Current status of hepatitis e virus infection in Korea

Hepatitis E virus (HEV) is an emerging pathogen associated with acute viral hepatitis, and HEV is becoming increasingly recognized. Approximately 2% of acute viral hepatitis is caused by HEV, and 18 cases of hepatitis E have been reported in Korea. Of these cases, only two have involved a history of travel from India, which suggests that they were imported cases. The remaining reported cases include a sporadic case of acute hepatitis E with genotype 4 HEV isolates and identification of the full genome sequence, as well as another case of genotype 4 HEV hepatitis that developed after ingestion of the raw bile juice of a wild bear living on a mountain in southern Korea. Moreover, genotype 3 HEV, which shows close genetic homology with swine HEV in Korea, has been detected in collected human serum samples. Therefore, genotypes 3 and 4 HEV are currently circulating in the Korean community and may be related to zoonotic transmission and food-borne infection. The reported anti-HEV seroprevalence of 17% to 27% in the Korean population suggests that HEV infection has been autochthonously circulating, thereby resulting in subclinical infection in Korea. Given the discrepancies among anti-HEV assays, the diagnosis of hepatitis E should be made with caution using adequate antibody assays, and HEV RNA should be preferably detected from the stool. Further virological characterization and epidemiological study of the virus are warranted.     

Current status and vaccine indication for hepatitis A virus infection in Korea

One of the major cause of recent acute viral hepatitis in Korean adults is hepatitis A virus (HAV) infection. Most of hepatitis A cases are young adults in their twenties or thirties, and the severity of the disease is related to the age of patients. The seroprevalence of HAV among the adolescents and young adults in their teens and twenties is about 10%, which suggests that a growing number of young adults are susceptible to HAV infection. Development of more adult cases with severe presentation is expected in the near future, and some preliminary data suggest the incidence rate of hepatitis A in Korea might be higher than 20/100,000 population. This clinical features and the epidemiological shift of HAV urge to promote childhood vaccination and consider catch-up vaccination for adolescents and young adults. More extensive evaluation on the nationwide epidemiology of HAV infection, cost-benefit analysis of HAV vaccination, and setting-up of guidelines for HAV vaccination are urgently warranted.     

Lack of correlation between hepatitis C virus genotypes and clinical course of hepatitis C virus-related cirrhosis

The influence of the hepatitis C virus (HCV)-genotype on liver disease severity was evaluated in 429 consecutive patients with chronic hepatitis C, including 109 with cirrhosis who were followed up prospectively, allowing for the assessment of the role of the HCV-genotype on disease outcome and on the development of hepatocellular carcinoma (HCC). HCV-1 was detected in 147 (46%) patients without cirrhosis and in 47 (43%) with cirrhosis (P: not significant), being mainly HCV-1b. HCV-2 was found in 103 (32%) cases without cirrhosis and in 30 (27.5) with cirrhosis (P: not significant), being mainly HCV-2a. HCV-3 was detected in 32 (10%) patients without cirrhosis and in 2 (2%) with cirrhosis (P < 0.005). Infection with more than one genotype (HCV-1/HCV-2 and HCV-1/HCV-3) was observed only in cirrhotic patients (6 of 109; 5.5%). During a mean follow-up of 67 +/- 22 months, 21 (19%) patients with cirrhosis showed worsening in Child's stage, 5 (4.5%) underwent liver transplantation, 23 (21%) developed HCC, and 24 (22%) died of complication of liver disease; the overall incidence of at least one of these events was 38.5%. By the Kaplan-Meier method and log-rank test, the cumulative probability of developing each or at least one of the above events did not differ in relation to the genotype of infecting HCV, apart from patients with mixed genotype infection who showed a significantly higher incidence of death (P < .05). These data indicate that HCV-genotypes do not have a significant effect on the severity and outcome of liver disease in patients with chronic HCV-infection. Patients with cirrhosis who are also infected by HCV-1 and HCV-2 had a similar prognosis and progression to HCC, while patients infected by more than one genotype showed the most unfavorable course of disease.(Hepatology 1997 Jan;25(1):211-5)     

Hepatitis C virus RNA and antibody response in the clinical course of acute hepatitis C virus infection.

