Hepatitis Monthly
Volume:19 Issue: 7, Jul 2019

People in prisons are at high risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. This study aimed to evaluate the prevalence of HBV and HCV exposure and associated risk factors in Iranian prisons. This cross-sectional study was conducted in 2016, among 29 prisons in Iran, blood samples were collected using multistage sampling. HBV and HCV diagnostic tests were conducted using enzyme-linked immunosorbent assay (ELISA). Univariate and multivariate logistic regression were used for the evaluation of factors associated with HBV and HCV exposure. Among 6,481 people in prisons, the prevalence of HCV and HBV antibodies were 8.21% (95% CI: 7.55 - 8.90) and 3.06% (95% CI: 2.65 - 3.50), respectively. Based on multivariate analysis, the most important risks associated for HCV exposure were the history of drug use (AOR 5.75, 95% CI 3.54 - 9.35) followed by the age of 30 years and older (AOR: 5.02, 95% CI: 3.65 - 6.9), the history of tattooing (AOR 2.42, 95% CI 1.96 - 3), the history of imprisonment (AOR 2.23, 95%CI 1.76 - 2.82), being single (AOR 1.91, 95% CI 1.54 - 2.37), low education (AOR 1.81, 95%CI 1.01 - 3.27), and the history of piercing (AOR 1.26, 95% CI 1.04 - 1.52). There was no significant association between HBV prevalence and independent variables (P > 0.05). These findings highlight a high prevalence of HCV infection in Iranian prisons. Efforts are needed to improve HCV screening and interventions, particularly among people with a history of drug use, and linkage to care.

  Human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV) viruses infect millions of people around the world. People who use drugs (PWUD) are at high risk of such viral diseases and could be the source of these infections to other people. Shared needle, unsafe extra-marital sexual contact, skin popping and other risky behaviors are well-known risk factors for the prevalence of these infections among PWUD worldwide. There is no valid information regarding the danger and rate of the above-mentioned viral infections and associated risk factors among PWUD referred to healthcare facilities in Kabul, Afghanistan for the treatment and support. The main objective of this study was to determine the prevalence and risk factors of HBV, HCV, and HIV among PWUD in Kabul, healthcare facilities. This study was conducted in 7 public and private healthcare facilities at the primary care level in Kabul, which provides social support and medical care to PWUD. All patients who referred to the healthcare facilities from May 2016 to October 2016 and signed the consent were included in this study. Out of 410 PWUD, 15 (3.7%) were positive for the HBV surface antigen (HBsAg), 45 (11%) were positive for HCV antibody, and one (0.2%) was positive for HIV antibody. Among the risk factor variables studied, the administration of drugs by injection was considered the most important for HCV (OR = 3.80, P < 0.01) and viral infections among PWUD (OR = 5.40, P < 0.01). This study draws attention to the high prevalence and spread of viral hepatitis among PWUD in Kabul, Afghanistan. The prevalence of HCV and HBV was higher among PWUD compared to general populations, and drug use via injection was an important risk factor for transmitting viral infections. Based on our results, active preventive programs focusing on educational campaigns targeted at the youth populations should be undertaken in Afghanistan. Further studies, especially among PWUD living without shelter in Kabul and other major cities of Afghanistan, are recommended in order to better analyze the dangers among drug addicts in Afghanistan.

Ursodeoxycholic acid (UDCA) is a secondary hydrophilic bile acid with alleviating effects on liver enzymes. This study aimed to investigate the effect of UDCA on the improvement of liver enzymes in children with hepatitis A infection. In this randomized clinical trial, 152 patients were randomly allocated to either intervention (UDCA) or control (no drug) group. Liver enzymes were measured six times within six months post-therapy. Statistical tests were carried out using SPSS 19 software. The mean ALT level reduced from 1296.7 ± 1236 IU/L to 15.4 ± 3 IU/L in the UDCA group after six months. ALT also reduced from 1062.3 ± 959 IU/L to 16.4 ± 5 IU/L in the control group. The ratio of patients with normal ALT levels was significantly higher in the UDCA group (n = 61, 80.3%) than in the control group (n = 51, 68%) two months post-therapy (P = 0.06). The mean level of AST reduced from 983.8 ± 1036 IU/L to 19.4 ± 5 IU/L in the UDCA group and from 981.8 ± 1177 IU/L to 22.8 ± 7 IU/L in the control group. The ratio of patients with normal AST levels was significantly higher in the UDCA group than in the control group one month (n = 34, 44.7% vs. n = 20, 26.7%, respectively; P = 0.02), two months (n = 51, 67.1% vs. n = 31, 41.3%, respectively; P = 0.001), and three months (n = 66, 86.8% vs. n = 56, 74.7%, respectively; P = 0.04) post-therapy. Six months post-therapy, all the patients reached normal AST and ALT levels in both groups. Our results indicated that UDCA accelerated achieving biochemical response in children with acute hepatitis A.

The recurrence of HCV infection after liver transplantation was the main cause of mortality and loss of graft in transplanted patients until the use of direct-acting antivirals (DAAs). We performed a monocentric retrospective study from November 2014 to September 2017 at “Ospedali Riuniti”, Ancona, Italy, to evaluate the outcome and tolerability of DAAs after liver transplantation. In total, 55 patients with HCV recurrence after liver transplantation treated with DAAs were included. The most frequent genotype was genotype 1a (36%), followed by genotype 3a (27%). The majority of the patients presented a mild or moderate hepatic fibrosis (METAVIR score of F0 - F1 in 20% and F2 in 27%). The patients received sofosbuvir + daclatasvir, sofosbuvir + ribavirin, sofosbuvir + simeprevir, sofosbuvir + ledipasvir, and sofosbuvir + velpatasvir in 54%, 18%, 13%, 13%, and 2% of the cases, respectively, for 12 or 24 weeks. The SVR 12 rate was 89% overall, without a statistically significant relationship with genotypes, fibrosis stage, and therapy. Moreover, 52% of the patients modified the dosage of tacrolimus in the first three months of therapy with DAAs, without statistical significance compared to the group that not changed tacrolimus dosage. The most frequent adverse events were anemia associated with ribavirin. IFN-free treatment with DAAs is highly effective for HCV relapse after liver transplantation and it showed high tolerability in our patients.

A 48-year-old man was admitted to our hospital with complaints of productive cough, anorexia, and sweating from two weeks ago. Laboratory studies revealed an increased level of liver enzymes. The work-up of serological markers was negative for both infectious and non-infectious causes of hepatitis. He denied smoking, alcohol consumption, occupational exposures, and illicit drug use. Interestingly, he had a history of contact with an antifungal toxin called tebuconazole about 15 days before admission. In toxicological examinations using gas chromatography with a nitrogen-phosphorus detector, the cause of poisoning was revealed to be fungicide tebuconazole. To confirm the causal relationship between toxin and hepatitis, exposure avoidance and repeated testing were considered. Complete recovery was achieved in all clinical symptoms and laboratory findings. We suggest that tebuconazole-induced hepatitis should be considered in farmers exposed to this fungicide.