Hepatitis Monthly
Volume:8 Issue: 4, Autumn 2008

At least 5% of hepatitis B carriers worldwide are infected with Hepatitis D virus (HDV). This study aims to determine the prevalence, transaminase levels and histopathological findings of HDV among patients with chronic active hepatitis B in southern Iran. During 2003-2004, 93 patients >15 years with chronic active hepatitis B were enrolled from referrals to Shiraz University of Medical Sciences in southern Iran. Nine (9.7%) patients were seropositive for the anti HDV antibody. 76.3% of patients were male and among the HDV positive group, all subjects were male too. A significantly higher AST and more advanced grade and stage of liver disease were observed in the HDV positive group. The most common mode of transmission in the positive group was intravenous drug use. The risk of liver disease progression in chronic hepatitis B appears to be higher in HDV infected patients. Intravenous drug abuse is an important risk factor for acquiring HDV infection. Checking anti-HDV is suggested in any patient with positive HBsAg, especially in males or those with history of intravenous drug abuse.

There are limited data on the prevalence of viral hepatitis in human immunodeficiency virus (HIV) infected individuals. Comorbid illnesses in patients infected with HIV are of great interest due to their association with poor outcomes and failure of antiretroviral therapy. This study evaluated the prevalence of coinfection by HIV and viral hepatitis D in an endemic area for HIV and hepatitis B in Kermanshah. We conducted a cross-sectional study in which serological markers for hepatitis B and D viruses were tested in a consecutive sample of all patients referred for treatment of HIV or acquired immunodeficiency syndrome (AIDS). Important variables such as age, gender, origin and exposure category were obtained from existing medical records and from the sexually transmitted diseases and AIDS surveillance database. Among the 888 subjects studied, the prevalence of chronic hepatitis B carriers was 6.4%; the rate of past infection was 40.2%. The presence of hepatitis B was associated with birth in hyperendemic areas of Kermanshah, male sex and illicit drug abuse. The prevalence of hepatitis B, C and D among patients with HIV or AIDS in Kermanshah was lower than that observed elsewhere and is probably associated with the local epidemiology of these viruses and the degree of overlap of their shared risk factors. The prevalence rate for HIV and co-infection with hepatitis D virus found in this study was much lower than those reported elsewhere. An opportunity presents itself to evaluate the prevention of hepatitis D and C through harm reduction.

Poor personal health in drug addicts predisposes them to Hepatitis E virus (HEV) infection. The objective of this study was to determine the prevalence of antibody to HEV (HEV- IgG) and evaluate epidemiological features of HEV infection among drug addicts. 224 drug addicts were included in this analytic descriptive study in Ahvaz, southern Iran, from 2005 to 2006. After a through physical examination and completing a questionnaire, 5 mL blood was obtained from each case and tested for anti-HEV-IgG by an enzyme linked immunosorbent assay (ELISA) method using commercial kit (Dia-prob). Data were analyzed in SPSS 11.5 using chi-square test. Of 228 cases, 35 (13.5%) were HEV-IgG positive. The sero-prevalence of positive HEV-IgG in injecting, inhalant and oral drug abusers was 22.8%, 9.1%, and 6.2%, respectively (p<0.05). HEV-IgG was positive in heroin, crack, and opiate abusers with a rate of 20.2%, 10.9%, and 11.6%, respectively. The sero-prevalence of positive HEV-IgG in the prison and addiction treatment center was 15.8%, and 13.3%, respectively (p>0.05). Drug addiction is associated with an increased risk of exposure to HEV and resulted in the high prevalence of anti-HEV-IgG in addicts.

