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International audience; Background:In the 2016 ESPGHAN recommendations on how to deal with hepatitis E virus infection in immunocompromised children, patients treated with chemotherapy were not specifically mentioned. Observations:Two teenagers treated with chemotherapy for acute leukemia and medulloblastoma, respectively, were diagnosed with hepatic cytolysis. After numerous investigations hepatitis E was found, limiting the good progress of the chemotherapy treatment. Conclusion:In the case of liver cytolysis in immunocompromised children treated with chemotherapy, hepatitis E virus infection has to be promptly diagnosed.

International audience; Background: Besides the prototypical hepatitis B virus (HBV) infectious particle, which contains a full-length double-stranded DNA (flDNA), additional circulating virus-like particles, which carry pregenomic RNA (pgRNA), spliced1RNA (sp1RNA) or spliced-derived DNA (defDNA) forms have been described. We aimed to determine the level of these four circulating forms in patients and to evaluate their impact on viral lifecycle.Methods: Chronic HBV untreated patients (n = 162), included in the HEPATHER cohort, were investigated. Pangenomic qPCRs were set up to quantify the four circulating forms of HBV nucleic acids (HBVnaf). In vitro infection assays were performed to address the impact of HBVnaf.Results: Hierarchical clustering individualized two clusters of HBVnaf diversity among patients: (1) cluster 1 (C1) showing a predominance of flDNA; (2) cluster 2 (C2) showing various proportions of the different forms. HBeAg-positive chronic hepatitis phase and higher viral load (7.0 ± 6.4 vs 6.6 ± 6.2 Log10 copies/ml; p < 0.001) characterized C2 compared to C1 patients. Among the different HBVnaf, pgRNA was more prevalent in C1 patients with high vs low HBV viral load (22.1% ± 2.5% vs 4.1% ± 1.8% of HBVnaf, p < 0.0001) but remained highly prevalent in C2 patients, whatever the level of replication. C2 patients samples used in infection assays showed that: (1) HBVnaf secretion was independent of the viral strain; (2) the viral cycle efficiency differed according to the proportion of HBVnaf in the inoculum, independently of cccDNA formation. Inoculum enrichment before infection suggests that pgRNA-containing particles drive this impact on viral replication.Conclusion: Besides the critical role of HBV replication in circulating HBVnaf diversity, our data highlight an impact of this diversity on the dynamics of viral cycle.Clinical trial registration: Patients were included from a prospective multicenter French national cohort (ANRS CO22 HEPATHER, NCT01953458).

Background Metagenomic next-generation sequencing (mNGS) was used to assess patients with primary or secondary immune deficiencies (PIDs and SIDs) who presented with immunopathological conditions related to immunodysregulation. Methods Thirty patients with PIDs or SIDs who presented with symptoms related to immunodysregulation and 59 asymptomatic patients with similar PIDs or SIDs were enrolled. mNGS was performed on organ biopsy. Specific Aichi virus (AiV) reverse-transcription polymerase chain reaction (RT-PCR) was used to confirm AiV infection and screen the other patients. In situ hybridization (ISH) assay was done on AiV-infected organs to identify infected cells. Virus genotype was determined by phylogenetic analysis. Results AiV sequences were detected using mNGS in tissue samples of 5 patients and by RT-PCR in peripheral samples of another patient, all of whom presented with PID and long-lasting multiorgan involvement, including hepatitis, splenomegaly, and nephritis in 4 patients. CD8+ T-cell infiltration was a hallmark of the disease. RT-PCR detected intermittent low viral loads in urine and plasma from infected patients but not from uninfected patients. Viral detection stopped after immune reconstitution obtained by hematopoietic stem cell transplantation. ISH demonstrated the presence of AiV RNA in hepatocytes (n = 1) and spleen tissue (n = 2). AiV belonged to genotype A (n = 2) or B (n = 3). Conclusions The similarity of the clinical presentation, the detection of AiV in a subgroup of patients suffering from immunodysregulation, the absence of AiV in asymptomatic patients, the detection of viral genome in infected organs by ISH, and the reversibility of symptoms after treatment argue for AiV causality.

Purpose: The present study investigated the effectiveness and applicability of superb microvascular imaging (SMI) in determining the degree of liver fibrosis noninvasively in comparison with shear wave elastography (SWE).Methods: Ninety-eight consecutive patients with chronic hepatitis B who underwent ultrasound (US)-guided needle biopsy were examined using US combined with SMI and SWE. The predictive performance of the two US techniques in staging liver fibrosis and inflammation was compared with reference to the histological findings obtained from liver biopsy. The intraobserver and interobserver reproducibility of SMI in vascularity scores were evaluated.Results: SWE values and SMI vascular scores were statistically significantly different among fibrosis stages (χ2(3)=76.3, χ2(3)=81.5, P

Inducible T-cell costimulator (ICOS) is a homodimeric protein expressed on the surface of activated T-cells that is being investigated as a potential therapeutic target to treat various cancers. Recent studies have reported aberrant increases in the soluble form of ICOS (sICOS) in human serum in disease-state patients, primarily using commercial ELISA kits. However, results from our in-house immunoassay did not show these aberrant increases, leading us to speculate that commercial sICOS ELISAs may be prone to interference. We directly tested that hypothesis and found that one widely used commercial kit yields false-positives and is prone to human anti-mouse antibody (HAMA) interference. We then analyzed a panel of healthy, cancer, chronic hepatitis C virus, systemic lupus erythematosus, and diffuse cutaneous systemic sclerosis human serum using our in-house immunoassay and reported the measured sICOS concentrations in these populations. Since even well characterized immunoassay methods are prone to non-specific interference, we also developed a novel sICOS LC-MS/MS method to confirm the results. Using these orthogonal approaches, we show that sICOS is a low abundance soluble protein that cannot be measured above approximately 20 pg/mL in human serum.

Background Non-invasive clinical algorithms for the detection of liver fibrosis (LF) can reduce the need for liver biopsy (LB). We explored the implementation of two serum biomarkers, enhanced liver fibrosis (ELF) and Mac-2 binding protein glycosylation isomer (M2BPGi), in clinical algorithms for LF in chronic hepatitis B (CHB) patients. Methods Two clinical algorithms were applied to 152 CHB patients: (1) transient elastography (TE) followed by biomarkers (TE/ELF and TE/M2GPGi); (2) biomarker test followed by TE (ELF/TE and M2BPGi/TE). Using the cut-off value or index for the detection of advanced LF (TE≥F3; 9.8 in ELF and 3.0 in M2BPGi), LB was expected to be performed in cases with discordant TE and biomarker results. Results In both algorithms, the expected number of LBs was lower when using M2BPGi than when using ELF (TE/ELF or ELF/TE, 13.2% [N=20]; TE/M2BPGi or M2BPGi/TE, 9.9% [N=15]), although there was no statistical difference (P=0.398). In the TE low-risk group (TE≤F2), the discordance rate was significantly lower in the TE/M2BPGi approach than in the TE/ELF approach (1.5% [2/136] vs. 11.0% [15/136], P=0.002). In the biomarker low-risk group, there was no significant difference between the ELF/TE and M2BPGi/TE approaches (3.9% [5/126] vs. 8.8% [13/147], P=0.118). Conclusions Both ELF and M2BPGi can be implemented in non-invasive clinical algorithms for assessing LF in CHB patients. Given the lowest possibility of losing advanced LF cases in the low-risk group when using the TE/M2BPGi approach, this combination seems useful in clinical practice.

