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Viral hepatitis are acute or chronic infections caused by viruses with liver tropism. Viral hepatitis' profilaxy and treatment can prevent cirrhosis, end‑stage liver disease or hepatocellular carcinoma. Hepatitis A and hepatitis B vaccines are currently available. Pre- and especially post-exposure hepatitis B prophylaxis is given by administration of anti-hepatitis B immunoglobulin. The treatment of chronic hepatitis B is done with interferons or nucleoside/nucleotide analogues. Antivirals are sometimes given for long periods because the hepatitis B virus cannot be eradicated with currently existing medication. In contrast, recent therapeutic advances allow a sustained virological response in over 90% of treated patients. Currently, the treatment of chronic hepatitis C is done with direct-acting antivirals, possibly associated with ribavirin, in most cases the administration of interferon being no longer necessary. [ABSTRACT FROM AUTHOR]

The management of hepatitis B virus (HBV) during pregnancy remains a challenge and involves various aspects of maternal-fetal care. Our objective is to provide a comprehensive review of the current knowledge regarding pregnancy and HBV infection, as well as recent efforts to reduce the rate of motherto- child transmission (MTCT). We also present the 2016 clinical experience with HBV positive patients. We analysed data from 43 HBV positive pregnancies, resulting in 44 live childbirths, in “Panait Sîrbu” Hospital during 2016. A literature review was also conducted examining recent studies devoted to the clinical, therapeutic, and prognostic aspects of HBV infection during pregnancy in order to extrapolate and interpret data that can help physicians in the management of HBV infection in this setting. In our study group, the mean maternal age was 30 (± 7) and the majority were primiparous. Caesarean section was the birth method in 39 (93%) of the cases, with 36 (83.7%) being born at term. In 7 cases (16.2%) spontaneous membrane rupture occurred. All the newborns received active immunoprophylaxis (HBV vaccine) and 38 (88.3%) also received passive immunoprophylaxis consisting in the administration of hepatitis B immune globulin (HBIG). Testing for HBV is recommended in every pregnancy, regardless of previous testing or vaccination. The identification of HBV-positive pregnant women remains the most effective way to prevent HBV transmission to new-borns, combined with passive and active prophylaxis at birth. Breastfeeding is not contraindicated for HBV patients, but it is not recommended for women taking antiviral drugs. Finally, there is no clear evidence that elective caesarean section reduces the risk of mother-tochild transmission compared to vaginal delivery. [ABSTRACT FROM AUTHOR]

Reactivation of hepatitis B virus (HBV) is one of the frequent complications in patients with chronic infection, following cytotoxic or immunosuppressive therapy. We present the case of a 46-year-old male, with a medical history of gastric extranodal marginal zone lymphoma of mucosal-associated lymphoid tissue (MALT lymphoma) and chronic hepatitis B, admitted in the Center of Gastroenterology and Hepatology at the Clinical Institute of Digestive Diseases and Liver Transplantation, in April 2014, accusing asthenia and epigastric pain. It should be noted that the chronic HBV infection had a low replication rate. After performing specific investigations the diagnosis of diffuse large B-cell nonHodgkin lymphoma, stage IV was set. The recommendations were to start the oncologic treatment, accompanied by antiviral prophylaxis to prevent hepatic flares. After six months, the patient presented a complete response to the oncologic treatment, but the decision of continuing with the prophylactic antiviral nucleoside analogue was made. [ABSTRACT FROM AUTHOR]

