Hepatitis Monthly
Volume:7 Issue: 2, Spring 2007

Patients with hemophilia are at high risk of post-transfusion hepatitis because of widespread use of plasma-derived products. As a consequence, hepatitis C virus (HCV) is the most common cause of chronic liver disease among hemophilic patients. The objectives of this study are to determine HCV prevalence, and analyze the effective agents in HCV infection in hemophilic patients. All patients with inherited coagulation disorders registered in hemophilia center of Isfahan (553 persons) were checked for HBsAg and anti-HCV, using enzyme-linked immunosorbent assay (ELISA) test. Positive tests for anti-HCV were confirmed by RT-PCR. Clinical history, laboratory and treatment data of all cases were studied in January 2006. From 465 men and 88 women with inherited coagulation disorders with the mean age of 23.4 ± 12.9 years, 125 patients (22.6%) were HCV positive, 2 (0.4%) were HBV positive and one (0.2%) was both HCV and HBV positive. Odds ratio between HCV infection and cryoprecipitate usage was 3 (CI 95%: 2-4.5) and between HCV and factor usage was 0.21 (CI 95%: 0.07-0.7). Considering the high chance of HCV infection after transfusion of cryoprecipitate and, a more careful pre-transfusion screening of blood for anti-HCV must be introduced in all blood banks. The usage of FFP less chance of HCV infection, instead of cryoprecipitate in patients who do not have volume restrictions may be preferable.

Hepatitis C virus (HCV) infection is the common cause of liver disease among thalassemic patients who receive recurrent blood transfusion. Recent studies in Iran has shown a high prevalance of HCV among Iranian thalassemic patients, inspite of low HCV seroprevalence in general population. In this study we investigated the prevalence of new cases of hepatitis C and its risk factor in the group of thalassemia major patients. This study was carried out in thalassemic ward of Shiraz University of Medical Sciences, southern Iran in year 2003. Cases were interviewed using a standard questionnaire including demographic, clinical history and HCV related risk behaviors. Then 3 blood samples were investigated by serum marker of anti-HCV antiboby (anti-HCV Ab) via Eliza-3th method in times zero, 45 days and after 6 months follow-up. The mean age of patients were 15.2 |¡ |6.3 (1-36 years old) and the proportion of male to female 1 to 1. The rate of HCV antibody positivity in the first sample was 25%. All of the second and third blood samples were negative. There was significant correlation between age and being positive for anti-HCV Ab (P < 0.001) and also between being positive anti-HCV Ab and the time they began to receive blood transfusion. The patients who started blood transfusion before 1996 (the year we started screening program for blood donors in Blood Bank in Iran) had 12.5 times more risk for being positive for anti-HCV Ab (odds ratio = 12.5). Our results approved the effect of screening program for blood donors in blood transfusion centers.

Chronic hepatitis B and C are prevalent diseases, especially in developing countries. In many of the patients they cause limitations in physical and mental functions and finally cause reduction in their life quality. We wanted to assess the quality of life in these patients. This research was done on 74 chronic hepatitis B and C patients of Rasht which their diseases were confirmed by serologic and histologic methods and their hepatic enzymes including AST & ALT was two times more than normal range for at least 6 months. Cross-sectional questionnaire survey performed in October 2003 till Jully 2004 in Gastrointestinal & Liver Diseases Research Center of Rasht (north city of Iran), Razi hospital. The questionnaires consisted of 29 questions that were given to the patients and they were let free to complete it. The individuals under survey consisted of 15 (20.27%) chronic hepatitis B patients and 59 (79.72%) chronic hepatitis C patients. 54 (72.79%) ones were male and 20 (27.02%) were female. Total adjusted score (up to 100 points) of life quality was 54.4 ± 22.5. No meaningful difference was seen between two sexes based on total score of life quality. Also, in different fields of life quality no significant difference was seen between two genders, except the systemic signs that the average of adjusted score of females (43 ± 28) was less than males (63 ± 27) that means meaningful statistical difference (P < 0.007). Generally, it seems that chronic hepatitis B and C have untoward life qualities which could result from concern of decrease of social support or fear of society or decrease in patronage of the family or friends and it is mandate to be concerned when furnishing services to these patients.

In this cross-sectional study, the frequency of hepatitis B and C among volunteer blood donors in blood banks of Sandeman Provincial & Lady Duffren Hospitals, Quetta, Pakistan was estimated. 1474 blood donors were selected by convenient sampling. After obtaining informed consent, brief history and examination were done. They were tested for HBsAg and anti-HCV antibodies in laboratory. The collected data analyzed by SPSS 12.0 and results shown in frequencies and percentages. Out of 1474 blood donors, 1284 (87.1%) were males and 190 (12.9%) were females. The mean age was 25 (range: 16-49) years. 71 (4.8%) were positive for HBsAg (63 males & 8 females), 26 (1.8%) for anti-HCV (21 males & 5 females) and 4 (0.27%) were positive for both (3 males & 1 female). Most of them belonged to ages 21-40 years. The frequency of hepatitis B is same as that of other part of the country contrary to the belief that Balochistan is a high prevalent region for hepatitis B as compare to the rest of the country, while the frequency of hepatitis C is less than expected. Health education and vaccination for hepatitis B should be encouraged and more vigilant efforts should be done.

