Biomarcadores convencionales y emergentes en hepatitis B / Conventional and emerging biomarkers in hepatitis B

A nivel mundial, 300 millones de personas están infectadas por el virus de la hepatitis B (VHB). A pesar de que existe una vacuna que previene la infección y se dispone de tratamiento antiviral que suprime la replicación del virus, no hay cura aún. El principal problema que evita la recuperación total del paciente, incluso para aquel que recibe tratamiento, es la persistencia de dos formas del genoma viral en los hepatocitos: el ADN circular covalentemente cerrado (ADNccc), el cual se encuentra en forma de episoma y tiene la capacidad de replicarse, y las secuencias lineales subge-nómicas que se integran en el genoma humano, con potencial oncogénico. Hasta el momento se dispone de unos pocos biomarcadores para monitorear o predecir la progresión de la enfermedad y la respuesta al tratamiento. Estos biomarcadores se detectan durante la infección, y son la base para la monitorización de la enfermedad y hacer un diagnóstico de la fase clínica de la infección. Recientemente han surgido nuevos biomarcadores como el antígeno relacionado con el core del virus de la hepatitis B (HBcrAg) y la detección del ARN del VHB, que parecen correlacionarse con los niveles transcripcionales del ADNccc, además, durante el tratamiento parecen ayudar a predecir la respuesta y podrían identificar aquellos a quienes se les puede suspender la terapia sin riesgo de recaída. En esta revisión, se describe la utilidad de los principales biomarcadores convencionales en hepatitis B, y se abordan los dos biomarcadores emergentes más estudiados que prometen evaluar el curso de la infección, al igual que determinar la progresión de la enfermedad y la respuesta al tratamiento.

Globally, 300 million people are infected with hepatitis B virus (HBV). Although there is a vaccine that prevents infection and antiviral treatment that suppresses the replication of the virus, there is still no cure. The main problem that prevents the total recovery of the patient, even for those who recei-ve treatment, is the persistence of two forms of the viral genome in hepatocytes: covalently close circular DNA (cccDNA), which is in the form of an episome that has the ability to replicate, and linear subgenomic sequences that are integrated into the human genome, with oncogenic potential. Few biomarkers are currently available to monitor or predict disease progression and response to treatment. These biomarkers are detected during infection and are the basis for monitoring the di-sease and making a diagnosis of the clinical phase of the infection. New biomarkers have recently emerged, such as hepatitis B core-related antigen (HBcrAg) and HBV RNA detection, which seem to correlate with cccDNA transcriptional levels while during treatment seem to help predict response, and could identify those for whom therapy can be discontinued without risk of relapse. In this review, the usefulness of the main conventional biomarkers in hepatitis B is described, and the two most studied emerging biomarkers are mentioned, which promise to evaluate the course of the infection, as well as to determine disease progression and treatment response.

Seropositivity For Viral Markers in Patients Undergoing Cataract Surgery Diagnosed Unexpectedly

Background: To find the prevalence of unexpected seropositive viral markers in the patients undergoing cataract surgery.Material & Methods:It was a longitudinal observational study. Total1180 cataract patients were studied. Patients were discovered unexpectedly positive for hepatitis B antigen, hepatitis C, human immunodeficiency virus during preoperative screening for cataract surgery. HBV and HCV patients were referred for medicine opinion and operated after treatment and clearance. HIV patients were referred to ART center for further management.Results:During the study period 1180 patients, 504 males and 676 females were studied. 34 patients work positive for HIV, twelve patients were positive for hepatitis B and 50 patients were found positive for HCV. The patients accidentally found positive were 18/34 for HIV, 6/12 for hepatitis B and 32/50 for hepatitis C.Conclusions:We concluded that preoperative screening should be done for viral markers before every cataract surgery to prevent spread of such infections. Mass immunization against hepatitis B should be done among health care workers.

THE STUDY OF SERO-PREVALENCE AND TRENDS OF HIV VIRAL MARKERS AMONG BLOOD DONORS IN NORTHERN INDIA

Transfusion of blood and blood components could be responsible for saving millions of life each year throughout the world. However, on the other hand , an improperly screened donated blood can be a source of transfusion transmitted infections (TTIs). Some important prevalent infections are caused by human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum and malaria parasite. To study the sero-prevalence and trends of HIV viral markers amidst blood donors in Northern India.The study was carried out in the blood bank section of Department of Pathology, Era's Lucknow Medical College, Era University, Lucknow. The present study was conducted as a retrospective & prospective observational study. Retrospective data of past eight years before commencement of study (2008 to 2015) and prospective data of one and a half years (2016 and 2017) was used in the study. Data of 22192 blood donors was explored for the present study. Only 10 donors were found to be positive for HIV viral markers. Prevalence of HIV positivity was relatively much lower than that reported in contemporary studies. Nevertheless, the present study underscored the need to carry out screening of viral markers and their periodic audit in order to understand the changing trends of sero-positivity among blood donors.

