Molecular genetic association of rs8099917 and rs1800795 polymorphisms in the progression of hepatitis Delta virus liver disease

Background: The relationship between viral infections and host factors holds high hopes for identifying the role of Interferon Lambda 3 (IFNL3) and Interleukin 6 (IL-6) polymorphisms in the development of Chronic Liver Disease (CLD) in patients infected with hepatitis Delta virus (HDV) in the Western Brazilian Amazon. Methods: Cross-sectional study conducted with a cohort of 40 chronic HDV patients, 27 with CLD and 13 without evident liver damage. Biological samples from the participants were analyzed using the polymerase chain reaction (PCR) technique, followed by sequencing by the automated Sanger method. Results: The rs8099917 T allele, from the IFNL3 gene, showed a higher frequency in both groups; however, it was not possible to establish an association with HDV infection [OR = 1.42 (0.42 - 4.75; p = 0.556 (95% CI). For IL-6, the rs1800795 G allele was superior to rs1800795 C. Analyzing both distributions in the studied groups, any association with HDV was absent (p > 0.05). Conclusion: The results suggest that the rs8099917 T/G (IFNL3) and rs1800795 G/C (IL-6) polymorphisms are not associated with the evolution of HDV in the studied population.

Hepatitis D: advances and challenges / 中华医学杂志(英文版)

Hepatitis D virus (HDV) infection causes the most severe form of viral hepatitis with rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Although discovered > 40 years ago, little attention has been paid to this pathogen from both scientific and public communities. However, effectively combating hepatitis D requires advanced scientific knowledge and joint efforts from multi-stakeholders. In this review, we emphasized the recent advances in HDV virology, epidemiology, clinical feature, treatment, and prevention. We not only highlighted the remaining challenges but also the opportunities that can move the field forward.

Reducción en la infección por VHB y VHD en dos poblaciones indígenas de la Amazonia peruana después de la vacunación contra la hepatitis B / Reduction of HBV and HDV infection in two indigenous peoples of Peruvian Amazon after the vaccination against hepatitis B

Resumen: Objetivo: Conocer el resultado de la vacunación contra la hepatitis B en las comunidades hiperendémicas Kandozi y Chapra de la Amazonia Peruana a partir de la prevalencia de infecciones por los virus de la hepatitis B (VHB) y Delta (VHD), ocho años después de iniciada la vacunación. Material y métodos: Se realizó un estudio transversal en 2 944 pobladores de 67 comunidades indígenas Kandozi y Chapra en abril de 2010. El tamizaje serológico para el antígeno de superficie del VHB (HBsAg), anticuerpos anti-HBc IgM e IgG, anticuerpos anti-HBs y anti-VHD se determinaron mediante pruebas de ELISA. Resultados: Las tasas de prevalencia del HBsAg, anti-HBc IgG, anti-HBs ≥10 mlUI/ml y anti-VHD fueron 2.3, 39.13, 50.95 y 2.11%, respectivamente. La prevalencia del HBsAg en niños <11 años fue cero. Entre los portadores del HBsAg, las tasas de prevalencia de sobreinfeccion por el VHD e infección aguda por el VHB fueron 2.11% (todos fueron >14 años) y 11.94%, respectivamente. Conclusiones: Estos hallazgos muestran la eliminación de portadores de VHB en niños <11 años, ocho años después de iniciada la vacunación contra el VHB.

Abstract: Objective: To determine the outcome of the vaccination against hepatitis, we determined the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections, eight years after introduction of the vaccination. Materials and methods: A cross-sectional study was performed in 2 944 participants of 67 Kandozi and Chapra indigenous peoples in April 2010. Serological screening for hepatitis B surface antigen (HBsAg), antibody anti-HBc IgM and IgG, antibody anti-HBs and anti-HDV were determined by ELISA tests. Results: The prevalence rates of HBsAg, anti-HBc total, anti-HBs ≥10 mlUI/ml and anti-HDV were 2.3, 39.13, 50.95 and 2.11%, respectively. The prevalence rate of HBsAg in children <11 years was 0%. Among carriers of HBsAg, the prevalence rates of HDV and acute HBV infections were 2.11% (all were >14 years) and 11.94%, respectively. HBsAg and anti-HBc total were associated with individuals ≥10 years (p<0.001). Conclusions: These findings show the elimination of HBV carriers in children <11 years, eight years following introduction of the vaccination against HBV.

