男男性行为人群甲型肝炎流行情况研究进展

[摘要]?甲型肝炎（甲肝）是由甲肝病毒（hepatitis A virus, HAV）引起的急性病毒性肝炎,主要经粪-口途径传播。自20世纪末甲肝疫苗出现,全球不同国家和地区甲肝发病率大大降低。但近年欧洲许多国家和美洲、亚洲、大洋洲的一些国家或地区均发生甲肝暴发,主要发病的人群为男男性行为者（men who have sex with men, MSM）,不同国家和地区MSM人群的HAV毒株存在关联,引起广泛关注。本文对甲肝在MSM人群中的流行情况进行综述,并探讨相关防控措施。     

戊型肝炎病毒核酸阳性血浆经输血传播感染恒河猴的研究

目的了解戊型肝炎病毒(HEV)核酸阳性血浆对灵长类动物的感染性和致病性。方法对抗-HEV IgM阳性而IgG阴性志愿献血员血浆进行HEV RNA检测，并将存在病毒血症献血员的10ml血浆静脉输入健康恒河猴，观察其对恒河猴的感染性和致病性。结果从1份抗-HEV IgM阳性而IgG阴性志愿献血员血浆中分离出HEV基因IV型RNA片段。该份血浆输入恒河猴后，恒河猴出现典型急性肝炎生物化学和病理表现，病毒血症，血清抗-HEV IgM和IgG抗体阳转。结论HEV病毒血癌献血员血浆输入可以引起灵长类动物的HEV感染以及急性肝炎，提示HEV经输血传播的可能性。     

家兔自然感染戊型肝炎病毒的动态观察

目的 了解自然条件下家兔感染戊型肝炎病毒(HEV)的方式和感染标志物的动态变化。方法 对养兔场28 d龄家兔断乳、分笼饲养,每周1次采集粪便检测HEV RNA,粪便HEV RNA转为阳性的家兔,每周采集静脉血,所有家兔每满1月龄时采集静脉血,进行血清HEV RNA、抗HEV-Ab及转氨酶检测,动态观察各种指标的变化直至家兔满5个月龄出栏。结果 共对47只家兔追踪观察,7周至5个月龄的10只家兔(21.3%,10/47)粪便中检测到HEV RNA,排毒时间在3~10周以上;其中7只家兔(14.9%,7/47)形成了病毒血症,病毒血症的出现晚于粪便排毒1~3周,持续时间为2~5周;至出栏时共有11只家兔(23.4%,11/47)转化为抗HEV-Ab阳性。基因序列分析显示HEV分离株均为兔HEV。结论 家兔从断乳到出栏的整个生长过程均对HEV均易感。家兔粪便排出病毒的时间比病毒血症持续时间长,但有家兔出栏时还处于病毒血症时期,因而家兔粪便及肉类制品可能具有传播兔HEV的危险性。     

戊型肝炎病毒蛋白的研究进展

戊型肝炎（Hepatitiv E）是由戊型肝炎病毒（hepatitis Evirus,HEV）引起的急性病毒性肝炎。该病主要经粪-口途径传播,有流行和散发两种形式。戊型肝炎的病死率较甲型、乙型、丙型和丁型肝炎高,孕妇的病死率可高达21％。自1995年印度由于水源污染发生了第一次戊型肝炎大暴发流行以来．先后在印度、尼泊尔、苏丹、吉尔吉斯斯坦等地有流行。我国自1980年以来。新疆,辽宁,吉林,内蒙古和山东等省均有戊型肝炎的流行。1986-1988年新疆南部地区发生流行,共发病119280例。死亡707例。在我国发生的急性病毒性肝炎中。戊型肝炎约占10％。     

急性戊型肝炎暴发流行107例临床分析

对一起发牛急性戊型肝炎爆发流行特殊群体的临床及流行病学的研究,揭示流行特点及临床规律。将 107例感染者临床观察、治疗和2年多的随访获得的临床及流行病学资料与既往暴发流行及散发报告资料进行分析比较,统计学处理;探讨治疗、临床转归及血清抗体的变化规律;同时对检测方法进行了改良。国人对戊型肝炎普遍易感,感染、发病率、症状轻重和预后与生活习惯、性别、年龄及原有疾病明显相关。抗体的出现有特异性,血清铁离子浓度对病情及预后有一定提示作用。戊型肝炎的防治应该引起进一步的重视,餐饮从业人员健康体检是关键。     

我院2009～2011年HIV确诊阳性流行调查报告

目的了解艾滋病的流行现状。方法对2009～2011年来我院进行HIV检测病人的总人数,性别,人群分布,传播途径进行统计并分析。结果我院2009～2011年确诊的HIV病人数在不断上升,年龄范围跨度大,文化层次也在提高,传播途径以性传播为主。结论艾滋病的流行应该引起全社会的广泛关注,加强性教育,提高全民认识,加强防范意识,减少因艾滋病给社会及家庭带来的危害。     

中国MSM人群HIV感染者中流行的HIV生物学特点及研究进展

男男性行为者(MSM)已成为传播艾滋病病毒(HIV)的高危人群之一,在该人群中流行的HIV毒株具有其在该人群中的生物学特点,所以对其流行亚型、机体的免疫反应和与性传播感染(STIs)这些方面,以及其研究进展进行了综述,以期为今后开展进一步的研究提供参考.     

