فهرست مطالب

Hepatitis - Volume:15 Issue: 7, Jul 2015

Hepatitis Monthly
Volume:15 Issue: 7, Jul 2015

  • تاریخ انتشار: 1394/05/08
  • تعداد عناوین: 9
|
  • Rahim Rahimi, Seyed Younes Hosseini, Mohammad Reza Fattahi *, Masood Sepehrimanesh, Alireza Safarpour, Seyed Ali Malekhosseini, Maryam Nejabat, Mahboobeh Khodadad, Maryam Ardebili Page 1
    Background
    Recurrence of Hepatitis B Virus infection in patients undergoing liver transplanted (LT) is a serious and often fatal problem. Lamivudine (LAM) and Hepatitis B Immunoglobulin (HBIG) are widely used to manage hepatitis B recurrence after liver transplantation. However, the outcomes in patients are less elucidated..
    Objectives
    The current study aimed to evaluate the YMDD motif mutations profile among the patients undergoing LT infected with HBV and treated with LAM/HBIG at least for one year..Patients and
    Methods
    Thirty patients with liver transplantation due to HBV were enrolled, while DNA level remained under detection limit of 50 IU/mL before transplantation and abnormal higher levels of liver enzymes after LT. The HBV genome detection was performed by two different Polymerase Chain Reaction methods following viral quantification by commercial Real-Time PCR. HbsAg detection, besides liver function tests were conducted as complementary assays. To assess nucleotide analogue mutations, the major part of polymerase gene (aa 80 - 240) was amplified by Nested-PCR, introduced to sequencing and subjected to phylogenetic analysis..
    Results
    Totally, according to the laboratory criteria there were 13 cases with detectable HBV genome, while the mean liver enzyme levels were higher in recurrent patients and HBsAg was detected only in four out of the 13 cases. Phylogenetic analysis demonstrated that all isolated genomes belonged to genotype D. Critical M204I mutation, as a proof for resistance to LAM, was detected among 46% of the subjects and natural entecavir resistance (S202I) was also distinguished in one subject. Viral quantification showed higher titer in LAM resistant group in comparison to the group with undetectable drug resistance mutant (P > 0.05)..
    Conclusions
    Although the patients carrying M204I mutation were more likely to show lack of responses to LAM therapy, LAM replacing by other nucleoside/tide analogs plus HBIG maybe still effective in decreasing hepatitis B recurrence after liver transplantation. However, it is suggested that drug resistance test should be considered by clinicians during therapeutic management to avoid the following viral breakthrough..
    Keywords: Drug resistance, Transplantation, Lamivudine
  • Anna Grzeszczuk *, Alicja Danuta Wandalowicz, Jerzy Jaroszewicz, Robert Flisiak Page 2
    Background
    HIV/HCV co-infection predisposes to accelerated liver damage and increased both liver-related and unrelated morbidity and mortality in patients with HIV infection..
    Objectives
    The aim of this study was to evaluate the prevalence of HCV infection, seropositivity, risk factors and genotype distribution among treated HIV positive patients. Furthermore, the occurrence and causes of deaths were analyzed..Patients and
    Methods
    Adult HIV-1 infected patients, with at least one antiHCV result, treated in one of Polish HIV/AIDS reference centers, participated in this cross-sectional study..
    Results
    Four hundred and fifty seven patients with a median age of 38 years (ranged 23 - 72), and predominantly male (76.6%) were enrolled in the study. Anti-HCV antibodies were detected in 325 individuals (71.1%). HCV RNA was detected in 207 of the 233 patients tested (88%). The HCV genotype analysis (n = 193) demonstrated almost equal distribution with slight genotype 1 domination as 37.3%, mainly 1b, followed by genotypes 3 as 32.1% and 4 as 30.6%. No association was found between HCV genotype and route of HIV acquisition. In univariate analysis, higher HCV seropositivity was related to male sex, intravenous drug use (IDU), mode of HIV transmission, history of drug and alcohol abuse and imprisonment. In multivariate analysis, only being injection drug user (P = 0.0001), imprisonment (P = 0.310) and younger age at the HIV diagnosis per each year (P = 0.025) were identified as risk factors for HCV infection. Sixty three deaths were reported; no association was found between HCV seropositivity and death prevalence..
