Viral hepatitis

Persons at high risk for human immunodeficiency virus (HIV) infection are also likely to be at risk for other infectious pathogens, including hepatitis B virus (HBV) or hepatitis C virus (HCV). These are bloodborne pathogens transmitted through similar routes; for example, via injection drug use (IDU), sexual contact, or from mother to child during pregnancy or birth. In some settings, the prevalence of coinfection with HBV and/or HCV is high. In the context of effective antiretroviral therapy (ART), liver disease has emerged as a major cause of morbidity and mortality in HIV-infected persons. Further, coinfection with viral hepatitis may complicate the delivery of ART by increasing the risk of drug-related hepatoxicity and impacting the selection of specific agents (e.g., those dually active against HIV and HBV). Expert guidelines developed in the United States and Europe recommend screening of all HIV-infected persons for infection with HCV and HBV and appropriate management of those found to be chronically infected. Treatment strategies for HBV infection include the use of nucleos(t)ide analogues with or without anti-HIV activity and/or peginterferon alfa (PegIFN) whereas HCV treatment is limited to the combination of PegIFN and ribavirin (RBV). Current approaches to management of HIVinfected persons coinfected with HBV or HCV are discussed in this review.

In this study, 520 serum samples from Yezodeer in the Hidaka district, Hokkaido, Japan were examined by enzyme-linked immunosorbent assay to investigate whether the animals were infected with hepatitis E virus (HEV). The distribution of optical density values showed a bimodal pattern and 181 samples (34.8%) were deemed to be antibody-positive against HEV. At least five (2.8%) of the positive sera gave specific bands by Western blot analysis. An age-dependent increase in prevalence of the antibodies was found among the animals. These findings indicate that Yezo-deer are a possible host for HEV infection. To avoid the risk of becoming HEV infected, the consumption of raw Yezo-deer meat must be prohibited.

Objectives: Population size estimates of People Who Inject Drugs (PWIDs) are needed to help policy makers understand the scope of the epidemic and allocate appropriate resources yet little is known about the size estimates of PWIDs in Uganda. We aimed to establish the number of people who inject drugs in Kampala Capital City and Mbale Municipality in Uganda.

Methods: We integrated three population size estimation methods into a cross-sectional survey of PWIDs in two urban centers. These methods included enumeration, Wisdom of the Crowds and multiplier method. The mean of the three estimates was hypothesized to be the most plausible size estimate with the other results forming the upper and lower plausible bounds. Data were shared with community representatives and stakeholders to finalize ‘best’ point estimates and plausible bounds. 

Results: We estimate there are approximately 550 PWIDs and 189 PWIDs in Kampala Capital City and Mbale Municipality respectively and plausibly 576-1,695 PWIDs living in these two urban centers. 

Conclusions: We employed multiple methods and used a wide range of data sources to estimate the size of PWIDs—a hidden population in Kampala Capital City and Mbale Municipality in Uganda. These estimates may be useful to advocate for and to plan, implement and evaluate HIV and Viral Hepatitis response for PWIDs.

Key words: People who inject drugs, Population Size Estimates, Enumeration, Multiplier, Uganda

Hepatocellular carcinoma (HCC) is one of the most common tumors in humans today, and its incidence has been rising over recent decades in Western countries. The main risk factors for the development of HCC are viral infections (hepatitis B and C), alcohol use, and the intake of mycotoxins in some areas of the world. In addition to these risk factors, genetic disorders such as hemochromatosis or α 1 -antitrypsin deficiency play a role. Regardless of the etiology, HCC generally develops on the basis of liver cirrhosis. Various pathomechanisms are effective during the neoplastic transformation of the hepatocyte. In chemical experimental models, hepatocarcinogenesis occurs in three stages: initiation, progression, and promotion. Molecular mechanisms of HCC development include the alteration in growth factor and tumor suppressor gene expression, dysregulation of apoptosis, and occurrence of reactive oxygen species generated during inflammation.

