Infections caused by the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are global public health problems. The safety of donated blood can be estimated by monitoring the prevalence of viral markers in the donor population. The present study was carried out in the Jazan region to determine the prevalence of HBV and HCV among Saudi blood donors.
Over a period of six years (January 2004 to December 2009), a total of 29 949 blood units were collected from healthy voluntary and replacement native Saudi blood donors. The donated units were serologically screened for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and antibody to hepatitis C virus (anti-HCV). These data were then analysed.
HBsAg was positive in 3.8% of the blood units that were collected, the blood units with anti–HCV seropositivity had the lowest prevalence (0.41%), and the prevalence of HBsAg was highest in the group that was > 46 years of age. A significant decline in the prevalence of HBV infection has been observed, from 5.6% in 2004 to 2.3% in 2009 (P < 0.001).
The present study showed that the prevalence of HBV and HCV was in a significant decline from 2004 to 2009, and the prevalence of HBsAg and anti-HCV significantly increased with age.
blood donors; hepatitis B virus; hepatitis C virus; Jazan; prevalence; Saudi Arabia
To estimate the prevalence of HIV and hepatitis C virus (HCV) and hepatitis B virus (HBV) co-infection as well as current risk behaviors among HIV positive and negative injection drug users (IDUs) in Chennai, India.
Cross-sectional analysis of a convenience sample of 912 IDUs recruited between March 2004 and April 2005. Specimens were tested for HIV, HBV and HCV. Adjusted prevalence ratios (PR) were estimated using Poisson regression with robust variance estimates.
The prevalence of HIV, HBsAg and anti-HCV were 29.8%, 11.1% and 62.1%, respectively. Among HIV-infected IDUs, prevalence of co-infection with anti-HCV and HBsAg/anti-HCV were 86% and 9.2%, respectively. In multivariate analysis, injecting at a dealer’s place (PR: 1.57) and duration of injection drug use ≥ 11 years (PR: 3.02) were positively associated with prevalent HIV infection. Contrastingly, alcohol consumption ≥ 1/week (PR: 0.55) was negatively associated with HIV. HIV positive IDUs were as or more likely compared to HIV negative IDUs to report recent high-risk injection-related behaviors.
There is a high burden of HIV, HCV and HBV among IDUs that needs to be addressed by improving access to therapies for these infections; further, preventive measures are urgently needed to prevent further spread of HIV, HBV and HCV in this vulnerable population.
Hepatitis B and C cause significant morbidity and mortality worldwide. Little is known about the existence of hepatitis B and C among high risk groups of the Pakistani population. The present study was conducted to determine the prevalence of Hepatitis B and C in high risk groups, their comparison and the possible mode of acquisition by obtaining the history of exposure to known risk factors.
This cross sectional study was carried out in Karachi, from January 2007 to June 2008.
HBsAg and Anti HCV screening was carried out in blood samples collected from four vulnerable or at risk groups which included injecting drug users (IDUs), prisoners, security personnel and health care workers (HCWs). Demographic information was recorded and the possible mode of acquisition was assessed by detailed interview. Logistic regression analysis was conducted using the STATA software.
We screened 4202 subjects, of these, 681 individuals were reactive either with hepatitis B or C. One hundred and thirty three (3.17%) were hepatitis B reactive and 548 (13.0%) were diagnosed with hepatitis C. After adjusting for age, security personnel, prisoners and IV drug users were 5, 3 and 6 times more likely to be hepatitis B reactive respectively as compared to the health care workers. IDUs were 46 times more likely to be hepatitis C positive compared with health care workers.
The prevalence of hepatitis B and C was considerably higher in IDUs, prisoners and security personnel compared to HCWs group. Hepatitis C is more prevalent than hepatitis B in all these risk groups. Prevalence of hepatitis C increased with the increase in age. Use of unsterilized syringes, used syringes, body piercing and illicit sexual relations were found to be important associated risk factors for higher prevalence of Hepatitis B and C in these groups.
Hepatitis B; Hepatitis C; High Risk Group; Pakistan
Hepatitis delta virus (HDV) and Hepatitis B virus (HBV) co-infection is well known to induce a spectrum of acute and chronic liver diseases which further advance to cirrhosis, fulminant hepatitis and hepatocellular carcinoma (HCC).
The aim of the present study was to determine the prevalence of hepatitis D virus super-infection among hepatitis B surface antigen (HBsAg) positive individuals in the highly populated province of Pakistan which is not well known.
Sera samples were subjected to HBsAg and anti-HDV screening and finally anti-HDV and HBsAg positive coinfected samples were used for HDV active RNA confirmation using nested polymerase chain reaction (PCR).
