A multicenter study of viral hepatitis in a United States hemophilic population

Hemophilia A and B patients seen at nine US regional treatment centers were tested for serologic markers of hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis delta virus (HDV) during 1987 and 1988. Because human immunodeficiency virus (HIV) infection, a potentially confounding variable, was present in 53% of the group, the population was divided by HIV status for analysis purposes. In the HIV-positive group (N = 382), less than 1% had not been infected with HBV, HCV, or HDV, whereas 75% had evidence of infection with HBV and 98% with HCV. HBsAg, a marker of active HBV infection, was present in 12% of subjects; 96% of these were HCV positive. Anti-HDV was detected in 35 subjects (9.1%); all were anti-HBc positive. Ten of the 35 (29%) also were positive for IgM anti-HDV, indicating current infection. All 10 were HBsAg positive and 7 of the 9 tested were HDV RNA positive. Severe/moderate hemophilia B patients were more likely to have experienced an HBV infection and to be anti-HDV positive than were similar hemophilia A patients (22% v 8%, P < .05). In the HIV-negative group (N = 345), the subjects were younger and had less severe hemophilia than the HIV-positive patients. No evidence of HBV, HCV, or HDV infection was found in 18%, whereas 33% had experienced HBV infection and 79% were anti-HCV positive. Within this group, 4% were HBsAg positive. All 13 subjects with anti-HDV (4% of the HIV-negative group) also possessed anti-HBc. One (7.7%) was IgM anti-HDV positive and the serum from another contained HDV RNA. Both of these individuals were HBsAg positive. As in the HIV-positive group, severe/moderate hemophilia B patients were more likely to be HBV and HDV positive than were hemophilia A patients (9% v 3%, P < .05). A prevalence study of viral hepatitis in a large US hemophilic population showed that active infection with HCV is common, occurring in 89% of all study patients regardless of HIV status. Evidence of active HBV infection was found in 8%; 19% of these were actively infected with HDV. HDV was more common in hemophilia B patients after controlling for disease severity.     

Chronic evolution of acute hepatitis B: the significance of simultaneous infections with hepatitis C and D. Copenhagen Hepatitis Acuta Programme

Seventy-six of 77 consecutive patients with hepatitis B surface antigen (HBsAg)-positive acute hepatitis were reevaluated using anti-hepatitis C virus (HCV), anti-hepatitis D virus (HDV), and IgM anti-hepatitis B core (HBc) testing. Anti-HCV and/or anti-HDV was found in 32 patients (42%). The presence of these markers was significantly associated with intravenous drug abuse (p less than 10(-6). Sixty-nine patients were IgM anti-HBc-positive, of whom two (3%) (95% confidence limits, 1-12%) became chronic HBsAg carriers with histologically verified chronic liver disease; both were anti-HCV and anti-HDV-negative. Among the remaining 67 IgM anti-HBc-positive patients 8 had HBV and HDV co-infection, 3 had HBV and HCV co-infection, and 1 had HBV, HCV, and HDV co-infection. Twenty-two had evidence of preceding or past HCV infection; two developed chronic active hepatitis in spite of HBsAg clearance. Seven patients with IgM anti-HBc negative. One was a chronic HBsAg carrier with HDV superinfection. One had subclinical acute HBV infection and became a chronic HBsAg carrier. In a further two patients reactivation of replication in a chronic HBV infection could not be disregarded. Three patients could not be classified; all had acute recent onset of symptoms, cleared HBsAg within 6 months, but lacked IgM anti-HBc. It is concluded that HCV and HDV superinfections in HBV carriers mimicking acute HBV infection with chronic evolution are rarely encountered in the present population in spite of high frequency of both HCV and HDV markers.     

