Correlation between hepatitis B surface antigen titers and HBV DNA levels

To assess the correlation between serum HBsAg titers and hepatitis B virus [HBV] DNA levels in patients with hepatitis B envelop antigen-negative [HBeAg -ve] HBV genotype-D [HBV/D] infection. A total of 106 treatment- na‹ve, HBeAg -ve HBV/D patients were included; 78 in the inactive carrier [IC] state and 28 in the active hepatitis [AH] stage. HBV DNA load and HBsAg titers were tested using TaqMan real-time polymerase chain reaction [PCR] and automated chemiluminescent microparticle immunoassay, respectively. The median [range] log10 HbsAg titer was significantly lower in the IC group compared with AH group, 3.09 [-1 to -4.4] versus 3.68 [-0.77 to 5.09] IU/mL, respectively; P < 0.001. The suggested cutoff value of HBsAg titer to differentiate between the two groups was 3.79 log10 IU/mL. In addition, there was a significant positive correlation between HBsAg and HBV DNA levels in the whole cohort, AH, and IC groups [r = 0.6, P < 0.0001; r = 0.591, P = 0.001; and r = 0.243, P = 0.032, respectively]. Serum HBsAg titers may correlate with HBV DNA in treatment-na‹ve HBeAg -ve HBV/D patients, and supports the use of HBsAg levels in clinical practice as a predictor of serum HBV DNA levels.

Hepatitis C genotype 4: genotypic diversity, epidemiological profile, and clinical relevance of subtypes in Saudi Arabia

Hepatitis C virus genotypes 4 [HCV-4] is the most prevalent genotype in Saudi Arabia, although it's various subtypes, mode and route of transmission remains unknown. The aim of this study was to analyze [i] the variability of the HCV-4 subtypes, the route and source of HCV transmission and [ii] the influence of HCV-4 subtypes on their therapeutic response. Sixty-four HCV-4 patients were analyzed retrospectively for the prevalence of various sub-genotypes and the possible mode of transmission, and it was correlated with their treatment response to pegylated interferon [PEG-IFN] alpha-2a and ribavirin therapy. Positive history of blood or blood products transfusion was noted in 22 patients [34%], hemodialysis in 10 patients [15.6%], surgery in 7 patients [11%], and unknown etiology in 25 patients [39%]. Prevalence of HCV-4 subtypes was 4a = 48.4% [31/64], 4d = 39% [25/64], 4n = 6.25% [4/64], and remaining combined [4m, 4l, 4r, 4o] 6.25% [4/64]. No significant correlation between subtypes and the source of transmission was recognized [P = 0.62]. Sustained virological response in all HCV-4 patients was 64% [41/64], while in each subtypes separately it was 4a 77.4% [24/31], 4d 52% [13/25], and combined [4n, 4m, 4l, 4r, 4o] 62.5% [5/8] [P = 0.046]. No obvious cause for the mode of HCV transmission was noted in majority of the patients. No significant correlation was observed between HCV-4 subtypes and the source of HCV infection. 4a and 4d subtypes were the most common in Saudi Arabia, and patients infected with 4a subtype responded significantly better to combination therapy than to 4d subtype

Epidemiology of viral hepatitis in Saudi Arabia: are we off the hook?

Some 400 million people worldwide are currently infected with the hepatitis B virus [HBV], and the infection is common in the Middle East. Another 170 million people around the globe presently live with chronic hepatitis C virus [HCV] infection. Both HBV and HCV represent a worldwide epidemic. Despite significant decline in the prevalence of HBV and HCV infection in Saudi Arabia, these viral diseases cause significant morbidity and mortality, and impose a great burden on the country's healthcare system. On the other hand, Saudi epidemiology studies have shown that the hepatitis A virus seroprevalence in the country has reduced considerably over the past two decades. The progress in mapping the epidemiological pattern of viral hepatitis in Saudi Arabia has not only aided our understanding of the disease, but has also exposed the small but relevant gaps in our identification of the intricate details concerning the disease's clinical expression. In this review, we aim to document the timeline of viral hepatitis epidemiology in Saudi Arabia, while summarizing the relevant published literature on the subject

Saudi gelines for the diagnosis and management of hepatocellular carcinoma: technical review and practice guidelines created and endorsed by the saudi association for the study of liver diseases and transplantation and the Saudi oncology society

Recognizing the significant prevalence of hepatocellular carcinoma [HCC] in Saudi Arabia, and the difficulties often faced in early and accurate diagnoses, evidence-based management, and the need for appropriate referral of HCC patients, the Saudi Association for the study of liver diseases and transplantation [SASLT] formed a multi-disciplinary task force to evaluate and update the previously published guidelines by the Saudi Gastroenterology Association. These guidelines were later reviewed, adopted and endorsed by the Saudi Oncology Society [SOS] as its official HCC guidelines as well. The committee assigned to revise the Saudi HCC guidelines was composed of hepatologists, oncologists, liver surgeons, transplant surgeons, and interventional radiologists. Two members of the task force served as guidelines editors. A wide based search on all published reports on all aspects of the epidemiology, natural history, risk factors, diagnosis, and management of HCC was performed. All available literature was critically examined and available evidence was then classified according to its strength. The whole document and the recommendations were then discussed in details by members and consensus was obtained. All recommendations in these guidelines were based on the best available evidence, but were tailored to the patients treated in Saudi Arabia. We hope that these guidelines will improve HCC patient care and enhance the multidisciplinary care needed for these patients