Out of total 200 HBsAg positive samples by rapid device, 96 (48%) were also found reactive for HBsAg using enzyme linked immunosorbant assay (ELISA). Out of these HBsAg ELISA positive samples, 80 (88.8%) were anti-HDV ELISA positive which were then subjected to PCR. The amplification results further confirmed 24 (30%) samples to be HDV RNA positive. HDV super-infection was more common in male patients than female patients (81% VS 19%).
The current study shows a high prevalence rate of HDV-HBV co-infection in Pakistan that tends to increase over time.
The goal of this study was to understand the knowledge about AIDS, identify the correlates and determine the prevalence of HIV infection, syphilis, HCV among migrant workers in Zhejiang, China.
A cross-sectional study using face-to-face anonymous questionnaire interviews was conducted and blood samples were collected for HIV, syphilis and Hepatitis C infection screening.
17,377 (92.8%) of 18,730 migrant workers approached were interviewed. Among 17,377 participants, the HIV/AIDS knowledge rate was 66.2%. A total of 12,694 (73%) of the participants reported having ever had sexual intercourse, with 30.1% of single participants reporting having had sexual intercourse. Among those respondents with sexual experiences, 7.5% admitted they had two or more sexual partners and 4.9% reported having had sex with casual (unpaid) partners in the previous 12 months, whilst 3.7% had paid for sex. More than half of those who had paid for sex (59.4%) had not used a condom every time in their sexual acts with the sex workers. Multiple logistic regression analysis indicated that high risk sexual behavior (defined as sex with a casual or commercial sex partner without using a condom consistently) was associated with being divorced or widowed (P<0.05 for single); male gender; shorter duration of stay in Zhejiang; working in factory, market or domestic service (P<0.05 for odd job); having a province of origin inside Zhejiang; and drug use. The prevalence of HIV and HCV infections were 0.02% (95% CI: 0.01%–0.06%) and 0.40% (95%CI: 0.31%–0.51%), respectively. The prevalence of syphilis among those who were sexually active was 0.55% (95% CI: 0.43%–0.70%). Risk factors for syphilis included shorter duration of stay in Zhejiang, ethnic minority status, being divorced or widowed and having had multiple sex partners.
Much greater efforts are needed to promote safer sex, and programs for the control of syphilis need to be tailored for migrant workers in China.
Hepatitis D virus (delta agent) markers were present in 111 (36%) of 308 intravenous drug abusers who were positive for hepatitis B surface antigen (HBsAg), 52 of these having hepatitis D virus antigenaemia. IgM antibody to hepatitis B core antigen (anti-HBc IgM) was present in 92 out of 95 subjects tested, indicating that hepatitis D virus and hepatitis B virus infections had been acquired simultaneously. Hepatitis D virus markers were present in three out of four patients with fulminant hepatitis, and in 80 of 223 (36%) with mild or moderate hepatitis compared with four of 29 (14%) of those who were asymptomatic. These proportional differences were significant (p less than 0.001). Hepatitis D virus markers were present in twice as many patients positive for anti-HBc IgM requiring admission to hospital with acute hepatitis compared with outpatients attending a drug treatment centre. Tests on one patient showed complete disappearance of HBsAg, but hepatitis D antigen (HDAg or delta antigen) and hepatitis B e antigen (HBeAg) were still present in serum samples. All five patients with chronic active hepatitis had hepatitis D antibody (anti-HD) compared with seven of 24 (29%) with chronic persistent hepatitis (p = 0.008). Blocking anti-HD persisted for long periods after simultaneous infections with hepatitis B virus and hepatitis D virus but at lower titres than in patients with chronic liver disease.
To evaluate intraocular pressure (IOP) control, visual prognosis and complications following manual small incision cataract surgery among eyes with phacomorphic glaucoma.
Materials and Methods:
This prospective, non-randomized interventional consecutive case series included all patients with phacomorphic glaucoma who presented to a tertiary eye care referral center in South India between March 2006 and April 2007. All patients underwent slit-lamp bio-microscopy, applanation tonometry and gonioscopy of the other eye to rule out angle closure. Small incision cataract surgery with intraocular lens implantation was performed in all affected eyes. Complete ophthalmic examination was done at each follow-up visit.
