人类免疫缺陷病毒与乙型肝炎病毒混合感染的研究进展

高效抗逆转录病毒疗法（HAART）使人类免疫缺陷病毒（HIV）感染者机会性感染发生率明显下降，因而原有的一些慢性疾病如慢性肝炎对HIV感染者的病死率起着越来越重要的作用。在美国的一些医院HIV感染者死亡原因中，慢性病毒性肝炎可占45％。在我国乙型肝炎病毒（HBV）携带者约占总人口的10％，而HIV感染者也在不断增加，HIV／HBV混合感染者必将逐渐增多。     

北京地区人类免疫缺陷病毒感染者合并乙型肝炎病毒感染的流行病学特征及影响因素分析

目的分析北京市人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)患者合并乙型肝炎病毒(HBV)感染的流行病学特征,并探索影响合并感染的相关因素。方法对北京地区HIV/AIDS定点治疗医院(北京协和医院、北京地坛医院、北京佑安医院)长期随访的接受抗反转录病毒治疗(ART)的13253例HIV感染者临床资料进行回顾性分析。结果排除未进行HBV标志物检测的患者1681例,共有11572例HIV感染者纳入研究,其中HIV合并HBV感染的患者532例(4.6%),主要为青壮年(28~48岁)男性,占85.9%,感染途径以同性性传播为主(74.8%)。87.4%的合并感染患者基线治疗接受了包含拉米夫定(3TC)、替诺福韦(TDF)两种抗HBV药物的治疗。2013—2018年,HIV合并HBV感染的年新增感染率呈波动性下降的趋势,年均增长率分别为6.37%、4.55%、3.92%、4.68%、4.24%和2.74%。HIV合并HBV感染的主要影响因素为年龄(28~48岁比<28岁,OR=2.807,95%CI 1.241~6.345)以及婚姻状况(已婚比未婚,OR=1.259,95%CI 1.004~1.579)。结论北京地区HIV合并HBV感染率为4.6%;2013—2018年HIV合并HBV的年新增合并感染率呈下降趋势。青壮年(28~48岁)已婚HIV感染者合并HBV感染的风险较高。     

《妊娠期HBV的阻断、预防、治疗和随访管理》解读

正慢性乙型肝炎(CHB)是全球公众健康的首要危险因素,并且是潜在疾病进展为肝硬化和肝细胞癌的主要病因。大部分HBV感染者主要由母婴传播(mother-to-child transmission,MTCT)导致。由于通过MTCT感染者大多数会转变为慢性HBV感染,在妊娠期给予适当的预防和管理对于预防MTCT至关重要,所以预防HBV围产期传播是全球努力减少慢性HBV感染负担的重要组成部分。     

HIV感染献血者并发感染HBV、HCV及梅毒调查分析

目的:了解曲靖市无偿献血人群中艾滋病病毒(HIV)感染者并发感染乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)和梅毒的状况。方法:应用酶联免疫吸附试验(ELISA),对HIV感染献血者检测HBsAg、抗-HCV、抗-TP。结果:133例HIV感染献血者中,HBV感染率为1.5%,HCV感染率为10.5%,梅毒感染率为7.5%。结论:曲靖市HIV感染的献血者中,并发HCV和梅毒感染率高,而并发HBV感染率较低。     

恶性淋巴瘤治疗相关性乙型肝炎病毒再激活

据世界卫生组织报道,全球超过1/3人口曾感染过乙型肝炎病毒(HBV),其中3.5亿为慢性感染者。HBV再激活是合并HBV感染的肿瘤患者接受细胞毒性化学治疗(化疗)期间常见并发症,轻者表现为无症状的自限性肝炎,重者出现急性肝衰竭而死亡。     

HIV感染合并慢性乙型、丙型肝炎的治疗(欧洲会议共识介绍)

全球有3．7～4亿的乙型肝炎病毒（HBV）携带者和超过1．8亿的丙型肝炎病毒（HCV）携带者。由于两者与HIV有共同的传播途径，因而有大量的患者合并HIV感染。全球约有几百万人合并感染HBV／HCV和HIV。在欧洲，约40％的HCV感染者以及8％的HBsAg阳性者合并HIV感染。     

