Impact of Hepatitis B and Hepatitis C Virus Infections in a Hematology-Oncology Unit at a Children's Hospital in Nicaragua, 1997 to 1999

The risk of acquiring both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in patients with hematological-oncological disorders has been documented. However, the impact and risk factors for such infections from different geographical areas vary, and the use of both immunological and molecular assays to determine HCV infections has been our approach. Children from a hematology-oncology unit (HOU) in Nicaragua were studied for both HBV and HCV serological markers; studies for the latter used both immunological (anti-HCV) and molecular (HCV RNA) assays. The children from the HOU included patients with leukemia, lymphoma, other neoplasias, and anemia and a smaller group with other hematological diseases. As a control group, children from other units at the same hospital were enrolled, as well as health care workers attending both patient populations. Pertinent clinical and personal data for each child at the HOU were obtained for statistical analysis. Of the 625 children from the HOU enrolled in this study 53.3% were infected with HCV and 29.4% had a prior or present HBV infection. In the child patient control group 3.2% had HBV markers and all were negative for HCV. The group of children with leukemia had the highest infection rate for both HBV and HCV. However, the determination of anti-HCV was found to have an overall low sensitivity in children from HOU, and a retest consisting of a molecular assay to determine HCV RNA was performed to better establish the total number of HCV-infected subjects in this group. The highest independent risk factor for infection was hospitalization. The very high prevalence rates for both HBV and HCV infection in this patient group indicate an urgent need to implement better control of known risk factors and to consider the use of both immunological and molecular assays for HCV diagnostic purposes.     

Occult hepatitis B virus and hepatitis C virus infections

Occult HBV infection is a well-recognised clinical entity characterised by the detection of HBV-DNA in serum and/or in liver in the absence of detectable hepatitis B surface antigen (HBsAg). Occult HBV infection has been described not only in patients who have resolved an acute or chronic HBV infection but also in patients without any serological markers of a past HBV infection. Occult HBV infection in patients with chronic HCV infection may induce more severe liver disease and lower response rate to interferon treatment. The existence of occult HCV infections has been also reported more recently. Occult HCV infection is characterised by the presence of HCV-RNA in liver and peripheral blood mononuclear cells in the absence of detectable serum HCV-RNA. Occult HCV infection may occur under two different clinical situations: in hepatitis C antibody-(anti-HCV) negative and serum HCV-RNA-negative patients with abnormal liver function tests and in anti-HCV-positive patients who have no detectable serum HCV-RNA and who have normal liver enzymes. The clinical relevance of occult HCV infections is still under investigation.     

MICA and recovery from hepatitis C virus and hepatitis B virus infections

The polymorphic MHC class I chain-related A (MICA) gene encodes a ligand that has different binding affinities for the NKG2D activating receptor of CD8+ T cells and natural killer (NK) cells. We hypothesized that MICA heterogeneity would affect recovery from hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. To test the hypothesis, we initially typed known MICA polymorphisms for 228 persons who cleared HCV infection and 442 persons with persistent hepatitis C matched on other factors affecting viral persistence. Although MICA(*)015 was detected more than two-fold more often in persons with viral clearance (odds ratio 0.36, 95% confidence interval=0.19, 0.80), it occurred in fewer than 5% of the study population. In a similar analysis of 442 persons with chronic hepatitis B and 768 matched controls who recovered, MICA(*)015 was detected in 2.0% of persons with chronic hepatitis B and only 0.9% of controls. No significant associations were detected with other MICA polymorphisms. While further investigation may reveal a structural basis of the MICA(*)015 associations, these data provide little support for the hypothesis that differential distribution of MICA alleles substantially affects recovery from HCV and HBV infections.     

HIV-1 prevalence and herpes simplex virus 2, hepatitis C virus,and hepatitis B virus infections among male workers at a sugar estate in Malawi