Effect of interferon treatment on hearing of patients with chronic hepatitis C

Some reports in the literature have linked interferon therapy for the treatment of hepatitis C [HCV] with hearing loss. The aim of this study has been to examine the effects of interferon therapy on hearing of patients treated for HCV. Patients were recruited according to preset inclusion criteria from two centers. All patients received standard dose pegylated interferon [PEG-IFN alpha-2b or alpha-2a] plus ribavirin [RBV]. All patients had pure-tone audiometry [PTA], tympanogram and distortion-product otoacoustic emission [DPOAE] before treatment, three months after initiation of treatment, and three months after completion of treatment. Twenty one patients were prospectively recruited. The mean age was 45.7 years. The male to female ratio was 1.1:1. The mean PTA was 15.9 +/- 5.3 before treatment, 17.4 +/- 6.1 during treatment and 16.5 +/- 5.1 after treatment. The differences between pre and mid, pre and post, as well as mid and post were not significantly different [P>0.05] in all audiological assessments. Our results indicate that PEG-IFN/RBV therapy does not have any impact on the hearing thresholds of patients with HCV

Liver abscess presentation and management in Saudi Arabia and the United Kingdom

Liver abscess [LA] is a well-described disease in the medical literature; however, information about its characteristics and outcome in the Middle East is lacking. We compared the mode of presentation, risk factors, management and outcome of LA patients in Saudi Arabia with cases from the United Kingdom [UK]. Retrospective review of LA patients from three tertiary care centers [2 from Saudi Arabia and 1 from the UK] over a period of 10 years, from 1995 to 2005. Data collected included demographic characteristics; clinical presentation; biochemical, microbiological and radiological findings; treatment modalities; and outcome. A total of 83 patients were diagnosed with LA, including 48 patients from Saudi Arabia and 35 patients from the UK. The mean [SD] age was 45.2 [20.3] years for those from Saudi Arabia and 55.4 [18.8] years for those from the UK [P=.022]. The majority of the patients were males [70% from Saudi Arabia and 80% from the UK]. Upper abdominal pain and fever were the commonest symptoms, each reported in 87% of the cases. Alkaline phosphatase elevation was the commonest liver function abnormality, seen in 66 [80%] patients. Organisms were isolated in 43 [52%] cases and the majority of these were coliforms [58%]. Amebic liver abscesses occurred in 19 [23%] patients and all of those patients were either from or had traveled recently to the Indian subcontinent. Complete resolution of the abscesses was achieved in 66 [80%] patients with aspiration and/or antibiotics, and 9 [10.8%] patients died. On multivariate analysis, underlying malignancy, hypotension and chest signs at presentation were predictors of poor outcome [P=.008, .029 and .001, respectively]. Successful resolution of LA is achievable in the majority of the cases, although underlying malignancy is associated with poor outcome. Amebic liver abscesses must be considered in patients with a history of travel to endemic areas

Liver biopsy for histological assessment - the case against

Percutaneous liver biopsy [LB] remains an important tool in the diagnosis and management of parenchymal liver diseases. In current practice, it is most frequently performed to assess the inflammatory grade and fibrotic stage of commonly encountered liver diseases, with the diagnostic role relegated to secondary importance. The role of LB remains a vastly controversial and debated subject, with an ever- increasing burden of evidence that questions its routine application in all patients with liver dysfunction. It remains, essentially, an invasive procedure with certain unavoidable risks and complications. It also suffers shortcomings in diagnostic accuracy since a large liver sample is required for an ideal assessment, which in clinical practice is not feasible. LB is also open to observer interpretation and prone to sampling errors. In recent years, a number of noninvasive biomarkers have evolved, each with an impressive range of diagnostic certainty approaching that achieved with LB. These noninvasive tests represent a lower-cost option, are easily reproducible, and serve as suitable alternatives to assess hepatic inflammation and fibrosis. This article aims to debate the shortcomings of LB while simultaneously demonstrating the diagnostic accuracy, reliability and usefulness of noninvasive markers of liver disease thereby making the case for their utilization as suitable alternatives to LB in many, although not all, circumstances

Coincidence of acute brucella hepatitis and dengue fever or serologic cross-reactivity?

Hepatic involvement in brucellosis is not uncommon since 10-20% of patient infected with brucella species can have abnormal liver function tests. The usual presentation of brucella hepatitis is in the form of chronic granulomatous hepatitis with mild to moderate elevation of liver enzymes, while acute hepatitis is rare. We report a young patient who presented with acute brucella-induced hepatitis and co-infection with dengue hemorrhagic virus resulting in severe elevation of liver enzymes and absence of granuloma on histology. His mother also simultaneously tested positive for both infections. The patient responded well to anti-brucella therapy with normalization of his liver profile. We discuss, herein, the hepatic involvement of these two infections and discuss the possible serological cross-reactivity between brucella and dengue fever virus