Prevalencia de infección por los virus de la hepatitis B, D y por retrovirus en la etnia Matsés (Loreto, Perú) / Prevalence of retrovirus, hepatitis B and D infection in the Matsés ethnic group in Loreto, Peru

RESUMEN Para determinar la prevalencia de infección por los virus de la hepatitis B y D (VHB y VHD, respectivamente), VIH y HTLV-1/2 en la etnia matsés, después de la inmunización contra el VHB se realizó un estudio transversal y poblacional, utilizando pruebas de ELISA y qPCR en 963 pobladores. Las prevalencias de HBsAg, anti-HBc y anti-HBs fueron 3,3%, 36,0% y 58,7%, respectivamente. En el 3,1% de la población la carga viral fue mayor a 2000 UI/mL. En menores de 10 años, la prevalencia de HBsAg y anti-HBc fue 0,0% y 2,6%, respectivamente, mientras que en el 94,4% se encontraron anticuerpos protectores. La prevalencia de infección por el VIH y el HTLV-1/2 fue 1,5% y 0,6%, respectivamente. Se concluye que existen tasas bajas de infección por el VHB y el VHD en la población infantil de la etnia matsés. Asimismo, se confirma la presencia de infección por el VIH y el HTLV-1/2.

ABSTRACT Observational, cross-sectional, populational study to determine the prevalence of infection by hepatitis B virus (HBV), hepatitis D virus (HDV), human immunodeficiency virus (HIV) and human T-lymphotropic virus type 1 and 2 (HTLV-1/2) in the Matsés ethnic group, after immunization against HBV. ELISA and qPCR tests were used in 963 residents. The prevalence of HBsAg, Anti-HBc and Anti-HBs was 3.32%, 36.03% and 58.67% respectively. In 3.1% of the population the viral load was greater than 2000 IU/mL. In children under 10 years, the prevalence of HBsAg and anti-HBc was 0.0% and 2.6%, respectively, while protective antibodies were found in 94.4%. The prevalence of HIV and HTLV-1/2 infection was 1.5% and 0.6%, respectively. It is therefore concluded that there are low rates of HBV and HDV infection in the Matsés child population. Likewise, the presence of HIV and HTLV-1/2 infection is confirmed.

Infección por el virus de la hepatitis delta / Hepatitis delta virus infection

El virus de la hepatitis delta (VHD) es un virus satélite del virus de la hepatitis B (VHB), dado que requiere el antígeno de superficie del VHB (HBsAg) para la producción de partículas virales infecciosas. Se han caracterizado ocho genotipos del VHD, con una distribución geográfica relacionada con la prevalencia de la infección por VHB. Se estima que aproximadamente el 5% de los pacientes con infección crónica por VHB también están infectados con VHD. Se han descrito dos tipos de infección: la coinfección simultánea por VHB y VHD, y la superinfección con VHD en un paciente previamente infectado por VHB, esta última asociada a una mayor morbilidad y mortalidad por falla hepática aguda. La infección se diagnostica en nuestro medio con la determinación de IgM contra el VHD, acompañada idealmente de la carga viral. Aunque el tratamiento de elección es la terapia con interferón alfa pegilado, en el momento se están evaluando otros medicamentos antivirales en ensayos clínicos, con resultados alentadores, teniendo en cuenta el efecto observado en la carga viral del VHD y/o del VHB en los pacientes. La presente revisión tiene como objetivo incluir temas como la biología del virus, la epidemiología, las características clínicas, el diagnóstico y el tratamiento en la infección por VHD.

Hepatitis delta virus (HDV) is a satellite virus of hepatitis B virus (HBV), as it requires the HBV surface antigen (HBsAg) for the production of infectious viral particles. Eight HDV genotypes have been characterized with a geographic distribution associated with the prevalence of HBV infection. It is estimated that approximately 5% of patients with chronic HBV infection are also infected with HDV. Two types of infection have been described: coinfection, by simultaneously contracting HBV and HDV infection, and superinfection, by contracting HDV when chronically infected with HBV, the latter associated with increased morbidity and mortality from acute liver failure. Anti-HDV IgM is used to diagnose the infection, ideally together with the detection of HDV-RNA. Although the treatment of choice is pegylated interferon alpha, other antiviral drugs are currently being evaluated in clinical trials, with encouraging results, in terms of their effect on HDV and/or HBV viral load in patients. This review aims to include topics such as virus biology, epidemiology, clinical manifestations, diagnosis, and treatment in HDV infection.