HIV-1 prevalence is approximately 23% among men working at a sugar estate in Malawi. Given the scale of the HIV epidemic in this country, it is important to determine possible cofactors of infection. The authors investigated associations between HIV-1 prevalence and herpes simplex virus 2 (HSV-2), hepatitis C virus (HCV), and hepatitis B virus (HBV) infections (indicated by anti-HSV-2, anti-HCV and HBsAg positivity, respectively) in a nested case-control study of 279 HIV-positive and 280 HIV-negative male workers. The prevalence of HSV-2 infection was 88.1% among HIV-positive persons and 64.3% among HIV-negative control subjects (p <.01). This difference persisted after adjusting for sexual behavior and history of sexually transmitted diseases (OR = 4.12; 95% CI, 2.21-7.68). The prevalence of HCV seropositivity was 12.7% among HIV-positive persons and 10.0% among control subjects (p =.31), whereas that of HBV infection was 16.9% among HIV-positive persons and 14.4% among control subjects (p =.46). HSV-2 infection is significantly associated with prevalent HIV-1 infection in this population. Therefore, preventive measures for HSV-2 and HIV infection should be emphasized.     

Hepatitis C virus core protein fused to hepatitis B virus core antigen for serological diagnosis of both hepatitis C and hepatitis B infections by ELISA

The sequence encoding the truncated core protein (amino acids 1–98) of hepatitis C virus (HCc) was expressed in E. coli for production of HCc_(1–98), or fused with the truncated core antigen (HBcAg) and segments from the preS1 and preS2 regions from hepatitis B virus (HBV) for production of HBcPreS₁PreS₂HCc_(1–98). The HCc_(1–98) and HBcPreS₁PreS₂HCc_(1–98) proteins reacted with sera from HCV-infected individuals by immunoblot analyses, while the latter protein also exhibited HBV core antigenicity. They induced antibodies against HBcAg and/or HCV core protein in rabbits and in mice. Moreover, HBcPreS₁PreS₂HCc_(1–98) is more immunogenic than HCc_(1–98) in terms of anti-HCc induction. An ELISA that employed recombinant HCV core antigens of either HCc_(1–98) or HBcPreS₁PreS₂HCc_(1–98) to detect anti-HCc and/or anti-HBc antibodies was developed. Evaluation of serum samples with different status of HBV and HCV infections suggested that HCc_(1–98) might be suitable for the determination of antibodies against HCV core protein, while HBcPreS₁PreS₂HCc_(1–98) might be of value to detect HCV and/or HBV infection in donated blood in HBV low-prevalence countries. J. Med. Virol. 57:104–110, 1999. © 1999 Wiley-Liss, Inc.     

Epidemiology of hepatitis B and hepatitis C virus infections among hemodialysis patients in Khartoum, Sudan

The epidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) is important for health planners and service providers. A cross‐sectional study was conducted to investigate the seroprevalence and associated risk factors for markers of HBV (HBsAg) and anti‐HCV among hemodialysis patients at the Ahmed Gasim hemodialysis unit, Sudan. Structured questionnaires were used to obtain socio‐demographic data and sera were tested for hepatitis B surface antigen (HBsAg) and antibody to HCV (anti‐HCV). Of the 353 patients enrolled in the study, HBsAg and anti‐HCV were detected in 16 (4.5%) and 30 (8.5%) patients, respectively. None of the patients were co‐infected with HBV and HCV. Multivariate analysis showed that duration of dialysis was significantly associated with anti‐HCV seropositivity [OR = 1.1, 95% CI = 1.2–1.3; P = 0.024]. No other socio‐demographic or clinical characteristics (age, sex, level of education, history of surgery, and number of units of blood transfused) were significantly associated with HBsAg or anti‐HCV seropositivity. The results of this study suggest that HBsAg and anti‐HCV have low prevalence among hemodialysis patients in Khartoum. Longer duration of dialysis was a risk factor for anti‐HCV. J. Med. Virol. 84:52–55, 2011. © 2011 Wiley Periodicals, Inc.     

Risk correlates of prevalent HIV,hepatitis B virus,and hepatitis C virus infections among noninjecting heroin users

OBJECTIVE: To examine lifetime correlates of HIV and hepatitis B and C (HBV and HCV) infections among noninjecting heroin users (NIUs). METHODS: Between March 1996 and March 2001, 483 eligible NIUs were tested for HIV, HBV, and HCV antibodies and administered structured interviews. Multivariate logistic regression analyses were stratified by injecting history. RESULTS: Among never-injectors (69.8%), significant (p <.05) correlates were unprotected sex with men who have sex with men (HIV and HBV), unprotected sex with NIUs (HIV), self-reported syphilis infection (HBV), longer duration of heroin use (HBV and HCV), shorter duration of cocaine use (HIV), blood transfusion before 1986 (HIV), and having been tattooed (HCV). Among former injectors (30.2%), significant correlates were receptive syringe sharing (HIV and HBV), frequent lifetime injection (HCV), longer duration of sexual activity (HBV), and having been tattooed (HCV). CONCLUSION: Never-injectors infected with HIV and HBV appear to have become infected mainly through sexual transmission, whereas former injectors appear to have become infected with HIV and HCV mainly though injecting risk and with HBV through both injecting and sexual risk. Interventions targeted at NIUs should prevent unsafe sex as well as the initiation or resumption of injecting. In addition, unhygienic tattooing, which may lead to HCV exposure, should be a focus of prevention efforts.     

