Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C

ABSTRACT Background: Hepatitis E virus (HEV) infection in patients with pre-existing liver disease has shown high morbidity and lethality. The consequences of HEV superinfection in patients with chronic hepatitis C virus (HCV) infection are not fully understood. This study aimed to evaluate the association between the presence of anti-HEV antibodies, liver cirrhosis, and insulin resistance. Methods: A total of 618 patients chronically infected with HCV were included from three reference centers for viral hepatitis in São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA). Results: The seroprevalence of anti-HEV in patients with cirrhosis was significantly higher than in patients without cirrhosis (13.2% vs 8%, OR = 1.74, p = 0.04). Seropositivity for anti-HEV, adjusted for sex, age, and HCV genotype showed an association trend with hepatic cirrhosis (aOR = 1.75, p = 0.059). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (aOR: 4.39; p = 0.045). Conclusion: Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in Brazil. The trend toward association between cirrhosis and previous HEV infection suggests that it may accelerate liver fibrosis in patients with chronic hepatitis C. In addition, previous infection by HEV is independently associated with insulin resistance in the studied population, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection, and may contribute to fibrosis progression.

Detection of hepatitis A, B, and C virus-specific antibodies using oral fluid for epidemiological studies

In this report, we examine the adaptability of commercially available serological kits to detect antibodies markers for viral hepatitis in oral fluid samples. We also assessed the prevalence of hepatitis A, B, and C virus-specific antibodies, and related risk factors for these infectious diseases through sensitivity of the tests in saliva samples to evaluate if oral fluid can be an alternative tool to substitute serum in diagnosis of acute viral hepatitis and in epidemiological studies. One hundred and ten paired serum and saliva specimens from suspect patients of having acute hepatitis were collected to detect antibodies to hepatitis A (total and IgM), hepatitis B (anti-HBs, total anti-HBc and IgM anti-HBc), and hepatitis C (anti-HCV) using commercially available enzyme-linked immunossorbent assay (EIA). In relation to serum samples, oral fluid assay sensitivity and specificity were as follows: 87 and 100 percent for total anti-HAV, 79 and 100 percent for anti-HAV IgM, 6 and 95 percent for anti-HBs, 13 and 100 percent for total anti-HBc, 100 and 100 percent for anti-HBc IgM, and 75 and 100 percent for anti-HCV. The consistency observed between antibodies tests in saliva and expected risk factors for hepatitis A and C suggests that the saliva method could replace serum in epidemiological studies for hepatitis A and C.

The Prevalence and Clinical Characteristics of Hepatitis-delta Infection in Korea / 대한간학회지

BACKGROUND/AIMS: The prevalence of hepatitis delta virus (HDV) infection has been estimated as being approximately 5% among global HBsAg carriers. The anti-delta positive rate in Koreans had been reported as being 0.85% in 1985. While the prevalence of HBV has been decreased from nearly 10% to 5% during the past twenty years, there have been no more studies on the anti-delta prevalence in Koreans. The aim of this study was to estimate the anti-delta prevalence in Koreans and to study the clinical characteristics of anti-delta positive patients in a single center. METHODS: Serum anti-delta was measured in one hundred ninety four HBsAg-positive patients who were admitted to our hospital from February 2003 to August 2003. We checked the genotypes of the HBV in the anti-delta positive patients. The clinical features of the anti-delta positive patients were compared to those clinical features of the anti-delta negative patients from the aspect of age, gender, mode of transmission, the positivity of HBeAg and serum HBV DNA. RESULTS: Serum anti-delta was positive in seven patients among the 194 subjects, giving a 3.6% positive rate. Among these seven patients, six had hepatocellular carcinoma (HCC) and the other one had cholangiocarcinoma. All of the anti-delta positive patients had the C genotype of HBV. The anti-delta positive patients showed significantly suppressed HBV DNA replication compared to the anti-delta negative patients. CONCLUSIONS: In Koreans, anti-delta was positive mainly in HCC patients with an approximate prevalence of 4%, and this rate has not changed much for the past twenty years. HBV DNA replication was suppressed by HDV infection.