Hepatitis C virus (HCV) entry, as the first key step during virus infection, includes cell attachment, interactions of virus envelope proteins with receptors or co-receptors on cell surface, membrane fusion and so on. Human CD81 is identified as an important receptor for HCV, which is known to interact with HCV E2 protein. The objectives of this study were to further determine the association between CD81 and HCV cell entry and provide information for the exploring of new anti-HCV agents. In this study, the recombinant plasmid pEGFP-CD81 was firstly constructed using green fluorescence protein (GFP) as reporter gene. Six small interfering RNAs (siRNA) targeting the open reading frame (ORF) or 3''-nontranslated region (3''-NTR) of CD81 genome were transcribed in vitro and transfected into pEGFP-CD81 expressing cells for the screening of silence effect. The most effective siRNA was selected to construct the short hairpin RNA (shRNA) - expressing plasmid pGCsi-CD81, which was stably transfected into Huh7.5 cells. After screening by G418, two cell clones with the CD81 expression levels mostly reduced were infected with HCV pseudoparticles (HCVpp) or cell culture derived infectious HCV (HCVcc), while the cells stably transfected with an irrelevant siRNA were used as negative control. Our results showed that the Huh7.5 cells where CD81 was silenced were completely resistant to infection by HCVpp or HCVcc, while those cells stably transfected with an irrelevant siRNA were sensitive to HCV infection. These data underscore the importance of CD81 as a receptor for HCV, and provide an approach for investigating the association between CD81 and HCV cell entry, which may be of potential value in the development of novel prophylactic or therapeutic agents for HCV infection.

Orthotopic liver transplantation (OLT) is the only treatment that improves the survival rate in patients with acute liver failure (ALF). Hepatocytes are anchorage dependent and require a substratum for their long-term survival. Various substrata are being used to improve the function and survival of these hepatocytes, but cannot be used clinically as they are animal derived. This has been overcome by thermoreversible gelation polymer (TGP). In the present study, rat hepatocytes embedded in TGP, were transplanted intraperitoneally in acute liver failure rat model. Efficacy of the transplanted cells was studied by assessing biochemical parameters and histopathology at different time points. The ALF condition reverted to normal 15 days after cell transplantation. The transplanted animals survived 100%. Therefore this study suggests that the cells in TGP provide substratum to the transplanted cells for long term survival and could successfully provide liver support in severe ALF.

Hepatitis B virus (HBV) infection is a worldwide problem. It is estimated that 400 million people are suffering from this infection. We conducted a systematic review to put all evidence on HBV infection in I.R. Iran and to make an accurate estimate of HBV infection prevalence in Iran for further planning to control the infection.Study Design: Meta-analysis and survey data analysis of all national and international papers, theses, congresses, reports, Iranian medical universities projects, research centers, reports of Deputy for Health affairs (published or unpublished).Setting & Population: Iranian general population with positive HBsAg in blood samplesSelection Criteria for Studies: All descriptive/analytical cross-sectional studies/surveys from April 2001 to March 2007 that have sufficiently declared objectives, proper sampling method with identical and valid measurement instruments for all study subjects and proper analysis methods regarding sampling design and demographic adjustmentsOutcomes: Presence of positive HBsAg in blood samples of study samples Fourteen studies met the inclusion criteria. They were from 7 (out of 30) provinces in which about 40 percent of the country population live. These provinces (HBsAg positive prevalence) were Golestan (6.3%), Tehran (2.2%), East Azarbaijan (1.3%), Hamedan (2.3%), Isfahan (1.3%), Kermanshah (1.3%) and Hormozgan (2.4%). The HBV infection prevalence in Iran is estimated to be 2.14 percent (95%CI: 1.92-2.35), in men and women 2.55 percent (95%CI: 2.25- 2.85) and 2.03 percent (95%CI: 1.6-2.46 percent) respectively. About 1.5 million people in Iran are living with HBV infection (mild to moderate prevalence according to WHO classification) and it is assumed that 15% to 40% of them are at risk of developing cirrhosis and/or hepatocellular carcinoma (HCC) without intervention. The prevalence of HBV infection has been reported higher in more recent studies compared to the study in 2000-2001.