Hepatitis D virus infection in Thailand: HDV genotyping by RT-PCR,RFLP and direct sequencing

Background: Hepatitis D virus (HDV) is a degenerate RNA virus or virusoid that requires the surface coat of hepatitis B virus (HBV), i.e. hepatitis B surface antigen (HBsAg), in order to become infectious. Three distinct genotypes of the virus have been classified. In this study, HDV genotypes were determined by restriction fragment length polymorphism (RFLP) and direct sequencing. In Thailand, simultaenous HDV/HBV infections are particularly prevalent among intravenous drug users (IVDU). Patients and Methods: A total of 743 IVDU sera were screened for HBV infection. HBsAg-positive samples were subjected to serological analysis for anti-HDV. RFLP analysis using the endonucleases Xho I and Sma I was performed on the PCR amplified HDV genome to establish the prevailing HDV genotypes. Results: 55 sera (7%) had detectable HBsAg; all 55 were subsequently subjected to serological analysis for anti-HDV, 12 (21.8%) of which were positive. Eight (66%) specimens had detectable HDV-RNA by RT-PCR. All polymorphisms were shown to be genotype I, a finding confirmed by direct sequencing. 36 HBsAg-positive sera obtained from the blood bank to serve as controls were negative for anti-HDV. Conclusion: Our data show that HDV infection is still limited among IVDU and that the pattern of polymorphism closely resembles that of the western HDV genotype I. Received: April 12, 2001 · Accepted: November 20, 2001     

Prevalence of hepatitis B among pregnant women assisted at the public maternity hospitals of São Luís,Maranhão,Brazil

IntroductionHepatitis B virus (HBV) infection is an important worldwide public health problem. In Brazil, the Ministry of Health estimates that 15% of the population has had contact with HBV, and that the mean rate of chronic carriers in Northeastern Brazil is around 0.5%.ObjectiveThe aim of this study was to assess the prevalence of HBV markers in pregnant women receiving prenatal care at the public maternity hospitals of São Luís.MethodsDemographical and epidemiological data were collected from 541 pregnant women according to the research protocol. Blood samples were collected, and the anti-HBc test was performed first. If positive, the sample was subsequently tested for HBsAg and anti-HBs. All HBsAg and/or anti-HBc positive samples were additionally tested for HBV-DNA.Results40 (7.4%) pregnant women turned out positive for anti-HBc. Of those, five (0.9%) were HBsAg positive, four (0.7%) were anti-HBc positive with negative HBsAg and anti-HBs, and 31 (5.7%) were positive for anti-HBc and anti-HBs. Anti-HBc positivity was associated with family history of hepatitis and education level below 11 years of schooling. HBV-DNA was positive in only one HBsAg-positive sample. There was no HBV-DNA positivity among HBsAg negative samples.ConclusionsThe prevalence of HBsAg in pregnant women in this study confirmed that São Luís is a low endemicity area. Occult hepatitis B was not detected in these samples.     

Seroepidemiological study on hepatitis delta virus infection in the Irabu Islands, Okinawa, Japan

A seroepidemiological study was performed to clarify the prevalence of hepatitis delta virus (HDV) infection among the general population in the Irabu islands, Okinawa, Japan. Of 2028 healthy people examined who had received their annual health check-up in 1994–95, 195 (9.6%) were positive for hepatitis B surface antigen (HBsAg). Of these 195 HBsAg-positive individuals, 46 (23.6%) showed a positive reaction for antibody to HDV (anti-HDV). The positivity rate of anti-HDV among HBsAg-positive subjects tended to increase with age up to 50–59 years of age. The prevalence of anti-HDV also varied among the seven districts in the islands (0–63.3%). None of the anti-HDV-positive subjects was included in the high risk group for parenterally transmitted diseases. The unusually high prevalence of anti-HDV among HBsAg-positive individuals, particularly in the older age groups, seemed to reflect the natural prevalence or previous HDV infection, rather than a current or imported infection of HDV. Although the great majority of HBsAg-positive subjects with anti-HDV were asymptomatic, abnormally high values of serum transaminases were more frequently seen in these subjects compared with HBsAg-positive subjects without anti-HDV.     

Epidemiology of hepatitis D virus (HDV) infection in an urban area of Northern Italy

Objectives

The introduction of vaccination against hepatitis B initially reduced the number of HBV (hepatitis B virus) and HDV (hepatitis delta virus) infections, but the decreasing trend of HDV infection seems to have stopped. The aim of this study was to assess the prevalence of HDV infection in the general population living in the catchment area of Legnano Hospital in northern Italy.