Changing seroepidemiology of hepatitis B, C, and D virus infections in high-risk populations

Needle-sharing and sexual contact are important transmission routes of hepatitis B, C, and D virus (HBV, HCV, HDV) infection. This study aimed to investigate the current status of these viral infections among high-risk populations including prostitutes and intravenous (i.v.) drug users, compared with the prevalence rate reported previously to examine the changing seroepidemiology. Of the 916 female prostitutes, 79 (9%) were positive for antibody to HCV (anti-HCV), 111 (12%) were positive for HBV surface antigen (HBsAg), and 5 (5%) had antibody to HDV (anti-HDV). The prevalence rate was significantly lower compared to that in 1989-1991 (12%, P = 0.037) for HCV infection, and to that in 1988 (59%) and 1996 (40%) (P < 0.0001) for HDV infection. Of the 494 i.v. drug users, 87 (18%) patients were HBsAg carriers and 12 (14%) were anti-HDV-positive. The prevalence rate of HDV infection was significantly lower than that reported in 1985 (79%, P < 0.0001). Among the 443 tested i.v. drug users, 182 (41%) were anti-HCV-positive, significantly lower than that in 1985 (53%, P = 0.026). Of the 263 male prostitutes, 11 (4%) were anti-HCV-positive, 45 (17%) were HBsAg-positive, and 7 (16%) were anti-HDV-positive. Of the 129 illegal immigrant prostitutes, 7 (5%) were anti-HCV-positive, 15 (12%) were HBsAg-positive and none were positive for anti-HDV. In conclusion, the findings indicate a declining prevalence of HCV and HDV infections among drug users and prostitutes over the past 16 years. Male prostitutes and immigrant prostitutes are new "high-risk" populations and may become a reservoir for disease transmission.     

Seroepidemiological survey of hepatitis B and C virus infections in Ghanaian children

The seroprevalences of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers were evaluated in a random sample of 803 children attending school in Ashanti-Akim North district in Ghana in order to gain a better understanding of transmission patterns of these viruses, particularly horizontal transmission of HBV. This rural district is typical of 70% of the Ghanaian population. The overall seroprevalence of at least one marker of HBV infection was 61.2%, with rates increasing from 48% to 80% between the ages of 6–18 years (P < 0.001). The overall HBsAg seroprevalence was 15.8%, with the proportion of HBsAg positives amongst those with anti-HBc increasing from 39.3% in 6–7-year-olds to 51.8% in 12–13-year-old. It appears that horizontal transmission during this age period was accompanied by a high rate of HBsAg carriage. Among those infected but not carriers, i.e., those HBsAg negative and anti-HBc positive, >50% lacked detectable levels of anti-HBs, an unusual pattern of convalescent immune response to HBV. The overall seroprevalence of anti-HCV was 5.4% and did not differ significantly by age or gender. Anti-HCV seroprevalence was not associated with the presence of any HBV marker. A better understanding of the unusually high prevalences of HBV and HCV infections demonstrated in this population is likely to influence vaccination and blood transfusion policies and to stimulate further evaluations of these infections and their vehicles of spread in highly endemic regions such as sub-Saharan Africa. © 1996 Wiley-Liss, Inc.     