The gradient between wedged and free hepatic venous pressures was measured in 10 unselected adult patients suffering from fulminant viral hepatitis. The gradient was increased in all the studied patients, ranging from 0.9 to 2. 1 kPa; this finding indicates that portal hypertension was present in all these cases. Ascites was present in all the five patients having a gradient above 1.5 kPa and affected only two of the five patients having a gradient below 1.5 kPa; this observation suggests that portal hypertension plays a role in the mechanism of ascites in fulminant viral hepatitis. Portal hypertension in fulminant viral hepatitis is likely to be the consequence of an intrahepatic block due to massive necrosis of the liver cells.

Descritores: Hepatite Viral; Descoberta de Conhecimento em Base de Dados; Mineração de Dados,C4.5 Abstract -In Brazil, data collected by the Information Systems for Public Health are underused due to its bulk and complexity. In this work the Knowledge Discovery in Databases (KDD) technique has been used onto the National Information System of Diseases of Notification (SINAN), with the objective of

Hepatitis adalah kelainan hati berupa peradangan (sel) hati. Peradangan ini ditandai dengan meningakatan kadar enzim hati. Peningkatan ini disebabkan adanya gangguan atau kerusakan membran hati. Ada dua faktor penyebabnya yaitu faktor infeksi dan faktor non infeksi. Faktor penyebab infeksi antara lain virus hepatitis dan bakteri. Selain karena virus Hepatitis A, B, C, D, E dan G masih banyak virus lain yang berpotensi menyebabkan hepatitis misalnya adenoviruses , CMV , Herpes simplex , HIV , rubella ,varicella dan lain-

Hepatitis adalah penyakit menular yang disebabkan oleh virus, menyerang pada hati manusia dan membuat peradangan pada hati. Hepatitis yang dibahas disini ada Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, dan Hepatitis E. Membahas tentang definisi penyakit, RAP (Riwayat Alamiah Penyakit), Epidemiologi Penyakit, Rantai Penularan, Upaya pencegahan dan upaya penanggulangan.

mediated lipid transfer. Of note, MAb C167 also potently blocked Huh-7.5 infection by an HCV strain recovered from HCVcc-infected chimpanzees. These results demonstrate that SR-B1 is essential for infection with HCV produced in vitro and in vivo and suggest the possible use of anti-SR-B1 antibodies as therapeutic agents.

Hepatitis adalah proses terjadinya inflamasi dan atau nekrosis jaringan hati yang dapat disebabkan oleh infeksi, obat -obatan, toksin, gangguan metabolik, maupun kelainan autoimun. Infeksi yang disebabkan virus, bakteri, maupun parasit merupakan penyebab terbanyak hepatitis akut. Virus hepatitis merupakan penyebab terbanyak dari infeksi

Le dépistage péri transfusionnel du virus de l'hépatite C justifie une évaluation médicoéconomique. Méthodes. -Quatre stratégies de dépistage péri transfusionnel appliquées à la population des patients transfusés en 1996 au CHU de Rouen ont été comparées : une stratégie renonçant au dépistage systématique réglementaire, une seconde appliquant le dépistage réglementaire pré et post-transfusionnel à trois mois, une troisième différant le dépistage post-transfusionnel à six mois et une dernière limitée au seul dépistage pré-transfusionnel. L'efficacité (nombre de cas positifs dépistés), l'efficience (coût moyen par cas positif dépisté) et les coûts marginaux de passage d'une stratégie à une autre ont été évalués par une analyse de décision.

Rifampicin, a highly colephilic antibiotic, is rarely toxic: its toxicity has predominantly minor hepatic and immunological effects. A 42-year-old man was admitted to our institution because of hepatotoxicity as a result of anti-tuberculosis therapy. He complained of jaundice, nausea, vomiting, and fever. At first presentation, he exhibited the following: plasma unconjugated bilirubin, 5.