Methods

Of the 22,758 subjects tested in 2007?C2008, the 488 who were HBsAg (hepatitis B surface antigen)-positive [including 107 (21.9%) of non-Italian origin] were subsequently tested for anti-HDV antibodies.

Results

Of the 488 subjects who tested positive for HBsAg, 24 (4.9%) were anti-HDV positive, all aged between 30 and 60?years. The difference in prevalence between males (7.1%) and females (1.9%) was statistically significant (p?p?Conclusions In the catchment area of our hospital, the prevalence of HDV infection does not seem to be due to patients of non-Italian origin, but to Italian patients who are not vaccinated against HBV and who survived the HDV epidemic of the 1970s and 1980s. Nevertheless, the increase in the number of immigrants from non-EU countries in recent years is soon likely to lead to a change in the epidemiology of HDV.     

Hepatitis B Virus Infection in Health Care Workers in Albania: a Country still Highly Endemic for HBV Infection

Abstract Background: Health care workers (HCW) have an elevated risk of acquiring and transmitting parenteral infections. The aim of this study was to evaluate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers with the final goal to encourage HBV vaccination of the non-immune Albanian HCW. Methods: Among 480 HCW enrolled, 92 were physicians, 246 were nurses/techniques, 120 were auxiliary workers and 22 were office workers. Results: The HBsAg, anti-HBc and anti-HCV prevalence were 8.1%, 70% and 0.6%, respectively. The highest (11.4%) HBsAg prevalence was observed in the youngest age group (20–30 years of age). High HBsAg prevalence (7.2–7.5%) was detected also in age groups above 30 years. The highest HBsAg prevalence (12.6%) was found in the auxiliaries. The anti-HBc prevalence increased significantly with age from 59% in HCWs younger than 39 years to 87% among those older than 50 years. After adjustments for different job categories, age older than 40 years remained independently associated with anti-HBc positivity (OR = 2.9; 95% CI 1.9–4.6) and inversely associated with the lack of HBV immunity or infection markers (OR = 0.4; 95% CI 0.2–0.7). Of 142 HBsAg negative and/or anti-HBc Ab negative sera, 28 (20%) tested positive for anti-HBs. The 114 remaining individuals with no HBV infection or immunity markers were vaccinated against HBV infection. Conclusions: A high HBV infection rate and low HBV vaccination coverage were found in Albanian HCW. Albania is a Mediterranean country still highly endemic for HBV infection and new strategies to promote HBV vaccination are to be adopted.     

Serologic markers of hepatitis B virus (HBV) and hepatitis D virus infection in carriers of hepatitis B surface antigen who are frequently exposed to HBV

Serum hepatitis B e antigen (HBeAg) and HBV DNA are indicators of active replication of HBV, whereas IgM antibody to hepatitis B core antigen (IgM anti-HBc) may indicate an active immune response to chronic HBV infection. Fifty-eight carriers of hepatitis B surface antigen (HBsAg) who had frequent parenteral exposures were studied for the presence of HBeAg, HBV DNA, IgM anti-HBc and hepatitis delta virus (HDV) serologic markers. Active replication of HBV was detected in 36.2% (25% of drug addicts, 16.7% of thalassemia patients, and 46.9% of hemodialysis patients) and seropositivity for IgM anti-HBc in 55.2% of the HBsAg carriers. Among the 39 HBsAg carriers who were negative for HBeAg, IgM anti-HBc was detected significantly more frequently than HBV DNA (46.1% vs. 5.1%, p less than 0.001). Serologic evidence of HDV infection was detected in 35% of drug addicts, 50% of thalassemia patients and in 9.4% of hemodialysis patients. These data revealed that continued replication of HBV was more frequent in hemodialysis patients than in drug addicts and thalassemia patients who are HBsAg carriers and the opposite was true for the prevalence of HDV infection.     

