Natural course and treatment of hepatitis D virus infection.

Hepatitis D virus (HDV) is a subviral satellite with hepatitis B virus (HBV) as its natural helper virus. After entry into hepatocytes, it utilizes host cellular enzymes to replicate by a double-rolling-circle mechanism. HDV is most often transmitted by contact with contaminated blood and body fluid, similar to HBV infection. Approximately 5% of the global HBV carriers are coinfected with HDV, leading to a total of 10-15 million HDV carriers worldwide. HDV infection can occur concurrently with HBV infection (coinfection) or in a patient with established HBV infection (superinfection). The pathogenesis of HDV remains controversial. A decline in the prevalence of both acute and chronic hepatitis D (CHD) has been observed worldwide. At present, therapy for chronic HDV infection is by the use of interferon-alpha. Compared to chronic hepatitis B or C, CHD treatment requires a higher dosage and a longer duration of treatment, and post-treatment relapses are common. In order to prevent the progression of CHD and its related morbidity and mortality, more effective treatments are needed.     

Acute hepatitis B virus superinfection in a Taiwanese patient with chronic hepatitis C.

Acute hepatitis B superimposed on patients with chronic hepatitis C is a rarely observed event, especially in hepatitis B virus (HBV)-prevalent areas where chronic HBV infection is usually acquired perinatally or at early infancy. The interactive relationship between HBV and hepatitis C virus (HCV) and clinical outcome in such patients remains controversial. We report a case of acute HBV superinfection which occurred during follow-up of chronic HCV infection in a 66-year-old woman. The patient developed hepatic decompensation at the acute stage. Unlike previously reported cases in Taiwanese, in which the patient either died of fulminant hepatic failure or subsequently relapsed with HCV viremia, this chronic hepatitis C patient with acute HBV superinfection had virologic remission with undetectable HBV DNA and HCV RNA during 9 months of follow-up.     

ACOG Committee Opinion No. 489: Hepatitis B, hepatitis C, and human immunodeficiency virus infections in obstetrician-gynecologists

In the health care setting, bloodborne pathogens such as the hepatitis B virus (HBV), hepatitis C virus, and human immunodeficiency virus (HIV) may be transmitted from infected patients to health care workers as well as from infected health care workers to patients. To reduce the risk of transmission, all practicing obstetrician-gynecologists should receive the HBV vaccine. Obstetrician-gynecologists infected with HBV, hepatitis C virus, or HIV are advised to follow the updated Society for Healthcare Epidemiology of America's recommendations, regarding infection-control measures, supervision, and periodic testing. These recommendations provide a framework within which to consider such cases; however, each case should be independently considered in context by the expert review panel.     

Estimation of seroprevalence of hepatitis B virus and hepatitis C virus in Taiwan from a large-scale survey of free hepatitis screening participants.

BACKGROUND/PURPOSE: Taiwan is a hyperendemic area of liver diseases. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the two major etiologies of liver diseases in Taiwan. This study investigated the seroprevalence of HBV and HCV in Taiwan. METHODS: Since 1996, a series of outreach community-based screening programs for liver diseases have been available to the general population aged > or = 18 years. Blood samples were obtained from the subjects and sent for hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV) tests. Results: The prevalence of HBsAg(+) was 17.3% (27,210/157,720), while the prevalence of anti-HCV(+) was 4.4% (6904/157,720). Geographic variation in HBV and HCV seroprevalence was found, with the highest anti-HCV positive rate in Miaoli County, Chiayi County, Chiayi City, and Yunlin County, and the highest HBsAg positive rate in Keelung City and Yilan City. The HBsAg positive rate progressively decreased after the age of 50 years, while the anti-HCV positive rate progressively increased after the age of 20 years. The estimated total number of HBsAg carriers in the general population > 20 years old is 3,067,307, while the estimated number of anti-HCV positive patients is 423,283. CONCLUSION: This study estimated a 17.3% seroprevalence of HBV and a 4.4% seroprevalence of HCV in Taiwan. Significant geographic variations in the seroprevalence of HBV and HCV were found. These data suggest the importance of modifying programs for the prevention and treatment of chronic viral hepatitis in Taiwan to reflect its varying prevalence and epidemiology.     