No study on the relationship between hepatic steatosis and sex hormone levels in male patients with chronic hepatitis B (CHB) infection has been conducted.We aimed to investigate the association between serum sex hormones and hepatic steatosis among a cohort of males with CHB.In this cross-sectional study, 268 male patients with CHB were enrolled. All participants underwent anthropometric measurement, blood testing, and FibroScan test. Multiple logistic regression analysis was used to investigate the association of serum sex hormones with hepatic steatosis.We included 137 males with and 131 without hepatic steatosis in this study. Subjects with serum testosterone (T) levels in the highest tertile had an odds ratio (OR) (95% confidence interval [CI]) of 0.35 (0.18-0.70) (P for trend=0.003); those with serum prolactin (PRL) levels in the highest tertile had an OR (95%CI) of 0.21 (0.10-0.45) (P for trend0.001); and those with serum estradiol/testosterone (E2/T) in the highest tertile had an OR (95%CI) of 4.02 (1.97-8.20) (P for trend0.001) for hepatic steatosis.Lower serum total T and PRL levels and higher total E2/T are independently associated with presence of hepatic steatosis in male patients with CHB.

Objectives Chronic hepatitis C (CHC) infection affects more than 70 million people worldwide and imposes considerable health and economic burdens on patients and society. This study estimated 2 understudied components of the economic burden, patient out-of-pocket (OOP) costs and time costs, in patients with CHC in a tertiary hospital clinic setting and a community clinic setting. Methods This was a multicenter, cross-sectional study with hospital-based (n = 174) and community-based (n = 101) cohorts. We used a standardized instrument to collect healthcare resource use, time, and OOP costs. OOP costs included patient-borne costs for medical services, nonprescription drugs, and nonmedical expenses related to healthcare visits. Patient and caregiver time costs were estimated using an hourly wage value derived from patient-reported employment income and, where missing, derived from the Canadian census. Sensitivity analysis explored alternative methods of valuing time. Costs were reported in 2020 Canadian dollars. Results The mean 3-month OOP cost was $55 (95% confidence interval [CI] $21-$89) and $299 (95% CI $170-$427) for the community and hospital cohorts, respectively. The mean 3-month patient time cost was $743 (95% CI $485-$1002) (community) and $465 (95% CI $248-$682) (hospital). The mean 3-month caregiver time cost was $31 (95% CI $0-$63) (community) and $277 (95% CI $174-$380) (hospital). Patients with decompensated cirrhosis bore the highest costs. Conclusions OOP costs and patient and caregiver time costs represent a considerable economic burden to patient with CHC, equivalent to 14% and 21% of the reported total 3-month income for the hospital-based and community-based cohorts, respectively.

У статті подані дослідження генетичного профілю (IL-4 (C589T), IL-10 (G1082A) і TNFα (G308A)), клінічних і біохімічних показників у 100 хворих на хронічний гепатит С, які проживають в Одеському регіоні. Проведено їх кореляційний аналіз з метою виявлення можливих маркерів тяжкості перебігу захворювання та його прогнозу.

Мета. Визначити особливості клініко-біохімічних параметрів та показників нейрогуморальної регуляції у хворих на хронічний гепатит С зі змішаною кріоглобулінемією залежно від інфікування різними генотипами HCV. Методи. Обстежено 78 хворих на хронічний гепатит С зі змішаною кріоглобулінемією. Вміст кріоглобулінів в сироватці крові визначали спектрофотометричним методом, вміст кортизолу — методом імуноферментного аналізу. Визначали спектральні параметри варіабельності ритму серця методом комп’ютерної кардіоінтервалометрії. Пацієнти були розподілені на 2 групи: 42 пацієнти, інфіковані 1-м генотипом HCV, та 36 хворих, інфікованих 2-м або 3-м генотипом HCV. Результати. Відсутня статистично значуща різниця клінічних ознак змішаної кріоглобулінемії, активності АлАТ та вмісту змішаних кріоглобулінів в сироватці крові у хворих, інфікованих 1-м та 2-м або 3-м генотипом вірусу. Уміст кортизолу в сироватці крові на 20,6 % вищий (р < 0,05) у хворих, інфікованих 1-м генотипом HCV. В результаті аналізу варіабельності ритму серця показник LF виявився на 24,5 % нижчим (р < 0,05), а показник HF — на 60,4 % вищим (р < 0,05) у пацієнтів, інфікованих 1-м генотипом HCV. Отже, у хворих, інфікованих 1-м генотипом HCV, виявлено більш виражений дисбаланс нейрогуморальної регуляції.

Цель — изучить особенности течения хронического вирусного гепатита В (ХГВ) у детей в зависимости от продолжительности болезни, штамма вируса и вирусной нагрузки. Обследован 61 ребенок с ХГВ в возрасте 3–18 лет. Всем больным проведено клиническое, лабораторное и инструментальное обследование. Клиническое течение ХГВ оценивалось по наличию клинических и лабораторных синдромов в течение всего периода заболевания. Методом полимеразной цепной реакции и при помощи иммуноферментного анализа определены штамм вируса гепатита В (HBV) и вирусная нагрузка. Фиброз печени оценивался по индексу APRI. ХГВ у трети детей характеризовался неактивным течением (иммунотолерантная фаза), у половины больных имела место низкая и минимальная активность воспалительного процесса в печени с минимальной клинической симптоматикой. У 55,9 % детей наблюдался горизонтальный путь передачи вируса. Установлено, что у больных с высокой вирусной нагрузкой и диким штаммом HBV ХГВ достоверно чаще имеет активное течение. С возрастанием продолжительности ХГВ вирусная нагрузка уменьшается. Установлена прямая связь средней силы между диким штаммом вируса и вирусной нагрузкой и сильная корреляция с активностью процесса в печени. У детей с ХГВ активность гепатита является предиктором прогрессирования фиброза печени.

In the article results of own researches concerning peculiarities of the course of asthenic syndrome in school-aged children with chronic hepatitis B, C and mixed forms are provided. It is established that chronic hepatitis C as well as a mixed hepatitis are accompanied by more evident symptoms of deadaptation and somatogenic asthenia than hepatitis B in which psychogenic manifestations prevailed. The degree of endogenous intoxication was also higher at hepatitis C.