Prevalence and clinical features of hepatitis delta virus infection in the Miyako Islands, Okinawa, Japan

The aims of this study were twofold: (1) to determine the prevalence and clinical features of hepatitis delta virus (HDV) infection among subjects positive for hepatitis B surface antigen (HBsAg) living in the Miyako Islands, Okinawa Prefecture, Japan, and (2) to clarify the relationship between HDV-RNA level and severity of HDV-related liver disease. One hundred and ninety-nine HBsAg-positive subjects (123 asymptomatic carriers [ASCs], 3 patients with acute hepatitis [AH], 50 patients with chronic hepatitis [CH], 15 patients with liver cirrhosis [LC], and 8 patients with hepatocellular carcinoma [HCC], were tested for antrbody to HDV (anti-HDV) by radioimmunoassay. Anti-HDV-positive individuals were examined to determine semi-quantified HDV-RNA level by polymerase chain reaction (PCR). The overall prevalence of anti-HDV among the 199 subjects was 21.1%. The positivity rate tended to increase with age or the severity of the underlying liver disease: anti-HDV-positive rates were 10.6% (13/123) in ASCs, 32.0% (16/50) in patients with CH, 40.0% (6/15) in patients with LC, and 87.5% (7/8) in patients with HCC. None of the patients with AH were positive for anti-HDV. There was no correlation between semi-quantified serum HDV-RNA levels and the severity of chronic liver disease in patients positive for anti-HDV. The present study showed the local spread of HDV infection in the Miyako Islands, Okinawa, Japan. Although the anti-HDV positivity rate tended to increase with the severity of the underlying liver disease, the severity of HDV-related liver disease did not correlate with the semi-quantified serum HDV-RNA level. (Received Oct. 13, 1997; accepted June 26, 1998)     

Prevalence of hepatitis virus infections in Kosovar refugees.

OBJECTIVES: To assess the prevalence of viral hepatitis infections in a sample of Kosovar refugees having arrived in southern Italy as a result of the 1999 war in the Balkans. METHODS: The 526 subjects who enrolled on voluntary basis from all age groups were tested for the prevalence of serologic markers for hepatitis virus types A, B, C, D, and E (HAV, HBV, HCV, HDV, HEV). RESULTS: Among the 526 refugees, the prevalence of total anti-HAV antibodies was 81%. A relevant finding was the presence of total anti-HAV antibodies in 61% of the children up to 10 years of age. The prevalence of anti-HEV antibodies was 2.5% among the subjects. Fifteen subjects (2.9%) were positive for hepatitis B surface antigen (HBsAg), whereas 17.5% tested positive for anti-hepatitis B core antigen (anti-HBc). In children up to 10 years of age, the prevalence of HBsAg and anti-HBc was found to be 0.4% and 6%, respectively. In subjects aged 11 to 20 years, 4.2% tested positive for HBsAg and 20.2% for anti-HBc. In the age group 21 to 30 years, 7.1% of the subjects were found to be HBsAg carriers, whereas 25.9% were found to be positive for anti-HBc. Among the refugees over 30 years of age, the prevalence of HBsAg was 4.2%, whereas anti-HBc was 43.7%. None of the refugees tested positive for anti-HDV. The prevalence of anti-HCV antibodies was 0.7%. CONCLUSIONS: The results of this seroepidemiologic study indicate a high circulation of HAV in the Kosovar population, whereas the prevalence of HEV antibodies was low and comparable to that of other European countries. The HBV infection seems to be at an intermediate level of endemicity and an immunization policy against HBV infection, through vaccination of all newborns and children before adolescence, may be advisable. Results of this study indicate that the level of endemicity of HCV infection in the Kosovar population is low.     

Frequency and Genotype of Hepatitis D Virus Infection in Patients Infected with HIV and Those Undergoing Hemodialysis

Background

Hepatitis D virus (HDV) is a defective virus dependent on hepatitis B virus (HBV) for its replication. Due to HDV transmission routes, patients undergoing hemodialysis and those with HIV infection are at risk of acquiring HDV.

Objectives

This study was aimed to determine the frequency and genotype of HDV infection among patients with HIV infection and those undergoing hemodialysis.

Patients and Methods

720 cases including 120 patients undergoing hemodialysis, and 600 patients with HIV infection were studied. All cases with positive results for HBsAg were evaluated for the presence of anti-HDV antibodies. Samples with Anti-HDV positive results were subjected to nested PCR for HDV-RNA confirmation, and sequenced for HDV genotype determination.

