A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica

The seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV), human T lymphotropic virus type-1 (HTLV-1) and syphyilis were determined in 129 HIV-1-infected patients using commercially prepared reagents. The seroprevalences were HCV, 0 (0/129); HBV, 37 (48/129); HTLV-1, 5 (6/129) and syphilis, 20 (26/129). Fifteen per cent (19/129) of the patients had active/chronic HBV infection. The seroprevalence of HBV was statistically significantly higher in HIV-1 infected men (24/49, 50 versus 17/80, 21; p = 0.005), while the seroprevalence of syphilis was statistically significantly increased in HIV-1 infected patients in the over-40 age group (10/31, 32 versus 6/53, 11; p = 0.05). These findings throw the spotlight on HBV infection and syphilis and suggest that these two sexually transmitted infections should be carefully surveyed in patients with HIV/AIDS in Jamaica. It is essential for management protocols in Jamaica to include screening for evidence of these co-infections

Safety and immunogenicity of indigenous recombinant hepatitis B vaccine (Shanvac-B) in comparison with commercially available vaccine.

AIM: To assess the clinical safety, reactogenicity and immunogenicity of an indigenously developed recombinant hepatitis B vaccine (Shanvac-B; Shantha Biotechnics) and to compare it with another commercially available vaccine (Engerix-B, SmithKline Beecham) in healthy adults. METHODS: 120 healthy adults randomLy received 20 micrograms of either Engerix-B (Group A; n = 61) or Shanvac-B (Group B; n = 59) in 0, 1, 2 months schedule. Anti HBs was assessed using commercially available AUSAB kits (Abbott Laboratories) one month after each dose. RESULTS: Protective seroconversion rates after first, second and third dose were 10%, 62.7% and 91.4%, respectively in Group A and 22.4%, 68.9% and 96.4% in Group B, respectively. The geometric mean titer (GMT) after the third dose was significantly high in Group B (419 mIU/mL) than in Group A (140 mIU/mL; p < 0.001). The GMT was significantly higher in women in both the groups. The indigenous vaccine was found to be clinically safe and well tolerated without significant side effects. CONCLUSION: The recombinant hepatitis B vaccine (Shanvac-B) developed in India is safe, well tolerated, and highly immunogenic, with high seroconversion and GMT response.

Inmunología de la hepatitis C / Immunology of hepatitis C

Esta revisión resume lo que actualmente se sabe acerca de las respuestas inmunes celular y humoral al virus de la hepatitis C. Los resultados de estudios sobre inmunogenicidad de las proteínas virales reportados hasta ahora son analizados, y los puntos de controversia acerca de la inmunología e inmunopatología de la hepatitis C son discutidos. Un cúmulo de evidencia apoya la existencia en sujetos infectados por el virus de la hepatitis C de fuertes respuestas inmunes humoral y celular. Las regiones inmunodominantes del virus de la hepatitis C al nivel de las células B y para células T CD4+ restringidas al CMH clase II son las proteínas Core, NS3 y NS4. Por su parte, los linfocitos T citotóxicos CD8+ que infiltran el hígado reconocen epítopes en la proteínas Core, E1, E2/NS1 y NS2 de una manera restringida al CMH clase I. Las respuestas de linfocitos citotóxicos a Core, NS3, NS4 y NS5 han sido detectadas en sangre periférica de pacientes crónicamente infectados con el virus de la hepatitis C. Aunque estas respuestas de células B y T pueden contribuir a eliminar el virus, en la mayoría de los casos no son capaces de resolver infecciones crónicas. Ningún epítope protector de células B o T ha sido encontrado hasta ahora. Es cada vez más claro que la respuesta inmune juega un papel fundamental en la patogénesis de la enfermedad hepática en pacientes con hepatitis C

Seroepidemiology of hepatitis A virus antibody in primary school children in Khon Kaen Province, northeastern Thailand.