BACKGROUND: We aimed to investigate the long-term effects of tenofovir disoproxil fumarate and entecavir treatment on bone mineral density and evaluated the fracture risk assessment tool score in patients with chronic hepatitis B. METHODS: A total of 58 chronic hepatitis B patients treated with tenofovir disoproxil fumarate (n = 40) and entecavir (n = 18) were included in this prospective study from 2012 to 2016. To evaluate bone mineral density, dual-X-ray absorptiometry, fracture risk assessment tool, and laboratory examinations were performed in all patients first at baseline and second at the end of the study. RESULTS: Age, sex, body mass index, fibrosis score, and viral load were similar in both groups. The mean follow-up was 33 months in the tenofovir disoproxil fumarate group and 31 months in the entecavir group. In patients treated with entecavir, there was no statistically significant difference between baseline and second bone mineral density including lumbar spine (L) and total hip T score. In patients treated with tenofovir disoproxil fumarate, there was a significant difference in the second bone mineral density compared with baseline bone mineral density for L3 (P = .033) and the major fracture risk assessment tool score (P = .03). When patients were divided into 3 groups (normal bone mineral density, osteopenic, and osteoporotic), there was a significant increase in the number of osteopenic patients in the total hip T score after tenofovir disoproxil fumarate treatment (P = .034). CONCLUSION: Our results suggest a decrease in the bone mineral density for lumbar spine (L3), an increase in the number of patients with hip osteopenia, and major fracture risk assessment tool score after long-term tenofovir disoproxil fumarate treatment in patients with rechronic hepatitis B.

Recent research has closely linked adipocytokines to liver inflammation and fibrosis progression in patients with non-alcoholic liver disease. This study aimed to determine the relationship of serum adiponectin and resistin levels with the severity of liver fibrosis in patients with chronic hepatitis B (CHB), depending on the duration of antiviral therapy.The cross-sectional study included 75 patients with CHB divided into two groups: the T1 group (undergoing antiviral therapy for up to 2 years) and the T2 group (undergoing antiviral therapy over 2 years). The control group consisted of 40 healthy people. Serum concentrations of adiponectin and resistin were estimated with the ELISA method, while the degree of liver fibrosis was determined using FIB-4 and APRI score.There were no statistically significant differences in the mean serum adiponectin levels in relation to the duration of antiviral therapy. Higher values of serum resistin concentration were confirmed in patients of the T1 group compared to healthy controls (p=0.001) and to the T2 group (p=0.031). The mean level of serum resistin concentration was significantly higher in the group of patients with a higher FIB-4 score (9.12±3.39 vs 5.58±3.36 ng/mL, p=0.001) and higher APRI score (17.45±3.96 ng/mL vs 4.82±1.11 ng/mL, p=0.001). A positive correlation was found between serum resistin levels and the degree of liver fibrosis (p0.001). There was no significant difference between mean serum adiponectin levels according to the values of FIB-4 and APRI scores.Progression of liver fibrosis estimated by FIB4 and APRI scores as well as the length of antiviral treatment had a significant effect on serum resistin values in CHB patients on antiviral therapy.Novija istraživanja su usko povezala adipocitokine sa progresijom upale i fibroze jetre kod bolesnika koji imaju bolesti jetre koje nisu povezane sa konzumiranjem alkohola. Cilj ovog istraživanja bio je da se utvrdi odnos serumskog nivoa adiponektina i rezistina sa težinom fibroze jetre kod pacijenata sa hroničnim hepatitisom B (CHB), u zavisnosti od trajanja antivirusne terapije.Studija preseka je obuhvatila 75 pacijenata sa HHB koji su bili podeljeni u dve grupe: T1 grupa (na antivirusnoj terapiji do 2 godine) i T2 grupa (na antivirusnoj terapiji preko 2 godine). Kontrolnu grupu je činilo 40 zdravih osoba. Serumske koncentracije adiponektina i rezistina su procenjene uz pomoć ELISA metode, dok je stepen fibroze jetre određen pomoću FIB-4 i APRI skora.Nije bilo statistički značajnih razlika u srednjim nivoima adiponektina u serumu u odnosu na trajanje antivirusne terapije. Veće vrednosti koncentracije rezistina u serumu su potvrđene kod pacijenata iz T1 grupe u poređenju sa zdravim pacijentima iz kontrolne grupe (p = 0,001) i pacijentima iz grupe T2 (p=0,031). Prosečan nivo koncentracije rezistina u serumu bio je značajno veći u grupi pacijenata sa većim skorom FIB-4 (9,12 ± 3,39 naspram 5,58 ± 3,36 ng/mL, p = 0,001) i većim skorom APRI (17,45 ± 3,96 ng/mL naspram 4,82 ± 1,11 ng/mL, p=0,001). Utvrđena je pozitivna korelacija između serumskog nivoa rezistina i stepena fibroze jetre (p0,001). Nije bilo značajne razlike između srednjih nivoa adiponektina u serumu prema vrednostima FIB-4 i APRI skoru.Napredovanje fibroze jetre procenjeno rezultatima FIB-4 i APRI, kao i du'ina antivirusnog lečenja su imali značajan uticaj na vrednosti rezistina u serumu kod pacijenata sa hroničnim hepatitisom B na antivirusnoj terapiji.

Summary Despite several recent meta-analyses on the topic, the comparative risk of hepatocellular carcinoma in patients with chronic hepatitis B (CHB) receiving entecavir (ETV) or tenofovir disoproxil fumarate (TDF) remains controversial. The controversy partly results from the arbitrary nature of significance levels leading to contradictory conclusions from very similar datasets. However, the use of observational data, which is prone to both within- and between-study heterogeneity of patient characteristics, also lends additional uncertainty. The asynchronous introduction of ETV and TDF in East Asia, where the majority of these studies have been conducted, further complicates analyses, as does the ensuing difference in follow-up time between ETV and TDF cohorts. Researchers conducting meta-analyses in this area must make many methodological decisions to mitigate bias but are ultimately limited to the methodologies of the included studies. It is therefore important for researchers, as well as the audience of published meta-analyses, to be aware of the quality of observational studies and meta-analyses in terms of patient characteristics, study design and statistical methodologies. In this review, we aim to help clinicians navigate the published meta-analyses on this topic and to provide researchers with recommendations for future work.

Background and objectives: Patients admitted to the intensive care unit (ICU) have an increased risk of hospital-acquired infection (HAI). A diagnosis of cancer alone increases the risk of sepsis three–five-fold, which further increases the risk of nosocomial infection, subsequently deteriorates results, and leads to high mortality. In this study, we aimed to assess the mortality rate among hematologic oncologic patients with suspected infection who were subsequently admitted to the ICU and the predictive factors that are associated with high ICU mortality. Materials and Methods: This retrospective cohort study was conducted in the hematological oncology critical care unit of a tertiary care hospital between November 2017 and February 2021. We analyzed anonymized medical records of hospitalized hematologic oncologic patients who were suspected or proven to have infection in the hematology-oncology department and were subsequently transferred to the ICU. Results: Both shorter hospitalization and shorter ICU stay length were observed in survivors [9.2 (7.7–10.4)] vs. non-survivors [10 (9.1–12.9), p = 0.004]. Sepsis had the highest hazard ratio (7.38) among all other factors, as patients with sepsis had higher mortality rates (98% among ICU non-survivors and 57% among ICU survivors) than those who had febrile neutropenia. Conclusions: The overall ICU mortality in patients with hematologic malignancies was 66%. Sepsis had the highest hazard ratio among all other predictive factors, as patients with sepsis had higher mortality rates than those who had febrile neutropenia. Chronic hepatitis (HBV and HCV) was significantly associated with higher ICU mortality.