A total of 74 eyes with phacomorphic glaucoma were included in this study. The preoperative mean IOP was 38.4±14.3 mmHg and mean IOP at last follow-up was 12.7±2.4 mmHg. There was a statistically significant difference between IOP at presentation and IOP at last follow-up (P< 0.001). None of the eyes required long-term antiglaucoma medication. No significant intraoperative complications were noted. The final postoperative best corrected visual acuity was 20/40 or better in 51 patients. Eighteen eyes had corneal edema and 36 eyes had anterior chamber inflammation. Both conditions resolved with standard medical therapy.
Manual small incision cataract surgery is safe and effective in controlling IOP and achieving good functional visual acuity with minimal complications in the management of phacomorphic glaucoma in developing countries.
Intraocular pressure; manual small incision cataract surgery; phacomorphic glaucoma
Incidence of preoperative rise in blood pressure (BP) in cataract surgery among hypertensive and normotensive patients.
To study the incidence of preoperative rise in BP in cataract surgery among normotensive individuals and hypertensive patients with historic good BP control in a population without other major chronic diseases.
Ophthalmology Service of a University Hospital.
Materials and Methods:
A prospective study with 822 patients older than 40 years of age, with cataract surgery indication, and without major chronic diseases other than hypertension. The patients were divided in two groups: hypertensive and normotensive. Preoperative data, physical exams and medical adverse events were recorded in an evaluation questionnaire.
The sample included 427 normotensive (52%) and 395 hypertensive patients (48%). The two groups had similar proportions of operations that were cancelled and not subsequently rescheduled, 2% (eight patients) in each group. The incidence of preoperative rise in BP was 3.7% in the normotensive group and 10.9% in the hypertensive group (P < 0.001).
Hypertensive patients with historic good BP control and without other major co-morbidities present a larger incidence of preoperative rise in BP than normotensive individuals in cataract surgery.
Cataract; high blood pressure; systemic diseases
To study the epidemiology of Hepatitis B virus (HBV) and Hepatitis C virus (HCP) in a relatively new industrial community in Yanbu, and to find out whether any relationship exists between increased serum Alanine Transferase (ALT) and HBV infection.
A group of Saudi male workers (n=332) (mean age = 32 years) were screened for Hepatitis B core antibody (anti-HBc), Hepatitis B surface antigen (HBsAg), Hepatitis C virus antibody (anti-HCV), and Alanine Transferase (ALT) level and the results were correlated with age and marital status.
Overall, the prevalence of anti-HBc, HBsAg, and anti-HCV were 23.2%, 7.7% and 0.6% respectively. Age-related HBsAg carrier rates were 7.8%, 6.4% and 9.4% for age groups 18-20, 21-30 and over 30 years respec-tively. Anti-HBc positivity rates lucre 7.8%, 24.3% and 23.1 M for the same age groups. Anti-HCV was positive in only two cases (0.6%) of all subjects. Con-sidering marital status, HBsAg and anti-HBc positivity rates were 7.8% and 20.5% for single subjects compared with 7.4% and 24.5% for married subjects (P=> 0.5 and > 0.5). Twenty-two percent of all subjects had ALT levels above 35 U/L with no correlation between the increase of ALT and anti-HBc or HBsAg positivity.
The findings of this work: (1) Support the notion of relatively low prevalence of HCV in the Saudi Population as compared to HBV. (2) Provide clues regarding possible routes of transmission of HBV in Saudis that may help in vaccination policies for control of HBV infection. (3) Emphasize the fact that ALT level is an independent factor of HBV infection, and (4) Signify the need to screen industrial workers fir non-viral causes of liver disease.
Hepatitis B virus (HBV); Hepatitis C virus (HCV); Alanine Transferase (ALT)
There are little data on the prevalence of serological markers of hepatitis B and hepatitis C viruses in pregnant women in Iran.
This study was designed to determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among pregnant women in Lorestan, west of Iran.
Patients and Methods
Serum samples of 827 pregnant women who lived in rural (36.8%) and urban areas (63.2%) of Lorestan were collected during 2007-2008. Data were obtained through questionnaires. Samples were first screened for anti-HCV and anti-HBc by ELISA. Those who were positive for anti-HBc were tested for HBsAg.
Anti-HBc was found in 28 of 827 pregnant women (overall prevalence, 3.4%; 14 of 523 in urban areas, 2.7%; 14 of 304 in rural areas, 4.6%). Of the 28 positive samples, 6(0.7%) were positive for HBs-Ag. Only 2 samples (0.2%) were anti-HCV-positive.
These results underscore the need for prenatal screening for HBV infection in pregnant women and treatment of newborns from HBsAg-positive mothers.More studies are needed to identify risk factors of HCV infection and highlight the importance of HCV screening and treatment programs.