乙型肝炎病毒感染的流行现状

乙型肝炎病毒(HBV)感染是一个重要的公共卫生问题,据世界卫生组织(WHO)公布的数据,全球20亿人已感染HBV,其中3.5～4亿人为慢性HBV携带者[1]。HBV感染可以引起急性和慢性肝脏疾病,包括肝硬化和肝癌[1]。乙型肝炎引起的与HBV相关的肝衰竭、肝硬化、肝癌,每年会导致100万人死亡。中国是HBV感染的高发区,2006年进行的HBV感染的血清流行病学调查结果显示,HBsAg携带率为总人口的7.18%。因此,     

HBV和HCV重叠感染的研究进展

乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染是目前全球慢性肝病的主要原因。据世界卫生组织（WHO）估计全球HBV和HCV慢性感染者分别超过3．5亿和1．7亿。由于具有共同的传播途径,所以HBV和HCV重叠感染现象的发生相当普遍,特别是在两种病毒都流行的地区,可达1％～15％。2004年东欧一项研究显示,在随机选择的2200健康个体中发现HBV／HCV重叠感染率为0．68％。     

细胞自噬在慢性肝炎病毒感染中的作用

一、慢性肝炎病毒 (一)乙型肝炎病毒 HBV感染呈全球流行,据世界卫生组织报道,全球约20亿人曾感染过HBV,其中3.5亿为慢性HBV感染者,每年约有100万人死于HBV感染所致的肝衰竭、肝硬化和肝细胞癌(Hepatocellular carcinoma,HCC)[1].我国1～59岁普通人群的HBsAg携带率为7.18％[2].据此推算,我国现有的慢性HBV感染者约9 300万例,其中慢性乙型肝炎患者约2 000万例[3].我国每年死于与乙肝相关肝病的约30万例.HBV慢性感染不仅难以治愈,造成患者病情的反复发作,且与HCC的发生密切相关[4].     

老年人慢性HBV感染的临床特点分析

目的探讨老年人慢性乙型肝炎病毒（HBV）感染的疾病谱及临床特点。方法比较53例老年慢性HBV感染者与相同例数的低年龄组慢性HBV感染者的性别、疾病谱、血清HBVDNA和ALT水平。结果老年组慢性HBV感染的疾病谱与低年龄组有显著不同,前者以非活动性HBsAg携带者为主（66.0%）,后者中HBeAg阳性慢性乙型肝炎患者较多（47.2%）。老年组慢性HBV感染者血清HBVDNA和ALT均明显低于低年龄组,差异有统计学意义（P〈0.05或P〈0.01）。两组总体性别组成差异无统计学意义。结论非活动性HBsAg携带者是老年慢性HBV感染的主要疾病谱,但HBeAg阳性或阴性慢性乙型肝炎（CHB）和乙型肝炎肝硬化的发生率仍较高,且存在HBV复制和肝脏病变。     

临床肝病患者中庚型肝炎病毒(GBV-C/HGV)的感染

本文应用抗-HGV酶联免疫法(EIA)和逆转录套式聚合酶链反应法(RT-PCR)检测150份乙型、120份丙型、15份戊型和49份非甲-戊型肝炎患者血清。结果显示:乙肝、丙肝、戊肝和非甲-戊型肝炎患者中抗-HGV抗体的阳性率分别为22.0％(33/150)、25.0％(30/120)、33.3％(5/15)和40.1％(20/49)。其中乙型、丙型、戊型和非甲-戊型肝炎的抗-HGV抗体阳性者中,HGV RNA的阳性率分别为58.3％(7/12)、60.0％(6/10)、40.0％(2/5)和45.5％(9/12)。说明GBV-C/HGV可与HBV、HCV或HEV合并感染,该病毒可能引起临床型肝炎。     

各型肝炎病毒单纯及重叠感染的研究

目的 探讨病毒性肝炎患者甲～戊，庚型肝炎病毒(HAV-HEV，HGV)单纯感染及重叠感染情况。方法 采用EIA法检测病毒性肝炎患者血清抗-HAV IgM，HBV标志物、抗-HCV IgM、抗-HDV IgM、抗-HEV IgM、抗-HGV IgM。结果 共检测210例病毒性肝炎患者HAV-HEV、HGV血清标志物，20例未检出(9．5％)，190例患者检出标志物阳性(90．5％)。HBV感染率89，5％(188／210，其中有34例为既往感染，占16．2％，现症感染154例，占73．3％)；HAV感染率29．0％(61／210)，HCV、HDV感染率均为8．1％(17／210)、HEV、HGV感染率依次为10．0％(21／210)、7．1％(15／210)。各临床类型中单纯感染占61．4％(129／210)，二重感染占32．4％(68／210)，以HAV HBV、HBV HDV、HBV HEV感染模式最常见，三重感染占6．2％(13／210)，以HAV HBV HDV感染模式最常见；临床上以肝炎肝硬化、重型肝炎重叠感染常见，急性肝炎最少见。结论 病毒性肝炎中HBV感染最常见，其次为HAV感染；单纯感染、二重感染多见，三重感染少见；重叠感染发生率随病情加重而增加。     