    Conclusions
    HIV/HCV co-infection is an important medical problem in North-Eastern Poland. A history of incarceration and younger age at HIV diagnosis were additional to IDU risk factors for HCV seropositivity in this cohort..
    Keywords: Human Immunodeficiency Virus_Hepatitis C Virus_Prevalence_Genotypes_Poland
  • Bita Geramizadeh *, Nasibe Seirfar Page 3
    Background
    Hepatocellular carcinoma is the most common primary liver cancer. Pathologic distinction between Hepatocellular Carcinoma (HCC) and adenocarcinoma (Cholangiocarcinoma (CC) and Metastatic Adenocarcinoma (MA)) can be challenging and sometimes requires immunohistochemical panels. Recently, Arginase-1 (ARG-1) and Glypican-3 (GPC-3) have been introduced for differentiation of these tumors..
    Objectives
    The aim of this study was to determine the diagnostic accuracy of ARG-1 and GLP-3 in differential diagnosis of liver tumors..Patients and
    Methods
    Eighty-nine formalin-fixed paraffin-embedded tissue blocks including 43 cases of documented HCCs, 19 cases of documented CC, and 27 cases of MA involving the liver (15 colon, 5 stomach, 3 pancreas, 2 gallbladder, 1 duodenum and 1 ampulla of vater) were evaluated for immunohistochemical expression of ARG-1 and GPC-3..
    Results
    Arginase-1 and GPC-3 demonstrated diffuse staining, as reactivity in > 97% of HCCs, whereas only one (5.3%) and 2 (10.5%) of 19 CC cases show positive staining for GPC-3 and ARG-1, respectively. The expression of both markers in MA showed 6 (22.2%) for ARG-1 and 3 (11.1%) for GPC-3, especially with colorectal origin. Our findings showed a statistically significant difference between ARG-1 and GPC-3 expression in HCC, CC and MA..
    Conclusions
    The findings of this study reveal that both ARG-1 and GPC-3 are helpful IHC markers to separate HCC from CC and MA. Furthermore, ARG-1 shows 100% sensitivity and 82.6% specificity for the diagnosis of HCC whereas GPC-3 demonstrated 97.7% sensitivity and 91.3% specificity for the diagnosis of this tumor..
    Keywords: Arginase, Glypican, 3, Hepatocellular Carcinoma, Cholangiocarcinoma, Adenocarcinoma
  • Rentao Yu, Shitao Ding, Wenting Tan, Shun Tan, Zhaoxia Tan, Shiqing Xiang, Yi Zhou, Qing Mao, Guohong Deng * Page 4
    Background
    Alpha-fetoprotein (AFP) has long been used as an effective biomarker for hepatocellular carcinoma (HCC) screening; however, not all HCC patients can be detected with an elevated AFP level, especially in early HCC patients. Protein Induced by vitamin K absence or antagonist-II (PIVKA-II) is another serum biomarker linked to HCC; however, sensitivity and specificity remain controversial and data in Chinese groups is even rarer..
    Objectives
    To evaluate the performance of PIVKA-II alone and combined with AFP in HCC screening in Chinese population..Patients and
    Methods
    This retrospective study enrolled 150 HCC patients in Southwest Hospital, of which 16 patients were excluded due to lack of basic information. A total of 347 patients with hepatitis B, 105 with non-HCC cancers and 53 healthy people were enrolled as controls. Levels of AFP and PIVKA-II were measured by chemiluminescence enzyme immunoassay (CLEIA) and chemiluminescent microparticle Immunoassay (CMIA), respectively..
    Results
    The sensitivity and specificity of PIVKA-II were 74.6% and 67.8% at a cutoff of 40 mAU/mL and 64.2% and 89.7% at a cutoff of 200 mAU/mL. The sensitivity and specificity of AFP were 76.7% and 65.0% at a cutoff of 20 ng/mL and 60.4% and 88.9% at a cutoff of 195.23 ng/mL. The combination of two markers had a sensitivity and specificity of 91.1% and 41.0%, respectively. The area under the receiving operating curve (AUROC) for PIVKA-II (0.756, 95% confidence interval, CI: 0.695 - 0.816) was less than the AUROC for AFP (0.823, 95% CI: 0.780 - 0.865), and in combination, the AUROC increased to 0.843 (95% CI: 0.801 - 0.885)..