Hepatitis B; Hepatitis C; Pregnant women; Anti-HBc antibody; HBs-Ag; Anti-HCV antibody
Background and Aims
Patients with human immunodeficiency virus (HIV) are also likely to be at risk for other infectious pathogens including hepatitis B(HBV) and C(HCV) viruses, which complicate the clinical course, management, and therapy. The literature on the prevalence of HBV/HCV coinfection with HIV in Iran is sparse. Hence this study was conducted to investigate this coinfection pattern and its risk factors in Isfahan, Iran.
All of the HIV-infected patients attending clinics for acquired immune deficiency syndrome (AIDS) research and education in Isfahan province during the period of May 1998 through April 2007 were included in this cross-sectional study. After giving their informed consent, the patients were screened for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV), and anti-HCV-positive cases were confirmed with the RIBA test. The demographic data and information about risk behaviors were collected as well. Multivariate logistic regression was used to identify independent risk factors for HBV and HCV.
The subjects included 130 patients (128 males and 2 females) with a mean age of 50.23 ± 8.81 years. Most of the subjects were unemployed (61.5%) and single (56.2%). A history of imprisonment, ,intravenous drug abuse, and high-risk sexual activity were reported by 83.7%, 83.5%, and 48% of the subjects, respectively. Coinfection with hepatitis viruses was observed in 78.5% of the subjects. Low levels of education, a history of imprisonment, and youth were the main risk factors for HCV/HIV coinfection (OR = 196, 114, and 0.9 respectively).
Our study showed that there is a high prevalence rate of HCV/HIV coinfection in Isfahan, Iran, with the major risk factor being a history of imprisonment.
HBV; HCV; HIV; Coinfection; Iran
Approximately 170 million people are infected with Hepatitis C virus (HCV) worldwide. The prevalence of chronic HCV infections in Pakistan is about 5%, with most individuals being infected with HCV genotype 3a. Data on HCV genotypes distribution across various districts of the country are scarce. One example is district Mardan from where such data is available only from 17 individuals. Accordingly, the present study aimed at determining HCV genotypes distribution among 177 HCV RNA positive individuals from district Mardan.
Serum samples (n = 215) from patients suspected of hepatitis C were collected and processed for Nested PCR based detection and subsequent genotyping. Gender-wise and age-wise differences in HCV prevalence and HCV genotypes distribution were determined by χ2 test. Out of the total 215 serum samples, 177 were found to be positive for HCV RNA. The genotype 3a was the most predominant genotype among HCV RNA positive samples with a prevalence of 90.3%, followed by genotype 1a (5.6%), mixed genotypes (2.8%), genotype 3b (0.6%) and genotype 4 (0.6%). The HCV prevalence was higher in young individuals than old people and was indicative of reduced survival rate beyond 40 years.
HCV genotype 3a is the most predominant genotype in district Mardan. The state of the art preventive and therapeutic strategies should be implemented to control the spread of HCV infections. Further temporal studies involving different geographical areas of Pakistan, are required to improve the control measures for HCV infection.
Hepatitis; Hepatitis C virus; HCV genotypes; Prevalence; Pakistan
To determine the incidence and risk factors of secondary cataract.
Materials and methods:
A retrospective study involving a review of medical records in the ophthalmology unit of the Yaoundé Gynaeco-obstetric and Paediatric Hospital in Yaoundé, Cameroon, was carried out. All patients who had cataract surgery between January 2006 and September 2010 were included. Variables included age, sex, past medical history, morphology of primary cataract, type of surgery, intraocular lens implantation, site of implantation, intra- and postoperative complications, and the time lapse for the presentation of secondary cataract. Both univariate and bivariate analyses were carried out. The χ2 test was used to compare proportions, and P-values <0.05 were considered statistically significant.
A total of 864 eyes of 718 patients had cataract surgery. Ninety-two eyes developed posterior capsule opacification, giving an incidence of 10.65%. The mean age of patients who developed secondary cataract was 52.3 ± 23.05 years, with a range of 4 years to 84 years. Secondary cataract was more frequent in the age group of 0–20 years. The time lapse for presentation of secondary cataract was 64.7 ± 9.53 days, with a range of 1 to 504 days. Risk factors for the development of secondary cataract were age (P = 0.000), sex (P = 0.011), cortical cataract (P = 0.000), and postoperative inflammation (P = 0.000).