Prevalencia de afección hepática, alcoholismo, hepatitis B, C y HIV en pacientes con antecedentes de consum / Prevalence of hepatic involvement, alcoholism, hepatis B, C and HIV in patients with background history of drug use

Drug addicts frequently have liver diseases for different reasons: alcohol abuse, the drugs themselves, but more often hepatitis B and C infections. AIDS is common in this population as well and could also affect the liver directly or in the form of hepatocellular or biliary damage. We conducted this study to determine the prevalence of liver diseases, alcoholism, hepatitis B and C infections, and HIV positivity in this population. We studied a cohort of 137 persons, all with a history of drug abuse, and investigated the quantity of alcohol intake, the kind of drug used, and he routes of drug administration. RESULTS: We found liver disease in 33.6%. The prevalence of alcoholism was 65.4%, of HCV 67.3%, and of HBV 17.3%. HDV was undetectable, whereas we found HIV at a frequency of 17.3%. HCV RNA was detected in 85.4% of HCV. The drug most often used was cocaine at 90.4%, followed by marihuana at 88.3%; LSD use occurred in 17.5%. We found parenteral drug use in 43.1%. We performed 22 liver biopsies, 21 associated with HCV, and detected histological changes consistent with chronic hepatitis in 17, with cirrhosis in 4, and with hepatocellularcarcinoma in 1.

Use of filter paper disks for hepatitis A surveillance.

BACKGROUND: Venous blood collection is a cumbersome and uncomfortable procedure during hepatitis A surveillance. Collection of capillary blood by finger prick is an alternative method. AIM: To evaluate the reactivity of capillary blood/anti-hepatitis A virus (HAV) IgG stored on filter paper disks for detection of anti-HAV antibody. METHODS: Venous blood specimens were collected from healthy individuals. Simultaneous capillary blood specimens obtained by finger prick were stored on filter paper disks. A reference standard of anti-HAV IgG in known concentrations was spotted on filter paper disks. The reactivities of anti-HAV IgG and capillary blood specimens eluted from filter paper disks were tested by blocking ELISA for detection of anti-HAV antibody. The results were evaluated by comparing optical density (OD) and neutralization values with those obtained for WHO anti-HAV IgG stored in liquid phase and homologous venous blood specimens, respectively. RESULTS: Among both venous and capillary-blood specimens stored for 10 days, percent neutralization shown by the same 46 specimens was > 50 and that of the same 3 specimens was < 50, indicating anti-HAV positivity and negativity, respectively. There was significant correlation between the OD values displayed by anti-HAV IgG from liquid phase and that eluted from filter paper disk (p < 0.01). Sixteen serum specimens stored for a period of 2 months showed results similar to those of the corresponding filter paper disk elutes. CONCLUSION: Use of filter paper disks could be a suitable choice for pre- and post-immunization collection of blood specimens during hepatitis A surveillance.

Determinación secuencial de anticuerpos contra el virus de la hepatitis E / Sequential antibody determination in hepatitis E virus

Twenty-four patients with presumptive diagnosis of HVE with a mean age of 37.7 years are presented. A qualitative antiHVE by ELISA was performed in all of them, and repeated at monthly intervals during a 6 month period, and 18 gave a positive result for acute HVE. The majority were detected 60 days after the initiation of their signosintomatology. Clinical characterization are outlined.

Seroprevalence of hepatitis A virus in Mumbai, and immunogenicity and safety of hepatitis A vaccine.