Prevalence of human immunodeficiency virus, hepatitis B and hepatitis C virus antibodies and hepatitis B antigen among commercial sex workers in Japan

OBJECTIVE: To investigate the prevalence of antibodies to human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and of hepatitis B surface (HBs) antigen in commercial sex workers (CSW) who attended a sexually transmitted disease (STD) clinic in Tokyo. METHODS: Surveys were conducted on 308 CSW and 384 control subjects for HIV antibody or 241 control subjects for HBs antibody and antigen and HCV antibody. RESULTS: HIV antibody was not detected in either CSW or control subjects. The positive rates for HBs antigen and antibody were 0.6 and 23.4%, respectively, in the CSW group, and 0.4 and 71.8% in the control group. The HCV antibody positive rate was 3.2% in the CSW group and 0.4% in the control group. CONCLUSION: A statistically significant difference between the two groups was observed only in HCV antibody positive rate. STD checkup for CSW alone is inadequate--STD health education and screening for the general public are also required.     

丙型庚型肝炎病毒母婴传播研究

目的 研究丙型、庚型肝炎病毒(HCV、HGV)母婴传播及其影响因素。方法 2000年1月至2002年12月应用第三代ELISA法检测HCV—Ab、HGV—Ab，FQ—PCR方法检测HCV—RNA、HGV—RNA。结果 2052例普通孕妇检测抗HCV阳性22例，阳性率1．07％，其中16例HCVRNA阳性母亲所生16例婴儿有3例HCVRNA阳性，母婴传播率为18．75％。318例普通孕妇检测抗HGV阳性8例，阳性率2．52％，其中4例HGVRNA阳性母亲所生4例婴儿1例HGVRNA阳性。结论 阴道分娩过程感染可能是HCV、HGV母婴传播主要途径，孕妇临产时创旧升高是孕妇母婴传播的危险因素。     

Chronic hepatitis B virus infection and dyslipidemia.

BACKGROUND AND PURPOSE: The association of chronic hepatitis B virus (HBV) infection and decreased levels of high-density lipoprotein cholesterol (HDL-C) has been well documented. However, the relationship between dyslipidemia and asymptomatic chronic HBV infection is still unclear. METHODS: In 1997, 1330 medical center employees (405 men and 925 women) were recruited to evaluate the effects of chronic HBV infection on serum lipid profile, including total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol, and triglycerides (TG). Among these patients, 195 were found to have chronic HBV infection and 35 (17.9%) of them were found to have elevated alanine aminotransferase (ALT). Multiple linear regression analyses were used to evaluate the effects of chronic HBV infection on serum lipids. RESULTS: The most significant finding was that levels of TC and HDL-C were decreased by 5.8 and 2.7 mg/dL respectively, among patients with asymptomatic chronic HBV infection (serum ALT < 40 U/L). After controlling for other determinants, male gender, old age, higher body mass index (BMI) and waist-to-hip ratio, current smoking, and hepatitis B surface antigen-negative status with ALT > or = 40 U/L were associated with lower serum HDL-C and higher TG levels. However, moderate to heavy alcohol drinking, physically active lifestyle, and lower BMI were associated with higher levels of HDL-C. CONCLUSIONS: Asymptomatic chronic HBV infection was associated with lower serum levels of TC and HDL-C. Elevation of ALT was also an indicator of lower levels of HDL-C in patients with chronic hepatitis B and lower serum HDL-C and higher TG levels in patients without HBV infection. These findings also indicated the need to monitor the risk of atherosclerotic diseases in patients with asymptomatic chronic HBV infection, especially those with lower HDL-C levels.     

Prenatal transmission of hepatitis B virus to neonates born to serum hepatitis B virus DNA-positive mothers.

Hepatitis B virus (HBV) DNA was detected by in vitro enzymatic DNA amplification techniques in 66.7% (six of nine) of hepatitis B virus surface antigen (HBsAg)-positive and in 21.1% (7 of 33) of HBsAg-negative pregnant women. Five of the HBV DNA and HBsAg-positive women and one HBV DNA-positive but HBsAg-negative woman gave birth to infants positive for serum HBV DNA at time of birth. These results suggest that HBsAg-negative pregnant women are potentially capable of transmitting HBV DNA to their infants.     