Hepatitis A is a disease commonly found in Thai children. Since 1984, there have been very few reports on the age specific prevalence of hepatitis A virus infection in the northeastern part of Thailand, which has the largest population and is the poorest area of the country. We studied the seroprevalence of hepatitis A virus (HAV) antibody in 3 primary school children in different areas of Khon Kaen Province, northeastern Thailand. Anti-HAV level was assayed by ELISA. Four hundred and forty-one children age 6-12 years were selected from one primary school in the urban area and two from rural areas. The highest prevalence was 22.6% at age 12 years and 0 at age 6 years. The seroprevalence was highest, 45%, in rural school children of the lowest socioeconomic status as compared to 10.8% and 2.6% in other urban school children. The overall prevalence was 12.7% and the age specific prevalence with 95% CI are presented. These data indicated a much lower seroepidemiological prevalence than previously reported and might be related to the level of socioeconomic and standard of public sanitation and living conditions.

Etiology of acute non-A, B, C hepatitis in Thai patients: preliminary study.

To better characterize the etiology of acute non-A, B, C hepatitis, 24 sera from 50 acute hepatitis without acute markers for hepatitis A, B, and C were examined for acute markers for the hepatitis E virus (HEV), cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2), and Epstein-Barr virus. Immunoglobulin M (IgM) specific for HEV, HSV-2, and CMV was detected using ELISA and total Ig specific to EBV was determined by standard indirect immunofluorescence. IgM to CMV was not observed in sera from any of the patients; whereas, IgM to HEV was detected in sera from 2 patients and IgM to HSV-2 was detected in 5 of 24 acute hepatitis patients. In addition, high titer of antibody was found in 2 of the patients. This results indicate that HSV-2 and HEV circulate in Thailand and are responsible for a small proportion of non-A, B, C hepatitis in Thailand.

Prevalência e implicaçöes do vírus da hepatite C em alcoolistas / Prevalence and implications of Hepatitis C virus in alcoholics

O vírus da Hepatite C parece ser mais prevalente em alcoolistas com e sem doença hepática associada. os autores avaliam a prevalência de anti-VHC em alcoolistas com e sem doença hepática alcoólica, bem como o comprometimento funcional hepático destes pacientes. Para tanto, foram avaliados prospectivamente 231 alcoolistas, tendo-se observado que o anti-VHC está presente em 8,2 por cento de 146 pacientes sem hepatopatia crônica e em 28,2 por cento de 85 pacientes com hepatopatia crônica. Embora neste estudo näo tenha havido correlaçäo da presença de anti-VHC com a classificaçäo de Child, os níveis de albumina e a atividade de protrombina foram menores naqueles pacientes com hepatopatia crônica e anti-VHC positivo, sugerindo um pior prognóstico nestes pacientes

Prevalência do anti-VHC (ELISA II) em doadores de sangue em sua correlaçäo com os níveis de ALT e com o anti-HBc: a experiência do Hospital Moinhos de Vento, Porto Alegre, RS / Prevalence of anti-VHC (ELISA II) of blood donors and its correlation with ALT levels and with anti-HBc at Hospital Moinhos de Vento, Porto Alegre-RS

Em um estudo retrospectivo,foram analisados os registros de 3.121 doadores de sangue, atendidos no ano de 1993 no Hospital Moinhos de Vento, Porto Alegre, RS. Setenta e sete por cento deles eram homens, 85 por cento brancos, com média de idade de 33,7 anos (DP +/-10,0). Houve maior prevalência do anti VHC em doadores näo brancos (7,4 por cento), quando comparados aos brancos (1,7 por cento) (p< 0,0001). Em todo grupo considerado, a prevalência do anti-VHC foi de 2,1 por cento, a do anti-HBc de 7,8 por cento e 6,0 por cento dos doadores tinham ALT> a 70 UI/L. Em 84,6 por cento dos doadores anti-VHC reagentes a relaçäo da densidade ótica da amostra/"cutoff" foi > a 2 e nestes a média da ALT foi 121,1 (+/-94,2) UI/L. Naqueles com relaçäo < a 2 a média da ALT foi de48,9 (+/-35,8) UI/L [p=0,02]. Quando analisados em conjunto, a sensibilidade dos marcadores indiretos (ALT igual ou superior a 70 UI/L e positividade do anti-HBc)em identificar doadores anti-VHC reagentes foi de 67,2 por cento