Results

HBsAg was found in 9 (7.5%) of 120 patients undergoing hemodialysis, and 9 (1.5%) of 600 patients with HIV infection. 3 (33.3%) of patients undergoing hemodialysis with positive results for HBsAg, and 5 (55.5%) of cases with HIV infection and positive results for HBsAg, had positive findings for anti-HDV which were then subjected to nested PCR. The amplification results confirmed that in 3 (37.5%) samples HDV-RNA was detected. Overall 2.5% of patients undergoing hemodialysis, and 0.8% of cases infected with HIV had positive results for anti-HDV and 1.7% and 0.2% of cases undergoing hemodialysis and patients infected with HIV had positive findings for HDV-RNA respectively. All of the HDV isolates were clustered in clade 1.

Conclusions

The survey showed that overall HDV frequency was not high in our high risk cases. Therefore, practitioners and health care managers should become aware of the risk of dual infection with HBV and HDV especially in high risk patients.     

A survey of bloodborne viruses and associated risk behaviours in Greek prisons

Aims. To determine HIV and hepatitis infection prevalence and correlates with risk behaviour. Design. Cross-sectional study: voluntary. anonymous HIV, hepatitis (HCV, HBV and HDV) surveillance and questionnaire on risk factors. Setting. Korydallos Prison, Athens and Ag. Stefanos Prison, Patra, Greece. Participants. Of 544 drug users imprisoned for drug related offences, all completed the questionnaire and 533 blood samples were collected. Measurements. HIV (by anti-HIV-1), HCV (by antiHCV), HBV (by anti-HBc, HBsAg) and HDV (by anti-HDV) prevalence. Data on demography, legal status, drug use, sharing of injecting equipment. Findings. Of the 544 drug users, 375 (68.9%) had injected drugs (IDUs) at some time, 35% of whom had injected whilst in that prison. Of the 533 blood samples tested, one was positive for anti-HIV-1 (0.19%), 310 for anti-HCV (58.2%), 306/531 (57.6%) for anti-HBc, 34/527 (6.5%) for HBsAg and 12/527 (2.3%) for anti-HDV. Prevalence rates for IDUs only were 0.27% for HIV-1, 80.6% for hepatitis C, 62.7% for hepatitis B and 3.3% for hepatitis D. Ninety-two per cent of IDUs injecting in prison shared needles, indicating that IDUs inject less but share more during incarceration. Multiple logistic regression revealed needle-sharing as the most important risk factor for HCV infection in IDUs. Prior knowledge of a positive hepatitis result did not appear to inhibit IDUs from practising risky behaviours in prison. Conclusions. The epidemic of hepatitis B and C among imprisoned IDUs identified by this study constitutes a major public health problem. Prevention programmes, such as counselling, HBV vaccination, community-based methadone maintenance treatment and syringe exchange schemes, are necessary in order to prevent a further spread. and correlates with risk behaviour.     

Impact of comorbidities on the severity of chronic hepatitis B at presentation

AIM: To evaluate the clinical relevance of each cofactor on clinical presentation of chronic hepatitis B.METHODS: Out of 1366 hepatitis B surface antigen (HBsAg) positive subjects consecutively observed in 79 Italian hospitals, 53 (4.3%) showed as the only cofactor hepatitis D virus (HDV) infection [hepatitis B virus (HBV)/HDV group], 130 (9.5%) hepatitis C virus (HCV) (group HBV/HCV), 6 (0.4%) human immunodeficiency virus (HIV) (group HBV/HIV), 138 (10.2%) alcohol abuse (group HBV/alcohol); 109 (8.0%) subjects had at least two cofactors and 924 were in the cofactor-free (CF) group.RESULTS: Compared with patients in group CF those in group HBV/alcohol were older and more frequently had cirrhosis (P < 0.001), those in group HBV/HDV were younger (P < 0.001), more frequently resided in the south of the country and had cirrhosis (P <0.001), those in group HBV/HCV were older (P < 0.001) and more frequently had cirrhosis (P < 0.001). These cofactors were all independent predictors of liver cirrhosis in HBsAg positive patients. Multivariate analysis showed that an older age [odds ratio (OR) 1.06, 95% CI: 1.05-1.08], alcohol abuse with more than 8 drinks daily (OR 2.89, 95% CI: 1.81-4.62) and anti-HDV positivity (OR 3.48, 95% CI: 2.16-5.58) are all independently associated with liver cirrhosis. This association was found also for anti-HCV positivity in univariate analysis, but it was no longer associated (OR 1.23, 95% CI: 0.84-1.80) at multivariate analysis.CONCLUSION: Older age, HDV infection and alcohol abuse are the major determinants of severe liver disease in chronic HBV infection, while HCV replication plays a lesser role in the severity of hepatic damage.     