OBJECTIVES: Since epidemiologic trends of hepatitis A are changing worldwide, we studied its seroprevalence in Mumbai, which is thought to be a high-endemicity area. The immunogenicity and safety of a hepatitis A vaccine were also studied. METHODS: Six hundred and seventy subjects (456 men; age range 6 mo-60 y) answered a questionnaire on social and medical history. Qualitative analysis of total anti-HAV was performed in all subjects by ELISA. One hundred and seven of 147 anti-HAV negative subjects received hepatitis A vaccine at months 0, 1 and 6. Subjects were followed up (months 1, 2, 6, 7) to look for side-effects and seroconversion. RESULTS: The seroprevalence of HAV was 523/670 (78%); 38% of children < 5 years were anti-HAV negative. Seroprevalence rates of 80% were reached by 15 years. Prevalence was lower in the higher socio-economic group (151/234; 64.5%) compared with the lower socio-economic group (372/436; 85%) (p < 0.001). One month after doses 1, 2 and 3 of the hepatitis A vaccine, seropositivity was 92%, 99% and 100%, respectively. Minor self-limited side-effects occurred in 19.5% of subjects; there were no major side-effects. CONCLUSIONS: The seroprevalence of anti-HAV is high in Mumbai. Seroprevalence is lower in the higher socio-economic groups. The hepatitis A vaccine is safe and immunogenic.

Virus de l'hepatite E: Detection des anticorps dans une population de donneurs de sang au liban

One hundred Lebanese volunteers blood donors were tested for the qualitative detection of antibodies against hepatitis E virus [HEV] by an immunoenzymatic method. This figure allows us to confirm the presence of infection due to HEV in Lebanon. More studies on a larger panel are necessary to confirm this result. This study leads us to suspect an HEV infection in front of an acute non A, non B, non C hepatitis even if the patients have not lived in an endemic area

Hepatitis E virus and Salmonella paratyphi A coinfection.

We report a patient with simultaneous Salmonella paratyphi A and hepatitis E virus infection. The possibility of coinfection with water borne diseases in India is emphasized.

Subacute hepatic failure in hepatitis A.

Hepatitis A is usually thought to be innocuous. We report a woman who developed subacute hepatic failure due to hepatitis A and died of the disease.

High prevalence of antibody against hepatitis A virus in an institution for the mentally handicapped.

Hepatitis A virus infection constitutes a world-wide public health problem, predominantly in developing countries. Mentally handicapped children, due to their incapacity for looking after themselves, comprise one of the high risk groups for hepatitis A virus infection. The aim of the present study was to determine the prevalence of hepatitis A virus antibody (anti-HAV) among the children and adults in the Institute for the Mentally Handicapped located in Nonthaburi, Thailand. The prevalence of anti-HAV IgG antibody was 92%. Immunity acquired against HAV was shown to increase in direct proportion to the age. To prevent future outbreaks of hepatitis A, water supply, sanitary conditions and personal hygiene should be improved at this and similar institutions. Furthermore, persons new to the institution (patients and staff) should be screened for anti-HAV and vaccinated with hepatitis A vaccine if nonimmune.

Herpes simplex hepatitis.

We report a 76-year-old man who presented with hepatitis. IgM antibodies to herpes simplex virus were positive and scraping from skin lesions showed presence of herpetic inclusion bodies. The patient died 4 days after the onset of illness.

Validacion de un ultramicroELISA de deteccion de anticuerpos contra el antigeno de superficie de la hepatitis B / Validation of an ultramicroELISA for the detection of antibodies against the hepatitis B surface antigen

Se presentan los resultados del estudio de validacion del ensayo ultramicroanalitico de deteccion de anticuerpos contra el antigeno de superficie de la hepatitis B (UMELISA anti HBsAg), que se realizo comparando los resultados obtenidos, con el juego diagnostico comercial Hepanostika anti-HBsAg. Se utilizaron para ello sueros procedentes de los ensayos clinicos de la vacuna recombinante cubana contra la hepatitis B. Con el primer panel de sueros (n = 300) se obtuvo el 93,1 por ciento de sensibilidad, el 98,5 por ciento de especificidad y una concordancia del 94,3 por ciento. El coeficiente de correlacion indico una tendencia similar de los resultados (p < 0,01) y no se encontraron diferencias significativas en el titulo promedio geometrico (TPG) entre ambos ensayos (P > 0,05). Con el segundo panel (n = 100), realizado en el Instituto de Medicina Tropical "Pedro Kouri" (IPK) y el Centro de Inmunoensayo (CIE) simulataneamente, se obtuvo una sensibilidad del 96,25 por ciento en ambos centros, una especificidad del 75 por ciento en el IPK y del 90 por ciento en el CIE y una coincidencia del 92 y 95 por ciento, respectivamente. El coeficiente de correlacion mostro valores similares y no hubo diferencias significativas entre las TPG alcanzadas por los 2 metodos (P > 0,05). Los resultados obtenidos en general muestran la validez del nuevo ensayo y la factibilidad de su utilizacion en la practica, ya sea para el seguimiento de la infeccion o para la realizacion de ensayos clinicos de evaluacion de vacunas