戊型肝炎人畜共患性的研究进展

戊型肝炎(Hepatitis E,以下简称戊肝)是由戊型肝炎病毒(Hepatitis E virus,HEV)引起的肠道传播为主的传染性疾病。戊肝的爆发流行主要累及发展中国家,常因饮用水源被污染所致,散发病例呈全球分布。HEV 主要侵犯青壮年,重型肝炎多,易感染孕妇并且病死率可高达15%～25%,严重     

Phylogenetic analysis of acute hepatitis C virus genotype 4 infections among human immunodeficiency virus‐positive men who have sex with men in Germany

Background: An ongoing HCV epidemic currently affects a growing proportion of HIV‐positive men who have sex with men (MSM) in Europe. Recently in the North‐Rhine region of Germany, we have observed an increase in acute HCV infections of genotype 4 (HCV‐4). Aims: To characterize the current spread of HCV‐4 among German MSM using a molecular epidemiological approach. Methods: Patient characteristics and sera were collected for HIV‐positive MSM diagnosed with acute HCV‐4 infections in the North‐Rhine region (n=14), Hamburg (n=14), Frankfurt (n=4) and Berlin (n=4). Part of the HCV NS5B region (436 bp) was amplified, sequenced and compared with HCV‐4 sequences from HIV‐positive Dutch, English and French MSM (n=50) as well as unrelated HCV risk groups (n=61). Results: NS5B sequences were obtained from 35/36 (97%) of German cases, all of which were HCV subtype 4d (HCV‐4d). The phylogenetic analysis of HCV sequences revealed two MSM‐specific HCV‐4d clusters of 71 and 12 sequences. All except one of the German MSM belonged to a large MSM‐specific HCV cluster containing MSM from all four different European countries. None of the HCV‐4 strains circulating among injecting drug users or in HCV‐4 endemic areas were part of the MSM‐specific clusters. Conclusions: HCV rapidly spreads among European HIV‐positive MSM through a joint international transmission network, separate from that of injecting drug users. In order to contain this epidemic, non‐parenteral routes of transmission, such as unsafe sex, must be taken into consideration and prevention measures should be refocused accordingly.     

Mycobacterium kansasii infections in patients positive for human immunodeficiency virus

The experience with Mycobacterium kansasii infections in patients who are infected with human immunodeficiency virus (HIV) at Parkland Memorial Hospital in Dallas is presented, and the literature on such infections is reviewed. The absolute and relative paucity of reports of M. kansasii infections in HIV-positive patients is emphasized. M. kansasii infections in HIV-positive patients are classified as either pulmonary or disseminated. Evidence of the lack of therapeutic response in patients with disseminated infections and of the potential for therapeutic response in patients with infections limited to the lung is reviewed and documented. Other unresolved diagnostic and therapeutic issues concerning M. kansasii infections in HIV-positive patients are reviewed.     

Hepatitis D virus and human immunodeficiency virus antibodies in parenteral drug abusers who are hepatitis B surface antigen positive

We studied unselected, hepatitis B surface antigen (HBsAg)-positive parenteral drug abusers for antibody to hepatitis D virus (anti-HD) and antibody to human immunodeficiency virus (HIV). The prevalences of anti-HD and antibody to HIV were 67% and 58%, respectively, and there was no association between positivity for these two markers. In a logistic regression model, anti-HD was associated with older age (P = .001), longer duration of drug abuse (P = .045), and the presence of liver disease (P = .002). Antibody to HIV was associated with a younger age (P = .003) and increased serum globulin levels (P less than .001). In patients infected with HIV, the severity of hepatic dysfunction remained correlated with anti-HD. In anti-HD-positive patients, most indices of hepatic dysfunction were similar whether or not antibody to HIV was present, but serum aspartate aminotransferase levels were significantly higher in patients with both anti-HD and antibody to HIV. (124 +/- 16 vs. 74 +/- 11, P less than .05).     