Effects of GB virus-C/hepatitis G virus on hepatitis B and C viremia in multiple hepatitis virus infections

Summary.  We found that patients with dual HBV and GBV-C/HGV infection had comparable serum HBV DNA positivity and mean virus concentration compared with age-matched HBV carriers, and those with triple infection had a significantly lower HBV DNA positivity. Serum HCV RNA positivity and mean virus titer were similar between HCV carriers with or without GBV-C/HGV co-infection, and those with GBV-C/HGV co-infection seemed to have a lower serum ALT level. These data suggest that GBV-C/HGV infection exerts no significant suppression on levels of chronic hepatitis B or hepatitis C viremia. Accepted December 4, 1997 Received September 8, 1997     

Prevalence of hepatitis A virus,hepatitis B virus,hepatitis C virus,hepatitis D virus and hepatitis E virus as causes of acute viral hepatitis in North India: A hospital based study

Context: Acute viral hepatitis (AVH) is a major public health problem and is an important cause of morbidity and mortality. Aim: The aim of the present study is to determine the prevalence of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV) as causes of AVH in a tertiary care hospital of North India. Settings and Design: Blood samples and clinical information was collected from cases of AVH referred to the Grade I viral diagnostic laboratory over a 1-year period. Subjects and Methods: Samples were tested for hepatitis B surface antigen, anti-HCV total antibodies, anti-HAV immunoglobulin M (IgM) and anti-HEV IgM by the enzyme-linked immunosorbent assay. PCR for nucleic acid detection of HBV and HCV was also carried out. Those positive for HBV infection were tested for anti-HDV antibodies. Statistical Analysis Used: Fisher’s exact test was used and a P < 0.05 was considered to be statistically significant. Results: Of the 267 viral hepatitis cases, 62 (23.22%) patients presented as acute hepatic failure. HAV (26.96%) was identified as the most common cause of acute hepatitis followed by HEV (17.97%), HBV (16.10%) and HCV (11.98%). Co-infections with more than one virus were present in 34 cases; HAV-HEV co-infection being the most common. HEV was the most important cause of acute hepatic failure followed by co-infection with HAV and HEV. An indication towards epidemiological shift of HAV infection from children to adults with a rise in HAV prevalence was seen. Conclusions: To the best of our knowledge, this is the first report indicating epidemiological shift of HAV in Uttar Pradesh.     

Viral replication in patients with concomitant hepatitis B and C virus infections

The aim of this study was to assess the implications of dual infection with hepatitis B virus (HBV) and hepatitis C virus (HCV). The HBV and HCV status in 100 patients with chronic hepatitis was analysed. HBV DNA was studied using liquid hybridization and the polymerase chain reaction (PCR). HCV viremia was measured using qualitative and quantitative PCR. The HCV genotype was determined by PCR. Patients were divided into three groups according to their HCV-RNA and HBsAg status: group I consisted of 40 patients with chronic hepatitis caused by HBV; group II, 40 patients with chronic hepatitis caused by HCV; and group III, 20 patients infected with both viruses. The HBV-DNA level was higher in group I than in group III (66.4 vs. 11.5 pg/ml; p<0.05). Quantification of HCV viremia revealed mean values of 36.9 copies × 10⁵/ml in group II and 5.5 copies/ml × 10⁵ in group III (p<0.05). The mean aminotransferase level and histological activity were higher in group III. HCV genotype 1b was the predominant type. The data suggest that there is reciprocal inhibition of viral replication in patients with dual HBV and HCV infection. Liver disease appears to be more severe in patients with chronic hepatitis B and C.     

Simultaneously high prevalences of hepatitis B and C virus infections in a population in Putian County, China

This study investigated a rare area of endemicity with a high prevalence of both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, in Putian County, China. Among 1,050 subjects, the overall prevalence of HBsAg seropositivity was 15.8%, and that of anti-HCV seropositivity was 28.9%. Intrafamilial viral transmission might be the major cause of the high prevalence of HBV infection in this region. However, HCV infection was shown to be associated with the use of inadequately sterilized medical equipment.     

Nosocomial transmission in simultaneous outbreaks of hepatitis C and B virus infections in a hemodialysis center

Reported here are details of a simultaneous outbreak of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections that occurred in a hemodialysis centre in northern Italy, with three patients seroconverting for HBsAg and four patients seroconverting for HCV antibodies. Phylogenetic analysis of the E2 region of the isolates from HCV-seroconverted patients showed the sequences were grouped in the same distinct branch as in a chronically HCV-infected patient, suggesting that the chronically infected patient was the index case. For the patients with HBV infection, phylogenetic analysis showed strong clustering among the sequences of the three patients who seroconverted to HBsAg and no relatedness between them and the sequences of patients chronically infected with HBV. For one of the patients who seroconverted to HBsAg, the last test with negative results for HBV markers had been performed 18 months prior to HBsAg seroconversion. This patient may have been previously infected with HBV and is presumed to be the source of the outbreak. This report emphasizes the importance of using universal precaution measures and HBV vaccination to prevent the transmission of viral hepatitis among chronic hemodialysis patients.     