Məqalədə xronik B virus hepatiti olan (BVH) xəstələrin immunoloji göstəricilərinin dəyişmələri və bu dəyişikliklərin immunomodulyator qrupuna daxil olan Kroven preparatı ilə korreksiyası haqqında məlumat verilmişdir. B virus hepatiti aşkar edilən 22 xəstənin immunoloji göstəriciləri müalicədən əvvəl və sonra öyrənilmişdir. Qanda T, B-limfositlər və immunoqlobulinlərin (İgA, İgM və İgG) qatılığı müalicədən əvvəl əhəmiyyətli səviyyədə aşağıda olmuşdur ki, bu da patoloji prosesin xronikləşməsinə yol açan ciddi səbəblərdən biri hesab edilir. B virus hepatiti aşkar edilən xəstələrinin kompleks müalicəsində immunomodulyatorun tətbiqi (kroven 5%-50,0)zamanı immunoloji göstəricilərin bərpası ilə yanaşı, ikincili bakterial mikroflora ilə ağırlaşmaların qarşısının alındığı müşahidə edilmişdir. Yalnız 4 xəstədə (18,1%) virus yükü yuxarı səviyyədə (˃1,2 x 108 cop/ml) olduğu üçün antiviral preparatlar qrupuna daxil olan Vikure – 1 mq (Entecavir) preparatı təyin edilib. Digər xəstələrə antiviral preparat təyin edilməsə də, immunoloji göstəricilər müalicədən sonra normadan yüksək olmuşdur. İmmunoloji göstəricilərin (T, B-limfositlər, İgA, İgM və İgG), norma daxilində olması xəstələrin kliniklaborator göstəricilərinin bərpasına kömək edir., В статье приведены сведения об иммунологических показателях больных хроническим вирусным гепатитом В (ХВГ) и их коррекции препаратом Kroven, относящимся к группе иммуномодуляторов. Изучены иммунологические показатели 22 больных, у которых был обнаружен вирусный гепатит В, до и после лечения. Концентрация Т-, В-лимфоцитов и иммуноглобулинов (IgA, IgM и IgG) в крови до лечения была значительно ниже, что считается одной из серьезных причин, приводящих к хронизации патологического процесса. У 4 пациента (18,1%) принимавщих препагам Kroven была обнаружена высокая вирусная нагрузка (˃1,2 х 108 cop/ml) и, поэтому им был назначен Vikure (Entecavir)  1 мг, который входит в группу противовирусных препаратов. Хотя остальным больным противовирусный препарат не назначался, у них иммунологические показатели после лечения были выше нормы. Наличие иммунологических показателей (Т, В-лимфоциты, IgA, IgM и IgG) в пределах нормы способствует восстановлению клинико-лабораторных показателей больных., The article provides information on the immunological indicators of patients with chronic viral hepatitis B and their correction using Kroven medication, which belongs to the group of immunomodulators. Immunological indicators of 22 patients diagnosed with viral hepatitis B were studied before and after treatment. The concentration of T and B-lymphocytes, as well as immunoglobulins (IgA, IgM, and IgG) in the blood, was significantly lower before treatment, which is considered one of the major causes leading to the chronicity of the pathological process. It was observed that the use of the immunomodulator Kroven 5%-50.0 in the complex treatment of patients diagnosed with viral hepatitis B, in addition to restoring immunological indicators, prevents complications with secondary bacterial microflora. Only 4 patients (18.1%) had a high viral load (greater than 1.2 x 108 copies/ml) and were prescribed Vikure (Entecavir) – 1 mg, which is included in the group of antiviral medications. Although the other patients were not prescribed antiviral medication, their immunological parameters after treatment were higher than normal. The presence of immunological indicators (T, B-lymphocytes, IgA, IgM, and IgG) within the norm helps to restore the clinical and laboratory indicators of patients., Azerbaijan Medical Journal, Выпуск 2 2023, Pages 50-54

This project is a scoping review that explores the literature on integrated care models for non-communicable diseases (NCDs) and infectious diseases (IDs) in low-resource settings of Sub-Saharan Africa. It aims to provide an overview of the types, components, effects, and challenges of such models and identify gaps and opportunities for future research and practice. Therefore, the finding from this review will be used as input to guide the future review and research on the development and implementation of the integrated care models for NCDs and IDs in Ethiopia.

In chronic hepatitis, a broad differential diagnosis should be considered to accurately identify the cause(s) of liver injury. Autoimmune liver diseases (autoimmune hepatitis, primary sclerosing cholangitis, overlap syndrome) can occur in the setting of limited symptoms; therefore, a high index of suspicion and appropriate diagnostic workup should be performed. Most children with autoimmune hepatitis achieve sustained remission with medical therapy; however, there are no equivalent therapies for primary sclerosing cholangitis that impact the progression of disease. Research should include biomarker studies to predict histologic remission in autoimmune hepatitis and mechanistic studies to define future treatment targets for primary sclerosing cholangitis.

Hepatitis C in children is on the rise due to perinatal transmission from infected mothers, and high-risk practices in adolescents and young adults. Prevalence remains underestimated because children at high risk are often not screened. Treatment has evolved over the past decade with the advent of new drugs, and global elimination is now possible. Direct-acting antiviral combinations are safe and effective, with sustained viral suppression rate >90%, and Food and Drug Administration-approved for children ≥3 years old. Although challenging, efficient screening and treatment of chronic hepatitis C virus early is cost-effective and reduces burden of disease and its complications.

Gamma-glutamyl transferase (GGT) has been predictive of chronic hepatitis C-related hepatocellular carcinoma (HCC) development. Its role in the risk of HCC in chronic hepatitis B (CHB) patients treated with nucleotide/nucleoside analogues (NAs) is elusive.A total of 2172 CHB patients from East Asia were randomized into development and validation groups in a 1:2 ratio. Serum GGT levels before and 6 months (M6) after initiating NAs and the potential risk factors were measured. The primary endpoint was HCC development 12 months after NA initiation.The annual incidence of HCC was 1.4/100 person-years in a follow-up period of 11 370.7 person-years. The strongest factor associated with HCC development was high M6-GGT levels (25 U/L; hazard ratio [HR]/95% confidence interval [CI]: 3.31/2.02-5.42, P .001), followed by cirrhosis (HR/CI: 2.06/1.39-3.06, P .001), male sex (HR/CI: 2.01/1.29-3.13, P = .002) and age (HR/CI: 1.05/1.03-1.17, P .001). Among cirrhotic patients, the incidence of HCC did not differ between those with high or low M6-GGT levels (P = .09). In contrast, among non-cirrhotic patients, the incidence of HCC was significantly higher for those with M6-GGT level25 U/L than for their counterparts (P .001). Cox regression analysis revealed that the strongest factor associated with HCC development in non-cirrhotic patients was high M6-GGT levels (HR/CI: 5.05/2.52-10.16, P .001), followed by age (HR/CI: 1.07/1.04-1.09, P .001). Non-cirrhotic elderly patients with high M6-GGT levels had a similarly high HCC risk as cirrhotic patients did (P = .29).On-treatment serum GGT levels strongly predicted HCC development in CHB patients, particularly non-cirrhotic patients, treated with NAs.