Purpose To evaluate the risk of myocardial infarction (MI) associated with the use of selective cyclooxygenase-2 (COX-2) inhibitors (coxibs). Methods Systematic review and meta-analysis of randomised controlled trials (RCTs) using a fixed-effect model to estimate the odds ratios (ORs) for risk of MI associated with coxibs compared against placebo, non-steroidal antiinflammatory drugs (NSAIDs) and other coxibs. Results Fifty-five trials (99 087 patients) were included in the meta-analysis. The overall pooled OR for MI risk for any coxib compared against placebo was 1.46 (95%CI: 1.02, 2.09). We found celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib were associated with higher MI risks compared against placebo. The pooled OR for any coxib compared against other NSAIDs was 1.45 (95%CI: 1.09, 1.93). Rofecoxib had a significantly higher risk of MI than naproxen (OR: 5.39; 95%: 2.08, 14.02) and valdecoxib had lower MI risk than diclofenac (OR: 0.14, 95%CI: 0.03, 0.73). There were no significant differences identified in the risk of MI from the available head-to-head comparisons of coxibs. Conclusions Coxibs were associated with increased risks of MI when compared against placebo or non-selective NSAIDs. Differences in MI risk were also apparent between comparisons of individual NSAIDs. Future work should consider using individual patient data (IPD) meta-analysis to explore differences in MI risk between different subgroups of patients.

Abbreviations: Anti HBc, antibody to hepatitis B core protein is a marker of current (in the presence of HBsAg) or past infection with HBV; Anti HBe, antibody to hepatitis e antigen can be a marker for low infectivity (in the presence of HBsAg, especially in wild type infection); Anti HCV, antibody to HCV is a marker of current (in the presence of HCV RNA) or past infection with HCV; CDC, centres for disease control; EPP, exposure prone procedures is the term for invasive procedures where there is potential for contact between the skin of the HCW and sharp surgical instruments, needles or sharp tissues in body cavities or poorly visualised/confined body sites; HBeAg, hepatitis B e antigen is a marker of level of infectivity; HBsAg, hepatitis B surface antigen detectable in serum in the majority of HBV infected patients; HBV, hepatitis B virus; HBV DNA, hepatitis B nucleic acids. Can be used to monitor infectivity Journal of Clinical Virology 27 213 Á/230 www.elsevier.com/locate/jcv 1386-6532/03/$ -see front matter #

Current hepatitis B vaccination programmes targeting risk groups have met with little success in controlling HBV infection in the general population. Despite the long-standing existence of unambiguous recommendations for risk-group vaccination, hepatitis B vaccination coverage remains low in most risk groups in most high-income countries. This low coverage may be attributed to a lack of perceived risk of hepatitis B and the absence of appropriate health care programmes targeting hepatitis B monitoring and vaccination for certain risk groups, particularly sex workers, injecting drug users, and prisoners. The Viral Hepatitis Prevention Board (VHPB) recognises the importance of raising the awareness of health care providers, policymakers, and the general public, about hepatitis B as a risk to both the community in general and to specific groups considered at increased risk. The VHPB also recognises that new strategies will have to be developed and implemented.

PURPOSE OF THE STUDY: The prevalence of hepatitis C virus (HCV) genotypes depends on geographic location (1). HCV genotyping is highly important for severity of infection assessment as well as for epidemiological investigations (2). The aim of our study was to determine the HCV genotype prevalence in four different risk groups (intravenous drug users (IDU), hemodialysis patients, patient undergoing transfusion and other risk factors (persons exposed to contaminant needles or sharps, medical or dental procedures, piercing, tattooing, etc.)) in the Republic of Macedonia and to evaluate its association with patient’s age, gender and mode of transmission. METHOD: Detection of HCV was done by using commercial assay (AMPLICOR HCV v2.0). HCV genotyping was performed with an ASO hybridization method using specific oligonucleotide probes for HCV genotypes 1-4 (3). SUMMARY OF RESULTS: A total of 613 HCV positive patients were investigated. The prevalence of HCV infection in the different risk...

Background~Aims: This study aimed to evaluate the protein and lipid redox status in plasma, erythrocytes and erythrocyte ghosts of alcoholics and of patients with non-alcoholic liver disease; we also investigated the relation to glutathione levels and the role of acetaldehyde and xanthine oxidase activity in plasma. Methods: Carbonyl and sulfhydryl proteins, glutathione and malondialdehyde levels and the activity of the circulating xanthine oxidase were determined in: active and abstinent alcoholics, patients with chronic viral hepatitis and healthy controls. Results: Active alcoholics showed a decrease of sulfhydryl protein and glutathione concentrations in plasma, erythrocytes and ghosts compared to the other groups. Also, an increase of the carbonyl protein and malondialdehyde levels and of the activity of circulating xanthine oxidase (9.2+1.8 nmol.min.ml, p<0.001) were observed. Significant correlations between carbonyl protein and malondialdehyde concentrations in plasma (r=O.775,p<O.O01), as well as between daily alcohol intake and carbonyl protein content in plasma (r=0.879, p<0.001) and erythrocytes (r=0.605, p<0.01) were observed. However, carbonyl protein levels did not correlate with the degree of liver injury. Incubation of plasma with acetaldehyde, but not with ethanol, significantly increased the carbonyl protein formation. Administration of N-Ethylmaleimide, a thiol depletor, or glutathione significantly increased or delayed, respectively, the carbonyl protein formation. Conclusions: Proteins are oxidatively modified in plasma and erythrocytes of active alcoholics, whereas no such alterations are detectable in patients with non-alcoholic liver disease. Protein oxidation in alcoholics does not seem to result directly from ethanol; circulating xanthine oxidase, delivered from injured cells, may play a contributory role and glutathione appears to be directly involved in the protection of plasma proteins against acetaldehyde toxicity.

In order to define hepatitis B virus (HBV) mutational patterns in Iran, nucleotide sequences obtained from 91 patients and encompassing the precore, basal core promoter (BCP) and surface (S) regions, were compared. The patients were grouped as asymptomatic carriers, chronic active hepatitis or cirrhotic patients. Genotypes and mutations were determined by sequencing and phylogenetic analysis. All strains belonged to genotype D, and most of them to subgenotype D1. All but two strains specified ayw2, one ayw3 and one adw2 determinants. Two deletions of 8-or 20-bp were found in the X region in eight strains, six from patients with chronic active hepatitis. Eight of 21 strains from patients with cirrhosis harboured unusual mutations such as a stop codon at position 69 in the S region or a previously not described mutation in the BCP region ( 1761 TC/ATTTG 1766 ). All patients infected by strains with the stop codon mutation had detectable HBsAg and high viral load. The accumulation of mutations found in the BCP and S regions in HBV strains from patients with chronic active hepatitis and cirrhosis may predict disease progression in Iranian HBsAg carriers.

The study of antibodymediated virus neutralization has been hampered by the lack of an efficient and high-throughput cell culture system for the study of virus neutralization. The HCV structural proteins have been shown to assemble into noninfectious HCV-like particles (HCV-LPs). Similar to serum-derived virions, HCV-LPs bind and enter human hepatocytes and hepatoma cell lines. In this study, we developed an HCV-LP-based model system for a systematic functional analysis of antiviral antibodies from patients with acute or chronic hepatitis C. We demonstrate that cellular HCV-LP binding was specifically inhibited by antiviral antibodies from patients with acute or chronic hepatitis C in a dose-dependent manner. Using a library of homologous overlapping envelope peptides covering the entire HCV envelope, we identified an epitope in the N-terminal E2 region (SQKIQLVN TNGSWHI; amino acid positions 408 to 422) as one target of human antiviral antibodies inhibiting cellular particle binding. Using a large panel of serum samples from patients with acute and chronic hepatitis C, we demonstrated that the presence of antibodies with inhibition of binding activity was not associated with viral clearance. In conclusion, antibody-mediated inhibition of cellular HCV-LP binding represents a convenient system for the functional characterization of human anti-HCV antibodies, allowing the mapping of envelope neutralization epitopes targeted by naturally occurring antiviral antibodies.