In the past two decades there have been major developments in the treatment of chronic hepatitis B. The introduction of new antiviral therapies, current knowledge about the natural history of the infection, the contribution of molecular biology to define multiple mutations in the HBV genome have imposed changes in therapeutic strategy lines. Hepatitis B virus (HBV) is a small DNA virus characterized by a high viremia and infectivity The virus is capable of integrating into the cell genome and hepatocellular damage is determined by the host's immune response not by the virus cytopathic effect. It is estimated that over 2 billion people have been exposed to HBV, chronic HBV infection affects more than 350 million people worldwide. Patients with chronic infection have a high risk of progression to cirrhosis and hepatocellular carcinoma (HCC). The goal of antiviral treatment is to prevent disease progression to cirrhosis and/or HCC. In deciding regarding interferon therapy or with nucleoside/nucleotide analogs (NAs), we should examine the relative merits and limitations of each strategy. The main advantage of the interferon therapy is the finite course of treatment and high durability. NAs are administered orally and have fewer side effects. [ABSTRACT FROM AUTHOR]

Background. There are over 50 years since the discovery of Australia antigen (HBsAg) and, despite tremendous progress, chronic HBV infection remains a major health issue. The treatment methodology for this infection is constantly perfecting and EASL has recently updated its fundamental principles. Aims. To evaluate the status viral load replication seconversion, quantitative HBsAg and fibrosis in dynamic as well as to establish some correlations and status HBs Ag( HBs antigen), HBe Ag (Hbe antigen) under the antiviral treatment with entecavir. Material and method. We selected for the study 48 patients who had at the initial evaluation, the results correlated of the tests FibroScan and FibroTest/FibroMax (initial and after 48 weeks), HBV- DNA- level, quantitative HBsAg, HBeAg, anti-HBs antibodies, anti-HBe antibodies in dynamic, adherence (0,3,6,12, months). Results and conclusions. Antiviral therapy with entecavir has improved the prognosis of patients included in the study after 24 months of treatment as follows: 50% of all patients in the study had HBeAg seroconversion, 76.4% had a maintained virologic response, 78% had a biochemical response, 37.5% - a histological response. The cases which had virologic rebound at 12, 24, 48 weeks were correlated with male sex, age 18-30 years old, initial high fibrosis staging F3 (staging F3 fibrosis) and F4, HBe Ag positive and antiviral treatment previous. [ABSTRACT FROM AUTHOR]

Background. Recent studies have shown that in HBV(hepatitis B virus) infected patients, high level viral multiplication collocates with a high risk of hepatocellular carcinoma, thus underlying the importance of keeping under control viral multiplication in chronic hepatitis HBV patients. Aims. To evaluate the status viral load replication seroconversion, fibrosis in dynamic ALT (alanin aminotransferase) in dynamic, and status HBs Ag (HBs antigen), HBe Ag (Hbe antigen) as well as to establish some correlations, under the antiviral treatment with entecavir. Material and method. We selected for the study 86 patients with age between 18 and 65 years old, who had at the initial evaluation, the results correlated of the tests FibroScan and FibroTest/ FibroMax (initial and after 48 weeks), HBV- DNA- level, HBsAg, HBeAg, anti-HBs antibodies, anti-HBe antibodies in dynamic, adherence (0,3,6,12, months). Results and conclusions. Antiviral therapy with entecavir has improved the prognosis of patients included in the study after 24 months of treatment as follows: 3,46% of all patient had HBsAg seroconversion 32,5% of all patients in the study had HBeAg seroconversion, 73,4% had a maintained virologic response, 76,4% had a biochemical response, 37% -- a histological response. [ABSTRACT FROM AUTHOR]

