Hepatitis Monthly
Volume:5 Issue: 4, Winter 2005

In order to evaluate some possible risk factors for the spread of hepatitis B infection, acase-control study was undertaken. The study population consisted of subjects who came to KarajHepatitisCenter. All subjects who met the inclusion criteria were considered as having chronic hepatitis and comprised our case group. Risk factors were evaluated using a questionnaire. Backward conditional logistic regression analysis was used. The case group consisted of 500 chronic subjects, and 434 subjects with negative tests for hepatitis B, hepatitis C and HIV comprised the control group. Age, male sex, marital status (being married), history of contact with hepatitis,extramarital sexual activity, IV-drug use, major surgery, experimental dentist visit and some jobs (police, barber, and driver) were found to be independent risk factors of being chronically infected with hepatitis B virus (odds ratio: 0.9,2.3, 2.1, 8.9, 6.5, 5.4, 1.6, 1.8 and 2.3, respectively). It seems to be of great importance to pay more attention to certain jobs, life styles and cultural matters in Iran that predispose people to a number of risk factors so as to implement measures to control HBV spread. Despite existence of a long list of risk factors, different epidemiological studies with alternative methodologies accompanied by meta-analysis of risk factors in each separate area seems to be helpful in providing information about transmission routes and surveillance of hepatitis B infection.

This study was done to find out the common routes of transmission of hepatitis B. We assessed 39598 volunteer blood donors for hepatitis B and C. Risk factors were obtained from 186 patients and 186 healthy donors. Independent risk factors were determined using logistic regression analysis. Prevalence of HBV was 1.08%. Female sex, education level lower than secondary school, being married, and age more than 35 years old, were risk factors in univariate analysis. Logistic regression showed that only duration of marriage, close contact with an HBV infected person, extramarital sexual contact, history of sexually transmitted diseases and high risk jobs were independent risk factors for prediction of hepatitis B infection. Risk factors which were addressed in this study covered 95.7% of the patients. Ghazvin is one of the low prevalent regions for hepatitis B in Iran. Prevalence of hepatitis B is decreasing in comparison with past decades. Horizontal mode is more important than vertical transmission in this region of Iran. Screening programs, education and vaccination, specifically in high risk groups are essential for prevention of new cases.

The significance of hepatitis B virus (HBV) serum titers has been examined in several clinical situations. Although most studies addressing this question have shown a correlation between virus serum titer and severity of liver damage, some others have failed to show any correlation between them. The aim of the present study was to determine any correlation between HBV viral load and the severity of liver disease.200 patients, including inactive carriers (n=104), patients with chronic active hepatitis (n=74: 55 HBeAg negative and 19 HBeAg positive) and with cirrhosis (n=22) entered the study. Quantitative serum HBV RNA assay was carried out using the PCR Amplicore technique. The mean age of the patients was 37 ± 12 years. A significant correlation was observed between HBV DNA viral load and ALT in cirrhotic patients (p=0.035, r=0.451). No correlation was observed between serum HBV DNA viral load and the histopathological score or grade, ALT or AST level in other CLD types (p>0.05). Our results indicate that the severity of liver disease is independent of serum levels of hepatitis B virus.The correlation between serum titers of hepatitis B virus and severity of liver disease clearly require further investigation.

Viral hepatitis remains a health threat to military forces. Most recently there has been concern about hepatitis C virus transmission during military service. Hepatitis B and C are the main causes of mortality and morbidity in military personnel. In this study, all WIAs of two corps of Revolutionary Guards of IR. Iran were checked for hepatitis B and C and liver function tests (LFT). A questionnaire was filled out for all WIAs, in which risk factors were asked. In this study, 563 WIAs were enrolled. Mean age was 38.9±3.9. Mean rate of disability was 25.5%. HBsAg positive prevalence was 4.8% and anti-HCV was 0.7%. In anti-HCV positive group, 50% had elevated enzymes and in HBsAg positive WIAs, 30.4% had elevated enzymes. All of HCV positive WIAs had surgery as a risk factor (100%). Based on the prevalence of anti-HCV positive, which shows a 5.5 times increase in prevalence of HCV in our study group, we recommend HCV infection screening in WIAs.

A 35-year-old man living in Sistan was reffered to our center because of fever, night sweats, myalgia, fatigue and elevated Alk-P, ALT and AST from which he was suffering for 8 weeks. He had no history of blood transfusion, IV drug abuse, systemic disease, or family history of hepatitis. He had not received any drugs for 3 months. He had a history of extramarital sexual contact 6 months before. Physical examination revealed hepatomegaly. There was no lymphadenopathy, rash, cough, icterus, and arthritis. He had lost 5 kilograms in weight.Laboratory tests showed Hgb 12, WBC 10000, PMN 65%, lym 40%, Plt 200,000, ESR - 95, ALT 70, AST 65, Alk-P 700, GGT 650, total bilirubin 1.7, direct bilirubin 0.5, Wright (-), 2ME (-), VDRL negative, PPD test 8mm, anti-HIV negative, HBsAg negative, anti-HCV negative, anti-HAV IgM negative, CPK 40, LDH 370, anti-CMV IgM negative, EBV antiviral capsid IgM negative and angiotansine converting enzyme (ACE) normal. Three blood cultures after 3 weeks were sterile. Abdominal and chest CT scan were normal. The results of echocardiography and bone marrow biopsy were normal. A liver biopsy was performed. Examination of the smear revealed noncaseating granulomas with epithelioid cells. These were distributed randomly through parenchyma. A liver sample was referred for mycobacterium tuberculosis PCR test, the result of which was negative. Acid fast staining for tubercle bacilli was negative. A portion of the fresh biopsy specimen was sent for culture, and after 6 weeks, the result of the culture was negative.