Acute and chronic viral hepatitis

Viral hepatitis is the most common cause of acute and chronic hepatitis. The term viral hepatitis generally refers to infections resulting from one of the hepatotrophic viruses: hepatitis A, B, C, D, and E. The last 10 years have brought many important advances in understanding the epidemiology, pathogenesis, molecular biology, and immunoprophylaxis of infections caused by hepatotrophic viruses. Development of sensitive and specific immunoassays has enabled detection of specific agents. This has allowed for identification of infected patients and monitoring response to therapy. Additionally, serologic markers have allowed for isolation of contaminated blood products and a reduction in the spread of disease. The remaining challenge is the application of this knowledge to the treatment and prevention of viral hepatitis. This article explores the risk factors, epidemiology, microbiology, clinical and laboratory diagnosis, treatment, and prevention of the hepatotrophic viral infections.     

Immune response to hepatitis B vaccine in parenteral drug abusers.

Responsiveness was assessed to a programme of vaccination of hepatitis B vaccine in a cohort of 197 intravenous drug addicts (mean age, 23.7 years) and their antibody response was compared with that of 271 healthy controls (mean age, 24.2 years). All participants were seronegative for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). The vaccination schedule consisted of three intramuscular injections (deltoid area) at months 0, 1 and 2. Although 70% of parenteral drug abusers received the three doses of vaccination, only 43.6% were evaluable for immune response. Fifty-eight per cent of heroin addicts and 80% of controls had evidence of anti-HBs seroconversion at 1 month after vaccination (chi 2 = 15.52, p less than 0.001). Geometric mean antibody titres were also significantly higher in controls (69.1 IU l-1; confidence interval 95%, 56.83 and 84.04) than in parenteral drug abusers (18.2 IU l-1; confidence interval 95%, 12.85 and 25.73) (F = 20.951, p less than 0.0001). The anti-HBs response was not influenced by coexistent anti-HBc, HCV antibody or HIV antibody seropositivity.     

Prevalence of blood-borne viral hepatitis in different communities in Yemen

It is generally believed that hepatitis B (HBV) and C (HCV) viruses are highly prevalent in the Republic of Yemen. This study investigated the prevalence of HBV and HCV markers in 494 blood donors from Aden, 493 blood donors from Sana'a, 97 residents from an African ethnic minority in Sana'a and 99 residents of Soqotra Island. There were significant differences in the prevalence of HBV carriage (HBsAg: 6.7, 15, 19.6 and 26.3% respectively; P < 0.001); past HBV infection (anti-HBc: 17.4, 18.5, 30.9 and 59.6% respectively; P < 0.001); susceptibility to HBV (absence of HBV markers: 73.3, 61.9, 38.1 and 9.1% respectively; P < 0.001), infectivity of HBV carriers (HBV DNA: 51.5, 33.8, 52.6 and 65.4% respectively; P = 0.028) and HCV antibodies (RIBA confirmed or indeterminate: 0.6, 0.2, 5.2 and 5.1% respectively; P < 0.001). A significant difference in HBV carrier rate and a borderline significant difference in the prevalence of natural infection was observed between males and females in the African community (P = 0.02 and 0.06 respectively). In contrast, in Soqotra Island, there was no significant sex difference in HBV carrier rate but susceptibility was significantly more prevalent in males (P = 0.03). This study illustrates that significant difference in prevalence and epidemiology exists among different communities within the same country, reflecting political, geographical and social differences. Control strategies should take these differences into account.     

Prevalence of sexual disorders in those young males who later become drug abusers

The purpose of this study was to learn about the frequency of sexual disorders in young males who later become substance abusers. We interviewed 228 men treated in 10 drug centers for substance abuse. The questionnaire that we used was designed to assess the onset of erectile dysfunction (ED) or of premature ejaculation (PE). Only those subjects who became substance users between the ages of 17 to 29 were taken into consideration. Of the 228 subjects recruited, only 130 met the inclusion criteria (mean age 33). These male patients had a prevalence of ED of 20.3% (cl 99% 12.3-31.2), whereas the prevalence of ED of age-matched males in the general population is 2.1% (cl 99% 0.36-5.46; p < 0.000001). The prevalence of PE in the sample prior to drug use was 37.5%. Sexual desire was in the normal range in nearly all subjects. The prevalence of ED in the men of our sample is higher than in age-matched individuals of the general population. These data suggest a new hypothesis: sexual disorders or the conviction that one has a sexual problem is a possible risk factor among men for drug abuse and addiction.     