Hepatitis B and C virus co-infections in human immunodeficiency virus positive North Indian patients

INTRODUCTION Diseases of the hepatobiliary system are a major problem in patients with human immunodeficiency virus (HIV) infection. An estimated one-third of deaths in HIV patients are directly or indirectly related to liver disease. Liver diseases in HI…     

Recently acquired hepatitis C virus infection among people living with human immunodeficiency virus at a university hospital in Taiwan

BACKGROUNDLittle is known about the engagement in hepatitis C virus (HCV) care and completion of HCV treatment in people living with human immunodeficiency virus (HIV) (PLWH) who have HCV coinfection in the Asia-Pacific region. Examining the HCV care cascade can identify barriers to the completion of HCV treatment and facilitate achievement of HCV micro-elimination in PLWH.AIMTo investigate the care cascade of incident HCV infections among PLWH in Taiwan.METHODSPLWH with incident HCV infections, defined as HCV seroconversion, were retrospectively identified by sequential anti-HCV testing of all archived blood samples at National Taiwan University Hospital between 2011 and 2018. All PLWH with incident HCV infections were followed until December 31, 2019. The care cascade of HCV examined included all incident HCV-infected patients, the percentages of anti-HCV antibodies detected by HIV-treating physicians in clinical care, plasma HCV RNA load tested, HCV RNA positivity diagnosed, referral to treatment assessment made, anti-HCV treatment initiated, and sustained virologic response achieved. Those who had HCV seroconversion during the interferon (IFN) era (2011–2016) and the direct-acting antiviral (DAA) era (2017–2018) were analyzed separately. The duration of HCV viremia—from the date of seroconversion to viral clearance by treatments or until the end of observation—and the incidence of sexually transmitted infections (STIs) during the HCV viremic period were estimated.RESULTSDuring the study period, 287 of 3495 (8.2%) PLWH (92.3% being men who have sex with men) who were HCV-seronegative at baseline developed HCV seroconversion by retrospective testing of all archived blood samples. Of the 287 incident HCV infections, 277 (96.5%) had anti-HCV antibodies detected by HIV-treating physicians, 270 (94.1%) had plasma HCV RNA determined and 251 (87.5%) tested positive for HCV RNA. Of those with HCV viremia, 226 (78.7%) were referred to treatment assessment, 215 (74.9%) initiated anti-HCV treatment, and 202 (70.4%) achieved viral clearance. Compared with that in the IFN era, the median interval from HCV seroconversion by retrospective testing to detection of HCV seropositivity by HIV-treating physicians was significantly shorter in the DAA era {179 d [interquartile range (IQR) 87-434] vs 92 d (IQR 57-173); P < 0.001}. The incidence rate of STIs in the DAA vs the IFN era was 50.5 per 100 person-years of follow-up (PYFU) and 38.5 per 100 PYFU, respectively, with an incidence rate ratio of 1.31 (95% confidence interval 0.96-1.77), while the duration of HCV viremia was 380 d (IQR 274-554) and 735 d (IQR 391-1447) (P < 0.001), respectively.CONCLUSIONWhile anti-HCV therapies are effective in achieving viral clearance, our study suggests more efforts are needed to expedite the linkage of PLWH diagnosed with incident HCV infections to HCV treatment.     

Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review

Hepatitis A virus(HAV)is one of the most common infectious etiologies of acute hepatitis worldwide.The virus is known to be transmitted fecal-orally,resulting in symptoms ranging from asymptomatic infection to fulminant hepatitis.HAV can also be transmitted through oral-anal sex.Residents from regions of low endemicity for HAV infection often remain susceptible in their adulthood.Therefore,clustered HAV infections or outbreaks of acute hepatitis A among men who have sex with men and injecting drug users have been reported in countries of low endemicity for HAV infection.The duration of HAV viremia and stool shedding of HAV may be longer in human immunodeficiency virus(HIV)-positive individuals compared to HIV-negative individuals with acute hepatitis A.Current guidelines recommend HAV vaccination for individuals with increased risks of exposure to HAV(such as from injecting drug use,oral-anal sex,travel to or residence in endemic areas,frequent clotting factor or blood transfusions)or with increased risks of fulminant disease(such as those with chronic hepatitis).The seroconversion rates following the recommended standard adult dosing schedule(2doses of HAVRIX 1440 U or VAQTA 50 U administered6-12 mo apart)are lower among HIV-positive individuals compared to HIV-negative individuals.While the response rates may be augmented by adding a booster dose at week 4 sandwiched between the first dose and the 6-mo dose,the need of booster vaccination remain less clear among HIV-positive individuals who have lost anti-HAV antibodies.     

Hepatitis delta virus superinfection among patients with chronic hepatitis B in southern Taiwan

To study the prevalence of hepatitis delta virus (HDV) superinfection among patients with chronic hepatitis in southern Taiwan, total and IgM anti-delta antibody (anti-HD) and delta antigen (HDAg) were determined in 85 histology-proven patients with chronic hepatitis. There were 12/85 (14.1%) cases with total anti-HD; 3 of them were also positive for IgM anti-HD. Another 9 (10.6%) cases were positive for HDAg. Thus, the prevalence of HDV superinfection was 21/85 (24.7%), which was significantly higher than previous reports in southern Taiwan. The difference was not seen if anti-HD was used as the only detector. It is concluded that, when other methods are used than previously, HDV infection is more common than previously thought and there is no difference between different parts of Taiwan.