High prevalence of hepatitis B,C and delta virus infections among blood donors in Mongolia

Summary. Serum samples obtained from 289 first-time and 114 repeat donors at the Blood Center of Mongolia (MBC) were tested for serological and molecular markers of hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis delta virus (HDV) infections. Among the 403 blood donors, 33 (8.2%), 21 (5.2%), and 27 (6.7%) tested positive for hepatitis B surface antigen (HBsAg) and/or HBV DNA, HCV RNA, and HDV RNA, respectively. Collectively, 55 donors were viremic for one or more of these viruses, and included 54 first-time donors (18.7%) and 1 repeat donor (0.9%) (P < 0.0001). One discrepant case with HBsAg detectable only at MBC was negative for HBsAg, HBV DNA and anti-HBc in this study. Four donors who were HCV-viremic in this study were negative for anti-HCV by the MBC method. Further efforts to increase the sensitivity and specificity of the currently-used tests are urgently required in Mongolia. Three donors who were positive for anti-HBc and anti-HDV but negative for HBsAg, had both HBV DNA and HDV RNA. This suggests that introduction of a new anti-HDV serological test is useful for not only HDV screening but also HBV screening of anti-HBc-positive, HBsAg negative donors, considering a possibility of viral interference by coexisting HDV.     

Human immunodeficiency virus,hepatitis B virus and hepatitis C virus seroprevalence in critically ill emergency department patients at a Trauma Care Centre,India

Introduction: Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the most common occupationally acquired infections amongst the healthcare workers (HCWs) with critically ill patients attending the emergency department being the most common source of occupationally acquired infections. Therefore, the present study was conducted at a 165 bedded level-1 trauma centre of India to ascertain the seroprevalence rate of HIV, HBV and HCV; and thus the risk associated with the occupational exposure in a busy emergency setting of the developing world. Methodology: A retrospective, 7 years study (2007-2013) was carried out at the JPNA Trauma Centre of the 2,500 bedded All India Institute of Medical Sciences, New Delhi. Records of all patients whose serum samples were sent to the laboratory for viral markers testing were obtained and those falling in the red area were included. Results: A total of 11,630 patients were received in the red area; and samples from 7,650 patients were sent for testing. Seropositivity of HIV, HBV and HCV in these samples was 0.28%, 3.4% and 0.9% respectively. The number of samples received was lesser than the total number of patients received in the red area. Conclusion: Adopting Standard Precautions (SP) can be used as an easy method to decrease the risk of occupationally acquired infections.     

Prevalence of hepatitis B,hepatitis C,and human immunodeficiency virus infections among hemophilia patients in Shiraz,south of Iran

Transfusion-transmitted viral infections, including hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infections continue to be a major challenge in hemophilia patient. This study was conducted to assess the seroprevalence of HBV, HCV, and HIV infections among Iranian hemophilia patients. A cross-sectional study was conducted on 580 hemophilia patients (mean age ± SD = 27.11 ± 14.9) referred to the Namazi hospital, Shiraz University of medical sciences, Shiraz, Iran during July 2012 to August 2015. Blood samples were taken from the patients and tested for HBV surface antigen (HBsAg), antibody to HBV surface antigen (anti-HBs), antibody to HBV core antigen (anti-HBc), anti-HCV antibody (HCVAb), and anti-HIV antibody (HIVAb). The association of HBV, HCV, and HIV infections with age, sex, type of hemophilia (A or B), severity of hemophilia, blood group system, history of blood transfusion, and surgery were statistically analyzed using SPSS software and chi-square/Fisher exact tests. The seroprevalence of HCVAb and HBsAg were 11.4 % (66/580) and 0.2 % (1/580), respectively. None of the hemophilia patients were positive for HIV antibody. There was a significant association between HCV seropositivity and age (P < 0.001), severity of hemophilia (P < 0.0001), and history of blood transfusion (P = 0.050). It seems that strategies for prevention of HBV and HIV infections have been successful in south of Iran, but HCV is still a major infection of concern in multi-transfused patients.