Prevalence of viral hepatitis markers in the population of Portugal

The prevalence of viral hepatitis markers in apparently healthy individuals of both sexes, born and living in both urban and rural areas of all the Portuguese provinces, was studied by radioimmunoassay.     

Vitamins in the treatment of chronic viral hepatitis

Hepatitis B virus (HBV)- and hepatitis C virus (HCV)-related chronic infections represent a major health problem worldwide. Although the efficacy of HBV and HCV treatment has improved, several important problems remain. Current recommended antiviral treatments are associated with considerable expense, adverse effects and poor efficacy in some patients. Thus, several alternative approaches have been attempted. To review the clinical experiences investigating the use of lipid- and water-soluble vitamins in the treatment of HBV- and HCV-related chronic infections, PubMed, the Cochrane Library, MEDLINE and EMBASE were searched for clinical studies on the use of vitamins in the treatment of HBV- and HCV-related hepatitis, alone or in combination with other antiviral options. Different randomised clinical trials and small case series have evaluated the potential virological and/or biochemical effects of several vitamins. The heterogeneous study designs and populations, the small number of patients enrolled, the weakness of endpoints and the different treatment schedules and follow-up periods make the results largely inconclusive. Only well-designed randomised controlled trials with well-selected endpoints will ascertain whether vitamins have any role in chronic viral hepatitis. Until such time, the use of vitamins cannot be recommended as a therapy for patients with chronic hepatitis B or C.     

Incidence of hepatitis B and HIV virus at cadaver of IV drug abusers in Tehran

Injection drug use has been the most growing rout of drug abuse in Iran in the past decade and it has been responsible for the transmission of HIV virus in more than two third of cases. The aim of the present study was to determine the prevalence of HIV and hepatitis B in a group of IDU cadavers and to compare the results to a group of cadavers of the normal population. In a case-control study the blood samples of the cadavers of 400 randomly chosen IDUS and 400 other cadavers as control group were checked for HBS antigen and Anti HIV antibody in the forensic medicine center of Tehran. The prevalence of HIV and HBV infection was compared in two groups according to their demographic characteristics. The number of HIV and HBV positive cadavers was significantly higher in the IDU group than the controls (6.25% vs 0.5%, P<0.001, 27.5% vs 3%, P<0.001). The risk of getting infected by HIV virus was 13.27 times greater in the IDU group and the risk of HBV infection was 12.26 times greater in this group as compared to the control group. The age distribution of IDU cadavers indicated that the percentage of IDU cadavers in the reproductive (21-40 years old) age was 80%. The greater prevalence of the HIV and HBV infection especially in the reproductive age of IDUS indicates a greater concern to the authorities for more attention to prevention and harm reduction programs.     

Predictive factors of fibrosis for chronic viral hepatitis C

AIM: To determine the histological aspects and associated factors to significant or severe fibrosis in patients with chronic viral hepatitis C. METHODS: Consecutive patients recruited between 1999 and 2005 were studied. Lecture of hepatic biopsies was performed by the same histopathologist, using the METAVIR grading. RESULTS: We investigated 109 patients (36 men and 73 women, mean age:49.3 years (19 - 65 years). Activity was graded A0, A1, A2 and A3 in respectively 2, 49, 51 and 7 cases. Fibrosis was graded F0, F1, F2, F3 and F4 in 3, 34, 35, 16 and 21 cases. In univariate analysis, associated factors to fibrosis more than F2 were age, diabetes, levels of ASAT, gamma glutamyl transpeptidase, alkaline phosphatase, prothrombin index and APRI score. In multivariate analysis, only age more than 50 years was associated with fibrosis more than F2 (p=0,006 adjusted OR [CI95%]:5,57[1,63 - 18,9]). Associated factors to fibrosis graded F4 were age, levels of ASAT, ALAT, gamma glutamyl transpeptidase, alkaline phosphatase, leucocytes, platelets, prothrombin index, APRI score and hepatic dysmorphy on ultrasound examination. In multivariate analysis, only APRI score more than 1,5 was associated with fibrosis graded F4 (p=0,04 adjusted OR [CI95%] :4,35 [2,25-6,76]). CONCLUSION: Age and APRI score are important prognosis factors in chronic viral hepatitis C.     