Hepatitis B and Delta: clinical aspects of patients in the Brazilian Western Amazonia / Hepatitis B y Delta: aspectos clínicos de pacientes en el Amazonas brasileño Occidental / Hepatite B e Delta: aspectos clínicos de pacientes na Amazônia Ocidental brasileira

ABSTRACT Objective: to analyze clinical, serological, biochemical and hematological aspects in patients infected with the hepatitis B (HBV) and Delta (HDV) viruses. Method: cross-sectional, descriptive and retrospective study, performed with patients chronically infected with HBV and superinfected with HDV. Results: among the 112 patients selected, 74% were monoinfected with HBV (Group HBV) and 26% were superinfected with HDV (Group HBV+HDV). There was no difference in gender distribution. The average age was 36 years with standard deviation of ±12 years. The symptoms and signs presented a higher proportion in Group HBV+HDV (p=0.001). In both groups, most patients had non-reactive AgHBe. The records of biochemical and hematologic changes showed highest proportion in Group VHB+VHD Group (p<0.05). Conclusion: the study found that patients were in clinical stages of the disease different from those in the initial examination for monitoring their chronic condition. The clinical profile suggests greater severity of liver disease among the patients superinfected with HDV.

RESUMEN Objetivo: Analizar los aspectos clínicos, serológicos, bioquímicos y hematológicos de pacientes infectados por el virus de las hepatitis B (VHB) y Delta (VHD). Método: Se trata de un estudio transversal, descriptivo, retrospectivo, realizado entre pacientes crónicos infectados de VHB y sobre infectados de VHD. Resultados: Entre los 112 pacientes seleccionados, el 74% estaba mono infectado por VHB (Grupo VHB) y el 26%, sobre infectado por VHD (Grupo VHB+VHD). No se encontró diferencia en la distribución por género. La edad promedio era 36 años, con desviación típica de ±12 años. Los síntomas y signos sobresalían en mayor proporción en el grupo VHB+VHD (p=0,001). Para ambos grupos, la mayoría de los pacientes estaba con AgHBe no reactivo. El registro de alteraciones bioquímicas y hematológicas atribuyó proporción más grande al grupo VHB+VHD (p<0,05). Conclusión: El estudio demostró que los pacientes, en la consulta inicial para el seguimiento de la condición crónica, estaban en diferentes estadios clínicos de la enfermedad. El perfil clínico sugiere que la gravedad de la enfermedad hepática es mayor entre pacientes sobre infectados de VHD.

RESUMO Objetivo: Analisar aspectos clínicos, sorológicos, bioquímicos e hematológicos entre pacientes infectados por vírus das hepatites B (VHB) e Delta (VHD). Método: Estudo transversal, descritivo, retrospectivo, realizado com pacientes cronicamente infectados por VHB e superinfectados por VHD. Resultados: Entre os 112 pacientes selecionados, 74% estavam monoinfectados por VHB (Grupo VHB) e 26% superinfectados por VHD (Grupo VHB+VHD). Não houve diferença na distribuição por gênero. A idade média foi de 36 anos, com desvio padrão de ±12 anos. Os sintomas e sinais apresentaram maior proporção no grupo VHB+VHD (p=0,001). Para ambos os grupos, a maioria dos pacientes estava com AgHBe não reagente. O registro de alterações bioquímicas e hematológicas apresentou maior proporção no grupo VHB+VHD (p<0,05). Conclusão: O estudo revelou que os pacientes estavam em diferentes estágios clínicos da doença na consulta inicial para acompanhamento de condição crônica. O perfil clínico sugere maior gravidade da doença hepática entre os pacientes superinfectados por VHD.

Hepatitis delta prevalence in South America: a systematic review and meta-analysis

Abstract Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.