    Conclusions
    PIVKA-II was as efficient as AFP when used as a single marker for HCC screening and the combination of two biomarkers gave a better performance..
    Keywords: Hepatocellular Carcinoma, PIVKA, Sensitivity, Specificity
  • Farnaz Hashemi, Ali Fathi Ashtiani, Babak Mirminachi, Maryam Sharafkhah, Golnaz Ekhlasi, Elham Jafari, Hossein Poustchi * Page 5
    Background
    Liver cirrhosis has a significant impact on patient’s quality of life and socioeconomic status and is associated with increased susceptibility to vehicle accidents and falls..
    Objectives
    This study was conducted to evaluate cognitive function in patients with cirrhosis..Patients and
    Methods
    All subjects, who underwent transient elastography (TE) between March 2014 and August 2014 in Shariati outpatient clinic, Tehran, Iran, were enrolled in the study. The diagnosis of cirrhosis was made based on clinical and laboratory findings and liver stiffness measurement (LSM) values > 14. Wechsler Memory Scale (WMS) and simple visual reaction time (RT) were the neuropsychiatric tests used to assess cognitive function, in all subjects..
    Results
    A total of 37 cirrhotic patients and 37 matched controls were included. Patients with cirrhosis had significantly lower mean quotient (MQ) score, compared with controls (91 ± 18.2 vs. 114.6 ± 17.5, P <0.001). All of WMS subscales, except associate learning, showed statistically significant differences between the two groups. Reaction time was more prolonged in patients with cirrhosis, compared with controls. Cognitive function of hepatitis C virus (HCV) patients was significantly impaired, with respect to logical memory, visual reproduction and MQ score, compared to other underlying causes of cirrhosis (P = 0.01, P = 0.04, and P = 0.01, respectively).
    Conclusions
    Our results suggested that neuropsychiatric and cognitive problems must be considered in the management of covert hepatic encephalopathy (HE) patients, especially in patients with HCV infection. The WMS and simple visual RT tests are useful methods for the early diagnosis of covert HE..
    Keywords: Hepatic Encephalopathy, Liver cirrhosis, Cognition, Wechsler Scales, Reaction Time
  • Morteza Ghoghaei, Foad Taghdiri, Elias Khajeh, Farid Azmoudeh Ardalan, Mojtaba Sedaghat, Sepideh Hosseini Shirvani, Shadi Zarei, Karamollah Toolabi * Page 6
    Background
    Obesity as a worldwide health problem is associated with nonalcoholic steatohepatitis (NASH). Since severe liver injury may be present in asymptomatic obese patients and a definite diagnosis of nonalcoholic steatohepatitis can only be made after an invasive procedure of liver biopsy, there is a need for noninvasive methods to predict the probability of NASH..
    Objectives
    To investigate the role of vitamin D endocrine system in predicting the probability of presence of NASH in asymptomatic morbidly obese candidates of bariatric surgery..Patients and
    Methods
    From December 09 to March 11, every patient undergoing bariatric surgery had a liver biopsy. Nonalcoholic steatohepatitis was diagnosed using the Lee’s criteria, the baseline labs obtained and the association between laboratory data and presence of NASH assessed..
    Results
    Forty-six patients (34 women, aged 36.5 ± 10.6 years) were analyzed. The mean levels of liver enzymes were significantly higher in the group with NASH (P value < 0.01). In an unadjusted logistic model, PTH was the only variable in vitamin D endocrine system which was significantly associated with NASH (odds ratio (OR): 1.04, 95%CI: 1.01 - 1.07). After adjustment for possible confounding factors, age (OR: 1.22, 95%CI: 1.00 - 1.50) and PTH (OR: 1.08, 95%CI: 1.01 - 1.16) were predictive factors for NASH (P value < 0.05)..