Dried blood spot sampling as an alternative for the improvement of hepatitis B and C diagnosis in key populations

BACKGROUNDTo achieve the elimination of hepatitis B and C, there is an urgent need to develop alternative strategies to increase the access of diagnosis, particularly among key populations such as people living with human immunodeficiency virus (HIV), individuals with coagulopathies and chronic kidney disease (CKD) patients. AIMTo evaluate the use of dried blood spot (DBS) in the detection of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers. METHODSA total of 430 individuals comprised of people living with HIV, coagulopathies and CKD provided paired serum and DBS samples. HBsAg, anti-HBc and anti-HCV were tested in those samples using a commercial electrochemiluminescence. Demographic and selected behavioral variables were evaluated to assess possible association with HBV and HCV positivity. RESULTSUsing DBS, HBsAg prevalence varied from 3.9% to 22.1%, anti-HBc rates varied from 25.5% to 45.6% and anti-HCV positivity ranged from 15.9% to 41.2% in key populations. Specificities of HBV and HCV tests using DBS varied from 88.9% to 100%. The HBsAg assay demonstrated the best performance in CKD and coagulopathy individuals and the anti-HCV test had a sensitivity and specificity of 100% in people living with HIV. Accuracy of HBV and HCV detection in DBS varied from 90.2% to 100%. In the CKD group, HBsAg positivity was associated with infrequent use of condoms, and anti-HBc positivity was associated with sharing nail cutters/razors/toothbrushes. Anti-HCV reactivity was positively associated with a history of transplantation and length of time using hemodialysis in both specimens. In people living with HIV, only the male gender was associated with anti-HBc positivity in serum and DBS.CONCLUSIONDBS with electrochemiluminescence are useful tools for the diagnosis and prevalence studies of hepatitis B and C among key populations and may increase the opportunity to foster prevention and treatment.     

Intrahepatic expression of hepatitis B core and surface antigens in chronic hepatitis delta-virus infection.

To evaluate the interference of hepatitis B virus (HBV) protein expression in the liver in chronic hepatitis delta-virus (HDV) infection, the intrahepatic expression of hepatitis B core and surface antigens (HBcAg and HBsAg) was studied in 36 HBsAg carriers who were seropositive for anti-HDV and in 36 anti-HDV negative controls [18 with serum hepatitis B e-antigen (HBeAg) and 18 with anti-HBe]. Of 18 HBeAg-positive patients with anti-HDV, 12 had HDV antigen (HDAg) in the liver. HBcAg was positive in 66.7% (8/12) of the HbeAg-positive patients with HDAg in the liver, and in 94.4% (17/18) of controls (p = 0.14). The distribution of HBcAg was exclusively cytoplasmic in 75% (6/8) of HDV-infected patients, but was mixed nuclear and cytoplasmic in 70.6% (12/17) of the controls. The prevalence and quantitative expression of HBcAg in the nucleus, but not in the cytoplasm, were significantly decreased in chronic HDV infection. HBsAg was positive in 91.6% (11/12) of HBeAg-positive patients with HDV infection and in all controls. Membranous expression of HBsAg was detected less frequently in HDV-infected patients than in controls (7/12 vs. 17/18, p = 0.05), while the prevalence and quantitative expression of HBsAg in the cytoplasm showed little or no difference. HDAg was detected in all of the anti-HBe-positive patients with anti-HDV. Of these, none had HBcAg detectable in the liver, nor did controls, while HBsAg was detected exclusively in the cytoplasm in 94.4% (17/18). The prevalence and quantitative expression of HBsAg in the cytoplasm was not different for HDV-infected patients or controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence and natural history of hepatitis B and C infections in a large population of IBD patients treated with anti-tumor necrosis factor-α agents

