Barriers and facilitators to viral hepatitis testing in Uzbekistan: scoping qualitative study among key stakeholders, healthcare workers, and the general population.

INTRODUCTION: In the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022-2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions. METHODS: This study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan. RESULTS: Following the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator. CONCLUSIONS: A multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.

Current perspectives of viral hepatitis.

Viral hepatitis represents a major danger to public health, and is a globally leading cause of death. The five liver-specific viruses: Hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus, and hepatitis E virus, each have their own unique epidemiology, structural biology, transmission, endemic patterns, risk of liver complications, and response to antiviral therapies. There remain few options for treatment, in spite of the increasing prevalence of viral-hepatitis-caused liver disease. Furthermore, chronic viral hepatitis is a leading worldwide cause of both liver-related morbidity and mortality, even though effective treatments are available that could reduce or prevent most patients' complications. In 2016, the World Health Organization released its plan to eliminate viral hepatitis as a public health threat by the year 2030, along with a discussion of current gaps and prospects for both regional and global eradication of viral hepatitis. Today, treatment is sufficiently able to prevent the disease from reaching advanced phases. However, future therapies must be extremely safe, and should ideally limit the period of treatment necessary. A better understanding of pathogenesis will prove beneficial in the development of potential treatment strategies targeting infections by viral hepatitis. This review aims to summarize the current state of knowledge on each type of viral hepatitis, together with major innovations.

Clinical diagnosis of viral hepatitis: Current status and future strategies.

Viral hepatitis (VH) is a significant public health issue with tremendous potential to aggravate into chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Recent decade has witnessed remarkable uprising in the drug development and effective treatment of VH. An upsurge is seen in identification of antiviral therapies with low rates of viral resistance, the improvement of Hepatitis B Virus (HBV) vaccination and the development of direct-acting antivirals for Hepatitis C Virus (HCV). But unfortunately, the "2030 worldwide eradication" objective of World Health Organization (WHO) is still unmet. It can be largely attributed to the deficit faced by the healthcare system concerning screening and diagnosis. A timely, accurate and comprehensive screening; encompassing maximum population coverage is essential to combat this disease. However, advancements in VH diagnostics remain inadequate and with a marginal use in routine practice. This paper deliberates upon the lacunae in traditional and prevailing diagnostic methodology of viral hepatitis, especially their inadequacy in meeting the unique situations prevailing low- and middle-income countries (LMIC).

Machine learning for prediction of viral hepatitis: A systematic review and meta-analysis.

BACKGROUND: Lack of accurate and timely diagnosis of hepatitis poses obstacles to effective treatment, disease progression prevention, complication reduction, and life-saving interventions of patients. Utilizing machine learning can greatly enhance the achievement of timely and precise disease diagnosis. Therefore, we carried out this systematic review and meta-analysis to explore the performance of machine learning algorithms in predicting viral hepatitis. METHODS: Using an extensive literature search in PubMed, Scopus, and Web of Science databases until June 15, 2023, English publications on hepatitis prediction using machine learning algorithms were included. Two authors independently extracted pertinent information from the selected studies. The PRISMA 2020 checklist was followed for study selection and result reporting. The risk of bias was checked using the International Journal of Medical Informatics (IJMEDI) checklist. Data were analyzed using the 'metandi' command in Stata 17. RESULTS: Twenty-one original studies were included, covering 82 algorithms. Sixteen studies utilized five algorithms to predict hepatitis B. Ten studies used five algorithms for hepatitis C prediction. For hepatitis B prediction, the SVM algorithms demonstrated the highest sensitivity (90.0%; 95% confidence interval (CI): 77.0%-96.0%), specificity (94%; 95% CI: 90.0%-97.0%), and a diagnostic odds ratio (DOR) of 145 (95% CI: 37.0-559.0). In the case of hepatitis C, the KNN algorithms exhibited the highest sensitivity (80%; 95% CI:30.0%-97.0%), specificity (95%; 95% CI: 58.0%-99.0%), and DOR (72; 95% CI: 3.0-1644.0) for prediction. CONCLUSION: SVM and KNN demonstrated superior performance in predicting hepatitis. The proper algorithm along with clinical practice could improve hepatitis prediction and management.

Hepatites virais: kits diagnósticos auxiliam no diagnóstico precoce

As hepatites virais são um grave problema de saúde pública no Brasil, e para encorajar a prevenção, diagnóstico e tratamento, em 28 de julho comemora-se o “Dia Mundial de Combate à Hepatite”. As hepatites virais mais comuns no país são causadas pelos vírus A, B e C.

Acute liver failure due to herpes simplex viral hepatitis diagnosed by skin lesions and blood tests: a case report.