Hepatitis C virus RNA, anti-hepatitis C virus immune response and biochemical markers of liver injury were investigated in 17 patients with acute non-A, non-B hepatitis. At the first observation, 1 to 3 wk from the clinical onset, all patients had hepatitis C virus RNA in their serum, and most (15 of 17) were positive for second-generation anti-hepatitis C virus enzyme immunoassay. Follow-up serum samples were available for 10 patients. The rate of recombinant immunoblot assay-confirmed anti-hepatitis C virus enzyme immunoassay reactivities increased from 67% in the first 3 wk to 86% after 21 wk. Elevated ALT levels were associated with hepatitis C virus RNA positivity in most of cases, but the viral nucleic acid was also detected in sera with normal or slightly increased enzyme values. None of the single antibodies tested were related to hepatitis C virus RNA positivity or to the clinical phase of the infection. Therefore hepatitis C virus RNA determination might provide important additional information as compared with anti-hepatitis C virus markers, allowing earlier diagnosis, discrimination of active infection and, possibly, prognostic evaluation.     

HBV superinfection in hepatitis C virus chronic carriers,viral interaction,and clinical course

We enrolled 44 patients with hepatitis B virus (HBV) acute infection, 21 anti-hepatitis C virus (HCV)-positive for at least 1 year (case BC group), 20 anti-HCV-negative (control B group), and 3 with HBV/HCV acute concurrent infection. For each case BC, a subject with chronic HCV infection alone was selected (control C group). At the first observation, 85.7% of patients in case BC group and 85% of those in control B group were HBV-DNA-positive (polymerase chain reaction [PCR]), with a similar trend towards a decrease and negativization in about 20 days; in the case BC group, seroconversion to antibody to hepatitis B e antigen (anti-HBe) was more rapid. HCV-RNA (PCR) was undetectable in all case BC patients but 1, who shortly became negative, whereas 85.7% of subjects in control C group were positive (P <.001). Severe acute hepatitis was more frequent in the case BC group than in the control B group (28.6% vs. 0%, P <.05). Of the 14 patients in the case BC group and of the 16 in the control B group followed up for more than 6 months, 1 in the first and 1 in the second group became hepatitis B surface angiten (HBsAg) chronic carriers. Of the 13 patients in case BC group who recovered, 1 cleared both anti-HCV and HCV-RNA, 6 became HCV-RNA-positive, and 6 remained HCV-RNA-negative. In patients with HBV/HCV acute concurrent infection, HBV-DNA became undetectable in 15 days, and HCV-RNA and anti-HCV became positive at days 30 and 45, respectively; these patients developed HCV-RNA-positive chronic hepatitis. In conclusion, HBV superinfection in chronic HCV carriers has a severe clinical course and strongly and persistently depresses HCV.     

Marrow transplantation from hepatitis C virus seropositive donors: transmission rate and clinical course

Bone marrow transplant recipients are at risk for acquiring hepatitis C infection from the donated marrow. Twelve patients who were hepatitis C virus (HCV) RNA-negative pretransplant received marrow from anti-HCV seropositive donors. HCV RNA was present in the sera of seven of these donors. After transplant, serial serum specimens were obtained from all marrow recipients for determination of HCV RNA and aminotransferase levels. All seven recipients of marrow from HCV RNA-positive donors were HCV RNA-positive after marrow infusion; none cleared virus from the serum. All five recipients of marrow from anti-HCV seropositive, HCV RNA-negative donors remained free of HCV RNA in serum up to day 100. Abnormal serum aminotransferases were common in both HCV RNA- negative and HCV RNA-positive marrow recipients. One HCV-infected recipient developed marked elevation in aminotransferases after immunosuppressive drugs were stopped. We conclude that the presence of HCV RNA in the serum of marrow donors is an accurate predictor of HCV infection in marrow recipients. The acute infection was subclinical in all patients. The long-term risk of chronic hepatitis C virus infection in these patients remains to be determined.     

Current treatment of hepatitis C virus infection

New strategies have led to better results in the treatment of HCV infection during the last few years. At present the recommended treatment for patients with chronic hepatitis C is a combination of pegylated interferon and ribavirin. The sustained virological response rate of this combination therapy is 42 - 48 % for patients with genotype 1 after a course of 48 weeks and 80 % for patients with genotype 2 or 3 after a course of 24 weeks. New nucleoside analogs may lead to a better tolerance and better outcomes. A new approach is the long term monotherapy with pegylated interferon in order to reduce the progression of fibrosis and the incidence of cirrhotic complications. At present the effectivity of protease inhibitors and of a therapeutic immunisation with the E1 envelope protein of the hepatitis C virus are being examined. Because the optimal treatment strategy for patients with an acute hepatitis C infection is still unclear, these patients should be included in clinical studies.     