Update on the management and treatment of viral hepatitis

This review aims to summarize the current evidence on the treatment of viral hepatitis, focusing on its clinical management. Also, future treatment options and areas of potential research interest are detailed. PubMed and Scopus databases were searched for primary studies published within the last ten years. Keywords included hepatitis A virus, hepatitis B virus (HBV), hepatitis C virus, hepatitis D virus (HDV), hepatitis E virus, and treatment. Outcomes reported in the studies were summarized, tabulated, and synthesized. Significant advances in viral hepatitis treatment were accomplished, such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A, hepatitis B, and hepatitis E vaccination. Drugs that cure hepatitis B, going beyond viral suppression, are so far unavailable; however, targeted antiviral drugs against HBV (immunomodulatory therapies and gene silencing technologies) are promising approaches to eradicating the virus. Ultimately, high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems. The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B, albeit further investigation is required. Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.     

HDV感染后乙型肝炎患者血清肝炎病毒标志物的变化

目的　分析HDV感染患者血清病毒性肝炎标志物的变化和意义 ,探讨HDV致病机理。方法　对 469例HDV阳性乙型肝炎患者常见各类型病毒性肝炎血清标志物的变化等作统计分析 ,以 2 13例HDV( -)乙型肝炎患者作对照。结果　HDV感染后血清HBeAg检出率降低 (P <0 .0 1)。在HDV ( +)HBVDNA( -)组 ,HBeAg( -)的机会大 (P <0 .0 1)。在急性肝炎、重型肝炎和肝硬化患者HDAg( +)HBeAg( -)为主要血清病毒表现形式 (P <0 .0 1或 0 .0 5 )。HDV感染后合并其它肝炎病毒感染率高于乙型肝炎组。结论　HDV感染可抑制HBV复制或HBeAg表达 ,混合感染HDV的乙型肝炎中HDV的直接细胞毒性作用可能起主要致病作用。重叠感染HDV的乙型肝炎患者其病情重、病死率高和容易慢性化。     

Viral hepatitis update: Progress and perspectives

Viral hepatitis, secondary to infection with hepatitis A, B, C, D, and E viruses, are a major public health problem and an important cause of morbidity and mortality. Despite the huge medical advances achieved in recent years, there are still points of conflict concerning the pathogenesis, immune response, development of new and more effective vaccines, therapies, and treatment. This review focuses on the most important research topics that deal with issues that are currently being solved, those that remain to be solved, and future research directions. For hepatitis A virus we will address epidemiology, molecular surveillance, new susceptible populations as well as environmental and food detections. In the case of hepatitis B virus, we will discuss host factors related to disease, diagnosis, therapy, and vaccine improvement. On hepatitis C virus, we will focus on pathogenesis, immune response, direct action antivirals treatment in the context of solid organ transplantation, issues related to hepatocellular carcinoma development, direct action antivirals resistance due to selection of resistance-associated variants, and vaccination. Regarding hepatitis D virus, we describe diagnostic methodology, pathogenesis, and therapy. Finally, for hepatitis E virus, we will address epidemiology (including new emerging species), diagnosis, clinical aspects, treatment, the development of a vaccine, and environmental surveillance.     

Hepatitis C virus micro-elimination: Where do we stand?

Hepatitis C virus (HCV) elimination by 2030, using direct-acting antiviral treatments, has been promoted by the World Health Organization. This achievement is not attainable, however, particularly after the 2020 pandemic of the coronavirus disease 2019. Consequently, the more realistic objective of eliminating HCV from population segments for which targeted strategies of prevention and treatment are easily attained has been promoted in Europe, as a valid alternative. The underlying idea is that micro-elimination will ultimately lead to macro-elimination. The micro-elimination strategy may target different specific populations and at-risk groups. Different settings, including prisons and hospitals, have also been identified as micro-elimination scenarios. In addition, dedicated micro-elimination strategies have been designed that are tailored at the geographical level according to HCV epidemiology and individual country’s income. The main elements of a valid and successful micro-elimination project are reliable epidemiological data and active involvement of all the stakeholders. Community involvement represents another essential component for a successful program.     

