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.

Epidemiological, clinical, and biochemical characteristics of Saudi patients with nonalcoholic fatty liver disease: a hospital-based study

The estimated prevalence of nonalcoholic fatty liver disease [NAFLD] in Saudi Arabia is 7% to 10%. Despite the high prevalence of risk factors including diabetes, obesity, and hyperlipidemia, no recent epidemiological studies have measured the disease burden. We aimed to determine the characteristics of Saudi NAFLD patients attending a university hospital, and study factors affecting alanine aminotransferase [ALT] levels. A prospective study among patients referred for ultrasonography in King Khalid University Hospital in Riyadh, Saudi Arabia from February to May 2009. NAFLD was defined as an appearance of fatty liver on routine abdominal ultrasound in the absence of coexisting liver disease and alcohol consumption. Patients were classified into normal and high ALT [ALT >60 U/L] level groups for analysis. The prevalence of NAFLD was 16.6% [218/1312]. Patients with normal ALT had the mean [SD] age of 45.9 [10.6] years and the mean body mass index of 34.5 [7.9] kg/m2. Forty percent of the 151 patients with normal ALT had diabetes, 66.2% were obese, and 29.1% had hypertension. Forty-three patients [23%] had high ALT levels. These patients had significantly lower age [P=.003] and fasting blood sugar [P=.03] than the normal ALT group. Non-diabetic patients [odds ratio 0.30, 95% CI 0.1-0.8], men [female OR 0.23, 95% CI 0.1-0.5], lower cholesterol [P=.001], high-density lipoprotein [P=.006], and low-density lipoprotein [P=.008] levels were more likely to be observed among patients with high ALT levels. In a multivariate analysis, younger age [OR 0.96, 95% CI 0.93-0.99], being male [OR 0.23, 95% CI 0.09-0.57], and a lower cholesterol level [OR 0.55, 95% CI 0.37-0.82] were significant predictors of high ALT levels. Based on the high prevalence of obesity and diabetes, the prevalence of NAFLD will continue to be high, unless awareness is inculcated among the local population

De novo malignancies after liver transplantation: a single-center experience

The recipients of liver transplantation [LT] are subjected to lifelong immunosuppression with its many drawbacks. De novo and recurrent malignancy in transplant recipients are attributed to attenuation of immunosurveillance. In the present study, we present our experience with de novo malignancies encountered after both deceased and living donor liver transplantations. Retrospective study of patients referred to LT center between April 2001 and January 2010. Various data were collected including type of malignancy and histopathologic features, immunosuppression regimen, and patient survival. Of 248 LT procedures performed in 238 patients [10 retransplants], 8 patients [3.4%] developed de novo post-LT malignancies. De novo malignancies included post-LT lymphoproliferative disorders [PTLD] in 5 patients who were all Epstein-Barr virus [EBV] positive, and who were treated successfully with anti-CD20 monoclonal antibody therapy, reduction of immunosuppression, and control of EBV activity; urinary bladder cancer in 1 patient who was treated with radical surgical resection and chemotherapy but died of bone and lung metastasis within 1 year of diagnosis; endometrial carcinoma in 1 patient who was treated with radical surgical resection; and Kaposi sarcoma in 1 patient who was successfully treated with surgical excision and reduction of immunosuppression. EBV-associated PTLD is the most frequently encountered de novo malignancy after LT and is easily treatable by chemotherapy and reduction of immunosuppression

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

Recurrence of hepatitis C virus genotype-4 infection following orthotopic liver transplantation: natural history and predictors of outcome

There are few reports on hepatitis C virus genotype 4 [HCV-4] recurrences after orthotopic liver transplantation [OLT]. Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes. All patients who underwent OLT [locally or abroad] for HCV related hepatic cir-rhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed. Of 116 patients who underwent OLT for hepatitis C, 46 [39.7%] patients satisfied the criteria of recur-rent hepatitis C. Twenty-nine [63%] patients were infected with HCV genotype 4. Mean [SD] for age was 54.9 [10.9] years. Nineteen of the HCV genotype 4 patients [65.5%] were males, 21 [72.4%] received deceased donor grafts, and 7 [24.1%] developed >1 acute rejection episodes. Pathologically, 7 [24.1%] and 4 [13.8%] patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 [31%] HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease. This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes