肝移植后乙型肝炎复发核苷类抗乙肝药物联合小剂量乙肝免疫球蛋白可能防治吗?

背景:近年来国内外均报道,抗乙型肝炎免疫球蛋白和拉米夫定在预防乙型肝炎、肝硬化肝移植后乙型肝炎的复发中取得了良好效果,但各大中心对于抗乙型肝炎免疫球蛋白使用剂量的报道不尽相同。目的:拟验证和探讨核苷类抗乙肝药物联合小剂量乙肝免疫球蛋白预防肝移植后乙型肝炎病毒复发的效果。方法:回顾性分析2006-05/2009-02昆明市第一人民医院暨昆明医学院附属甘美医院肝移植中心因乙型肝炎相关性肝病行肝移植患者59例,移植前诊断为乙型肝炎后肝硬化失代偿期50例,其中乙型肝炎病毒DNA阳性15例。移植前5例给予拉米夫定治疗,1例给予阿德福韦酯治疗,1例给予恩替卡韦片治疗,治疗时间为2周～1年。移植后所有患者术后第1天开始肌注200U/d的乙肝免疫球蛋白,1个月后根据患者的乙肝两对半的滴度情况进行调整,55例患者同时口服拉米夫定,3例服用阿德福韦酯,1例服用恩替卡韦。结果与结论:2例患者移植后出现乙型肝炎病毒再感染,未检测是否为YMDD变异毒株感染,移植后1年和1年以上乙型肝炎病毒再感染率均为2%。移植前血清乙型肝炎病毒DNA阴性者移植后乙型肝炎病毒再感染率为2%,乙型肝炎病毒DNA阳性者移植后乙型肝炎病毒再感染率为7%。提示因乙型肝炎相关性肝病而行肝移植患者,移植后服用核苷类抗乙肝药物,同时联合200U小剂量乙型肝炎免疫球蛋白可以很好地预防肝移植后乙型肝炎的复发。     

乙肝病毒相关肝病患者肝移植后外周血单个核细胞及肝组织中乙型肝炎病毒cccDNA的检测

背景：肝移植后受者体内绝大部分病毒负荷被清除,植入新肝后其复发性肝炎病原体从肝外进入肝内的途径及其复制规律目前尚无定论。 目的：检测肝移植前后外周血单个核细胞和肝组织中乙型肝炎病毒cccDNA及血清中乙型肝炎病毒DNA的表达。 方法：采用淋巴细胞分离液从乙肝病毒相关终末期肝病37例患者外周血中分离出单个核细胞,采用荧光定量PCR检测肝移植前后及移植后乙肝复发3个时期外周血单个核细胞和肝组织中cccDNA及血清乙型肝炎病毒DNA表达。 结果与结论：肝移植前,单个核细胞cccDNA阳性12例,肝组织cccDNA阳性6例,检出率分别为32%和16%,单个核细胞、肝组织中cccDNA拷贝范围分别为(3.028~6.508)×10⁴,(4.158~6.234)×10⁴ 拷贝/mL。肝移植后,单个核细胞cccDNA阳性1例,无血清乙型肝炎病毒DNA检测阳性病例。6例肝移植后乙肝复发病例中外周血单个核细胞cccDNA阳性4例,肝组织活检cccDNA阳性1例,6例血清乙型肝炎病毒 DNA均为阳性。提示乙肝病毒相关终末期肝病患者肝移植后乙肝复发途径可能是残留乙肝病毒在外周单个核细胞中以cccDNA为模板复制,然后再迁移到肝脏。     

健康体检人群3632例乙肝五项检测结果分析

目的 了解健康体检人群中HBV感染率及乙肝五项血清学标志物感染模式的分布状况. 方法 采用ELISA方法 检测被检者乙肝血清学标志物.结果 通过统计学分析显示,健康体检人群中,HBV感染率为12.61%,其中"大三阳"模式占2.70%,"小三阳"模式占6.75%,HBsAb(+)、HBeAb(+)、HBcAb(+)模式占5.95%, HBsAg(+)、HBcAb(+)模式占3.03%, HBeAb(+)、HBcAb(+)模式占4.10%,单项HBsAb模式占41.0%;HBsAg(+)总检出率女性10.92%,男性13.86%; HbsAb(+)总检出率49.56%,其中女性54.32%,男性46.06%,青年组53.50%,老年组36.00%;乙肝五项血清学标志物全部为阴性的34.25%(1244/3632).结论 本次调查健康体检人群中的HBV感染率为12.61%;HBsAg(+)检出率男性高于女性;HBsAb(+)检出率女性高于男性,青年组高于其他组别,老年组最低;乙肝五项血清学标志物模式为10种,主要以常见模式为主.     

活体肝移植中轻度脂肪变性供肝的应用

背景：在活体肝移植中使用脂肪变性供肝不但影响供者的安全,同时也影响受者的生存。 目的：评价活体肝移植中使用轻度脂肪变性供肝时供者的安全性及受者预后情况。 方法：回顾性分析104例成人间右半肝活体肝移植的资料,根据移植过程中供肝活检病理标本的脂肪变性程度将所有病例分成4个组。比较各组移植供受者移植后2周的肝体积增生率,分析104例成人间活体右半肝肝移植受者移植后死亡情况及原因。 结果与结论：4组病例在供受者移植后肝功能的恢复和受者后移植预后无明显差别,没有肝功能延迟恢复和原发无功发生。轻度大泡性脂肪肝者只要残肝足够可以成为合适的活体肝移植供者。使用轻度大泡性脂肪肝并不增加受者病死率和移植物失功。     

供受者感染乙肝病毒对造血干细胞移植后肝炎复发及愈后的影响

目的分析移植前供、受者感染乙肝病毒对造血干细胞移植后肝炎复发及愈后的影响。方法对上海第一人民医院2006年1～11月移植前供、受者感染乙肝病毒的23例恶性血液病患者,进行移植前后肝功能、乙肝免疫标记物、HBVDNA等检测,并结合临床综合分析。血清丙氨酸氨基转移酶（ALT）、γ谷氨酰转肽酶（GGT）采用速率法,血清总胆红素（TBIL）采用终点比色法检测;乙肝病毒血清标志物采用酶免疫测定（EIA）;HBVDNA测定采用聚合酶链反应（PCR）试剂盒。结果①9例HBV感染的自体移植患者移植后3例发生乙型肝炎,其中2例为移植前HBsAg阳性,乙肝发作时3例HBVDNA及肝功能指标均明显增高;②14例HBV感染的供、受者移植后5例患者发生乙型肝炎,HBVDNA及肝功能指标均明显增高;③移植前HBsAg或HBVDNA阳性移植后发生乙肝相关性肝损的几率显著高于阴性组（X^2分别为8.44、9.07,均大于X0.005^2,P〈0.005）;④移植前HBsAg或HBVDNA阳性对移植预后均无影响（X^2分别为2.58、0.24,均小于X0.05^2,P〉0.05）;⑤1例患者异体移植后41d,乙肝合并戊肝,发生急性黄疸性肝炎,第46天重症GVHD死亡。结论移植前HBsAg和HBVDNA阳性均是HBV感染和再激活的高危因素,移植要密切监测免疫标志物和HBVDNA。移植前HBsAg和HBVDNA阳性不影响患者的生存,要注意非常见肝炎的多重感染。     

免疫干预后母婴传播乙肝病毒标记物分析

目的：分析免疫干预后乙肝阳性产妇与新生儿脐带血标本乙肝标志物,评价其临床价值。方法：对我院228例经免疫预防乙肝阳性产妇所生新生儿脐带血资料进行回顾性分析,比较产妇与其新生儿乙肝标志物模式。结果：新生儿脐带血HBsAg和（或）HBeAg阳性23例,宫内感染率10.1%;其中双阳组产妇61例,所娩新生儿脐带血HBsAg和（或）HBeAg阳性21例,宫内感染率34.4%;单阳组167例,所娩新生儿脐带血HBsAg阳性2例,宫内感染率1.2%,两组宫内感染发生率有显著性差异（P〈0.05）。结论：产妇和新生儿HBeAg阳性是宫内感染和HBV感染慢性化的危险因素;对产前孕妇、出身后新生儿进行免疫干预是阻断HBV母婴传播的有效手段。     

Rh(D)血型不合的肝移植临床分析

背景：血型不合器官移植可能发生严重的排斥反应、移植物抗宿主病及溶血反应。 目的：回顾分析Rh(D)阴性肝癌患者接受Rh(D)阳性供肝移植的方法及疗效,并结合文献复习探讨该方法的可行性。 方法：1 例Rh(D)阴性肝癌患者接受Rh(D)阳性供肝移植过程中,应保证供肝的良好灌洗,尽量减少出血,缩短手术时间,移植中移植后输注适量的异型红细胞及血浆。 结果与结论：肝移植后,受者肝功能恢复正常,未发生急慢性排斥反应及输血相关并发症。随访1年,受者存活良好。说明在无合适供体的情况下,只要供肝得到充分灌洗、移植中控制出血、移植后采用合理的免疫抑制方案,Rh(D)阴性肝病患者移植Rh(D)阳性供肝可达到良好效果。     

调节性T细胞亚群在肝移植中的作用及临床应用进展北大核心

背景:肝移植后的免疫排斥反应严重影响患者的生存质量,而调节性T细胞在抑制肝移植排斥反应及免疫耐受方面发挥着重要作用。目的:综述调节性T细胞在肝移植术中的作用及其在临床上的应用进展,为调节性T细胞在肝移植及其他器官移植方面的研究及临床应用提供思路。方法:第一作者于2021年2月应用计算机在PubMed和中国知网数据库检索1970年1月至2021年2月相关文献,以“regulatory T cells,liver transplantationg”为英文检索词,以“调节性T细胞、肝移植”为中文检索词,最终纳入49篇文献进行分析。结果与结论:①调节性T细胞是一类控制体内自身免疫反应性的T细胞亚群,又称抑制性T细胞,调节性T细胞可分为天然产生的自然调节性T细胞和诱导产生的适应性调节性T细胞,自然调节性T细胞主要为CD4^(+)CD25^(+)T细胞,占外周血及脾脏CD4^(+)T细胞的5%-10%,调节性T细胞在抑制肝移植排斥反应及维持免疫耐受方面发挥着重要作用。②肝移植后,受者受到移植肝的刺激,调节性T细胞的数量及活性增加,同时叉状头转录因子的表达量增多。③肝移植后发生排斥反应时受者体内调节性T细胞的数量及活性较低。④肝移植后免疫耐受者体内调节性T细胞的数量及活性较高,并且调节性T细胞能够诱导及维持免疫耐受。⑤向肝移植后受者输注调节性T细胞能够减轻移植后的排斥反应,延长移植肝的存活时间。     

恩替卡韦联合人免疫球蛋白预防肝移植后乙肝复发

背景：长期应用拉米夫定导致YMDD变异是肝移植后乙肝复发的主要原因。近年来恩替卡韦等新型强效低耐药抗病毒药物在乙肝相关性肝病中取得的很好的疗效,但对其在肝移植后预防乙肝复发作用的研究较为少见。 目的：分析恩替卡韦联合小剂量乙型肝炎人免疫球蛋白在肝移植后预防乙型肝炎复发的作用。 方法：回顾性分析253例乙型肝炎病毒相关性肝移植患者的随访资料。所有患者肝移植前即开始给予核苷(酸)类似物预防,肝移植中和移植后均给予核苷(酸)类似物联合低剂量乙型肝炎人免疫球蛋白的预防方案。在所有患者和具有乙肝复发危险因素(术前HBeAg阳性、乙型肝炎病毒DNA阳性、肝癌、YMDD变异)的患者中分别比较恩替卡韦+乙型肝炎人免疫球蛋白和拉米夫定+乙型肝炎人免疫球蛋白预防的不同效果。 结果与结论：共完成253例乙型肝炎病毒相关性肝移植,死亡29例。拉米夫定组共202例,有16例复发,26例死亡,复发率为7.92%(16/202);恩替卡韦组共51例,未发现乙型肝炎病毒复发,3例死亡,两组患者复发率、死亡率差异不明显。恩替卡韦+乙型肝炎人免疫球蛋白与拉米夫定+乙型肝炎人免疫球蛋白相比,能有效降低具有乙肝复发危险因素患者的乙肝复发率。复发后均停用乙型肝炎人免疫球蛋白,并调整核苷(酸)类似物,经治疗乙型肝炎病毒DNA均<500 IU/mL,肝功能稳定。Log-rank检验显示乙型肝炎病毒复发后及时治疗对患者长期存活率无明显影响。结果说明,在核苷(酸)类似物联合乙型肝炎人免疫球蛋白预防方案的预防下,乙肝复发后及时处理对预后影响不大。恩替卡韦联合乙型肝炎人免疫球蛋白能有效预防乙肝复发。对于具有危险因素的患者,恩替卡韦联合乙型肝炎人免疫球蛋白较拉米夫定联合乙型肝炎人免疫球蛋白可以更有效地降低肝移植后乙肝复发率。     

1026例输血前患者血HBsAg、抗HCV、抗HIV和梅毒抗体检测结果分析

目的分析输血前患者传染病感染情况。方法选择本院海南分院2013年1月至12月共1026例输血前患者,对乙肝表面抗原(HBsAg)、丙肝抗体(抗HCV)、艾滋病抗体(抗HIV)和梅毒抗体检测结果进行分析。结果 HBsAg阳性者102例,阳性率为9.94%;抗HCV阳性者18例;阳性率为1.75%;抗HIV阳性者2例,阳性率为0.19%;梅毒抗体阳性者23例,阳性率为2.24%。感染指标阳性率在临床科室分布方面的差异具有统计学意义(P<0.05)。结论输血患者在输血前,传染病有一定的感染率,尤其是乙肝感染率很高。因此,输血前进行传染病检测很有必要,可减少或避免医院感染以及医疗纠纷的发生。     

Lamivudine prophylaxis and treatment of hepatitis B Virus-exposed recipients receiving reduced intensity conditioning hematopoietic stem cell transplants with alemtuzumab

Individuals with past exposure to hepatitis B virus (HBV) may reactivate HBV following bone marrow transplantation. Alemtuzumab (CAMPATH)-based reduced intensity conditioning bone marrow transplantation has been associated with a high incidence of viral infections. Lamivudine prophylaxis for HBV should be instituted in this setting. The management of 240 CAMPATH-based reduced intensity conditioning bone marrow transplantation, carried out over an 8-year period at Kings College Hospital, was reviewed. Hepatitis B core total antibody (anti-HBc) testing identified recipients and donors with previous HBV exposure. Fifteen donor-recipient pairs were identified as being at risk of HBV reactivation. Eight recipients of anti-HBc negative donors were HBsAg negative, anti-HBc positive pre-transplantation. Five anti-HBc negative recipients received transplants from HBsAg negative, anti-HBc positive donors. Two HBV carrier recipients had one anti-HBc negative and one positive donor, respectively. Pre-transplant lamivudine prophylaxis was given to 8/10 (80%) anti-HBc positive recipients. Although HBsAg and HBV DNA were detected 4 months after bone marrow transplantation in one patient who did not receive prophylaxis, a good antiviral response was documented on starting lamivudine. The two HBV carrier recipients had stopped lamivudine at 8 and 31 months post-bone marrow transplantation, respectively, and died of liver failure with a sharp rise in HBV DNA levels. The five anti-HBc negative recipients with anti-HBc positive donors remained HBsAg and HBV DNA negative. Although lamivudine prophylaxis prevented HBV reactivation, it is unclear at what stage post-transplantation prophylaxis can be discontinued. Close monitoring of liver function tests (LFTs), HBsAg, and HBV DNA must be undertaken even after stopping antiviral prophylaxis.     