BACKGROUND: The incidence of acute liver failure from herpes simplex virus is rare. CASE PRESENTATION: A 71-year-old Japanese man was diagnosed with acute liver failure and was transferred to our hospital. Steroid therapy, plasma exchange, and hemodiafiltration were started for liver failure, and antimicrobial therapy was initiated for pneumonia. Staphylococcus epidermidis was detected in blood culture. Skin rash appeared; a positive anti-herpes simplex virus result led to the diagnosis of acute liver failure from herpes simplex virus. Hence, acyclovir was started. After blood tests improved, treatments for acute liver failure were discontinued. Antimicrobial therapy was continued; however, he died. In this case, persistent bacteremia and drug-induced liver damage due to acyclovir may have contributed to his death. CONCLUSIONS: Acute liver failure can lead to complications and death. Thus, careful observation is crucial, even if the patient has shown some improvements.

Metabolomics in viral hepatitis: advances and review.

Viral hepatitis is a major worldwide public health issue, affecting hundreds of millions of people and causing substantial morbidity and mortality. The majority of the worldwide burden of viral hepatitis is caused by five biologically unrelated hepatotropic viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). Metabolomics is an emerging technology that uses qualitative and quantitative analysis of easily accessible samples to provide information of the metabolic levels of biological systems and changes in metabolic and related regulatory pathways. Alterations in glucose, lipid, and amino acid levels are involved in glycolysis, the tricarboxylic acid cycle, the pentose phosphate pathway, and amino acid metabolism. These changes in metabolites and metabolic pathways are associated with the pathogenesis and medication mechanism of viral hepatitis and related diseases. Additionally, differential metabolites can be utilized as biomarkers for diagnosis, prognosis, and therapeutic responses. In this review, we present a thorough overview of developments in metabolomics for viral hepatitis.

The Neuropsychiatric Aspect of the Chronic Viral Hepatitis.

Chronic viral hepatitis is a systemic disease characterized by a wide range of extrahepatic manifestations, such as cognitive impairment, chronic fatigue, sleep disorders, depression, anxiety and a decrease in quality of life. This article presents a summary of the main theories and hypotheses about the occurrence of cognitive impairment, features of treatment of patients with chronic viral hepatitis. Often, extrahepatic manifestations can outstrip the clinical manifestations of liver damage itself, which requires the use of additional diagnostic and treatment methods, and they can also significantly change the treatment tactics and prognosis of the disease. Changes in neuropsychological parameters and cognitive impairments are often recorded in patients with chronic viral hepatitis at stages characterized by the absence of significant liver fibrosis and liver cirrhosis. These changes usually occur regardless of the genotype of the infection and in the absence of structural damage to the brain. The purpose of this review is to study the main aspects of the formation of cognitive impairment in patients with chronic hepatitis, cirrhosis of viral etiology.

Um novo processo de gestão e dispensação dos antivirais no SUS para tratamento de hepatites virais B e C, no Estado do Rio de Janeiro

O processo de migração facilitou o acesso, diminuiu a burocracia e o tempo para o paciente receber os medicamentos em comparação com o sistema do CEAF. O SICLOM agiliza a dispensação cadastrando o paciente e fazendo a crítica automática da prescrição médica. Os relatórios disponíveis no sistema ainda não permitem uma avaliação mais aprofundada dos tratamentos dispensados e das características clínicas dos pacientes. O número de tratamentos deverá aumentar de acordo com o número de diagnósticos.

Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction. / Recomendaciones para el diagnóstico integral de las hepatitis virales crónicas en una única extracción analítica.

The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.

Spectrum of viral hepatitis in hospitalized children in western India.

Viral hepatitis is a major public health problem affecting children globally. Clinical presentation varies from asymptomatic illness to hepatitis, and liver failure. Data on clinical features and laboratory parameters were collected and analysed on 300 children, aged 1-12 years, admitted with confirmed viral hepatitis. A small majority (52%) were boys. The mean age of presentation was 6.9 ± 2.8 years with the commonest symptoms being anorexia or vomiting (in 98%), fever (in 89%) and jaundice (in 71.3%). Tender hepatomegaly was seen in 31.7%. Almost all (97.6%) had hepatitis A, though mixed infection (A & E) was seen in 1.7%. Only 8% had serum bilirubin levels >200 µmol/L. Significantly elevated (>20 µkat/L) levels of aspartate transaminase and alanine transaminase were seen in 19% and 25.3% of cases respectively. Coagulopathy (PT >15 s) was present in 11.0% cases. HAV remains the most common cause of viral hepatitis in children in our environment. Public awareness and universal vaccination should be the focus to prevent morbidity and mortality due to these pathogens.

Acute liver failure in tropical infections- thinking beyond viral hepatitis!

Acute liver failure is characterised by the presence of jaundice and encephalopathy with or without coagulopathy in a patient with a previously normal liver.1 A variety of tropical infections can lead to this clinical presentation. Hepatosplenomegaly and bleeding manifestations are common in such patients. Deranged liver biochemistry and poor outcomes are hallmarks of viral hepatitis inducing liver failure.