Atypical crusted scabies in a patient with chronic liver disease caused by hepatitis B and D viruses

Abstract: Crusted scabies is a less common variant of scabies that is highly contagious, difficult to treat and involves infestation by Sarcoptes scabiei var. hominis. The classical clinical presentation includes crusted, scaly and generally non-pruritic lesions usually located on the head, neck, palmar, plantar and periungual region. It was first described in Norway in 1848 in patients with leprosy who presented with crusted lesions. In this study, we report the case of a patient with crusted scabies with florid clinical manifestations and chronic liver disease due to hepatitis B and delta virus infection.

Transplante hepático na hepatite delta: experiência da América do Sul / Liver transplantation in hepatitis delta: south america experience

ABSTRACT BACKGROUND: The Amazon region is one of the main endemic areas of hepatitis delta in the world and the only one related to the presence of genotype 3 of the delta virus. OBJECTIVE: To analyze the profile, mortality and survival of cirrhotic patients submitted to liver transplantation for chronic hepatitis delta virus and compare with those transplanted by hepatitis B virus monoinfection. METHODS: Retrospective, observational and descriptive study. From May 2002 to December 2011, 629 liver transplants were performed at the Walter Cantídio University Hospital, of which 29 patients were transplanted due to cirrhosis caused by chronic delta virus infection and 40 by hepatitis B chronic monoinfection. The variables analyzed were: age, sex, MELD score, Child-Pugh score, upper gastrointestinal bleeding and hepatocellular carcinoma occurrence before the transplantation, perioperative platelet count, mortality and survival. RESULTS: The Delta Group was younger and all came from the Brazilian Amazon Region. Group B presented a higher proportion of male patients (92.5%) compared to Group D (58.6%). The occurrence of upper gastrointestinal bleeding before transplantation, MELD score, and Child-Pugh score did not show statistical differences between groups. The occurrence of hepatocellular carcinoma and mortality were higher in the hepatitis B Group. The survival in 4 years was 95% in the Delta Group and 75% in the B Group, with a statistically significant difference (P=0.034). Patients with hepatitis delta presented more evident thrombocytopenia in the pre-transplantation and in the immediate postoperative period. CONCLUSION: The hepatitis by delta virus patients who underwent liver transplantation were predominantly male, coming from the Brazilian Amazon region and with similar liver function to the hepatitis B virus patients. They had a lower incidence of hepatocellular carcinoma, more marked perioperative thrombocytopenia levels and frequent episodes of upper gastrointestinal bleeding. Patients with hepatitis by delta virus had lower mortality and higher survival than patients with hepatitis B virus.

RESUMO CONTEXTO: A região Amazônica é uma das principais áreas endêmicas da hepatite delta no mundo e a única relacionada com a presença do genótipo 3 do vírus delta. OBJETIVO: Analisar o perfil, mortalidade e sobrevida dos pacientes cirróticos submetidos a transplante hepático por hepatite crônica pelo vírus delta e comparar com os transplantados pela monoinfecção do vírus da hepatite B. MÉTODOS: Estudo retrospectivo, observacional e descritivo. Entre maio de 2002 a dezembro de 2011, foram realizados 629 transplantes de fígado no Hospital Universitário Walter Cantídio, dos quais 29 pacientes foram transplantados por cirrose causada pela infecção crônica do vírus delta e 40 pela monoinfecção crônica da hepatite B. As variáveis analisadas foram: origem, idade, sexo, escore de MELD, classificação de Child-Pugh, ocorrência de hemorragia digestiva alta e carcinoma hepatocelular antes do transplante, número de plaquetas perioperatória, mortalidade e sobrevida. RESULTADOS: O Grupo Delta foi mais jovem e todos oriundos da região Amazônica Brasileira. O Grupo B apresentou maior proporção de pacientes do sexo masculino (92,5%) em relação ao Grupo D (58,6%). A ocorrência de hemorragia digestiva alta antes do transplante, escore de MELD e classificação de Child-Pugh não obtiveram diferenças estatísticas entre os grupos. A ocorrência de carcinoma hepatocelular e a mortalidade foram maiores no grupo com hepatite B. A sobrevida em 4 anos foi de 95% no Grupo delta e 75% no Grupo B com diferença estatisticamente significante (P=0,034). Pacientes com hepatite delta, apresentaram mais acentuada plaquetopenia no pré-transplante e no pós-operatório imediato. CONCLUSÃO: Os pacientes com hepatite por vírus delta submetidos ao transplante hepático eram predominantemente homens, vindos da região da Amazônia brasileira e com função hepática semelhante a dos pacientes com vírus da hepatite B. Apresentavam menor incidência de carcinoma hepatocelular, níveis de trombocitopenia perioperatória mais acentuados e episódios frequentes de hemorragia digestiva alta. Os pacientes com hepatite por vírus delta apresentaram menor mortalidade e maior sobrevida que os pacientes com vírus da hepatite B.