Frequent Occult Hepatitis B Virus Infection in Patients Infected with Human Immunodeficiency Virus Type 1

The presence of hepatitis B virus (HBV) serological markers was investigated in 170 patients (137 male, 33 female) infected with human immunodeficiency virus (HIV) type 1. Antibodies to the hepatitis B core antigen (anti-HBc antibodies) were detected in 115 (68%) patients. Of these 115, 14 (12%) were hepatitis B surface antigen (HBsAg) positive, 60 (52%) presented anti-HBs antibodies, and 41 (35%) were anti-HBc positive only. All 115 of the anti-HBc positive samples were tested for HBV DNA by using two polymerase chain reaction (PCR) assays that amplify the core and pre-S regions of the HBV genome, respectively. HBV DNA was detected in 23 samples: 7 of 14 (50%) HBsAg-positive samples, 12 of 60 (20%) anti-HBs-positive samples, and 4 of 41 (10%) samples positive for anti-HBc only. Six samples (all HBsAg positive) were positive in both PCR assays and 17 samples were HBV DNA positive in only one assay. The mean viral load in HBsAg-positive patients was higher than that observed in HBsAg-negative patients. A number of patients were receiving treatment with lamivudine, a drug that interferes with both HBV and HIV replication. However, neither the rate of HBV DNA positivity nor HBV load was significantly different between patients treated with lamivudine and those not treated with this drug. Electronic Publication     

Changes in serologic markers of hepatitis B following autologous hematopoietic stem cell transplantation.

Korea is an endemic area for hepatitis B virus (HBV) infection. Reactivation of HBV is a well-recognized complication in patients with chronic HBV infection undergoing cytotoxic or immunosuppressive therapy, and there are some reports of hepatitis B reverse seroconversion after HSCT. This study evaluated changes in HBV serology after HSCT. We reviewed the medical records of 141 patients who had available HBV serologic data after autologous HSCT. Patient information was retrospectively collected from the BMT database. Before transplantation, 12 patients were positive for hepatitis B surface antigen (HBsAg) and received lamivudine prophylaxis. There was 1 case of reactivation of HBV among these patients. One hundred twenty-nine patients were negative for HBsAg before HSCT, of whom 110 were positive and 19 were negative for hepatitis B surface antibody (anti-HBs). Sixty-two of the 110 patients who were positive for anti-HBs were also positive for hepatitis B core antibody (anti-HBc). Eight patients were negative for anti-HBs and anti-HBc. Seven patients who were initially negative for HBsAg were identified as positive after HSCT, and 5 of those 7 patients developed acute hepatitis, thus indicating reverse seroconversion. Univariate analysis showed that reverse seroconversions were observed more frequently with multiple myeloma than another disease (P = .005; relative risk, 11.854; 95% confidence interval, 1.381-101.770). Other factors, such as age, sex, and presence of HBcAb before HSCT, had no statistically significant affect on reverse seroconversion. In conclusion, reverse seroconversion of HBV is not a rare complication of autologous HSCT, and the risk of reverse seroconversion after treatment is a serious concern due to possible complications arising from patients' suppressed immune systems.     

Prevalence of Williams e1 antigen in comparison with e2 antigen in hepatitis B antigen carriers and patients in hemodialysis unit

The prevalence of both e1 and e2 antigens in 1,158 sera of asymptomatic HBsAg carriers, carriers in hemodialysis units, and HBsAg-negative blood donors was examined. The detection rate of e1 antigen was as high as 80% in asymptomatic carriers, 95% in hemodialysis patients, and even 13.1% in HBsAg-negative donors. All of the e1 antigen-positive specimens in such HBsAg-negative sera were found to have both or either anti-HBs and anti-HBc, suggesting the past history of Hepatitis B virus (HBV) infection of the donors. In the HBsAg-positive serum, the detection rate of e2 antigen (17%) was lower than that of e1 (80%), and all sera having e2 antigen were positive for e1 antigen. The titers of HBsAg, HBcAg, and anti-HBc in e2 antigen-positive sera were higher than that of sera detecting only e1 antigen. The appearance of e1 antigen and e2 antigen in the course of post-transfusion hepatitis B was studied with five cases. Retrospective study showed that three of them each received one unit of HBsAg-positive blood, and the other two received HBsAg-negative blood but with high-titered anti-HBc. In four cases out of five, in which e2 antigen was detected during the course of infection, the initial detection of e2 antigen occurred at or just before the elevation of liver enzyme levels. On the other hand, e1 antigen was detected relatively early after transfusion, and the time of onset. Moreover, the detection period of e1 antigen persisted longer, even after the disappearance of HBsAg antigenemia. These two separate studies suggest that not only e2 antigen but also e1 antigen are associated with the infection of HBV, but they are distinct from each other; the e2 antigen may have the properties of a signal of the viral activity in the patient as suggested by many others, but e1 antigen does not seem to bear such diagnostic values.     