丙型肝炎疫苗研究现状与方向

丙型肝炎(丙肝)病毒(hepatitis C virus,HCV)主要经血液传播,是急性和慢性肝炎、肝硬化、肝癌的重要致病因子。目前全球HCV感染者约有1.7亿,每年新增感染者达300万～400万,我国HCV感染者近4 000万。HCV感染的慢性率高达70%以上,至今尚无有确切保护作用的疫苗问世,迫切需要发展有效的疫苗预防、控制HCV的感染和传播。     

乙型肝炎病毒DNA疫苗的研究现状

乙型肝炎(乙肝)病毒(HBV)DNA疫苗是指通过克隆HBV抗原基因,并将其插入真核表达载体构建而成的重组DNA分子。通过皮下、肌肉注射或颗粒轰击技术将重组DNA分子导人体内,使目的基因在体内表达,从而诱导机体产生针对此种抗原的体液免疫和细胞免疫。     

Current views on hepatitis C virus infection

Hepatitis C virus infection affects more than 4 million people in the United States and is a leading cause of liver failure necessitating transplantation. Effective combination therapies are now available for subgroups of patients at risk for progression to cirrhosis. The benefits of therapy in immunosuppressed hosts, such as HIV-infected patients and liver transplant recipients, are less well established.     

丙型肝炎病毒感染的自然演变规律分析

目的　了解我国人群丙型肝炎病毒 (HCV)感染的自然演变规律。方法　 2 0 0 1- 12～ 2 0 0 2 - 0 7对河北省固安县和赵县 2 83例因单采血浆而感染丙型肝炎者进行调查分析 ,男性 137例 ,女性 14 6例。行腹部超声检查及丙氨酸氨基转移酶 (ALT)、天冬氨酸氨基转移酶 (AST)、谷氨酰转肽酶 (GGT)采用速率法检测 ,HCVRNA的测定采用荧光定量PCR方法。转化生长因子 - β1(TGF - β1)、组织金属蛋白酶抑制因子 - 1(TIMP - 1)、三型前胶原肽(PⅢP)、四型胶原 (PC -Ⅳ )、透明质酸 (HA) ,采用ELISA方法。结果　 (1)非侵入性诊断 (包括临床诊断、超声诊断、血清学诊断 )为慢性肝炎轻度者 14 6例 ,占 5 1 .6 % ;中度 97例 ,占 34. 3% ;重度 15例 ,占 5 . 3% ;肝硬化 4例 ,占1 .4 % ;脂肪肝 2 1例 ,占 7 .4 %。(2 ) 2 83例感染者中 2 5 8例测定了HCVRNA ,阴性率 2 3. 3% ,表明该组人群感染HCV后 12～ 2 5年有较高的HCV自发阴转率。 (3)慢性肝炎重度和肝硬化组的ALT、AST、GGT均值明显高于其他组 ,慢性肝炎重度组ALT值异常率为 5 3 .3% (8/ 15 ) ,AST值异常率为 5 3 .3% (8/ 15 )。肝硬化组ALT值异常率为10. 0 % (4/ 4 ) ,AST值异常率为 10. 0 % (4/ 4 ) ,差异有显著性。 (4)慢性肝炎重度和肝硬化组肝纤维化血清学诊断指     

Clinical course of pregnant women with chronic hepatitis C virus infection and risk of mother-to-child hepatitis C virus transmission

As far as concerns chronic hepatitis C virus infection in pregnant women, different points remain to be elucidated, such as the clinical course, the rate of mother-to-child hepatitis C virus transmission and, in particular, its route and the possible risk factors. This review aimed to analyse current data on the prevalence of chronic hepatitis C virus infection in pregnant women and its relationship with risk factors, the rate of mother-to-child hepatitis C virus transmission and the factors possibly involved, particularly the maternal hepatitis C virus viral load and the human immunodeficiency virus coinfection, and the type of delivery and feeding. Finally, the appropriate timing for HCV-RNA testing in newborns has been reviewed.     

Current status of liver transplantation for hepatitis B virus

The management of hepatitis B in liver transplantation has evolved significantly over the past 2 decades. Introduction of hepatitis B immune globulin and subsequently nucleos(t)ide analogues has revolutionized transplantation for hepatitis B virus (HBV), increasing survival for patients transplanted for this indication. With the availability of new and potent antivirals for HBV, the need for liver transplant should continue to decrease in the coming years. Moreover, the newer antivirals with high resistance barriers will allow effective long-term viral prophylaxis and therefore, prevention of recurrence.