BackgroundThe prevalence rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients with inflammatory bowel disease (IBD) have been reported to be higher than rates of infection among the general population. Although several cases of HBV infection reactivation in IBD patients treated with anti-TNF-α agents have been described, no evidence exists that anti-TNF-α therapy exacerbates the course of HCV. The aims of this study were to assess the prevalence of HBV and HCV and the rate of HBV vaccination in a population of IBD patients; and to investigate the long-term effects of anti-TNF-α therapy in the subgroup with HBV or HCV infections.Methods301 patients were studied. Prior to the initiation of anti-TNF-α therapy, serum samples were tested for HBsAg and anti-HBc, anti-HBs and anti-HCV antibodies. During the follow-up, HBsAg and anti-HBc positive patients underwent periodic blood testing for viral markers, HBV-DNA and liver function; anti-HCV positive patients were assessed for liver function and HCV-RNA.ResultsOne patient was HBsAg positive (0.3%), and 22 (7.3%) tested positive for anti-HBc. Seventy-two patients (23.9%) had been vaccinated for HBV. Four patients tested positive for anti-HCV (1.3%). During anti-TNF-α therapy, none of the patients experienced HBV or HCV reactivation.ConclusionsHBV and HCV infection rates were similar to infection rates among the general population. Less than one quarter of the patients had been vaccinated against HBV. Anti-TNF-α agents appear to be safe for patients with HBV infection; more data are needed for patients with HCV infection.     

Silent HDV epidemics culminates in high levels of liver cirrhosis in endemic region despite 20 years of HBV vaccination

The hepatitis delta virus (HDV) is believed to be a vanishing infection in countries with successful hepatitis B virus (HBV) vaccination programs. We assessed the current status of HDV infection in Tuva, a region of the Russia that has been highly endemic for HBV. The proportion of HDV-infected patients among HBsAg-positive patients in the regional registry in 2020 was 32.7% (786/2401). An analysis of the medical records of 514 HDV patients demonstrated that 37.5% (193/514) had liver cirrhosis at the first doctor's visit, and 7.4% of patients lived in families where another family member had HDV. All HDV patients were infected with genotype HDV-1, 94.5% had HBV genotype D, and 5.5% had genotype A. A serosurvey conducted among 1170 healthy volunteers showed that the average detection rate of HBsAg with anti-HDV was 1.0% (95% CI: 0.57–1.81%). No anti-HDV positive samples were detected in participants aged under 30 years. The HBsAg/anti-HDV positivity rate peaked at 7.4% in patients aged 50–59 years, which was significantly higher than in a similar age cohort surveyed in 2008 (1.6%, p < .0001). A Bayesian analysis showed that HDV circulation in Tuva resulted from two waves of introduction, the first in the 1810s (95% HPD: 1741–1834) from Central Asia, and the second in the 1960s (95% HPD: 1953–1979) from Russia. HBV has a much longer history of circulation in Tuva with the MRCA for the predominant genotype HBV-D dated to 972 (95% HPD: 535–1253) for subtype D1, 1274 (95% HPD: 936–1384) for D2, and 1173 (95% HPD: 1005–1618) for D3. A SkyGrid reconstruction of population dynamics showed an increase in the intensity of HDV spread in recent decades. This situation shows the need for HDV screening and prevention measures among people living with HBV.     

The immune landscape in hepatitis delta virus infection—Still an open field

Hepatitis delta virus (HDV) is known to cause the most aggressive and severe form of viral hepatitis, yet it remained under-diagnosed but does require early diagnosis for accurate disease staging. Antibody to HDV (anti-HDV) is the primary screening tool and should be assessed in patients with hepatitis B surface antigen (HBsAg) positivity, as HDV is a satellite RNA virus of hepatitis B. Additionally, the viral load (HDV RNA) should be assessed in those with positive anti-HDV, to differentiate between active infection and resolved hepatitis delta. Data regarding immune responses in HDV are limited but show dysfunctional adaptive and innate immunity. Many studies however fail to distinguish between active and resolved infection. Limited treatments are available for HDV, but promise has been shown with the newly approved Bulevirtide, a first-in-class HBV entry inhibitor. Thus immune response during therapy requires further investigation, along with additional targets for HDV cure.     