Update on the management of hepatitis B and C infections in the neonatal period

Hepatitis B virus and hepatitis C virus have received a significant amount of attention in recent years, and both viruses share a significant amount of similarities with one another beyond just that they both primarily target the liver. In recent years, cases of both infections have been fueled by a nationwide epidemic of injection drug use. Most relevant to this audience, they are both transmitted from mother to child. The increased cases in young adults combined with mother to child transmission translate into more exposed infants that will need to be managed and followed. Screening of pregnant women for hepatitis B infection coupled with appropriate treatment and prophylaxis measures are incredibly effective to preventing transmission. Prevention of hepatitis C infection is not yet possible, but advances in antiviral therapy make interruption of transmission a future possibility.     

Nonresponse to 18-month lamivudine monotherapy in chronic hepatitis B patients with dual genotype B and C infection and acute exacerbation.

Molecular epidemiologic studies have indicated the possible existence of mixed infection of different hepatitis B virus (HBV) genotypes in chronic hepatitis B (CH-B) carriers, but the effect of dual HBV genotype B and C infection on the efficacy of lamivudine therapy remains unclear. We report four CH-B patients with dual HBV genotype B and C infection and acute exacerbation who received lamivudine monotherapy for about 18 months. None of them had achieved a sustained response at the end of the 18-month trial of treatment.     

The desire to become a parent when infected with human immunodeficiency virus, hepatitis C virus or hepatitis B virus

The French law (arrêté du 10 mai 2001) allows Assisted Reproductive Techniques (ART) in case of infection with human immunodeficiency virus, hepatitis C virus or hepatitis B virus. Our six years' experience is positive even if pluridisciplinary care needs specific equipment and human forces. Couples express high motivation. The wish to become a parent leads to a better care of the infection. ART results are excellent in case of male contamination, not as good when the female partner is infected but still encouraging. No contamination of the partner or the offspring occurred after ART. Data are already collected in France in this context. A European register should be constituted in an early future.     

新生儿乙型肝炎病毒血清标志物检测及其转归

目的探讨乙型肝炎病毒携带产妇所生新生儿血清乙型肝炎病毒标志物(HBV-M)转归。方法2001年3月至2006年3月在暨南大学附属第一医院进行产前检查的500例HBsAg阳性产妇所生新生儿,根据母亲HBeAg状态分为HBeAg阳性组144例,HBeAg阴性组356例。两组新生儿在出生12 h内均注射乙型肝炎免疫球蛋白100 IU,并按常规0、1、6方案分别在出生时、1月龄和6月龄注射基因重组乙型肝炎疫苗5 μg,注射主被动免疫前分别抽取外周静脉血检测HBV-M。结果两组新生儿出生时外周血HBsAg、HBeAg均阳性者分别为24例和9例,追踪至6月龄时HBsAg阳性例数分别为10例和5例,HBsAg阴转率差异无统计学意义。两组新生儿出生时HBsAg阳性、HBeAg阴性者分别为4例和21例,追踪至6月龄时,HBsAg阴转率分别为100%和85.7%。出生时HBsAg阴性、HBeAg阳性者,HBeAg阳性组为29例,占20.1%,显著高于HBeAg阴性组比例(P<0.01),其6月龄HBsAg阳转率为6.9%,明显低于HBeAg阴性组(P<0.01)。在接受全程主被动免疫的情况下,HBeAg阳性组新生儿6月龄HBsAg和HBsAb阳性率分别为9.7%和67.4%,HBeAg阴性组分别为3.1%和78.1%,两组比较差异有统计学意义(P<0.05)。结论新生儿出生时外周血HBsAg阳性不能作为判断宫内感染的指标,HBeAg阳性新生儿预后与母亲HBeAg状态密切相关,母亲HBeAg阳性会抑制新生儿对乙型肝炎疫苗的反应。     

ACOG Committee Opinion. Number 332, May 2006 (replaces No. 203, July 1998): Hepatitis B and hepatitis C virus infections in obstetrician-gynecologists

Hepatitis B and hepatitis C may be transmitted form patients to health care workers and from health care workers to patients. To reduce the risk, all obstetrician-gynecologists who provide clinical care should receive hepatitis B virus vaccine. Obstetrician-gynecologists who are hepatitis B surface antigen positive and e antigen positive should not perform exposure prone procedures until they have sought counsel from an expert review panel. Because the risk of hepatitis C virus transmission is lower than that of hepatitis B virus transmission, routine testing of health care workers is not recommended, and hepatitis C virus-positive health care workers are not required to restrict professional activities.