The incidence of secondary cataract, though high in this study, is lower than that reported in other studies.
cataract; secondary cataract; incidence; Cameroon
A key issue in the prevention and control of Sexually Transmitted Diseases (STD) is to provide access to health centres, and in diagnosing and treating STD. The present study is aimed to assess the prevalence of sexually transmitted diseases (STDs) and Hepatitis C virus (HCV) in a population of immigrant female sex workers (FSWs). We conducted a cross sectional survey of FSWs working in Verona, North-eastern Italy. Screening test included serology for STDs [including Human Immunodeficiency Virus (HIV), syphilis and Hepatitis B virus (HBV)] and hepatitis C virus (HCV).
Sixteen out of 345 (4.6%) street FSWs screened during 1999-2007 resulted positive for HIV, 12 (3.5%) were positive for HBsAg, 7 (2.0%) were positive for syphilis serological test, and 3 (0.9%) were positive for HCV. Comparison of the prevalence data between women from Africa (286/345, 82.8%) and other countries showed no statistical difference for HIV infection (R.R. 1.44; 95% CI, 0.34-6.19) and for presence of HBsAg (R.R. 2.27; 95% CI, 0.30-17.24). The positivity of syphilis serologic tests had a lower prevalence among African FSWs (mostly coming from Nigeria) than among FSWs from Eastern Europe (57/345, 16.5%). This difference was statistically significant (R.R. 0.03; 95% CI, 0.00-0.28). The prevalence of HIV infection increased with age (p=0.04, by chi2 for trend analysis), but not with the time worked as sex workers in Italy. Moreover, the presence of any of the screened infections was predictable by both age and earlier time of immigration by way of logistic multivariable regression.
The prevalence of HIV and HBsAg was higher in the whole analyzed cohort compared to the general population; prevalence of syphilis was significantly higher in FSWs from Eastern Europe than in FSWs from Africa. HCV prevalence remains low among non intravenous drug abuser FSWs. The data offers a starting point to address targeted intervention that would prevent FSWs acquiring and transmitting STDs.
Prostitution; sexually transmitted diseases; HIV.
Postoperative bacterial endophthalmitis is a devastating complication of cataract surgery. Methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis is rare. Recent debate over MRSA screening in United Kingdom (UK) National Health Service (NHS) hospital services has implications for cataract patients and ophthalmology services.
To discuss issues for clinical practice as based on reflective experience at a UK district general NHS hospital in relation to care of MRSA-positive cataract patients.
Retrospective case series and reflective practice.
Three cases presented highlight practice points around cataract patients colonized with MRSA. Known or determined MRSA-colonized patients should be treated with anti-microbial agents at time of cataract surgery known to be active against MRSA. Preventative treatment with intracameral vancomycin or intravenous teicoplanin alongside appropriate topical treatments may be of merit. Importantly fluoroquinolones, often prescribed by cataract surgeons, may have a selective effect favoring the proliferation of MRSA.
MRSA screening may cause unnecessary delays in cataract care and may represent a patient safety concern in its own right. Patients colonized with MRSA may safely undergo cataract surgery provided there is no evidence of periorbital infection and provided appropriate infection control and antibiotic prophylaxis measures are used. The well-prepared cataract surgeon needs to be aware of developments in infection control and should liaise with local clinical microbiology colleagues in relation to bacterial resistance to antibiotics.
methicillin-resistant Staphylococcus aureus (MRSA); endophthalmitis; screening
Patient's satisfaction for a given treatment is an important clinical outcome because a satisfied patient is more likely to comply with treatments, attend follow-ups and advocate the service to others. Therefore, knowing patients' expectations before a planned procedure or treatment and the actual level of satisfaction and fulfillment of their initial expectations thereafter is much helpful. As far as the knowledge and experience of the researchers is concerned, there has not been any study conducted in Ethiopia to find out about patients' preoperative expectations and postoperative level of satisfaction for actual outcomes. This study was therefore, conducted to describe and find out the relationship between preoperative expectations of cataract patients and the actual postoperative experience and their satisfaction level following the surgery at ophthalmology department in Jimma University Specialized Hospital.
A prospective cohort study of patients undergoing first eye cataract surgery was conducted from July 10 to Oct., 10, 2007 in the Ophthalmology department of Jimma University Specialized Hospital. Detailed interviews that included general and vision specific health status measures and patients' preoperative expectations for cataract surgery outcomes were performed followed by visual acuity testing. Postoperatively, visual acuity testing was taken again and patients' level of satisfaction with attained postoperative vision was assessed. Data were collected and filled in a separate questionnaire form for each patient, and entered into a computer and analyzed using SPSS for Windows version 12.0.