Comparison of liver histology in chronic active hepatitis C and chronic active hepatitis B.

OBJECTIVE: To study the histological features of chronic active hepatitis C (CAH-C) and to compare these with those of chronic active hepatitis B (CAH-B). METHODS: Thirty-two liver biopsy specimens from patients with chronic active hepatitis and presence of antibodies to hepatitis C on second generation enzyme immunoassay were studied and compared with those in 34 patients with CAH-B. Seventeen of the 32 CAH-C patients had fully developed or developing cirrhosis of liver whereas the remainder had only chronic active hepatitis. RESULTS: Among 32 patients with CAH-C, fatty change (20), Kupffer cell hyperplasia (30), sinusoidal lymphocytosis (27) lymphoid follicles aggregates in portal tracts (26) and bridging necrosis (16) were regular features. Focal necrosis, bile duct necrosis, cholestasis and ground glass cells were however seen much less often. On the other hand, in patients with CAH-B, fatty change (no patient), sinusoidal lymphocytosis (one patient) and lymphoid follicles/aggregates in portal tracts (one patient) were rare. Also, Kupffer cell hyperplasia (22 patients) was seen less commonly in patients with CAH-B as compared to CAH-C. Focal necrosis (34 patients), bile ductular proliferation (9 patients), cholestasis (17 patients) and ground glass cells (15 patients) were more prominent in CAH-B. CONCLUSION: Presence of certain histological features can help in distinguishing between CAH-C and CAH-B.

Reduction in the prevalence of antibody to hepatitis A virus among young Saudi adults: implications for hepatitis a vaccine

Viral etiology was investigated in 133 Saudi patients with acute hepatitis seen in King Khalid University Hospital, Riyadh. Between July 1993-May 1994. Out of the 133 patients. 51[38.3%] were diagnosed as having acute hepatitis due to hepatitis A virus [HAV]. Hepatitis C virus [HCV] was the second most common etiological agent [20.3%]. There were 35 patients with acute hepatitis [26.3%] in whom no viral marker for HAV, HBV, HCV, CMV or Epstein-Barr virus [EBV] was detected. Among the 51 patients with acute hepatitis due to HAV, the majority [882%] were children [1-12 years] and only 6[11.8%] were adults [15-24years]. This is in contrast to patients with HCV or HBV infection where the majority were adults: 74.1% and 82.3% respectively. The diagnosis of acute hepatitis due to HAV in Saudi adults, an observation not seen earlier, indicated a change in the epidemiological pattern of HAV infection in the Saudi population. This change was confirmed by the significant reduction in the prevalence of anti-HAV in 630 Saudi subjects [1-30 years old] [50.2%] investigated in 1994 compared to that of587 subjects of the same age group investigated in 1986[76.5%] [P < 0.005]. In the light of these results, a nation-wide survey is recommended to confirm this pattern in other areas. It is important that high-risk Saudi groups be identified and evaluated for their anti-HAV status as these groups are candidates for HAV vaccination

Prevalencia de marcadores serológicos de hepatitis viral A, B y Delta en escolares aparentemente sanos de Huanta (Perú) / Serological markers of hepatitis A, B and Delta in school children of Huanta, Peru