Persistent hepatitis C virus (HCV) infection evokes autoimmune response including production of autoantibodies and concomitant autoimmune disorders. Numerous types of autoantibodies such as non-organ-specific autoantibodies and liver-specific autoantibodies have been identified in sera of patients with HCV-related chronic liver disease (CLD). The production of these autoantibodies in HCV-related CLD reflects "virus-induced autoimmunity." Molecular mimicry between the HCV polyprotein and self-proteins, and polyclonal B cell activation by chronic HCV infection have been proposed as possible mechanisms for the occurrence of autoantibodies in HCV-related CLD. Some autoantibodies are tightly associated with concurrent autoimmune diseases, and others closely associated with peculiar human leukocyte antigen (HLA) haplotypes. Changes in the titers of autoantibodies during the antiviral treatment may predict the sustained virological response in individuals. In this article, we mainly focus on the interpretations of autoantibodies in HCV-related CLD.

Hepatitis C virus (HCV) is the foremost cause of parenterally transmitted non-A, non-B hepatitis. Effective treatment with Interferon (IFN) based regimens has been shown to reduce morbidity and mortality, improve health-related quality of life, and avoid the huge costs associated with end stage liver disease. HCV-3 has been associated in Europe and the USA to illicit drug abuse in the 70''s, while recent epidemiological reports have shown that HCV-3 prevalence is on the rise in both Western Europe and in Middle East. The standard of care for patients with HCV-3 is a 24 week therapy regimen with a combination of Pegylated Interferon (Peg-IFN) and Ribavirin (RBV). Despite the cumulative high rates of sustained virological response (SVR) obtained with this schedule of treatment, it is now clear that a subgroup of patients exists in which lower rates of SVR are achieved. Bridging fibrosis/cirrhosis, high baseline viremia and lack of rapid virological response (RVR) have been identified as predictors of treatment failure in many studies. Recently, "allocation" and randomization trials based on HCV-RNA negativity at week 4 (RVR) have evaluated the chance of abbreviating the treatment schedule to 12-16 weeks, since RVR emerged as a strong predictor of SVR. In this review article we will discuss the current therapeutic strategies in HCV-3 to understand in which subset of patients further treatment customization is possible.

Toxocariasis is a worldwide human helminthiasis. This disease is mostly asymptomatic and caused by Toxocara canis and Toxocara cati, intestinal nematodes (roundworms) in dogs and cats. These can cause visceral larva migrans syndrome in humans who ingest eggs from contaminated soil or consume of meat of paratenic hosts. A 6-year-old child had fever, chills, right upper quadrant pain, eosinophilia of 20%, elevated total serum immunoglobulin levels. Ultrasonography demonstrated two hypoechoic heterogeneous hepatic lesions 0.7 × 0.7 cm in size, located in the right lobe of liver. An enlarged periportal lymph node was noted. The case was diagnosed as hepatic toxocariasis based on sonographic and biopsy finding. The final diagnosis was confirmed by ELISA test. It can be concluded that hepatic toxocariasis should be included in the differential diagnosis of multiple liver nodules, particularly in cases of eosinophilia.

Acute hepatitis A virus is almost always a mild illness with a benign outcome in babies and children but the disease isoften symptomatic in adults and the fulminant form may occur in them. Also infrequent atypical clinical forms ofinfection, such as relapsing hepatitis, prolonged hepatitis, and cholestatic hepatitis may be seen in adults. We did notfound any cases of hepatitis A meningoencephalitis in the review of literature, so we decided to introduce this case. Wereport a case of meningoencephalitis of hepatitis A virus infection. He had cerebrospinal fluid abnormality due tomeningoencepalitis. Meningoencephalitis is an atypical presentation of hepatitis A virus infection. Atypicalmanifestations of hepatitis A should be considered in adult patients.Acute hepatitis A virus is almost always a mild illness with a benign outcome in babies and children but the disease isoften symptomatic in adults and the fulminant form may occur in them. Also infrequent atypical clinical forms ofinfection, such as relapsing hepatitis, prolonged hepatitis, and cholestatic hepatitis may be seen in adults. We did notfound any cases of hepatitis A meningoencephalitis in the review of literature, so we decided to introduce this case. Wereport a case of meningoencephalitis of hepatitis A virus infection. He had cerebrospinal fluid abnormality due tomeningoencepalitis. Meningoencephalitis is an atypical presentation of hepatitis A virus infection. Atypicalmanifestations of hepatitis A should be considered in adult patients.