Background: Fibroscan (FS) and Fibrotest (FT) are the most validated two methods for noninvasive evaluation of liver fibrosis. Each of them has proved a good sensitivity and specificity for identifying liver fibrosis stage compared to liver biopsy. Used together their sensitivity and specificity raises. We compared their correlation in different types of viral hepatitis (B and C). Materials and methods: 230 patients were included in the study, 100 patients with chronic hepatitis B and 130 with chronic hepatitis C. All the patients had FS, Fibromax/FT and CBC performed in the same day. Only patients with valid investigations (according to their manufacturer's recommendations) were included in the study. APRI and FIB4 scores were also calculated for each patient. Results: FT and FS correlation: an overall correlation of 70.9% (163/230) was found if we accepted a maximum of one degree difference between the two methods. The correlation was statistically significant for the corresponding Metavir stage (r=0.449, p<0.0001) and for absolute values (r=0.422, p<0.0001). For the Castera algorithm 65.6% of the biopsies would be avoided. The prediction of FT by FS measured by AUROC is higher for F4 and F3 (0.823, CI 0.745-0.901 and 0.659, CI 0.560-0.759) while for lower grade is poor. Liver stiffness is significantly influenced by alfa2macroglobulin, GGT, ALT, AST, platelets (r=0.251, 0.445, 0.255, 0.372, -0.330, p<0.0001) and cholesterol (r=-0.222, p=0.005). This correlation is valid regardless etiology. In the VHC group we also found a correlation of stiffness with glycemia (r=0.273, p<0.0001. APRI and FIB4 are as well correlated with FT and respectively FS (r=0.515, 0.373, 0.725, 0.491, p<0.0001). Conclusions: We found a satisfactory agreement between methods, regardless etiology. Using an algorithm like the one proposed by Castera and noninvasively classifying the fibrosis as none/mild, severe or cirrhosis seems more appropriate and accurate than trying to exactly stage the fibrosis according Metavir score, moreover, that this is actually the clinician's interest. [ABSTRACT FROM AUTHOR]

Objectives of the study: 1. Monitoring the evolution of 125 patients with chronic hepatitis B treated with Peginterferon α 2A, 180 μg/week, in order to establish the occurrence of thyroid disfunctions in the course of this particular treatment; 2. Finding correlations between patients' clinical and epidemiological parameters (age, gender, level of disease activity, the potential moment of infection and the occurrence of clinical and biological modification of the thyroid). Methods: The prospective clinical study was conducted on a sample of 125 patients with chronic hepatitis B, aged 18-65 years old. Study period: 6 years. Patient monitoring was performed by determining antithyroid antibodies to identify autoimmune thyroiditis, or TSH, T3 and T4, at the beginning of the therapy, and then quarterly. Results: Of 125 patients with chronic active hepatitis with HBV included in the study, 9.6% of patients had positive antithyroid antibodies at the end of therapy, 7.2% had changes of hypothyroidism and 1.6% hyperthyroidism change. Patients with hypothyroidism at the end of therapy had late positive antithyroid antibodies. Dose reduction of Peginterferon during therapy in the context of iatrogenic haematological changes in patients with positive antithyroid antibodies led to their disappearance. Regarding HBV chronic active hepatitis, there were no significant differences in thyroid dysfunction secondary to a weekly treatment with Interferon therapy 2A 9 MIU x 3 / week. Patients should be monitored at least 6 months after treatment to prevent worsening of thyroid dysfunction. No significant differences were found on the occurrence of thyroid changes in HBeAg-positive to HBeAg-negative ones. Conclusion: The incidence of thyroid dysfunction in patients with chronic hepatitis B, in most studies, does not differ considerably from the native population. [ABSTRACT FROM AUTHOR]

The coexistence of a chronic hepatitis B and an alcoholic hepatopathy leads to a mixed hepatopathy where both factors have at least an additive effect, producing more severe hepatic lesions, with an important potential to evolve towards liver cirrhosis and hepatocellular carcinoma. The study was aimed at analyzing the main biological, virology and histopathological findings of the mixed hepatopathy (alcohol plus viral B). Two test groups were used, cases composed of patients with a mixed hepatopathy, and controls including patients with lone hepatitis B. A comparative analysis was done on factors such as age, sex, viral strains involved, severity of fibrotic and necroinflammatory lesions, identifying lesions specific to the alcoholic aggression, the enzymatic profile, viral kinetics, specific features of the stages of the viral B infection when combined with an alcoholic aggression. [ABSTRACT FROM AUTHOR]