Huanta es un valle interandino del Perú ubicado a 2,400 msnm y cuenta con 45,000 habitantes. La Hepatitis viral en esa localidad es conocida por su severidad clínica y elevada morbi-mortalidad. Métodos.- Se estudió la prevalencia de marcadores de las hepatitis virales A, B y Delta en 143 escolares clínicamente sanos, elegidos aleatoriamente de 4 centros educativos existentes en la ciudad. Se obtuvieron, datos epidemiológicos en relación a hepatitis viral y una muestra de sangre venenosa para la determinación de HBsAg, anticuerpos anti-HBc, anti-HBc IgM, anti-VHA Y ANTI-VHD por la técnica de ELISA (Lab Abbott). Resultados.- Se incluyeron 93 varones y 50 mujeres. La edad promedio fue 13.2 años (7-20a). Anticuerpos contra VHA fueron detectados en 140 sujetos (98 por ciento). Se determinó infección previa por VHB en 117 (82.0 por ciento) e infección activa en 4 (2.7 por ciento). La tasa de portadores de HBsAg fue 16 por ciento (23). Infección por VHD se encontró en 21 de 117 (17.9 por ciento) infectados por VHB. Infección por VHB y el antecedente de uso de inyectables fue una asociación significativa (OR:3.7 IC 1.3-11, p < 0.012). No hubo diferencias en relación a sexo. Conclusión.- Se muestra elevada prevalencia de infección por VHA, VHB y VHD en escolares de Huanta, siendo la primera vez que se describe infección por el virus Delta en dicha zona. Fue significativa la asociación entre infección por VHB y el antecedente del uso de inyectables. La alta prevalencia de HVB y HVD, sugiere la existencia de una relación con la morbi-mortalidad por hepatitis en huanta, debiendo considerarse programas de control mediante inmunización contra HVB

Hepatitis E virus: epidemiological, clinical and serological studies of north Indian epidemic.

BACKGROUND: A large waterborne epidemic of viral hepatitis occurred in the city of Karnal (Haryana) from February to April 1987. An attempt was made to study the epidemic clinically, serologically and etiologically. METHODS: A house-to-house search of the city was conducted for the detection of acute hepatitis cases. Patients willing to give blood samples for liver function tests were studied. RESULTS: A total of 1273 persons (0.79% of persons surveyed) were affected by viral hepatitis. Of the 477 clinically and biochemically documented cases, more than 75% were adults, while only 11% were less than 10 years old. Children below 15 years of age and females had a significantly higher incidence of anicteric hepatitis. Serological markers for acute hepatitis A and B viruses were absent in 85% of patients. Antibodies to hepatitis E virus (HEV) were detected in 84% of acute phase sera studied by indirect immunofluorescence assay. Liver biopsy showed characteristic features of cholangitic hepatitis. Three of 19 pregnant females who developed hepatitis died. No residual clinical or biochemical abnormality was detected in any of the patients followed up for 8 months. This epidemic correlated with the timing of unsupervised digging of lanes to provide new tap water connections to houses in the congested area of the city. This resulted in damage to the sewerage system and leakages which contaminated drinking water supply. CONCLUSION: HEV was transmitted by contaminated drinking water in this epidemic. Most affected individuals were adults, and recovered without sequelae. Affected pregnant women had a worse outcome.

The study of HCV antibody and serologic tests for syphilis in Thai patients with gynecologic disorders.

Investigation for prevalence of antibodies to hepatitis C virus (HCV) and to Treponema pallidum was conducted in 883 females with gynecologic disorders who were admitted to the gynecological ward of the Department of Obstetrics and Gynecology, Siriraj Hospital during April to August 1991. The study population consisted of 678 patients with malignancies and 205 patients with benign diseases. Anti-HCV antibody was found in 3.1% of the cases with malignancies and 1.46% of those with benign diseases. Among the gynecologic malignant group, the patients with carcinoma of cervix had the highest prevalence of HCV antibody (3.6%). The positive serologic tests for syphilis in patients with carcinoma of cervix (9.8%) were significantly higher from those in patients with ovarian carcinoma (3.75%) (p < 0.01). There were 3 cases with carcinoma of cervix who were simultaneously sero-positive for both HCV and syphilis.