Serum specimens (327) from patients with chronic hepatitis B were evaluated for hepatitis B virus (HBV) DNA using three commercial assays -Chiron Quantiplex™ (CA), Digene Hybrid Capture (DA) and Abbott HBV DNA assay (AA). The HBV DNA values obtained following evaluation were used to compare the linearity, responsiveness and precision of each assay and to determine the conversion between the three different assay values. The comparison was accomplished using a new statistical approach termed the multi-measurement method (MMM). MMM is a minimal bias, non-linear regression technique that allows simultaneous multiassay performance evalua-tion as well as assay value interconversion. MMM analysis demonstrated that the CA was more sensitive and responsive than either the DA or the AA. Both the CA and DA were more precise than the AA. Validation of the MMM results was performed using two additional data sets of 551 and 100 specimens, respectively. MMM is a novel statistical tool that has a broad application for the generation of statistically normalized laboratory data and for interassay standardization. Fig. 3 (a) Comparison of MMM (q q ) and linear regression (n) using a data set obtained from Kapke et al. [7] (n = 551). For specimens with HBV DNA quantification above 100 MEq ml -1 by CA and ≈ 11 pg ml -1 by AA, the R 2 was 0.99. (b) CA-measured, MMM-derived DA 'expected' HBV DNA values in pg ml -1 (x axis) vs DA-measured 'observed' HBV DNA values in pg ml -1 (R 2 = 0.96) (n = 100).

c Centro de Investigación Biom edica en Red de Enfermedades Hep aticas y Digestivas (CIBERehd), M alaga, España Recibido el 30 de junio de 2009; aceptado el 2 de julio de 2009 Disponible en Internet el 4 de noviembre de 2009 PALABRAS CLAVE Inmunosupresores; Hepatotoxicidad; Daño hep atico; Antgonitas del factor de necrosis tumoral a; Infliximab

The seroprevalence of viral hepatitis in healthcare workers has important public health implications. To assess the risk factors for the acquisition of viral hepatitis in an unvaccinated cohort from an hyperendemic region, 567 healthcare workers from a large hospital in the capital of the Republic of Yemen were interviewed and tested for serological markers of infection with viral hepatitis. 54/543 (9.9%) tested positive for hepatitis B surface antigen (HBsAg), 174/543 (32.0%) had positive hepatitis B core antibodies (anti-HBc), and 19/546 (3.5%) had hepatitis C antibodies (anti-HCV). Age (OR ¼ 1.04, 95% CI 1.02-1.06), male sex (OR ¼ 2.0, 1.32-3.03), and occupation (healthcare workers not carrying out exposure prone procedures, OR ¼ 1.61, 1.06-2.44) were found to be independent predictors for the likelihood of detecting either HBsAg or anti-HBc by multivariate logistic regression analysis. No independent risk factors for anti-HCV positive status were identified. Our findings support the adoption of universal HBV immunisation programmes and infection control precautions. The absence of known risk factors predicting anti-HCV positive serostatus suggests the main mode of transmission of hepatitis C in this cohort in the Yemen remains undiscovered.

Background and Purpose: Patients treated for pediatric malignancy are at high risk of parentrally transmitted viral hepatitis. Blood product transfusions are the major risk factor. The aim of this study is to detect the seroprevalence of hepatitis B and C viral infections in pediatric malignancy patients, before, during and after chemotherapy. Material and Methods: Two hundred and twenty two pediatric malignancy patients, presenting to the National Cancer Institute, Cairo University during the period from June 2000 to March 2001, were enrolled in this study. They were classified into two groups (I & II). Group I included 111 newly diagnosed cases of pediatric malignancy. Patients in this group were evaluated initially before starting chemotherapy and after six months of treatment. Group II included 111 cases of pediatric malignancy who ended chemotherapy and were already put under follow up from the beginning. Patients of both groups were subjected to full clinical evaluation. Sera of these patients were investigated for liver functions and hepatitis markers including HBsAg, HBcIgM, HBV-DNA by PCR (if HBsAg and/or HBcIgM were positive), HCV-Ab (IgG) and HCV-RNA by PCR (if HCV Ab was positive). Results: In-group I, the seropositivities for HBV and HCV were found to be 3.6% and 0.9%, respectively, at diagnosis and increased significantly to 18.2% and13.1%, respectively, after 6 months of therapy. In-group II, the seropositivities for HBV and HCV after cessation of therapy were found to be as high as 34.2% and 39.6%, respectively. Correlation between hepatitis markers and number of blood transfusions, surgery, sex, type of malignancy and liver function were listed. Conclusions: There is high serprevalence of hepatitis B and C in pediatric malignancy. Blood product transfusion is the major risk factor. It is possible that the very high rate of HCV seroconversion in these patients may not only depend on clearly documented parenteral exposure, but also on other unrecognized routes of transmission.