Acute hepatitis A, B and C but not D is still prevalent in Mongolia: a time trend analysis

BACKGROUND/AIMS: Mongolia has one of the highest hepatitis A, C, B and D infection incidences worldwide. We sought to investigate changes in the proportion of acute viral hepatitis types in Mongolia over the last decade. METHODS: The cohort comprised 546 consecutive patients clinically diagnosed with acute viral hepatitis from January 2012 to December 2014 in Ulaanbaatar Hospital, Mongolia. A time trend analysis investigating the change in proportion of acute hepatitis A virus, hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection among the cohort with respect to a previous published study was undertaken. RESULTS: Acute hepatitis A, B and C was diagnosed in 50.9%, 26.2% and 6.0% of the cohort. Notably, 16.8% of the cohort had a dual infection. The etiologies of acute viral hepatitis were varied by age groups. The most common cause of acute viral hepatitis among 2-19 year olds was hepatitis A, HBV and superinfection with HDV among 20-40 year olds, and HCV among 40-49 year olds. Patients with more than one hepatitis virus infection were significantly older, more likely to be male and had a higher prevalence of all risk factors for disease acquisition. These patients also had more severe liver disease at presentation compared to those with mono-infection. CONCLUSIONS: Acute viral hepatitis is still prevalent in Mongolia. Thus, the need for proper infection control is increasing in this country.

Expression and Purification of Recombinant Hepatitis Delta Virus (HDV) Antigen for Use in a Diagnostic ELISA for HDV Infection Using the High-Density Fermentation Strategy in Escherichia coli / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>Hepatitis Delt a Virus (HDV) antigen is widely used as a capture antigen in ELISAs for the identification of HDV infection; large amounts of recombinant HDV antigen with active antigenicity are required for this purpose.</p><p><b>METHODS</b>Reconstruct the gene of HDV antigen based on the bias code of Escherichia coli, the recombinant protein expresses by high-density fermentation with fed-batch feeding strategy, and purify by immobilized metal chromatography. The sensitivity and specificity of this antigen detect by ELISA method.</p><p><b>RESULTS</b>The expression of HDV antigen can reach 20% of the total cell mass in the soluble form. The recombinant HDV antigen can be conveniently purified (98%) by immobilized metal ion affinity chromatography (IMAC) using the interaction between a His-tag and nickel ions. Production of recombinant HDV antigen can reach 0.5 g/L under conditions of high-density cell fermentation. Applied to the diagnostic ELISA method, the recombinant HDV antigen shows excellent sensitivity (97% for IgM and 100% for IgG) and specificity (100% for IgG and IgM) for the detection of anti-HDV antibodies.</p><p><b>CONCLUSION</b>Expression and purification the recombinant HDV antigen as a candidate protein for application in a diagnostic ELISA for HDV infection. Large-scale production of the protein can be achieved using the high-density fermentation strategy.</p>

The 2014 Hepatology Society of the Philippines consensus statements on the management of chronic hepatitis B

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region. In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth). The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children. The consensus statements will be amended accordingly as new therapies become available.