Riesgo relativo de transmision del virus de la hepatitis C en pacientes politransfundidos / Relative risk of hepatitis C virus transmission in polytransfused patients

El virus de la hepatitis C (HCV) ha demostrado ser el agente responsable de una importante proporción de casos de hepatitis entre pacientos con exposición parenteral frecuente. En este trabajo, estudiamos la seroprevalencia de anticuerpos anti-HCV en 48 pacientes hemodializados y politransfundidos, 42 de los cuales recibieron 11,2 transfusiones en promedio durante el tratamiento. Los pacientes fueron estratificados en cuatro grupos según el número de transfusiones recibidas (<6-9, 10-5 y > 15 transfusiones), y se utilizaron cocientes de Odds para estimar el riesgo de presentar a anticuerpos anti-HCV para cada grupo en relación con el grupo menos expuesto. De los pacientes transfundidos, 59 por ciento presentaron anticuerpos anti-HCV. Estratificados según el número de transfusiones estos porcentajes fueron de 16 por ciento, 66 por ciento, 62,5 por ciento y 100 por ciento respectivamente. En conclusión, hallamos una elevada seroprevalencia de anticuerpos anti HCV, significativamente mayor en aquellos pacientes que recibieron mayor número de transfusiones. Nuestros resultados concuerdan estrechamente con estudios realizados en Córdoba, y destacan la necesidad de estudiar las unidades de sangre para descartar aquellas que presenten anticuerpos contra HCV

Human antibodies to dengue and yellow fever do not react in diagnostic assays for hepatitis C virus

Hepatitis C virus (HCV) is a recently described causative agent of the great majority of post-transfusion non A-non B hepatitis and is classified within the Flaviviridae family. Due to a high prevalence of anti-HCV and other flaviviruses circulating in Brazil, such as dengue and yellow fever, we investigated the possibility of serological cross-reactivity between these viruses. Different panels of human sera positive for dengue type 1 (9 cases) and type 2 (7 cases) from 6 patients naturally infected with yellow fever and from 94 adults vaccinated against the 17D strain of yellow fever were tested against HCV antigens used in diagnostic assays. Two enzyme immunoassay systems were tested: one, an in-house test using recombinant antigens from core, NS3 and NS5 regions of the HCV genome (Research Foundation for Microbial Disease of Osaka University, Japan); and another, using synthetic peptides representing immunodominant epitopes of structural core and non-structural NS4 and NS5 HCV regions (INNOTEST HCV Ab, Innogenetics, Belgium). A line immunoassay (INNO-LIA HCV Ab, Innogenetics, Belgium) was used as a confirmatory test. In this, HCV antigens are coated as discrete lines on a nylon strip with plastic backing. Besides 4 control lines on each strip, a total of 6 HCV lines are present: line A consists of several NS4 epitopes, line B consists of several NS5 epitopes and lines C-F contain several core epitopes. This test not only confirms but differentiates antibodies to hepatitis C virus. No positive results were detected with these tests, indicating that hepatitis C infection can be evaluated by current assays in regions where flaviviruses are endemic

A study of the efficacy of liposomes in comparison to new and established adjuvants in potentiating the antibody response against hepatitis B virus surface antigen.

The dehydration-rehydration vesicle (DRV) method was used to encapsulate hepatitis B surface antigen (HBsAg) in phosphatidylcholine (PC) and distearoyl phosphatidylcholine (DSPC) liposomes giving entrapment values of 31.7% and 33.1% respectively. A comparison of antibody levels, as determined by ELISA, in the primary and secondary immune responses in mice immunized twice with 1 microgram HBsAg free, or in formulations of PC DRV, DSPC DRV, Syntex Adjuvant Formulation (SAF), alum and Freund's Complete Adjuvant (FCA) showed that by far, FCA was the best adjuvant in both the primary and secondary IgG1, IgG2a and IgG2b responses. In the secondary response, apart from FCA, DSPC DRV and SAF were equally efficacious and better adjuvants than alum and PC DRV for the IgG2a and IgG2b subclasses. SAF was a better adjuvant for HBsAg than alum, DSPC DRV and PC DRV (in descending order of efficacy) in the secondary IgG1 response.