Seroepidemiological studies on hepatitis B and D viruses infection among five ethnic groups in southern Taiwan

In order to compare the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infection among five ethnic groups in Pingtung County of southern Taiwan, a total of 240 serum samples were collected from September to October, 1985, from the following five ethnic groups: Taiwanese, Hakka, Mainland Chinese, aboriginal Paiwanese, and aboriginal Rukaiese. Ages of subjects ranged from 5 to 69 years. All sera were tested for hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs), and core antibody (anti-HBc) by radioimmunoassay (RIA). Hepatitis B e antigen (HBeAg) and antibody to hepatitis D antigen (anti-HDV) were also tested for those with HBsAg-positive sera. Results showed that 44.1% of all sera examined were negative for HBsAG but positive for both anti-HBs and anti-HBc; additionally, 24.6% were negative for both HBsAg and anti-HBs but positive for anti-HBc. Only 134 serum samples showed negative results for HBV markers, indicating an HBV infection rate of 88.8%. The anti-HDV positive rate was estimated to be 2.7% among HBsAg-positive subjects. The HBsAg-positive rates among Rukaiese, Paiwanese, Hakka, Taiwanese, and Mainland Chinese were 25.8, 22.5, 16.7, 12.9, and 10.0%, respectively; while the prevalence rates of HBV infection among the above five groups were 94.2, 94.6, 85.4, 87.5, and 82.5%, respectively. Differences in the HBsAg-positive rate and HBV infection rate among these ethnic groups were statistically significant. We conclude that people living in Pingtung County are more frequently infected with HBV when compared with inhabitants in northern Taiwan.     

Significance of anti-HBc IgM in the differential diagnosis of viral hepatitis

IgM antibody to hepatitis B core antigen (anti-HBc IgM) as determined by IgM capture immunoassay is generally present in high titer during acute hepatitis B infection. A strong positive reaction for anti-HBc IgM during acute hepatitis is indicative of an acute HBV infection even in hepatitis B surface antigen (HBsAg)-negative patients. With the help of anti-HBc IgM otherwise unidentified HBV infection can be diagnosed in HBsAg-negative patients and an optimal combination of diagnostic tests for acute hepatitis B infection would therefore include assays for both HBsAg and anti-HBc IgM. In the HBsAg carrier with or without chronic liver disease the presence and meaning of anti-HBc IgM is still a matter for discussion. Detection of a weak positive result for anti-HBc IgM in HBsAg-positive patients without a recent history of acute hepatitis cannot always be regarded as a definite marker of recent hepatitis B infection. However. quantitation of the anti-HBc IgM results seems to improve the clinical value of the test. Comparison of the available anti-HBc IgM assays is needed and may well establish a reliable cut-off level that would differentiate acute from chronic hepatitis B and ongoing from resolving hepatitis B in HBsAg-positive patients.     

Occult hepatitis B virus infection in the setting of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co‐infection: Clinically relevant or a diagnostic problem?

The clinical relevance of occult hepatitis B virus (HBV) infection, defined as detectable HBV DNA serum/liver, in the absence of hepatitis B surface antigen (HBsAg), is unclear. We determined the prevalence of serum occult HBV infection in HIV/HCV co-infected patients enrolled in APRICOT, a randomized multinational trial that investigated the efficacy and safety of peginterferon alfa-2a (40 kDa) plus ribavirin for treatment of HCV. We also examined the effect of prior HBV exposure to liver histology at baseline. Only HBsAg-negative patients were eligible. At screening, serum HBV DNA was assessed by commercial assay (detection limit = 200 copies/mL). Patients were divided into four serological groups: anti-HBs+/anti-HBc+; anti-HBs-/anti-HBc+; anti-HBs+/ anti-HBc-; anti-HBs-/anti-HBc-. Baseline liver biopsy grade and stage were compared among groups. Serum HBV DNA was undetectable in all patients, (n = 866). Results of anti-HBs and anti-HBc was available for 176 patients: 60 (34.1%) anti-HBs+/anti-HBc+; 60 (34.1%) anti-HBs-/anti-HBc+; 11 (6.3%) anti-HBs+/anti-HBc-; 45 (25.6%) anti-HBs-/anti-HBc-. There were no differences among the groups in the histological grade or stage at baseline liver biopsies. Occult HBV infection in serum was not detected in this large immunocompetent cohort. Moreover, prior exposure to HBV did not appear to have any affect on baseline liver histology.     