Receptor for Hepatitis B and D Virus / 대한내과학회지

Chronic hepatitis B affects 400 million people worldwide and is one of the leading causes of liver-related morbidity and mortality. All clinically available hepatitis B virus (HBV) drugs are nucleoside or nucleotide analogs that inhibit viral reverse transcriptase (RT) activity. Resistance to these HBV drugs has been widely reported, and is due to specific mutations in the viral RT domain. Therefore, the development of new, non-polymerase targeting anti-HBV agents is urgently needed. A potential drug target, the HBV receptor that mediates the viral entry process, has been recently identified using human primary hepatocytes, northern tree shrew (Tupaia belangeri) hepatocytes, and HepaRG cells. A transporter of bile acids, sodium taurocholate cotransporting polypeptide (NTCP), was identified as the receptor for HBV and hepatitis D virus, and the transport function of NTCP was correlated with HBV entry. Therefore, functional inhibitors of NTCP may inhibit HBV infection, and viral entry was blocked by several NTCP receptor-targeting compounds. The HBV receptor is an attractive target for development of entry inhibitors, and serves as a model for the mechanistic study of HBV entry and infection. This review will summarize the characteristics and clinical importance of NTCP, and will discuss the potential therapeutic use of NTCP inhibitors to prevent HBV entry.

Inactive hepatitis B surface antigen carriers and intrafamilial tramsmission: results of a 10-year study

BACKGROUND/AIMS: The aims of the present study were to determine the outcomes of inactive hepatitis B virus (HBV) surface antigen (HBsAg) carriers over a 10-year study period and to elucidate the HBV serological profile of their family members. METHODS: We retrospectively analyzed the medical files of inactive HBsAg carriers followed up at the Department of Infectious Diseases of Kocatepe University Medical Faculty Hospital between March 2001 and January 2011. RESULTS: In total, 438 inactive HBsAg carriers were enrolled in this trial. The follow-up period was 33.7+/-22.5 months (mean+/-SD). Anti-hepatitis-B surface antibody seroconversion occurred in 0.7% of cases, while chronic hepatitis B was found in 0.5%. The anti-hepatitis-D virus (HDV) status was evaluated in 400 patients and anti-hepatitis C virus (HCV) in 430. It was found that 1% and 0.2% were positive for anti-HDV and anti-HCV, respectively. HBV serology was investigated in at least 1 family member of 334/438 (76.3%) patients. The HBsAg positivity rate was 34.6% in 625 family members of 334 patients. A comparison of the HBsAg positivity rates in terms of HBV DNA levels in index cases revealed that HBsAg seropositivity rates were higher in family members of HBV DNA-negative patients than in family members of HBV DNA-positive cases (P=0.0001). CONCLUSIONS: The HBsAg positivity rate was higher in family members of inactive HBsAg carriers than in the general population; these family members therefore have a higher risk of HBV transmission. Furthermore, despite negative HBV DNA levels, transmission risk was not reduced in these patients, and horizontal transmission seems to be independent of the HBV DNA value.

Effects of counseling and education to patients presenting with hepatitis at a tertiary care hospital

Hepatitis is an escalating problem in Pakistan due to lack of awareness about its risk factors. To create awareness about risk factors for hepatitis in patients coming for its treatment at a tertiary care hospital using a counseling intervention. The study was conducted at civil hospital, Karachi. Patients having hepatitis B or C were enrolled. Each patient filled a pre and post counseling questionnaire [after 6 months]. A total of 153 hepatitis positive patients were counseled. There were 108 females and 45 males. Majority [83] had hepatitis C virus, 56 had hepatitis B virus, 08 had co-infection of hepatitis B virus and hepatitis D virus and 06 had hepatitis B virus with hepatitis C virus. Counseling was done on multiple parameters. Pre counseling figures for using brand new syringes were 32% which improved to 81% after counseling, for using screened blood these changed from 22% to 81%, for sterilized dental instruments they improved from 21% to 65% and for avoiding road side barbers they improved from 58% to 78%. The figures for hepatitis B virus vaccination in hepatitis C virus patients rose from 3% to 36.6% and for families rose from 2.6% to 43.1%. Great improvements were seen in the awareness and health seeking behavior of hepatitis cases following behavior change communication. More stress should be given on preventive strategies through mass awareness and counseling programs to control disease spread

Prevalência de anticorpos anti-vírus da hepatite D (HDV) em pacientes com hepatite B no Rio de Janeiro e caracterização molecular do genoma completo do HDV / Prevalence of antibodies to hepatitis D virus (HDV) in patients with hepatitis B in Rio de Janeiro and molecular characterization of the complete genome of HDV