Giriş ve Amaç: Ekonomik ve çevre şartlarının düzeltilmesi ve eğitim düzeyinin artması ile hepatit A enfeksiyonuna duyarlılık ileri yaşlara kaymaktadır. Fakat hastalığın ciddiyeti de yaşla birlikte artmaktadır. Tıp fakültesi öğrencilerinin tıp eğitimleri süresince hepatit A enfeksiyonu olan hastalarla karşılaşma olasılıkları olduğu gibi, hepatit A enfeksiyonu olan öğrencilerin de hastalarla teması olmaktadır. Bu nedenle hepatit A geçirmemiş veya aşılaması olmayan tıp fakültesi öğrencileri hepatit A enfeksiyonu açısından risk altındadır . Bu çalışma Pamukkale Üniversitesi Tıp Fakültesi 6. sınıf öğrencilerinin hepatit A seroprevalansını ve etkileyen faktörleri incelemek amacıyla yapılmıştır.

Gereç ve Yöntem: Kesitsel tipteki bu çalışmanın evrenini, Pamukkale Üniversitesi Tıp Fakültesi 2012-2013 öğretim yılı içerisindeki 6. sınıf öğrencileri oluşturmuştur. Örneklem seçimine gidilmeden evren üzerinde çalışılmış, ancak anket formlarının uygulandığı günlerde devamsız olan ya da anket formunu doldurmak istemeyen 4 (%8,3) öğrencinin çalışma dışında tutulması nedeniyle 44 (%91,6) öğrenci çalışma kapsamına alınmıştır. Araştırmanın verileri Ekim 2012’de toplanmıştır. Çalışmaya katılan öğrencilere hepatit A seroprevalansı ve etkileyen faktörleri ortaya koymayı amaçlayan bir anket formu doldurtulmuştur. Veri toplama aracında araştırmacılar tarafından oluşturulan, 10 sorudan oluşan demografik verileri sorgulayan sorular, 4 sorudan oluşan sosyoekonomik düzeyi ölçen sorular ve 10 sorudan oluşan hepatit A risk faktörleri ile ilgili sorular vardır. Bu çalışmada anti-HAV IgG sonuçları retrospektif olarak değerlendirilmiştir. Olguların serum örneklerinde anti HAV IgG düzeyleri Pamukkale Üniversitesi Tıp Fakültesi Hastanesi Mikrobiyoloji Laboratuvarı’nda ELISA (Architect, i200oSR) yöntemiyle çalışılmıştır. Sonuçların yorumu üretici firmanın önerileri doğrultusunda; 1 s/co altındaki değerlere sahip numuneler negatif ve ≥ 1 s/co değerlerine sahip örnekler pozitif olarak değerlendirilmiştir. Verilerin analizi için SPSS paket programı kullanılmıştır. Veriler değerlendirilirken tanımlayıcı istatistikler, kategorik bağımsız değişkenlerin karşılaştırılması için ki-kare veya Fisher testi kullanılmıştır.