Clinical significance of occult hepatitis B virus infection in chronic hepatitis C patients

Background/Aims

We investigated the frequency of occult hepatitis B virus (HBV) infection in anti-hepatitis C virus (HCV)-positive individuals and the effects of occult HBV infection on the severity of liver disease.

Methods

Seventy-one hepatitis B virus surface-antigen (HBsAg)-negative patients were divided according to their HBV serological status into groups A (anti-HBc positive, anti-HBs negative; n=18), B (anti-HBc positive, anti-HBs positive; n=34), and C (anti-HBc negative, anti-HBs positive/negative; n=19), and by anti-HCV positivity (anti-HCV positive; n=32 vs. anti-HCV negative; n=39). Liver biopsy samples were taken, and HBV DNA was quantified by real-time PCR.

Results

Intrahepatic HBV DNA was detected in 32.4% (23/71) of the entire cohort, and HBV DNA levels were invariably low in the different groups. Occult HBV infection was detected more frequently in the anti-HBc-positive patients. Intrahepatic HBV DNA was detected in 28.1% (9/32) of the anti-HCV-positive and 35.9% (14/39) of the anti-HCV-negative subjects. The HCV genotype did not affect the detection rate of intrahepatic HBV DNA. In anti-HCV-positive cases, occult HBV infection did not affect liver disease severity.

Conclusions

Low levels of intrahepatic HBV DNA were detected frequently in both HBsAg-negative and anti-HCV-positive cases. However, the frequency of occult HBV infection was not affected by the presence of hepatitis C, and occult HBV infection did not have a significant effect on the disease severity of hepatitis C.     

HBV and HAV infection in chronic hepatitis in argentina

Sera of 1 55 chronic hepatitis (CH) patients in Argentina were tested for the presence of HBsAg, anti-HBs, anti-HBc, and anti-HAV. Our purpose was to define the role that both virus A and B might play in the etiology and pathogenesis of this condition. The patients were divided into two groups: group I (57) HBsAg-negative; group II (98) HBsAg-positive. The control group consisted of 1,209 healthy blood donors from Banco Central de Sangre de Rosario; 286/ 1,209 (24%) had viral markers for HBV. In group I, 38/57 (67%) had anti-HBs and/or anti-HBc, but none had anti-HBs alone. Group II showed a higher percentage of males (P < 0.05). We found similar incidence of anti-HAV among group I, group II, and the control group.     

Anti-HBc IgM bei akuter und chronischer Hepatitis-B-Virus-Infektion

Summary Hepatitis B core antigen (HBcAg) synthesized in E. coli was used for determination of immunoglobulin M class-specific antibodies against HBcAg. It was found that 98% of cases with acute hepatitis B surface antigen (HBsAg) positive hepatitis type B were anti-HBc immunoglobulin M (IgM) positive. Atypical hepatitis B was detected in 33% of anti-HBc-positive HBsAg-negative cases with acute hepatitis. Anti-HBc IgM was positive for 6 months in acute resolving hepatitis type B, whereas cases resulting in chronic hepatitis B remained anti-HBc IgM-positive for up to 900 days. Chronic HBsAg carriers with severe liver disease had anti-HBc IgM more often than individuals with minor liver damage; 83% of HBsAg-positive liver cirrhoses, 63% of chronic aggressive hepatitis, 50% of HBsAg-positive liver carcinoma, but only 17% of chronic persistent hepatitis or 7% of healthy blood donors were anti-HBc IgM-positive. Determination of anti-HBc IgM is useful in detecting atypical hepatitis B virus infections without HBsAg in serum and, with some restrictions, in discriminating acute and chronic hepatitis type B.