Of the 200 patients operated for cataract, 179 (89.5%) were followed for the whole five weeks. The average expected preoperative Visual Function-15 score was 96.3, compared to an achieved (postoperative) Visual Function-15 score of just 96.2. However, the most unrealistic expectations observed were reading small prints and doing fine handiwork. The final pinhole visual acuity postoperatively was ≤ 6/18 in 126 (70.4%) patients. Of the 78 (39%) patients who were bilaterally blind preoperatively, 5 (2.5%) patients remained blind postoperatively.
Significant improvements were obtained in clinical, functional, and perceived vision by cataract surgery involving extracapsular cataract extraction with posterior chamber intraocular lens implantations. Expectations regarding visual functioning after cataract surgery were very high, and in most cases and in most cases they were fulfilled.
Cataract surgery; patient's satisfaction; visual function; Jimma; Ethiopia
Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age.
The study targeted the low to middle socioeconomic population that comprises 80% to 85% of the population. Consent was obtained from parents of the eligible children before administering questionnaire and collected a blood sample for anti-HCV and HBsAg serology.
3533 children were screened for HBsAg and anti-HCV. 1826 (52 %) were males. 65 (1.8 %) were positive for HBsAg, male to female ratio 38:27; mean age 10 ± 4 years. 55 (1.6 %) were positive for anti-HCV with a mean age 9 ± 4 years. 3 (0.11%) boys were positive for both HBsAg and anti-HCV. The overall infection rate was 3.3 % in the studied population. Hepatitis BsAg was more prevalent in subjects who received therapeutic injections 45 (69.2%) positive [Odd Ratio OR = 2.2; 95% Confidence interval CI: 1.3–3.6] inspite of using new needle and syringe 44 (67.7%) positive [OR = 2.2; 95% CI: 1.3–3.7] and vaccination in the government healthcare facilities 46 (70.7 %) positive with [OR = 3.0; 95% CI: 1.4–6.4]. These factors were not significant in anti-HCV positive cases.
There is a need to educate general population regarding HBV and HCV infection and risks associated with inappropriate therapeutic injections. Hepatitis B vaccine should be administered to all newborns regardless of maternal HBsAg status.
Hepatitis co-infection with HIV is associated with increased morbidity and mortality.
This cross sectional study was carried out among HIV positive patients and HIV negative blood donors, HIV infected patients were recruited from the antiretroviral therapy clinics of the Lagos State University Teaching Hospital, in Nigeria. The diagnosis of HIV infection among patients and predonation screening of control blood donors was carried out using Determine1/2 screening rapid kits. (Inverness Medical, Japan). Reactive patients’ sera were confirmed with Enzyme Linked Immunosorbant Assay (Elisa) based immuuocomb1&11 comb firm kits (Orgenics, Israel). Hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) were assayed using 4th generation Dialab Elisa kits for patients and control sera.
Dual presence of HBsAg and anti-HCV was observed in 4(3.9%) of HIV infected patients, while 29(28.4%) and 15(14.7%) were repeatedly reactive for HBsAg and anti-HCV respectively. HIV negative blood donor controls have HBsAg and anti-HCV prevalence of (22) 6.0% and (3) 0.8% respectively. The prevalence of hepatitis co infection is higher among the male study patients 16(50%) than the female32 (45.7%).p > 0.001.Data analysis was done with statistical Package for social sciences (SPSS,9) and Chi square tests.
This study reveals a higher risk and prevalence of HBV and HCV co infections among HIV infected patients compared to HIV negative blood donors p < 0.001.
HIV; Hepatitis B; Hepatitis C; coinfections; Nigeria
A retrospective study was carried out to assess the performance of hepatitis C diagnostic assays in our laboratory, and to determine the prevalence of hepatitis C among blood donors at the Sultan Qaboos University Hospital.
From 1991 to 2001, approximately 55,000 serum samples collected from blood donors and patients were submitted to our laboratory for testing. All sera were screened for antibodies to hepatitis C virus (HCV) by three successive generations of the enzyme-linked immunosorbent assay (ELISA). Anti-HCV positive sera were further tested by recombinant immunoblot assay (RIBA). Reverse-transcriptase polymerase chain reaction (RT-PCR) for HCV RNA was carried out on a limited number (241) of ELISA positive samples.
Out of 30012 samples from blood donors that were screened for anti-HCV, 272 (0.91%) were positive. Of these, 46.5% were confirmed positive by RIBA. The proportion of patient sera that were confirmed positive varied from 95% among intravenous drug users to 81% in patients with hepatitis to 70% in those with haemoglobinopathies. HCV RNA was detected in 67%, 6%, and 0% of the RIBA positive, indeterminate and negative samples respectively.
