young males; HBsAg was positive in 190 subjects [4.2%]. Prevalence of HBs Ag in individuals from Sindh was significantly higher than those from other regions. Major risk factors for HBV infection were sharing of razors [56.8%], history of intravenous injections [39.5%], jaundice in the subject [18.4%] and jaundice in family [18.9%]. In HBs Ag positive subjects, 11.1% revealed no identifiable risk factor. There is more than two fold reduction in the HBs Ag prevalence over the last ten years. Major risk factors in the population are exposure to contaminated blood and use of needle sticks. However, a sizeable number of HBV infection do occur in our young healthy males which go undetected and are only detected on screening at the time of employment. Despite the already detailed knowledge about the transmission of hepatitis B, more work is required to search other mode of transmission on Hepatitis B

Prevalence of hepatitis B and C in a healthy cohort

Hepatitis B virus [HBV] and hepatitis C virus [HCV] are the commonest causes of chronic liver disease all over the world including Pakistan. Earlier studies show wide variation in the results regarding the positivity of HBV and HCV infections [total number 665] in different groups of Pakistani populations. Prospective, descriptive. July-September 2004, Combined Military Hospital, Khuzdar and Armed Forces Institute of Pathology [AFIP], Rawalpindi. Healthy adults belonging to different areas of Pakistan were screened for Hepatitis B surface antigen [HBsAg] and anti-Hepatitis C virus antibodies [Anti-HCV] by rapid method and positive cases were confirmed by ELISA from Armed Forces Institute of Pathology [AFIP] Rawalpindi. The sero-positivity of anti-HCV was found to be 3.3% and that of HBsAg was 3%. There was wide variation in prevalence of anti-HCV and HBsAg in different areas of Pakistan. This study indicates that although there is trend toward decline in prevalence of hepatitis B, there is considerable HCV and HBV threat to our population and there is a genuine need for strict adherence to preventive measures

Treatment response in HCV related chronic hepatitis

To evaluate the virological response to treatment with interferon and ribavirin in patients with hepatitis C related liver disease. Design: A descriptive study. Place and Duration of Study: January to September 2002 at Virology Department, Armed Forces Institute of Pathology Rawalpindi. Material and Two hundred seventy-nine patients were included in the study. These patients had taken interferon and ribavirin treatment for HCV related chronic hepatitis, and were referred to AFIP for HCV RNA testing by polymerase chain reaction [PCR] between January 2002 and September 2002. Out of 279 cases, 229 had taken the treatment for 06 or 12 months and were tested for end-of-treatment response [ETR]. Fifty patients had completed their treatment regimens of 6 or 12 months treatment, at least 24 weeks before their PCR test and were having follow-up testing for sustained viral response [SVR]. The sera of these patients were tested for HCV RNA by PCR, using a commercial kit of Amplicor [Roche] for qualitative detection of HCV RNA. Out of 229 cases tested for end-of-treatment response, 198 [86.5%] had no detectable HCV RNA [responders] and 31[13.5%] were PCR positive [non-responders]. Thirty-eight out of 50 cases, tested for a sustained viral response, had a negative result for HCV PCR thus showing sustained response rate of 76%. The viral remission/response to interferon and ribavirin combination therapy in our patients was better than that quoted in other regions