Detection of hepatocellular carcinoma (HCC) at an early stage enables patients to receive curative treatment with survival gains. Current international liver society guidelines recommend the enrollment of patients at high risk for HCC in surveillance programs. In Korea, surveillance for HCC advocated for patients with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis. The established surveillance tool for HCC is liver ultrasonography plus serum alpha-fetoprotein measurement every 6 months. However, there would be obstacles to the improvement of efficacy and cost-effectiveness of the HCC surveillance test. Assessing who is at risk of developing HCC remains incompletely validated. Also, which surveillance tools to use according to patients' characteristics are controversial. The present paper reviews the latest knowledge regarding the strategies and cost-effectiveness of HCC surveillance.

The transmission of viral hepatitis type B (HBV) is of significant public health concern. The infection result depends on how well the virus interacts with the host and in particular, on the ability to respond inherently and adaptively to the humoral and cellular immunity. The purpose of this study is to evaluate clinical, immunology and tracer status (viral). This study showed the relationship between the immune and chronic conditions of Iraqi patients who are chronic hepatitis virus B or HBV carriers. The study included (111) chronically-viral hepatitis type (b) and (112) hepatitis virus surface antigen type (b) healthy carriers from out of patients. The result of this study proved that a non-significant correlation was observed between cellular immune response (CD4 and CD8) among chronic hepatitis B patients. For CD8+ lymphocytes: there was a highly significant decrease (P

Liver biopsies are recommended to exclude significant liver inflammation in patients with chronic hepatitis B (CHB) with elevated HBV DNA but without other indications for antiviral treatment. We aimed to investigate the proportions and determinants of significant inflammation in Asian patients with CHB with detectable HBV DNA. We conducted a cross-sectional study that retrospectively included 581 patients with CHB with detectable HBV DNA who had undergone liver biopsy. Liver inflammation and fibrosis were staged by Scheuer's classification. Significant inflammation and significant fibrosis were defined as G ≥ 2 and S ≥ 2, respectively. There were 179 (30.8%) patients with alanine aminotransferase (ALT) 2 × ULN. A total of 397 (68.3%) patients had significant inflammation, and 340 (58.5%) patients had significant fibrosis. Significant inflammation was found in 85% of patients with significant fibrosis and in 44.8% of patients without significant fibrosis. Furthermore, 28.7% of patients with CHB with detectable HBV DNA and normal ALT in the absence of significant fibrosis had significant inflammation. Moderate HBV DNA (5-7 log10 IU/mL) was a risk factor for significant inflammation (odds ratio [OR] 6.929, 95% confidence interval [CI] 2.830-16.966, P < 0.001) in patients with CHB with detectable HBV DNA, especially for patients with detectable HBV DNA and normal ALT in the absence of significant fibrosis (adjusted OR 13.161, 95% CI 1.026-168.889, P = 0.048). Conclusion: A high proportion of CHB patients with detectable HBV DNA and normal ALT in the absence of significant fibrosis have significant liver inflammation. Liver biopsies are recommended to evaluate liver inflammation in such patients, especially for those with moderate HBV DNA.

Background: Small percentage of hepatitis C (HCV) patients develop hepatocellular carcinoma (HCC) during their lifetime, suggesting that genetic factors might modulate HCC development. Numerous variations on the vitamin D receptor gene (VDR) have been recognized in human cancers. The majority of them cause VDR to be unable to bind to 1, 25-OH-D. The aim of the present work was to investigate the relation of VDR FokI (rs2228570), BsmI (rs3782905) and ApaI (rs7975232) gene polymorphisms and the risk of HCC development in chronic HCV Egyptian patients. Methods: A total of 311 Egyptian patients were enrolled for this study. They were divided into 3 groups: 103 patients with liver Cirrhosis, 107 patients with HCC and 101 normal healthy subjects as the control group. Human genomic DNA Extraction was carried out using QIAamp® DNA Blood Mini Kit (QIAGEN) Genotyping of VDR ApaI (rs7975232) single nucleotide polymorphism (SNP) was carried out using real-time PCR TaqMan allelic discrimination assay with allele-specific designed fluorescent MGB probes. Results: Patients with HCC had a higher frequency of ApaI CC genotype (P=0.035) CI (0.031-0.038). Patients with HCC carried a higher ratio of ApaI CC genotype compared to those with liver cirrhosis (x2=5.4 and P = 0.03) or controls (x2=6.8 and P = 0.01). Univariate analysis revealed that age, lower platelet count (3/μL), higher AFP (>100 ng/ml), and ApaI CC genotype were the factors significantly associated with the development of HCC. Stepwise logistic regression analysis showed that all were independent predictors. Conclusion: ApaI CC VDR gene mutation is an independent risk factor for HCC development in Egyptian Cirrhotic HCV patients.

BACKGROUND AND AIM Besifovir dipivoxil maleate (BSV) was reported to have comparable antiviral efficacy and superior renal and bone safety to tenofovir disoproxil fumarate (TDF) in chronic hepatitis B (CHB) patients. The present study aims to evaluate changes of liver histology and intrahepatic covalently closed circular DNA (cccDNA) levels by BSV treatment in comparison with TDF therapy. METHODS This is a subset study of the phase 3 trial comparing BSV with TDF. Among them, only CHB patients willing to participate in a histologic evaluation study were enrolled. Liver histologic examination and intrahepatic cccDNA quantification were performed. RESULTS A total of 46 CHB patients received liver biopsies (BSV, n = 29; TDF, n = 17). After 48 weeks of treatment, virological response rate was comparable between the groups (P = 0.707). Follow-up liver biopsies showed that necroinflammation was significantly improved in the both groups. However, the histological response rate defined as the proportion of subjects whose modified histologic activity index score decreased by ≥ 2 without deterioration in fibrosis was higher in the BSV group than in the TDF group (77.8% vs 36.4%, P = 0.048). The proportion of subjects with Ishak fibrosis score 3 or more decreased from 77.7% to 55.5% in the BSV and that decreased from 72.7% to 45.4% in the TDF group. The intrahepatic cccDNA significantly decreased from baseline after 48 weeks of BSV or TDF treatment (P

New hepatitis B virus (HBV) infections are decreasing owing to improved antiviral therapy and increased HBV vaccination worldwide; however, the number of HBV infections remains a major cause of liver carcinogenesis. HBV triggers cytotoxic immunity to eliminate HBV-infected cells. Therefore, the HBV pathophysiology changes in persistently infected individuals depending on host immune responses and HBV DNA proliferation state. To prevent liver cirrhosis and carcinogenesis caused by HBV, it is important to treat HBV infection at an early stage. Active treatment is recommended for the immunoactive hepatitis B surface-antigen-positive and -negative phase, but not during the immune-inactive phase or immune-tolerant phase; instead, follow-up is recommended. However, these patients should be monitored through regular blood tests to accurately diagnose the immune-inactive or -tolerant phases. The treatment regimen should be determined based on the age, sex, family history of liver cancer, and liver fibrosis status of patients. Early treatment is often recommended due to various problems during the immune-tolerant phase. This review compares the four major international practice guidelines, including those from the Japanese Society of Hepatology, and discusses strategies for chronic hepatitis B treatment during the immune-tolerant, immune-inactive, and resolved phases. Finally, recommended hepatitis B antiviral therapy and follow-up protocols are discussed.