O vírus da hepatite D (Hepatitis D Virus ou HDV) é um vírus defectivo que necessita da presença do vírus da hepatite B (HBV) para completar seu ciclo infeccioso. A infecção pelo HDV está associada a uma forma mais grave de hepatite e com aumento do risco de progressão para complicações, tais como, cirrose e carcinoma hepatocelular. No Brasil, a Bacia Amazônica é uma área endêmica para a infecção pelo HDV, no entanto, poucos dados foram avaliados em outras regiões do país. Este estudo avaliou a prevalência de HDV em pacientes com infecção aguda ou crônica pelo HBV, acompanhados no Ambulatório Hepatites Virais, Rio de Janeiro, Brasil, entre 2006 e 2011. Um total de 368 amostras de soro de pacientes positivos para o antígeno de superfície do vírus da hepatite B (HBsAg) foi testado para a presença de anticorpos anti-HD utilizando o ensaio comercial ETI-AB-DELTAK-2, de acordo com as instruções do fabricante. Amostras com resultados reagentes ou indeterminados foram retestadas em duplicata, para confirmação ou não do resultado. Amostras anti-HD positivos foram testadas por PCR para amplificar um fragmento da região genômica do antígeno delta (HDAg). As amostras positivas para HDV RNA foram submetidas ao sequenciamento de nucleotídico, a fim de identificar o genótipo do HDV. As sequências obtidas foram alinhadas utilizando o programa Clustal X e a análise filogenética foi realizada usando o programa MEGA v.5. A carga viral do HBV foi quantificada por meio do ensaio comercial COBAS ® TaqMan ® HBV e o genótipo do HBV foi determinado pelo ensaio INNO-LIPA. Nossa população de estudo consistiu de 243 homens e 125 mulheres, com média de idade de 43 anos (1-82 anos), sendo 138 e 230 pacientes com infecção aguda e crônica pelo HBV, respectivamente. Cinco pacientes foram positivos para anticorpos anti-HD (infecção aguda pelo HBV, n = 1; infecção crônica pelo HBV, n = 4) e um dos pacientes com infecção crônica pelo HBV apresentou amostras com HDV RNA detectável. A análise filogenética mostrou que a sequência do HDV se agrupou com o genótipo 3. Dos quatro pacientes que tiveram HBV DNA detectado, três apresentaram baixos níveis de HBV DNA. Em relação ao genótipo de HBV, o genótipo A foi mais prevalente (n = 4). A fim de caracterizar a variabilidade genética de todo o genoma de HDV, o genoma completo foi sequenciado e as sequências de aminoácidos deduzidas foram inferidas utilizando o programa MEGA v.5. O genoma da amostra identificado no presente estudo é constituído por 1673 nucleotídeos e mostrou apenas 88,7% de similaridade com as sequências de genótipo 3 caracterizadas até o momento. A região LHDAg (large HDAg) da amostra brasileira contém múltiplas substituições de aminoácidos, que são conservadas em todas as sequências completas de genótipo 3, cujo significado ainda não foi estabelecido. Este trabalho constitui o primeiro estudo sobre a caracterização da variabilidade genética do genoma completo do HDV no Brasil. Em conclusão, apesar da soroprevalência de HDV ser considerada baixa em nossa coorte, este resultado destacou a importância da investigação infecção pelo HDV em áreas não endêmicas.

Hepatitis D virus infection in the Western Brazilian Amazon - far from a vanishing disease / Infecção pelo vírus da hepatite D na Amazônia brasileira - longe de uma doença em declínio

INTRODUCTION: A decline in hepatitis D virus (HDV) occurrence was described in Europe and Asia. We estimated HDV prevalence in the Brazilian Amazon following hepatitis B vaccination. METHODS: This is a cross-sectional survey of HDV measured by total antibodies to HDV (anti-HD T). RESULTS: HDV prevalence was 41.9% whiting HBsAg carries and was associated with age (PR = 1.96; 95% CI 1.12-3.42; p = 0.01), hepatitis B virus (HBV) infection (PR = 4.38; 95% CI 3.12-6.13; p < 0.001), and clinical hepatitis (PR =1.44; 95% CI 1.03-2.00; p = 0.03). Risk factors were related to HDV biology, clinical or demographic aspects such as underlying HBV infection, clinical hepatitis and age. CONCLUSIONS: Our study demonstrated that HDV infection continues to be an important health issue in the Brazilian Amazon and that the implementation of the HBV vaccination in rural Lábrea had little or no impact on the spread of HDV. This shows that HDV has not yet disappeared from HBV hyperendemic areas and reminding that it is far from being a vanishing disease in the Amazon basin.