The aim of this study was to determine the effect of lamivudine on liver function and clinical status of the patients with decompensated cirrhosis arising from hepatitis B virus (HBV). In a clinical trial on the basis of liver consideration in 55 patients with cirrhosis that had positive HBsAg and HBV DNA, Child-Pugh score more than 8 and some other criteria were treated with lamivudine. In these patients, serumlevel of bilirubin, albumin, ALT, AST and also the PT-INR were controlled at the beginning of study and then at intervals of 2 to 6 months and finally 12 months after the start of treatment. Five patients died in the first 6 months of treatments. The following results are related to 50 patients being under treatment with lamivudine at least for a period of 6 months. In these patients mean Child-Pugh score was decreased from 11 ± 2 to 7 ± 1 (P < 0.0001). All of the patients tolerated this drug very well. Lamivudine can be effective in improvement of liver function in patients with decompensated liver cirrhosis resulting from HBV, but for determination of proper period of treatment, further studies are necessary.

To analyze comparatively the risk factors and complications of hepatitis B and C infections at Khyber Teaching Hospital, Peshawar. A cross-sectional observational study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar, from March 2005 to October 2006. Relevant information''s were obtained from the patients with the aid of a pre-designed questionnaire prepared in accordance with the objectives of the study. A total of 432 patients with positive anti-HCV antibody 252 (58.33%) and positive HBs Ag 180 (41.66%) were included. The age range of the patients with anti-HCV antibody was from 11 to 84 years with the mean age of 47.5 years, while in HBV cases was 50.5 years (range: 7 to 87 years). In HCV positive cases, 165 (65.47%) were males and 87 (34.52%) were females while in HBV patients, 123 (68.33%) were males and 57 (31.67%) were females. The risk factors of HCV patients were: intravenous drug users, 23.81%; HCV positive sexual partners, 15.07%; blood or blood products transfusion, 13.49%; and occupational acquired-HCV, 7.14%. The major risk factors of HBV were: intravenous drug users, 33.88%; HBsAg positive sexual partners, 23.33%; blood transfusion, 14.44%; and dental procedures (tooth extraction or root canal treatment), 9.44%. Unknown source of infection was recorded in 25% of HCV and 10.56% of HBV patients. Complications consequences in HCV patients were: chronic hepatitis, 34.52%; liver cirrhosis, 16.26%; hepatocellular carcinoma, 0.79%; fulminant hepatitis, 0.79%; while 47.61% were asymptomatic or sub-clinical symptomatic. In HBV patients, complications were acute hepatitis, 5.56%; fulminant hepatitis, 0.5%; chronic healthy carriers, 31.67%; chronic hepatitis, 24.44%; liver cirrhosis, 6.11%; and hepatocellular carcinoma, 1.10%; while 40.55% were clinically asymptomatic or with sub-clinical disease. Coexistence of HCV and HBV were recorded in 52 (12.03%) patients. History of sexual transmission favors HBV infection while blood transfusion and occupational exposure were recorded mainly in HCV positive patients. Chronic persistent hepatitis and liver cirrhosis were recorded more significantly with HCV infection while HBV favor carrier state or presents as a sub-clinical disease.

Hepatitis B virus (HBV) infection is a leading cause of liver disease worldwide. It is estimated that approximately 350 million people worldwide have chronic HBV infection. In this study, immunochromatographic assays (ICAs) detection methods including rapid tests were compared with serum HBV-DNA detecting by polymerase chain reaction (PCR) system. 240 patients including 120 samples that were positive with quantitative PCR method and 120 that were negative by either PCR or EIA methods were selected. Samples were examined by strip and device from Intec, Blue Cross, Acon, Atlas, DIMA and Cortez companies compare to the quantitative PCR method as gold standard for detecting HBsAg. Strip from Intec and Blue Cross, compare to the Acon, Atlas, DIMA and Cortez devices had higher sensitivity in detecting HBsAg in serum. Also positive and negative predictive values of these two strips were higher compare to the rest. In addition true negative value, specificity and positive predictive value of Acon and DIMA strips were higher for detecting HBsAg compare to the rest of the strips. Rapid diagnostic tests are inexpensive, easy to complete, and impose the minimum discomfort to patients, as well as suitable for case-finding and epidemiological surveillance. But it should be considered that negative results with strips or device dose not exclude the presence of HBV DNA and therefore one can be use rapid tests as a back up to standard testing methods. Immunochromatographic results should be interpreted with caution, when the sample has relatively low reactivity by PCR method.

Viral hepatitis has a special relationship to renal diseases. Hepatitis B and C viruses (HBV and HCV) infections are more prevalent in renal failure patients than in general population, an important cause of morbidity and mortality of renal failure patients on chronic dialysis and after renal transplantation. The association is largely due to the frequent use of blood products in patients with end-stage kidney diseases and multiple invasive medical procedures to which these patients are exposed. The effects of renal failure on the general health and immune status of patients with renal diseases also make viral hepatitis more difficult to diagnose as well as to manage. Finally, there have been few studies of the natural history and therapy of viral hepatitis in renal failure patients, making conclusions difficult. This paper will review the prevalence, incidence, clinical features, and natural histories of HBV and HCV infections and suggest recommendations for management and therapy in renal failure patients and patients undergoing renal transplantation.