Based on RIBA, the prevalence of anti-HCV among blood donors in Oman is close to 0.5%. In our experience, RIBA-positivity is predictive of HCV infection in two thirds of subjects, and HCV infection is highly unlikely in those who are RIBA-negative. The experience at SQUH with three types of HCV assays has enabled the laboratory to develop a test algorithm, starting with screening anti-HCV ELISA.
hepatitis C virus; ELISA; RIBA; polymerase chain reaction
The country of Georgia has a high prevalence of tuberculosis (TB) and hepatitis C virus (HCV) infection.
To determine whether HCV co-infection increases the risk of incident drug-induced hepatitis among patients on first-line anti-TB drug therapy.
Prospective cohort study; HCV serology was obtained on all study subjects at the time of TB diagnosis; hepatic enzyme tests (serum alanine aminotransferase [ALT] activity) were obtained at baseline and monthly during treatment.
Among 326 study patients with culture-confirmed TB, 68 (21%) were HCV co-infected, 14 (4.3%) had chronic hepatitis B virus (HBV) infection (hepatitis B virus surface antigen positive [HBsAg+]), and 6 (1.8%) were HIV co-infected. Overall, 19% of TB patients developed mild to moderate incident hepatotoxicity. In multi-variable analysis, HCV co-infection (adjusted Hazards Ratio [aHR]=3.2, 95% CI=1.6-6.5) was found to be an independent risk factor for incident anti-TB drug-induced hepatotoxicity. Survival analysis showed that HCV co-infected patients developed hepatitis more quickly compared to HCV seronegative patients with TB.
A high prevalence of HCV co-infection was found among patients with TB in Georgia. Drug-induced hepatotoxicity was significantly associated with HCV co-infection but severe drug-induced hepatotoxicity (WHO grade III or IV) was rare.
AIM: To evaluate the overlap of autoimmune hepatitis in hepatitis C virus (HCV)-infected patients with intense interface hepatitis.
METHODS: Among 1759 patients with hepatitis C submitted to liver biopsy, 92 (5.2%) presented intense interface hepatitis. These patients were evaluated regarding the presence of antinuclear antibody (ANA), anti-smooth muscle antibody (SMA) and anti-liver/kidney microsomal antibody (LKM-1), levels of γ-globulin and histological findings related to autoimmune hepatitis (plasma cell infiltrate and presence of rosettes).
RESULTS: Among patients with hepatitis C and intense interface hepatitis there was a low prevalence of autoantibodies (ANA = 12%, SMA = 5%, LKM-1 = 0%) and the median γ-globulin level was within the normal range. Typical histological findings of autoimmune disease were observed in only two cases (2%). After applying the score for diagnosis of autoimmune hepatitis, only one patient was classified with a definitive diagnosis of autoimmune hepatitis. Since overlap with autoimmune hepatitis was not the explanation for the intense necroinflammatory activity in patients with chronic hepatitis C we sought to identify the variables associated with this finding. The presence of intense interface hepatitis was associated with more advanced age, both at the time of infection and at the time of the biopsy, and higher prevalence of blood transfusion and alcohol abuse.
CONCLUSION: Although possible, overlap with autoimmune hepatitis is a very rare association in HCV-infected patients with intense interface hepatitis, an unusual presentation which seems to be related to other host variables.
Hepatitis C; Liver biopsy; Antinuclear antibody; Autoimmune hepatitis; Interface hepatitis
Cross-sectional studies have documented that 2-10% of patients who are chronically infected with hepatitis C virus (HCV) are also positive for hepatitis B virus (HBV) surface antigen (HBsAg). Data related to HCV-HBV coinfection are lacking in Korea. This study evaluated the clinical characteristics, the treatment efficacy of peginterferon alfa plus ribavirin, and the changes induced by such treatment in HBV status in chronic hepatitis C (CHC) patients coinfected with HBV.
Eighteen (2.37%) HBsAg-positive CHC patients were selected from among the 758 subjects from the K(G)yeonggi-Incheon Peginterferon alfa and ribavirin in chronic hepatitis C Treatment (KIPECT) study, which evaluated the treatment efficacy and safety of peginterferon alfa plus ribavirin in CHC patients. Data on changes in the status of HBV infections were obtained.
HCV genotype 1b was the most common (44%). The overall sustained virologic response rate was 72% in all patients, and 60% and 87.5% in genotypes 1 and 2, respectively. Two of the 18 patients were positive for HBeAg, and 15 had baseline HBV DNA level of less than 2,000 IU/mL. Two of the three whose levels exceeded this threshold showed no detectable DNA after treatment. After the completion of treatment, serum HBV DNA levels were increased in the two patients whose baseline HBV DNA levels were less than 2,000 IU/mL.