Bulgular: Çalışmaya katılan öğrencilerin yaş ortalaması 23,7±1,6 olup, % 59,1’i (n=26) kadındır. Katılımcıların %52,3’ünün (n=23) annesinin öğrenim durumu lise ve üzeri, % 61,4’ünün (n=27) babasının öğrenim durumu yüksekokuldur. Katılımcıların % 36,4’ünün (n=16) sosyoekonomik düzeyi düşük, % 45,5’inin (n=20) orta olarak bulunmuştur. Katılımcıların % 31,8’inin (n=14) 12 yaşına kadar yaşadığı evdeki kişi sayısı 5 ve üzeri olarak saptanmıştır. Katılımcıların %25’i (n=11) üniversite öğrenimi öncesi kreş ve/veya yurtta kaldığını, % 27,3’ü (n=12) çocukluk dönemindeki el yıkama alışkanlığının orta-kötü olduğunu belirtmiştir. Katılımcıların %4,5’inin (n=2) çocukluk döneminde evindeki kullandığı içme suyunun kuyu/tulumba suyu olduğu, %56,8’inin (n=25) ise şebeke suyu olduğu saptanmıştır. Katılımcıların %20,5’i (n=9) çocukluk dönemindeki evinin atık sisteminin foseptik olduğunu belirtmiştir. Serum örneklerinin sadece 12’sinde (%27,3) anti HAV IgG pozitif olarak bulunmuştur. Baba öğrenim durumu ve en uzun süre yaşanılan bölge anti HAV seropozitifliğini etkileyen bağımsız faktörler olarak belirlenmiştir.

Sonuç ve Öneriler: Çalışmamız hepatit A enfeksiyonuna duyarlılığın ileri yaşlara kaydığını göstermektedir. Hastalığın ileri yaşta daha ağır ve komplikasyonlu seyredebileceği göz önüne alındığında risk altındaki bir grup olarak tıp fakültesi öğrencilerinin tıp eğitimine veya en azından klinik çalışmalara başlamadan önce hepatit B’de olduğu gibi, hepatit A infeksiyonu açısından serolojik olarak taranması ve yakalama (catch up) bağışıklama programlarının oluşturulması uygun görünmektedir.

Anahtar Kelimeler: Hepatit A, seroprevalans, tıp fakültesi öğrencileri

Immigration and globalization have added to the challenges of public health concerns regarding chronic HBV and HCV infections worldwide. The aim of this study is to review existing global literature across ethnic populations on HBV and HCV related human leukocyte antigen (HLA) associations in relation to susceptibility, viral persistence and treatment. Extensive literature search was conducted to explore the HLA associations in HBV and HCV infections reported across global populations over the past decade to understand the knowledge status, weaknesses and strengths of this information in different ethnic populations. HLA DR13 is consistently associated with HBV clearance globally. HLADRB1*11/*12 alleles and DQB1*0301 are associated with HBV persistence but with HCV clearance worldwide. Consistent association of DRB1*03 and *07 is observed with HCV susceptibility and non-responsiveness to HBV vaccination across the population. HLA DR13 is protective for vertical HBV and HCV transmission in Chinese and Italian neonates, but different alleles are associated with their susceptibility in these populations. HLA class Ⅰmolecule interactions with Killer cell immunoglobulin like receptors (KIR) of natural killer (NK) cells modulate HCV infection outcome via regulating immune regulatory cells and molecules. HLA associations with HBV vaccination, interferon therapy in HBV and HCV, and with extra hepatic manifestations of viral hepatitis are also discussed. Systematic studies in compliance with global regulatory standards are required to identify the HLA specific viral epitope, stage specific T cell populations interacting with different HLA alleles during disease progression and viral clearance of chronic HBV or HCV infections among different ethnic populations. These studies would facilitate stage specific therapeutic strategies for clearance of HBV and HCV infections or co-infections across global populations and aid in identification of HBV-HCV combined vaccine. HLA associations of chronic HBV or HCV development with confounding host factors including alcohol, drug abuse, insulin resistance, age and gender are lacking and warrant detailed investigation across global populations.