A study of spectrum and fetomaternal outcome of Jaundice in pregnant women: an experience from a tertiary referral centre of North India

Background: Pregnancy in jaundice is an important Medical disorder, commonly seen in developing countries like India. The objective of the study was to evaluate the causes leading to jaundice in pregnancy and to analyse the feto-maternal outcome in patients of jaundice in pregnancy.Methods: This was a prospective observational study of antenatal cases with jaundice admitted in the Department of Obstetrics and Gynecology, King Georges Medical University, Lucknow over a period of one year after getting approval of ethical clearance. Total 122 cases were enrolled after informed consent.Results: Total of 122 cases were enrolled, Incidence of jaundice in pregnancy was 1.2%. Majority of patients were of age group 20-25 years 48.4%. About 69.7% presented at gestational age of 29-40 weeks. Most common cause was pre-eclampsia 33.6%, followed by cholestasis 23.75% and hepatitis 17.2%. Amongst hepatitis, most common was hepatitis B in 26.7%. Out of 122 cases, 59.8% delivered while 50.2% were undelivered 52.4% patients improved and were discharged while 47.6% patients expired. Vaginal deliveries were 56.1%, abdominal deliveries were 43.9%, and main reason for maternal mortality was hepatic encephalopathy in 64.6%. Mortality was higher in patients with total bilirubin > 10mg%. Perinatal mortality was 37%.Conclusions: Pregnancy complicated with jaundice carries very poor maternal and fetal outcome. Poor outcome may be attributed to delay in seeking medical advice, lack of awareness, lack of proper antenatal checkups 100% ANC booking can help in reducing fetomaternal morbidity and mortality.

Outcome and management of antenatal patients with jaundice in tertiary care centre of eastern India: a retrospective study.

Background: Aim of current study was to know the etiological factors of jaundice among pregnant patients, outcome and their management. Methods: A retrospective study done at IMS, BHU in obstetrics and gynecology department among pregnant patients with jaundice admitted in obstetric wards and labour room in six months duration. Results: Among total 1960 admissions, 78 (3.97%) patients presented with jaundice. Out of all admissions 27 (1.37%) were HBSAg, 8 (0.40%) HEV, 7 (0.35%) HCV, 6 (0.30%) of HBSAg and HEV co-infection, cholestasis with pregnancy 20 (1%) and 10 (0.51%) patients with pre-eclamptic liver disease with HELLP. Conclusions: Jaundice in pregnancy may be lethal to mother and fetus. As the course of disease is also rapid and in short period it may affect the fetus in utero also, early detection and prompt management of these cases should be done.

Detection of HBV DNA in Needle Biopsied Paraffin Embedded Liver Tissues of Chronic Hepatitis B Patients by PCR: Comparison with Serological and Immunohistochemical Studies

In this study, the prevalence of Hepatitis B virus(HBV) DNA in the needle biopsied paraffin embedded liver tissues of chronic hepatitis B patients by rapid nested PCR was examined. DNA was extracted by NaOH with boiling, and amplified by rapid air thermocycler with glass capillary tubes and nested PCR with two primer sets specific for the surface and the core genes of HBV. The PCR results were compared to that of serum HBeAg, serum HBV DNA by dot blot hybridization with a radioactive DNA probe, and tissue immunohistochemical (HBsAg/ HBcAg) studies. Among 44 patients with chronic hepatitis with serum HBsAg positivity, HBV DNA could be detected by PCR in 43 liver tissues (98%). This results were comparable to the positive rates of 94%(31/33) for serum HBV DNA, 80%(35/44) for serum HBeAg, and 59%(26/44) and 75%(33/44) for tissue HBsAg and HBcAg, respectively. The accordance rate between tissue PCR and serum DNA probe testing was 91%. The results indicate that HBV DNA detection by rapid nested PCR of paraffin embedded liver tissues by needle biopsy is a more sensitive method to detect the HBV DNA carrier than the serum HBeAg or tissue HBsAg/HBcAg status, and is well correlated with the result of serum HBV DNA probe testing. Therefore this method is a practical indicator for the diagnosis and replication status in retrospective analysis.