    Conclusions
    Elevated serum PTH level was the predictive factor for NASH in morbidly obese patients. Also, we reported elevated serum liver enzymes, high serum PTH levels and older age as predictors of NASH in patients seeking obesity surgical treatments..
    Keywords: Steatohepatitis, Obesity, Parathyroid Hormone, Bariatric Surgery
  • Li-Hui Long *, Cai-Qin Xue, Jun-Feng Shi, Juan-Ni Dong, Li Wang Page 7
    Context: To systematically evaluate the effects of hepatoprotective agents, when delivered either alone or in combination with other antiviral or non-antiviral drugs in patients with hepatitis B and hepatic fibrosis..
    Objectives
    The current randomized controlled clinical trials aimed to evaluate the efficacy of combinations of antiviral and non-antiviral hepatoprotective agents on indexes of liver function and liver fibrosis in patients with hepatitis B..Data Sources: Published literatures in Chinese and English on hepatoprotective treatment strategies for chronic hepatitis B and liver fibrosis were searched in three databases and randomized controlled clinical trials were selected.. Study Selection: Data were extracted according to a variety of inclusion and exclusion criteria. Meta-analysis was employed to analyze the data..
    Results
    A total of 22 randomized controlled trials encompassing 1,714 cases were considered in the meta-analysis. The obtained results indicated that the combination of antiviral drug and hepatoprotective agent was better than antiviral drug alone to improve liver function. Similarly, regarding liver fibrosis, using two different hepatoprotective agents was better than using one agent. The normalization rates of Aminotransferase (ALT) and total Bilirubin (TBil) were improved 25.7% by two hepatoprotective agents compared to the single agent. Acetylcysteine was superior to ursodeoxycholic acid or silibinin to reduce ALT. Ursodeoxycholic acid was superior to acetylcysteine or silibinin to reduce TBIL..
    Conclusions
    Hepatoprotective agents combined with antiviral drugs can significantly improve liver function and liver fibrosis parameters in patients with hepatitis B..
    Keywords: Hepatitis B, Liver Cirrhosis, Meta, Analysis, Ursodeoxycholic Acid (UDCA), Silibinin, Acetylcysteine
  • Carol Stanciu *, Anca Trifan Page 8
    Hepatitis C can be cured and even eradicated by new “revolutionary” treatments. However, at present exorbitant prices, Eastern European countries cannot afford the new treatments, while in western rich and developed countries (e.g. Germany and France) they are already available. Concerted efforts of governments, public health officials, and the community at large, are needed to negotiate agreements with pharmaceuticals companies to make the new treatments accessible and affordable. When science has demonstrated that hepatitis C can be cured, it would be unforgivable if millions of infected patients from eastern parts of the continent were denied access to new treatment on grounds of high prices and financial constraints..
    Keywords: Hepatitis C, Treatment, Access
  • Sahand Ghaleh Baghi *, Seyed Moayed Alavian, Leila Mehrnoush, Shima Salimi Page 9
    Background
    Interleukin-10 (IL-10) is an important anti-inflammatory cytokine. The polymorphisms of its promoter gene have been considered to be related with the chronicity of hepatitis B infection..
    Objectives
    The aim of this study was to evaluate the polymorphisms at different positions in the IL-10 promoter gene in patients with chronic hepatitis B..Patients and
    Methods
    Totally, 166 patients with chronic hepatitis B infection were enrolled. Genotypes at different positions (i.e. -819, - 592, and - 1082) in the IL-10 gene promoter were determined..
    Results
    The C/A genotype at position -592, C/T genotype at position -819, and GCC/ATA haplotype of the IL-10 gene promoter were significantly more common in the patients with cirrhosis. The genotypes were significantly different between the hepatitis B e antigen (HBeAg)-negative and HBeAg-positive patients at position -592 (C/A and C/C), position -819 (C/C and C/T), and position -1082 (A/A and G/A)..
    Conclusions
    Some IL-10 promoter gene polymorphisms predisposed the infected hepatitis B virus cases to cirrhosis in our study population..
    Keywords: Genotype, Interleukin, 10, Polymorphism, Genetic, Promoter Regions, Genetic, Liver Cirrhosis