Hepatitis C prevalence in prison populations is much higher than in the community. Effective hepatitis C treatment within this population does not only have a direct individual health benefit, but may lead to substantial community dividend. We reviewed available evidence on hepatitis C treatment in prison settings, with a focus on the European Union/European Economic Area. A systematic review of the literature (PubMed, EMBASE, Cochrane library) was performed and complemented with searches for conference abstracts and grey literature. Thirty-four publications were included reporting on the effectiveness, acceptability and economic aspects of hepatitis C virus treatment models of care to achieve treatment completion and sustained viral response in prison settings. Available evidence shows that hepatitis C treatment in prison settings is feasible and the introduction of direct-acting antivirals will most likely result in increased treatment completion and better clinical outcomes for the prison population, given the caveats of affordability and the need for increased funding for prison health, with the resulting benefits accruing mostly in the community.

How to obtain copies of this and other HTA programme reports An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).

Viral hepatitis A is still common in Italy, especially in Southern regions. In this study, a metapopulation model for hepatitis A virus (HAV) transmission is proposed and analyzed. Analytical results on the asymptotic and transient behaviors of the system are carried out. Based on the available Italian movement data, a national spatial contact matrix at the regional level, which could be used for new studies on the transmission dynamics of other infectious diseases, is derived for modeling fluxes of individuals. Despite the small number of fitted parameters, model simulations are in good agreement with the observed average HAV incidence in all regions. Our results suggest that the mass vaccination program introduced in one Italian region only (Puglia, the one with the highest endemicity level) could have played a role in the decline of HAV incidence in the country as a whole. The only notable exception is represented by Campania, a Southern region showing a high endemicity level, which is not substantially affected by HAV dynamics in Puglia. Finally, our results highlight that the continuation of the vaccination campaign in Puglia would have a relevant impact in decreasing long-term HAV prevalence, especially in Southern Italy.

How to obtain copies of this and other HTA programme reports An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).

L'infection virale C est associée à des manifestations auto-immunes diverses. Nous rapportons deux cas d'association d'une cirrhose biliaire primitive et d'une hépatite virale C de génotype 1b. Ces deux patientes avaient, en plus d'une cytolyse, une cholestase anictérique avec des anticorps antimitochondries à 1/200 de type M2. La biopsie hépatique objectivait une hépatite chronique dans un cas et des signes évocateurs d'une cirrhose biliaire primitive dans l'autre. Une patiente était traitée par une bithérapie pégylée et l'autre uniquement par l'acide ursodésoxycholique en raison d'une anémie hémolytique auto-immune associée. À travers ces deux observations, nous soulignons la rareté de cette association ainsi que ses difficultés diagnostiques et thérapeutiques.

Forty-three women who had had viral hepatitis one or more years ago and 35 healthy women who were age and parity matched were given an oral contraceptive containing 0.05ig ethinyl estradiol and 0.5mg levonorgestrel for six consecutive months. Liver function tests (serum bilirubin, SGOT, SGPT aid serum alkaline phosphatase) and serum proteins (total, albumin, globulins, ceruloplasmin, haptoglobin and alpha-1 antitrypsin) were measured before beginning trkeatment and after three and six months of use.

Overall prevalence of hepatitis B (HBV) in the UK is low. However, among migrants from endemic areas, prevalence has been shown to be high. Furthermore, timely diagnosis and/or referral are required prevent serious health consequences through early institution of treatment.
Methods: We identified locations that would be familiar to Chinese members of the community with the objective of facilitating testing. Dried blood spot samples were collected from 229 Chinese subjects and tested for HBV and also for hepatitis C virus (HCV) infection – offering complete chronic viral hepatitis screening.
Results: HBsAg was positive in 20/229 (8.7 %) participants, (10F, 10M). Five women and one man were aware of their condition, but only one man and none of the women were under specialist care. The average length of residence in the UK for positive patients was 15 years (range 2-40).
Evidence of HBV past infection, HBcAb(+)/HBsAg(-), was seen in 28/229 participants (12.2%).
HCV antibody testing produced negative results in all participants.
The methodology of testing was well accepted, 139/144 (95%) responded to a feedback questionnaire declaring no discomfort and 100% finding the information session useful.
Conclusion: This model of outreach testing is helpful for addressing health inequalities afflicting the UK’s Chinese community.