Web-Based Service Provision of HIV, Viral Hepatitis, and Sexually Transmitted Infection Prevention, Testing, Linkage, and Treatment for Key Populations: Systematic Review and Meta-analysis.

BACKGROUND: Despite the growth of web-based interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been reported. OBJECTIVE: This study aimed to inform the World Health Organization guidelines for HIV, VH, and STI prevention, diagnosis, and treatment services for key populations by systematically reviewing the effectiveness, values and preferences, and costs of web-based outreach, web-based case management, and targeted web-based health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender-diverse people, and people in prisons and other closed settings). METHODS: We searched CINAHL, PsycINFO, PubMed, and Embase in May 2021 for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed the risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and Risk of Bias in Non-randomized Studies of Interventions tools for non-RCTs. Values and preferences and cost data were summarized descriptively. RESULTS: Of 2711 records identified, we included 13 (0.48%) articles in the effectiveness review (3/13, 23% for web-based outreach; 7/13, 54% for web-based case management; and 3/13, 23% for targeted web-based health information), 15 (0.55%) articles in the values and preferences review, and 1 (0.04%) article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that web-based approaches are as effective as face-to-face services in terms of reaching new people, use of HIV, VH, and STI prevention services, and linkage to and retention in HIV care. A meta-analysis of 2 RCTs among men who have sex with men in China found increased HIV testing after web-based outreach (relative risk 1.39, 95% CI 1.21-1.60). Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on hookup platforms compared with more traditional social media platforms. CONCLUSIONS: Web-based services for HIV, VH, and STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and for infections other than HIV (ie, VH and STIs).

Hepatitis aguda grave en niños de etiología no precisada y lo que es conocido, mayo 2022 / Severe acute hepatitis in children of unspecified etiology and what is known, May 2022

Hepatitis aguda es el término empleado para describir una variedad de condiciones patológicas caracterizadas por la inflamación aguda del parénquima hepático que evoluciona a la normalización de las pruebas funcionales hepáticas en un período menor a seis meses. Puede variar en el rango de leve y autolimitada a enfermedad severa que requiere trasplante hepático. Etiológicamente, puede ser ocasionada por agentes tóxicos, drogas, factores ambientales, procesos autoinmunes o agentes infecciosos (bacterias, hongos, parásitos y virus). Los virus son considerados los agentes etiológicos más comunes de la hepatitis aguda. Los virus de la hepatitis A, B, C, D y E son reconocidos como los causantes de hepatitis viral y difieren entre ellos en modos de trasmisión, severidad de la enfermedad, distribución geográfica y métodos de prevención. Otros agentes virales pueden causar una hepatitis aguda: virus Epstein-Barr, citomegalovirus, virus herpes simplex, coxsackievirus, virus dengue, coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (SARS-CoV-2, por sus siglas en inglés).1 El 5 de abril de 2022, el Punto Focal Nacional del Reglamento Sanitario Internacional de Escocia Central notificó al Reino Unido un aumento significativo e inesperado de casos (10) de hepatitis aguda grave en niños menores de 10 años, previamente sanos, en los que no se identificó asociación conocida con los viajes. En nueve de los casos, el inicio de los síntomas fue en marzo de 2022 y en uno, en enero de 2022. Los 10 casos detectados fueron hospitalizados. Como resultado de una investigación a nivel nacional, el 8 de abril de 2022, en el Reino Unido se habían identificado un total de 74 casos, estableciendo como definición de caso confirmado toda persona que hubiera presentado una hepatitis aguda (resultado negativo a los virus de hepatitis A a la E) con transaminasas séricas >500 UI/L (Aspartato Transaminasa-AST o Alanina Transaminasa -ALT), con 10 años de edad o menos, desde...(AU)

[Viral Hepatitis in Patients with Inflammatory Bowel Disease].

There has been a rise in the incidence of inflammatory bowel disease (IBD) in developing countries, including South Korea. Consequently, the use of immunosuppressive agents such as immunomodulators or biologics has also increased. Due to immunosuppression, patients on these agents are at increased risk of various opportunistic infections during treatment, which may sometimes lead to serious adverse outcomes. Viral hepatitis, especially hepatitis B, is one of the infectious conditions that can be reactivated during immunosuppressive therapy, and adequate strategies for monitoring and prophylaxis are needed to prevent it. South Korea is one of the countries with intermediate endemicity for hepatitis A and B. Thus, taking adequate precautions against viral hepatitis could prevent new infections or reactivation of these conditions in patients with IBD on immunosuppressive therapy. In this review article, we have summarized the latest evidence on viral hepatitis in patients with IBD that would be of assistance in clinical practice.