树突细胞的成熟状态和慢性病毒性肝炎

树突细胞 (dendriticcells,DC)是体内最强的提呈细胞 ,能诱导T细胞定向分化为Th1或Th2 ,在其成熟过程中伴随着表面分子的种类和数量 ,细胞功能及迁移能力等方面的变化而变化 ,并受多种因素的调节。本文就此及DC在慢性病毒性肝炎发生和临床上的作用进行综述。     

病毒性肝炎住院患者葡萄球菌属感染与耐药性研究

目的探讨病毒性肝炎住院患者葡萄球菌属感染与耐药性,为合理使用抗菌药物提供依据。方法选取2013年11月-2014年12月住院治疗的病毒性肝炎合并葡萄球菌属感染患者80例,留取患者感染标本送检,采用法国生物梅里埃公司VITEK-AMS6全自动细菌鉴定系统进行葡萄球菌属鉴定,并使用纸片扩散法(K-B)进行药敏试验,分析葡萄球菌属的耐药性。结果 80例病毒性肝炎合并葡萄球菌属感染患者送检标本检出108株葡萄球菌属,金黄色葡萄球菌28株占25.93%,凝固酶阴性葡萄球菌80株占74.07%,金黄色葡萄球菌及凝固酶阴性葡萄球菌在标本中检出均以痰液为主,分别占64.29%及43.75%,其次均为血液、尿液、腹水,分别占17.86%及25.00%、10.71%及18.52%、7.14%及9.26%;耐甲氧西林金黄色葡萄球菌检出率为28.57%,耐甲氧西林凝固酶阴性葡萄球菌检出率为11.25%,耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌耐药性均较严重,对青霉素、苯唑西林耐药率均达100.00%,仅对万古霉素耐药率为0。结论病毒性肝炎住院患者葡萄球菌属的组成、来源、耐药性各有其特点,需要动态监测并根据结果正确选择抗菌药物治疗,以减少感染的发生率。     

Surveillance programs for chronic viral hepatitis in three health departments

Although chronic hepatitis B and chronic hepatitis C are diseases of public health importance, only a few health departments nationally have chronic viral hepatitis under surveillance; these programs rely primarily on direct reporting by medical laboratories. We conducted an evaluation to determine if lessons from these programs can guide other health departments. Between December 2002 and February 2003, we visited the Connecticut Department of Public Health, the Multnomah County Health Department in Portland, Oregon, and the Minnesota Department of Health to determine the capacity of their chronic hepatitis registries to monitor trends and provide case management. We found that the registries facilitated investigations of potentially acute cases by identifying previously known infections, and aided prevention planning by pinpointing areas where viral hepatitis was being diagnosed. For chronic cases, case management (defined as the process of ensuring that infected individuals and their partners receive medical evaluation, counseling, vaccination, and referral to specialists for treatment when indicated) was provided for hepatitis B in Multnomah County, but was limited in other programs; barriers included resource constraints, difficulties confirming chronic infection, and privacy concerns. Finding innovative ways to overcome these barriers and improve case management is important if chronic hepatitis surveillance is to realize its full potential.     

慢性病毒性肝炎中转化生长因子α的水平变化

目的 研究慢性病毒性肝炎患者血清TGF-a水平变化及其与肝功能生化指标、预后等的关系,探讨TGF-a作为反映慢性肝炎患者肝细胞损害严重程度或再生情况指标的可行性. 方法 采用ELISA 方法对26例慢性重型肝炎患者、30例慢性乙型肝炎患者及20例正常人的血清TGF-a水平进行检测,并结合临床资料进行分析. 结果 (1)慢性乙型肝炎组血清TGF-a水平较对照组升高(P＜0.01).(2)不同预后的慢性重型肝炎患者血清TGF-a水平存在差异,有效组(包括临床治愈出院、好转出院)血清TGF-a含量较正常对照组显著升高(P＜0.05),无效组(包括过渡到肝移植、自动出院、死亡)略降低但差异无统计学意义(P＞0.05).(3)在慢性乙型肝炎组中,血清TGF-a含量与ALT、AST、总胆红素(TBil)及白蛋白(ALB)均无相关性;在慢性重型肝炎组中,血清TGF-α含量与ALT、AST、TBil、ALB及凝血酶原时间(PT)均无相关性.血清TGF-a含量与甲胎蛋白(AFP)呈正相关(rs=0.763,P＜0.01). 结论 (1)不同预后的慢性重型肝炎患者血清TGF-a水平存在差异;(2)血清TGF-a水平在一定程度上能反映肝细胞的再生情况.     