The prevalence of HBV coinfection in CHC patients was 2.37% and most of the patients were inactive carriers. The treatment efficacy was similar to that of HCV mono-infection. Reactivation of HBV replication was observed in some patients after CHC treatment.
Hepatitis B virus; Hepatitis C virus; Coinfection
Prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis G virus (HGV), and hepatitis E virus (HEV) was investigated among 574 healthy blood donors in Bolivia. HCV RNA and HGV RNA in the serum were identified by a nested reverse transcription-PCR using primers derived from the 5′ untranslated region (5′ UTR). We also tested for hepatitis B surface antigen (HBsAg) and for the antibody to HEV. The results revealed that HGV RNA was present in 84 of 574 (14.6%) tested blood donors, whereas HBsAg was detected in only 2 (0.3%) donors, and no individuals positive for HCV RNA were found. Anti-HEV immunoglobulin G (IgG) was detected in 93 (16.2%) individuals and anti-HEV IgM was found in 10 (1.7%) individuals among the same population. Phylogenetic analysis of 44 HGV isolates in the 5′ UTR showed that 27 (61%) isolates were genotype 3 (Asian type) and the remaining 17 (39%) isolates were genotype 2 (United States and European type). Moreover, we obtained a full-length nucleotide sequence of the HGV genome (designated HGV-BL230) recovered from a Bolivian blood donor. The BL230 was composed of 9,227 nucleotides and had a single open reading frame, encoding 2,842 amino acid residues. Interestingly, the BL230 belonged to genotype 2 of HGV at the level of a full-length sequence, although this was classified as genotype 3 by a phylogenetic analysis based on the 5′ UTR sequence. The BL230 differed from previously reported HGV/hepatitis GB virus type C isolates by 12 to 13% of the nucleotide sequence and 4% of the amino acid sequence. Our data indicate a high prevalence of HGV in native Bolivians, and the major genotype of HGV was type 3.
To estimate the incidence of Hepatitis C virus (HCV) and the predictive factors through repeated routine laboratory analyses.
An observational cohort study was carried out in Quatre Camins Prison, Barcelona. The study included subjects with an initial negative HCV result and routine laboratory analyses containing HCV serology from 1992 to 2011. The incidence of infection was calculated for the study population and for sub-groups by 100 person-years of follow-up (100 py). The predictive factors were determined through Kaplan-Meier curves and a Cox regression. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated.
A total of 2,377 prisoners were included with a median follow-up time of 1,540.9 days per patient. Among the total population, 117 HCV seroconversions were detected (incidence of 1.17/100 py). The incidence was higher between 1992 and 1995 (2.57/100 py), among cases with HIV co-infection (8.34/100 py) and among intravenous drug users (IDU) without methadone treatment (MT) during follow-up (6.66/100 py). The incidence rate of HCV seroconversion among cases with a history of IDU and current MT was 1.35/100 py, which is close to that of the total study population. The following variables had a positive predictive value for HCV infection: IDU (p<0.001; HR = 7,30; CI: 4.83–11.04), Spanish ethnicity (p = 0.009; HR = 2,03; CI: 1.93–3.44) and HIV infection (p = 0.015; HR = 1.97; CI: 1.14–3.39).
The incidence of HCV infection among prisoners was higher during the first part of the study and among IDU during the entire study period. Preventative programs should be directed toward this sub-group of the prison population.
Background. Hepatitis C virus (HCV) represents a major worldwide public health problem.
Though several studies from Yemen have provided an estimate of the prevalence
of this viral infection, there exist only few studies which reflect the status in the general population.
Aim. The present study was designed to investigate the prevalence of hepatitis C infection among
general population in central region of Yemen. Methods. The study population comprised 2,379 apparently
healthy subjects who were screened for hepatitis C antibodies (HCV Abs) status using ELISA quantitative
technique. Seroprevalence rate of seropositive subjects was calculated and stratified by age, sex,
educational level, and monthly income. Results. The study showed that out of 2,379 subjects, 31
(1.3%) were HCV Abs positive. Higher prevalence of HCV Abs was found among females, 24
(1.01%), than males, 7 (0.29%). The age specific prevalence rose from 00 (0.00%) in subjects aged
≤14 years to a maximum of 9 (0.38%) in subjects aged ≥55 years. The prevalence of HCV Abs was
more prevalent in illiterate subjects and increased with decreasing monthly income. Conclusion.
It was found that variables including age and educational level were significantly associated with
HCV Ab positivity and not associated with gender and monthly income.