Lack of occult hepatitis B virus infection among blood donors with isolated hepatitis B core antibody living in an HBV low prevalence region of Iran

BackgroundOccult hepatitis B virus (HBV) infection in blood donors is considered a potential threat for the safety of the blood supply, however conclusive studies on this issue are lacking. The aim of this study was to assess the occult HBV infection in blood donors with isolated hepatitis B core antibody (anti-HBc) living in the city of Arak, in the Central Province of Iran, as a low prevalence region for HBV.MethodsA total of 531 voluntary blood donors in Arak, Iran were included in this study. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), anti-HBc, and hepatitis C antibody (anti-HCV) were tested in all subjects. The presence of HBV-DNA was determined quantitatively in plasma samples of cases with isolated anti-HBc (HBsAg-negative, anti-HBs-negative, and anti-HBc-positive) by real-time PCR using the artus HBV RG PCR kit on the Rotor-Gene 3000 real-time thermal cycler.ResultsOf 531 subjects enrolled in this study, 11 (2.1%, 95% confidence interval 0.8–3.2%) had isolated anti-HBc. HBV-DNA was not detected in any of the cases with isolated anti-HBc.ConclusionsOur study showed that all the blood donors with isolated anti-HBc were negative for HBV-DNA, and occult HBV infection did not occur in the blood donors of this low prevalence region for HBV infection.     

Highly endemic hepatitis B infection in rural Vietnam

BACKGROUND AND AIM: Hepatitis B is a major public health problem in Vietnam; however, estimates of the prevalence of hepatitis B virus (HBV) and hepatitis delta virus (HDV), and risk factors in rural Vietnam are limited. The aim of this study was to determine HBV and HDV prevalence, and identify risk factors for HBV infection. METHODS: A cross-sectional seroprevalence study was undertaken in two rural districts in Thai Binh province. The study population was randomly selected using multistage sampling. Demographic and behavioral risk information and serological samples were obtained from 837 participants. RESULTS: Mean age was 42.3 years +/- 15.8 (range, 16-82 years), and 50.8% were female. Prevalence of anti-HBV core antibody (anti-HBc) and hepatitis B virus surface antigen (HBsAg) was 68.2% and 19.0%, respectively, and hepatitis B e antigen HBeAg was detected in 16.4% of the HBsAg-positive group. Prevalence of HDV was 1.3% in the HBsAg-positive group. Factors associated with HBV infection (anti-HBc or HBsAg positive) were age 60 years or older (OR, 3.82; 95% CI, 1.35-10.80; P = 0.01), residence in Vu Thu district (OR, 3.00; 95% CI, 2.16-4.17; P < 0.0001), hospital admission (OR, 2.34; 95% CI, 1.33-4.13; P = 0.003) and history of acupuncture (OR, 2.01; 95% CI, 1.29-3.13; P = 0.002). Household contact with a person with liver disease (OR, 2.13; 95% CI, 1.29-3.52; P = 0.003), reuse of syringes (OR, 1.81; 95% CI, 1.25-2.62; P = 0.002) and sharing of razors (OR, 1.69; 95% CI, 1.03-2.79; P = 0.04) were independent predictors of HBsAg positivity. Alanine aminotransferase (ALT) level was elevated (>40 IU/L) in 43% of the HBsAg-positive group; proportion elevated was higher in HBeAg-positive (65%) compared with HBeAg-negative (39%) individuals in this group (P = 0.02). CONCLUSION: Hepatitis B virus infection is highly endemic in rural Vietnam. Poor infection control activities in health-care settings contribute to high HBV prevalence in this region. Universal HBV infant vaccination and improved infection control procedures are required for improved HBV control in Vietnam.