佛山市吸毒人群艾滋病、乙型肝炎、丙型肝炎及梅毒感染状况调查

目的 了解佛山市吸毒人群HIV、肝炎和梅毒的感染情况,为预防、控制和治疗提供参考依据。方法 对佛山市2003年部分在押吸毒人员进行HIV、HBV、HCV和梅毒血清学检测。结果 706名吸毒者血液标本中,抗-HIV、HBsAg、抗-HCV及梅毒抗体阳性率分别为3．5％、21．1％、60．1％和5．9％。在检出的25例HIV感染者中,HIV／HBV、HIV／HCV、HIV／TP双重感染率分别为32．0％(8／25)、40．0％(10／25)和4．0％(1／25),HIV／HBV／HCV三重感染率为28．0％(7／25),未发现四重感染的现象。结论 应加大对吸毒人群的监测和防病知识宣传力度,开展干预措施,降低HIV等疾病在高危人群中扩散和传播的危险性。     

上海市黄浦区1956-2011年病毒性肝炎疫情分析

目的 研究上海市黄浦区1956-2011年病毒性肝炎疫情的流行特征,评价防治工作成效。方法 通过收集黄浦区历年肝炎疫情的纸质或电子资料,运用生态学研究方法,利用地区的、人群的资料,研究疾病的流行面貌,对历年疾病流行特征和趋势进行研究,采用描述性统计方法分析数据。结果 1956-1994年病毒性肝炎发病处于较高水平,1988年达历史最高值,发病率为5191.78/10万。1995年后控制在较低水平。1960-1980年死亡率较高,2000-2011年平均死亡率为0.10/10万,下降至较低水平。肝炎以男性多发,男女发病数之比为1.67：1。甲肝和乙肝以30~40岁年龄组发病率最高,发病率分别为3.81/10万和8.71/10万。甲肝、戊肝在1-4月出现高发。结论 1956-2011年上海市黄浦区病毒性肝炎预防控制效果明显。     

Prevalence of hepatitis C in a drug using and non-using welfare population

CONTEXT: Drug use is a primary route for the transmission of the Hepatitis C virus (HCV). A substantial proportion of welfare recipients have been shown to be substance abusers. In addition, federal legislation has imposed limits on the number of months individuals may receive benefits and has mandated most recipients to participate in a 'work activity' in exchange for benefits. HCV symptoms may inhibit welfare recipients' ability to seek and maintain employment. OBJECTIVE: To assess the prevalence of HCV in a sample of Temporary Assistance to Needy Families (TANF) recipients and the effects of HCV antibody seropositivity on employability. DESIGN, SETTING, AND PARTICIPANTS: The sample for this study consisted of 380 individuals participating in a longitudinal study of employment patterns among TANF recipients in Houston, TX, funded by the National Institute on Drug Abuse (NIDA). Private interviews regarding welfare receipt, employment, and drug use were conducted at intake into the study and at 4-month intervals for one year. Participants agreed to a one-time blood test. Blood samples were tested for the presence of HCV antibodies by enzyme linked immunoassay. MAIN OUTCOME MEASURE: Employment status over time by HCV antibody status. RESULTS: Overall, 12% of all participants tested positive for the presence of HCV antibodies. A significantly greater proportion of chronic drug users (31%) than non-drug users (4%) tested positive for the presence of Hepatitis C antibodies. Those who tested positive for hepatitis C had significantly lower rates of employment. CONCLUSIONS: Potential infection with Hepatitis C may constitute an employment barrier for many welfare recipients.