Despite effective vaccines and approved therapeutic agents, hepatitis B virus (HBV) remains a prevalent global health problem. Current guidelines rely on a combination of serologic, virological, and biochemical markers to identify the phase in the natural history of chronic HBV infection. Discordant serologic results can occur, which may lead to misclassification. Commonly encountered results that differ from the typical profiles seen in chronic HBV infection are described. For each scenario, the frequency of occurrence, possible explanations, and recommendations for clinical management are discussed. Recognition of discordant serologic findings is crucial for optimal clinical decision.

Background Few models to predict antiviral response of peginterferon were used in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients and the prediction efficacy was unsatisfied. Quantitative antibody to hepatitis B core antigen (anti-HBc) is a new predictor of treatment response. We aimed to develop a new model to identify HBeAg-positive Chinese patients who were more likely to respond to peginterferon. Methods Data from 140 peginterferon recipients with HBeAg-positive were applied with generalized additive models and multiple logistic regression analysis to develop a baseline scoring system to predict serological response (SR: HBeAg loss and HBeAg seroconversion 24 weeks post-treatment) and combined response (CR: SR plus serum HBV DNA levels Results Anti-HBc levels, alanine aminotransferase ratio, and HBeAg were retained in the final model. The new model scored from 0 to 3. Among patients with scores of 0, 1, or ≥2, SR was achieved in 6.45% (2/31), 13.21% (7/51), and 55.36% (31/56), respectively, and CR in 3.23% (1/31), 9.43% (5/53), and 25.00% (14/56), respectively. Our model has a higher AUROC for SR comparing to Chan’s (Z = 2.77 > 1.96, p < 0.05) and Lampertico’s (Z = 2.06 > 1.96, p < 0.05) model. The negative predictive value for SR and CR were both 100% in patients with score 0 and hepatitis B surface antigen ≥20,000 IU/mL at week 12. Conclusions Patients with higher scores at baseline were more likely to respond to peginterferon. This new model may predict the treatment response.

Hepatitis B is the leading cause of hepatocellular cancer (HCC) worldwide. Untreated, annual HCC incidence rates in chronic hepatitis B subjects are 0.4% in noncirrhotics and 2% to 3% in cirrhotics. Surveillance with ultrasound with/without α-fetoprotein at 6-month intervals is recommended in at-risk persons including children. Antiviral therapy in chronic hepatitis B with entecavir or tenofovir significantly lowers the risk of HCC across all stages of liver disease, and lowers the risk of HCC recurrence following curative therapy. There are insufficient data to recommend use of tenofovir over entecavir in the prevention of de novo or recurrent HCC postcurative therapy.

Summary Background Hepatitis B e antigen (HBeAg) seroconversion is an important intermediate outcome in HBeAg-positive chronic hepatitis B patients. This study aimed to explore whether hepatitis B virus (HBV) RNA serum levels can predict HBeAg seroconversion treated with entecavir. Methods Serum samples from HBeAg-positive children previously treated with entecavir were retrospectively analyzed. HBV RNA levels were measured at baseline, weeks 12, 24, 48, 72 of therapy. Ability of individual biomarkers to predict HBeAg seroconversion was evaluated using receiver operating characteristics (ROC) analyzes. Results Serum HBV RNA was detectable in 51 children with a median of 6.05 (4.04–8.29) log10 IU/mL at baseline. Patients with subsequent HBeAg seroconversion showed a significantly larger decline in median HBV RNA levels during treatment from baseline to week 12 of 1.96 (0.30–3.38) and to week 24 of 2.27 (1.20–3.38) log10 IU/mL, respectively, in comparison to HBeAg-positive patients without HBeAg seroconversion (P 0.85, P Conclusion On-treatment HBV RNA dynamic predicts entecavir-induced HBeAg seroconversion in children with chronic hepatitis B living in China.

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BACKGROUND Quantitative hepatitis B core-related antigen (qHBcrAg) has a better correlation with intrahepatic hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) than HBV DNA or hepatitis B e antigen (HBeAg), but data are still lacking for its clinical application. AIM The aim was to investigate serum qHBcrAg levels in patients with chronic hepatitis B and assess the correlation of serum qHBcrAg with pregenomic RNA (pgRNA), cccDNA, and HBeAg seroconversion. METHODS This study was a secondary analysis of patients who underwent percutaneous liver biopsy between July 2014 and June 2019 in two multicenter randomized controlled clinical trials of peginterferon vs nucleos(t)ide analog (NUC)-based therapy (NCT03509688 and NCT03546530). Serum qHBcrAg, pgRNA, HBV DNA, hepatitis B core antigen, HBeAg, liver cccDNA, and HBV DNA were measured. The correlations of serum qHBcrAg with other biomarkers were analyzed. RESULTS A total of 139 patients were included. The mean qHBcrAg levels were 5.32 ± 1.18 log10 U/mL at baseline and decreased during treatment (all P < 0.0001). Serum qHBcrAg levels were positively correlated with pgRNA (r = 0.597, P < 0.0001) and cccDNA (r = 0.527, P < 0.0001) levels. The correlation of serum qHBcrAg level and intrahepatic HBV DNA levels at baseline was weak but significant (r = 0.399, P < 0.0001). HBcrAg predicted HBeAg seroconversion, with areas under the receiver operating characteristics curve of 0.788 at 24 wk and 0.825 at 48 wk. Log HBcrAg at wk 24 and 48 was independently associated with HBeAg seroconversion [odds ratio (OR) = 2.402, 95% confidence interval (CI): 1.314-4.391, P = 0.004; OR = 3.587, 95%CI: 1.315-9.784, P = 0.013]. CONCLUSION Serum HBcrAg levels were correlated with HBV virological markers and could be used to predict HBeAg seroconversion.

A reverse phase-high-performance liquid chromatography-diode array detector method is developed for the determination of the antiviral drug sofosbuvir in bulk and Sofos® 400 mg tablet dosage forms. Sofosbuvir is used for the treatment of chronic hepatitis C. The separation is carried out using a gradient mobile phase consisting of 0.05% H3PO4 and acetonitrile. A symmetry C18 column (4.6 × 100 mm, 2.5 µm, Waters XSELECT HSS T3) is used with a flow rate of 1.5 mL min−1 using ultraviolet detection at 260 nm with a diode array detector and an injection loop volume of 10 µL. A sharp peak is obtained at a retention time of 14 min. The method is validated appropriately according to the requirements of the United States Pharmacopeia and the International Conference on Harmonization guideline Q2 R1. System suitability, linearity, range (1.5–4.5 µg mL−1), precision, accuracy, specificity, robustness, detection and quantification limit of the method are assured. A forced degradation study of sofosbuvir is conducted under the conditions of hydrolysis, oxidation, thermal and photolysis.