INTRODUÇÃO: É descrito declínio na ocorrência do vírus da hepatite D (VHD) na Europa e Ásia. Estimamos a prevalência de infecção pelo VHD na Amazônia Ocidental, após a introdução da vacinação contra hepatite B. MÉTODOS: Este é um estudo de corte transversal da prevalência do VHD medido pela ocorrência de anticorpos totais (anti-HD T). RESULTADOS: A prevalência do VHD encontrada foi 41,9% entre os portadores do HBsAg, e esteve associado à idade (RP = 1,96; IC 95% 1,12-3,42; p = 0,01), infecção pelo HBV (RP = 4,38; IC 95% 3,12-6,13; p < 0,001) e história clínica de hepatite (RP =1,44; IC 95% 1,03-2,00; p = 0,03). Fatores de risco mostraram-se associados à biologia do HDV, aspectos clínicos e demográficos como infecção prévia pelo VHB e idade. CONCLUSÕES: O estudo demonstra que a infecção pelo VHD continua sendo um importante problema de saúde pública na região, e que a implantação da vacinação contra o VHB na área rural de Lábrea teve um impacto pouco significativo no controle do VHD, percebe-se que este ainda não desapareceu de áreas hiperendêmicas do VHB, e está longe de poder ser classificado como uma doença em declínio na bacia Amazônica.

Frequency of hepatitis-D in HbsAg positive cases at Peoples university of medical and health sciences for women hospital Nawabshah

To find out the frequency of delta virus [HDV] in HBV positive patients. Observational Study. This study was conducted at the Department of Medicine PUMHS Nawabshah form 01-01-2011 to 31-12-2011. 200 adult patents of conformed Hepatitis B were included in the study blood samples of all the patients were screened for HDV by Elisa method / PCR during period of one yare. Clinical status of positive and negative patients was also compared. Anti HDV was found in 32 patients [15%1] among them 20 [62%] were male and 12 [38%] were female. The prevalence of HDV infection in HBV +ve patients is significant our area. Primary eradication of Hepatitis B virus is required

Prevention of Viral Hepatitis and Vaccination / 대한내과학회지

Hepatitis viruses are most important cause of acute and chronic hepatitis. In past, hepatitis B virus was one of the major causes of acute hepatitis. Recently, around 60-70% of acute hepatitis is attributed to hepatitis A virus infection. In this article, we will discuss the route of hepatitis virus infection, how to prevent transmission of viral hepatitis and who should be immunized to each hepatitis viruses.

The analysis of hepatitis delta virus infective markers in the hepatitis is B virus infective people / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the distribution of hepatitis delta virus (HDV) marker among hepatitis B virus (HBV) infected patients and to reveal its clinical significance.</p><p><b>METHOD</b>To collect the clinical data and sera samples of HBV infected patients and to detect HDAg, Anti-HDV as well as HBV infection markers by means of enzyme-linked immunosorbnent assay. These data combined with clinical diagnostic results and biochemical index were then analyzed.</p><p><b>RESULT</b>462 samples of HBV infected patients were collected including 210 HBV carriers without symptom, 175 chronic HBV infections, 35 acute HBV infections and 42 liver fibrosis. The HDV infection rate was 4.8% overall. The highest infection rate of 9.5% was found in the group of liver fibrosis whereas the lower rate of 6.9% was found in HBV chronic carriers. HDV infection rate was 7.8% among the population of 40-60 years old, obviously higher than any other age groups.</p><p><b>CONCLUSION</b>HDV infection was significantly higher in the chronic HBV patients and liver fibrosis patients. Because HDV infection was highly associated with the progress of liver disease, we suggest the screen of HDV markers among hepatitis patients and discriminate whether the patient was co-infected with HDV.</p>