Características serológicas y epidemiológicas de la hepatitis vírica aguda en la cuenca amazónica del Brasil / Serologic and epidemiologic characteristics of acute viral hepatitis in the Amazon Brasin of Brazil

Durante el período de junio de 1979 a diciembre de 1984 se estudiaron la frecuencia y las causas de la hepatitis aguda, incluida la fulminante, en el municipio de Boca do Acre, localizado en el extremo sudoccidental del Amazonas brasileiro. Se hicieron estudios serológicos por medio de las técnicas de radioinmunoensayo y ensayo inmunoenzimático. Los estudios previos de prevalencia serológica indicaron que la hepatitis A y la hepatitis B eran muy endémicas en toda la región y que la mayoría de las personas contraían la infección en los primeros 10 años de vida. La hepatitis A causó el 37% de todos los casos notificados, fue el tipo predeominante entre los niños mayores de cinco años y produjo un patrón epidémico. La hepatitis B constituyó el 48% de los casos y fue una causa importante de enfermedad tanto en los niños como en los adultos. La hepatitis no-A, no-B se presentó principalmente en adultos mayores. La incidencia de las hepatitis aguda y fulminante fue de 3,33 y 0,365 casos anuales por cada 1.000 habitantes, respectivamente. En más de 85% de los casos de hepatitis fulminante existía infección activa por el virus de la hepatitis B (VHB) y los sueros de los pacientes daban resultados positivos respecto al antígeno de superficie de la hepatitis B (AgsHB). la causa individual más frecuente de hepatitis fulminante fue la superinfección por virus delta de portadores del VHB. Las tasas de hepatitis aguda fulminante halladas en Boca do Acre son considerablemente mayores que las informadas con anterioridad en el continente americano y en otras partes del Brasil. Si bien la hepatitis A y la hepatitis B son causas importantes de hepatitis aguda, la infección combinada por virus delta y VHB es la causa principal del tipo poco común de hepatitis fulminante encontrado en la región estudiada

Transmissäo passiva do anticorpo do vírus A da hepatite (anti-VHA) em Salvador - Bahia / Passive transmission of virus A of hepatite (anti-HAV) antibody in Salvador - Bahia

Uma amostra de 229 gestantes da populaçäo de Salvador foi submetida à dosagem do anti-VHA pelo enzimaimunoensaio, levando-se em consideraçäo a faixa etária e o nível sócio-econômico. A prevalência do anticorpo do vírus A, nesta amostra, foi de 97, 38//, com média de idade das gestantes de 25,6 anos. Em todas as faixas etárias, houve uma elevada prevalência par o anti-VHA. A transmissäo transplacentária foi estudada em 75 recém-nascidos de mäes positivas, sendo a frequência do anti VHA de 98,7//. A prevalência do anticorpo do virus A, no primeiro ano de vida, foi determinada em 299 crianças, sendo que, na faixa etária de 1 a 2 meses, foi de 84,9//, e, na de 5 a 6 meses, de 96,4//. Nos lactentes com idade de 7 a 8 meses, a positividade para o anti-VHA foi de 5,4//, e de 11 a 12 meses, de 4,5//. Os resultados obtidos permitiram-nos chegar às seguintes conclusöes: 1§ - a prevalência geral na amostra das gestantes é elevada, coincidindo com a encontrada em outras populaçöes com características semelhantes; 2§ - a incidência do anti-VHA nos recém-nascidos é alta, demonstrando a transmissäo transplacentária em quase todos os recém-nascidos; 3§ - as crianças permaneceram imunos à infecçäo pelo vírus A até o 6§ mês de vida; 4§ - a baixa prevalência do anti-VHA, após o 6§ mês de vida, permanecendo inalterada atá o 12§ mês, sugere que, já sem imunidade adquirida passivamente das mäes, näo se contaminaram pelo vírus A