BACKGROUND There is little evidence about the association of pre-existing hepatitis C infection (HCV) with outcomes in patients with coronavirus disease 2019 (COVID-19). AIM To assess the prevalence of history of HCV among patients with COVID-19 and to study the relationship of in-hospital mortality in relation with other predictors of poor outcomes in the presence or absence of COVID-19 induced acute liver injury. METHODS In a retrospective single-center study design, 1193 patients with COVID-19 infection were studied. Patients were then classified into those with and without a history of HCV, 50 (4.1%) and 1157 (95.9%) respectively. RESULTS Multivariate cox-regression models showed that age, HCV, D-Dimer, and ferritin were the only predictors of in-hospital mortality. Acute liver injury and fibrosis score (Fib-4 score) were not different between both groups. Multivariate cox-regression model for liver profile revealed that aspartate aminotransferase/ alanine aminotransferase ratio, Fib-4 score, and HCV were predictors of in-hospital mortality. After propensity score matching HCV was the only predictor of mortality in the multivariate cox-regression model. A model including HCV was found to add predictive value to clinical and laboratory parameters. CONCLUSION In patients with COVID-19, history of HCV infection leads to an accentuated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virulence, irrespective of baseline comorbidities, admission laboratory variables, or COVID-19-induced liver injury, which may be related to extrahepatic effects of HCV leading to enhanced ACE-2/TMPRSS mechanisms of SARS-CoV-2 viral entry, baseline cytokine-mediated pro-inflammation, and endothelial dysfunction.

Hepatitis B virus (HBV) is a highly prevalent infection worldwide. It primarily infects liver and presents with features of chronic liver disease. Rarely, it presents with extra-hepatic manifestations. Kidney involvement in HBV infection is not uncommon. However, presentation with rapidly progressive glomerulonephritis is distinctly rare. A 40-year-old man with undiscovered HBV infection presented with fever-triggered body swelling for one month. Serum creatinine was 2.3 mg/dl on admission, which increased during hospitalization to 4.5 mg/dl. Renal biopsy demonstrated crescentic membranoproliferative glomerulonephritis, immune complex-mediated. Clinical, laboratory and imaging studies revealed mild chronic liver damage. Complete renal, hepatic and virological remission was achieved with steroids, plasmapheresis and antiviral therapy. This case emphasizes on early diagnosis and institution of multimodal therapy for better outcomes.

The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS), introduced in 2017 by the American College of Radiology, standardizes the technique, interpretation, and reporting of screening and surveillance ultrasounds intended to detect hepatocellular carcinoma in high-risk patients. These include patients with cirrhosis of any cause as well as subsets of patients with chronic hepatitis B viral infection. The US LI-RADS scheme is composed of an ultrasound category and a visualization score: ultrasound categories define the exam as negative, subthreshold, or positive and direct next steps in management; visualization scores denote the expected sensitivity of the exam, based on adequacy of liver visualization with ultrasound. Since its introduction, multiple institutions across the United States have implemented US LI-RADS. This review includes a background of hepatocellular carcinoma and US LI-RADS, definition of screening/surveillance population, recommendations and tips for technique, interpretation, and reporting, and preliminary outcomes analysis.

INTRODUCTION Chronic Hepatitis D virus (HDV) infection is a global disease leading to rapidly progressive liver disease with increased liver-related mortality and hepatocellular carcinoma. Therapies are minimally effective; however, an increased understanding of the HDV lifecycle has provided new potential drug targets. Thus, there is a growing number of investigational therapeutics under exploration for HDV with the potential for successful viral eradication. AREAS COVERED This review discusses the clinical impact of HDV infection and offers an in-depth look at the HDV life cycle. The authors examine current and new drug targets and the investigational therapies in clinical trials. The search strategy was based on PubMed database and clinicaltrials.gov which highlight the most up-to-date aspects of investigational therapies for chronic HDV infection.

Aim: Chronic hepatitis B infection is the main cause of liver complications such as hepatic failure, liver cirrhosis and hepatocellular carcinoma (HCC). In this study, we attempted to evaluate molecular characterization and phylogenetic analyses of full-length viral genomes from chronic hepatitis B virus (HBV)-infected patients. Methods: The full-length genomic sequence of the five HBV isolates from Ahvaz (city of Iran) patients was amplified, cloned in pTZ57R/T vector, sequenced and examined. Results: Phylogenetic analyses showed that all isolates belonged to genotype D (D1/D3). Serotyper tool identified ayw2 serotype in all HBV isolates. YMDE mutation was detected in an HBV isolate in the reverse transcriptase domain. Conclusion: In the present study, the analyses of full-length sequence of genome revealed that the HBV genotype D, sub-genotype D1/D3, and subtype ayw2 were predominant among Ahvaz HBV strains. As HBV genome replicates and is mediated via reverse transcription process, periodic investigations of full HBV genome are needed.

The CC5 and CXC3 chemokines (CK) pathways are involved in the pathogenesis and outcome of several disease states, including chronic hepatitis C (CHC). The kinetics of Regulated upon Activation Normal T cell Expressed and Secreted (RANTES) (CCL5) and IP-10 (CXCL10) during direct-acting antivirals (DAA) treatment was retrospectively analyzed in 18 liver transplant recipients (LT-R) compared with 20 patients with CHC and 49 healthy controls (HC). CK levels were determined at baseline, week 4, end of treatment, 24 weeks post-treatment (sustained virological response [SVR]), and later-on during follow-up (FU), 12 and 24 months post-DAA. At baseline, median RANTES levels were higher in HC than in both LT-R (

Resumen: La infección por el virus de la hepatitis B (VHB) continúa siendo un problema de salud pública mundial, en México se estima que podría haber por lo menos tres millones de personas adultas que han adquirido la hepatitis B (anticuerpo anti-antígeno central del VHB [anti-HBc] positivo), de ellos cerca de 300,000 portadores activos (antígeno de superficie del VHB [HBsAg] positivo) podrían requerir tratamiento. Al ser prevenible por vacunación, debe enfatizarse la vacunación universal. Esta infección es un factor de riesgo mayor para el desarrollo de carcinoma hepatocelular, el estudio semestral con ultrasonido hepático y alfafetoproteína sérica favorece la detección temprana de esta neoplasia y debe realizarse en todo paciente con infección crónica por VHB, independientemente de la presencia de fibrosis avanzada o cirrosis. En la actualidad, la terapia de primera línea, son análogos nucleós(t)idos con alta barrera a la resistencia. Abstract: Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.

Hintergrund Die chronische Hepatitis-B-Infektion stellt einen wesentlichen Risikofaktor für die Entwicklung eines hepatozellulären Karzinoms (HCC) dar. Wenngleich sich die Therapiemöglichkeiten des HCC stetig verbessern, kommt präventiven Maßnahmen eine entscheidende Bedeutung zu. Schlussfolgerung Mit der Hepatitis-B-Impfung steht ein wirksames Mittel zur Verhinderung einer Infektion mit dem Hepatitis-B-Virus (HBV) zur Verfügung. Eine konsequente Impfung führt nicht nur zu einem Rückgang HBsAg-positiver Patienten, sondern bewirkt auch einen Rückgang der HCC-Inzidenz, wie bereits in den 1990er-Jahren in Taiwan gezeigt wurde. Ein suffizienter Schutz vor einer HBV-Infektion verhindert zudem die Infektion mit dem Hepatitis-D-Virus, das mit einem besonders hohen HCC-Risiko behaftet ist. Neuere Ansätze befassen sich auch mit dem therapeutischen Einsatz von Impfstoffen zur Behandlung bereits Infizierter. Wesentlich ist auch das Erkennen bestehender Virushepatitis-Erkrankungen, um Therapien zu beginnen und das HCC-Risiko zu minimieren.