江门市120例静脉吸毒者HBV、HCV和HGV感染状况

目的 了解静脉毒瘾者乙型肝炎病毒(HBV),丙型肝炎病毒(HCV)及庚型肝炎病毒的感染状况。方法 对广东省江门市120例静脉毒瘾者血浆的HBV、HCV和HGV的标记物进行了检测,采用ELISA法检测HBsAg,HBeAg,抗-HBc,抗-HBe,抗-HBs,抗-HCV;逆转录聚合酶链反应(RT-PCR)检测HGV RNA。结果 120例静脉毒瘾者中HBsAg阳性有13例(10.83％),抗-HBs阳性41例(34.71％),单项抗-HBc阳性7例(5.83％),抗-HCV阳性89例(74.17％),HGV RNA阳性28例(23.33％)。13例HBsAg阳性中9例抗-HCV阳性,3例HGV RNA阳性;7例单项抗-HBc阳性中5例抗-HCV阳性,2例HGV RNA阳性;28例HGV RNA阳性中20例抗-HCV阳性;2例HBsAg、抗-HCV、HGV RNA同时阳性。结论 静脉毒瘾者是HCV和HGV的高危感染人群;HBV,HCV和HGV三种病毒的感染之间在静脉毒瘾者中无相关性。     

Hepatotropic viruses:Is Roma population at risk?

Roma people make up a significant ethnic minority in many European countries,with the vast majority living in Central and Eastern Europe.Roma are a vulnerable population group in social,economic,and political terms.Frequent migrations,life in segregated communities,substandard housing,poverty,and limited access to quality health care,including low immunization coverage,affect their health status and predispose them to various diseases,including viral hepatitis.Hepatitis A,B,and E are highly prevalent among Roma and mainly associated with low socioeconomic status.In contrast,hepatitis C does not seem to be more frequent in the Roma population.Enhanced efforts should be directed towards the implementation of screening programs,preventive measures,and treatment of viral hepatitis in Roma communities throughout Europe.     

重叠HCV感染对HBV／C基因热点变异的影响

为探讨乙型肝炎病毒（ＨＢＶ）重叠丙型肝炎病毒（ＨＣＶ）感染时ＨＣＶ对ＨＢＶ复制和基因变异的影响，采用套式聚合酶链反应（ＰＣＲ）与限制性片段长度多态性（ＲＦＬＰ）相结合。对１９例ＨＢＶ感染重叠ＨＣＶ感染（Ａ组）和３１例单独ＨＢＶ感染（Ｂ组）的慢怀肝病患者分析前Ｃ区密码２８终止是（Ａ８３）和Ｃ密码９７异亮氨酸变为亮氨酸变异Ｌ９７）。结果显示Ａ组第一次ＰＣＲ阳性率（１６％）明显低于Ｂ组（６５％）（Ｐ，０     

丙型肝炎病毒C33c抗原及HBxAg在人原发性肝细胞癌中的分布及意义

作者应用免疫组化法对１０２例人原发性肝细胞癌（ＰＨＣ）组织进行了ＨＣＶ及ＨＢＶ抗原定位研究。ＨＣＶＣ３３ｃ抗原及ＨＢｘＡｇ在ＰＨＣ中的阳性检出率分别是８１．４％及７４．５％，Ｃ３３ｃ抗原和ＨＢｘＡｇ阳性占所检病例９４．１％，二者同时阳性为６１．８％，１０２例ＰＨＣ中５０例有癌旁肝组织，其Ｃ３３ｃ抗原和ＨＢｘＡｇ的阳性检出率分别是６２％和９２％。ＨＣＶＣ３３ｃ抗原定位于肝癌细胞的胞浆内，在胞浆内局灶分布或充满整个胞浆，有的紧靠核膜，胞核未见阳性信号。Ｃ３３ｃ抗原阳性细胞在ＰＨＣ中呈散在、局灶分布为主，在癌旁肝组织呈弥漫分布为主。