Objective: This study has been conducted to highlight the prevalence of chronic hepatitis in patients presenting with vague symptoms such as generalized body aches and weakness. Methods: A cross-sectional study was conducted in Tehsil Headquarter Hospital Sharaqpur, Sheikhupura, Pakistan. During a period of two and a half months, 751 patients presenting to general outdoor department with vague symptoms were selected through random sampling. They were tested for Anti Hepatitis C Virus Antibodies, Hepatitis B Surface Antigen, and Anti Human Immunodeficiency Virus Antibodies with Rapid Immunochromatographic Test Kits. Statistical analysis was performed using IBM SPSS Statistics version 23. Results: Of the 751 randomly selected patients, 28 were eliminated due to missing data. Out of 723 included participants, 36% were male and 64% were female with a mean age of 53.11±11.2 years. 26.42% people were screened positive for Hepatitis C (N=191). 1.7% people were screened positive for Hepatitis B (N=13). Whereas only 0.12% (N=1) were HIV positive. Conclusion: This study established that Chronic Hepatitis often presents with mild and vague symptoms. Also, the prevalence of HCV is significantly higher in our population in spite of the ongoing hepatitis control programs and is rising in contrast to the global decline.

Purpose — to develop a method for predicting intrauterine fetal infection in pregnant women with CHB, infected and uninfected HIV, which provides the high accuracy of prognosis, is simple and accessible in practice and is achieved by analyzing multiple risk factors for mother-to-fetus transmission. Materials and methods. The course and consequences of pregnancy were analyzed in 211 women with chronic hepatitis B (CHB), not infected with HIV and in 18 — with CHB infected with HIV. The replicative activity of the virus and the activity of the inflammatory process in the liver were evaluated. We studied the dynamics of indicators depending on the trimester of pregnancy, the degree of immunosuppression caused by HIV. The frequency of risk factors was determined by «case-control» studies, and the frequency of identified risk factors was calculated in the groups of mothers in whom CHB was transmitted to the child and in those in which it did not occur. The degree of influence of individual risk factors was determined by the value of relative risk (RR), determined by their 95% confidence interval (95% CI), the reliability of the results (p) according to the Student's t-test. Differences at p105 copies/ml in the third trimester, HIV infection, immunosuppression caused by HIV (CD4+ Т-lymphocytes

BACKGROUND Tenofovir amibufenamide (TMF) can provide more efficient delivery than tenofovir disoproxil fumarate (TDF). AIM To compare the efficacy and safety of TMF and TDF for 48 weeks in patients with chronic hepatitis B (CHB). METHODS We performed a randomised, double-blind, non-inferiority study at 49 sites in China. Patients with CHB were assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo. The primary efficacy endpoint was the proportion of patients with hepatitis B virus (HBV) DNA less than 20 IU/mL at week 48. We also assessed safety, particularly bone, renal and metabolic abnormalities. RESULTS We randomised 1002 eligible patients. The baseline characteristics were well balanced between groups. After a median 48 weeks of treatment, the non-inferiority criterion was met in all analysis sets. In the HBeAg-positive population, 50.2% of patients receiving TMF and 53.7% receiving TDF achieved HBV DNA less than 20 IU/mL. In the HBeAg-negative population, 88.9% and 87.8%, respectively, achieved HBV DNA less than 20 IU/mL in the TMF and TDF groups. Patients receiving TMF had significantly less decrease in bone mineral density at both hip (P

Objectives: To describe the frequency of depression in patients with hepatitis C (HCV) and relate to the biological variables and liver function. Methods: Cross-sectional, descriptive study with a quantitative approach, which assessed depression using the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the association with biological and liver function variables in 85 patients HCV chronically infected indicated for direct-acting antiviral therapy (DAA) between May 2018 and May 2019. Results: Depression was detected in 47.1% of patients, predominantly mild depression (95%). However, depression occurred independently of biological characteristics, such as gender, age, education, associated comorbidities and liver function, such as degree of fibrosis and viral genotype. Conclusions: The frequency of depression was high in patients with HCV and had no statistical relationship with biological characteristics and liver function, suggesting that active search for depression could be a valuable strategy in managing these patients.

Long-term antiviral treatment of chronic hepatitis B patients has been proven to be beneficial in reducing liver-related complications. However, lengthy periods of daily administration of medication have some inevitable drawbacks, including decreased medication adherence, increased cost of treatment, and possible long-term side effects. Currently, discontinuation of antiviral agent has become the strategy of interest to many hepatologists, as it might alleviate the aforementioned drawbacks and increase the probability of achieving functional cure. This review focuses on the current evidence of the outcomes following stopping antiviral treatment and the factors associated with subsequent hepatitis B virus relapse, hepatitis B surface antigen clearance, and unmet needs.

Introduction: Hepatitis B continues to be a major health problem around the world. 257 million people are estimated to be chronically infected with hepatitis B worldwide. Chronic hepatitis B (CHB) patients are likely to develop various comorbidities, including diabetes, insulin resistance, hyperlipidemia, nonalcoholic fatty liver disease, and obesity. Proper nutrition is essential for the management of both hepatitis B and its associated comorbidities. Material and Method: The study was completed a total of 105 patients. The universe of the study comprised of CHB patients who were admitted to the nutrition and dietetics outpatient clinic of a public hospital in Turkey between 1 October 2019 and 31 December 2019. Biochemical and ultrasound results, anthropometric measures, demographic characteristics, dietary habits, and 1-day food records were retrospectively recorded from patient files. Results: Female patients were more likely to consume 2 main meals per day (57.8%) whereas most male subjects (75.6%) consumed 3 meals. Both female and male patients had above-normal Body Mass Index (BMI) (31.2 kg/m2 and 29.2 kg/m2, respectively), and they also had high dietary fat (%) and cholesterol consumption than recommendation. In addition, males had borderline The fasting blood glucose (FBG), total cholesterol, and triglyceride levels, and both sexes were at risk for abdominal obesity. Dietary carbohydrate, fiber, B1, B6, calcium, magnesium, and phosphorus intake were higher in males than in females. Conclusion: This study was found on above-normal BMI values, and high dietary fat (%), and cholesterol consumption in both males and females. Moreover, males had borderline FBG, total cholesterol, and triglyceride levels, and both sexes were at risk for abdominal obesity. In the setting of CHB, it is crucial to maintain an adequate and balanced diet to control body weight, prevent nutritional disorders, protect the liver, and improve overall well-being. More comprehensive studies are needed to better understand the link between nutrition and hepatitis B.