Hepatitis B virus reactivation among hepatitis C patients treated with direct-acting antiviral therapies in routine clinical practice

BackgroundHepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients treated with IFN-free direct acting antiviral (DAA) therapies has recently emerged as a potential risk. Given the potential burden of this issue, further data are needed to establish its actual clinical impact.ObjectivesThe aim of the present study was to analyze the occurrence of HBV reactivation in a cohort of CHC patient treated with DAAs in routine clinical practice.Study designConsecutive CHC patients with different genotypes, treated with DAA between January 2015 and January 2016 were included in the study. Subjects had been tested for HBsAg and anti-HBc antibodies before antiviral therapy. HBV-DNA levels were examined in anti-HBc positive patients at baseline and 24 weeks after the end of treatment. Post-treatment HBsAg determination was performed in case of HBV-DNA positivity. Serum anti-HBs kinetics was analysed in anti-HBs and anti-HBc positive subjects.ResultsA cohort of 137 consecutive HCV patients treated with IFN-free regimens in routine clinical practice was evaluated. From this cohort, plasma samples of 44 subjects with positive serology for HBV (anti-HBc positive) were tested for HBV-DNA levels at baseline and 24 weeks after the end of treatment. Two of them were HBsAg-positive, while the others had signs of a past HBV exposure (HBsAg-negative ± HBsAb-positive). No reactivation was found in HBcAb-positive and HBsAg-negative subjects. In the two HBsAg-positive, one experienced an increase in HBV-DNA levels of ≥2 log₁₀ IU/mL during treatment. However, the reactivation was without clinical impact and, most important, was followed by HBsAg loss.ConclusionsBased on our experience, a past HBV infection seems not to be a condition predisposing to HBV reactivation. On the contrary, in HBsAg-positive subjects not in suppressive treatment with nucleos(t)ide analogs, regular monitoring of HBV-DNA during and after DAA treatment should be considered.     

Assessment of hepatitis B surface antigen negative blood units for HBV DNA among replacement blood donors in a hospital based blood bank in Nigeria

BackgroundHepatitis B virus infection is one of the greatest threats to blood safety all over the world. The laboratory algorithm based on only the detection of hepatitis B surface antigen (HBsAg) leaves a gap for infected HBsAg negative donors to donate blood during the “window period” (WP) and late stages of infection.ObjectiveTo estimate the frequency of the presence of HBV deoxyribonucleic acid (DNA) in HBsAg negative blood units screened using two different assays for HBsAg in a high endemic region.MethodsFrozen serum aliquot of 100 replacement blood donors who donated blood units that were HBsAg negative were retrieved and tested for HBV DNA. Sample positive for HBV DNA was sequenced by Sanger''s method, genotyped and the viral load was determined.ResultsOne sample (1%) was positive for HBV DNA. The HBV viral load of the sample was 768,000 IU/ml. The partial S-gene of the Hepatitis B virus isolated was genotype E using the NCBI viral genotyping tool.ConclusionsThere is still a risk of HBV infected blood unit escaping detection when donor testing is limited to HBsAg screening. The use of NAT which can substantially reduce HBV infected blood donors from the donor pool should be considered.     

Performance of a new rapid test for the detection of hepatitis B surface antigen in various patient populations

BackgroundRapid diagnostic tests (RDT) have been developed for the detection of hepatitis B surface antigen (HBsAg). They represent a promising alternative to enzyme immunoassays and a powerful tool for large-scale screening and diagnosis of HBV infection, especially in regions without easy access to serological and molecular testing.ObjectivesThe aims of the present study were to evaluate the characteristics and clinical performance of a new CE-marked HBsAg RDT, DRW-HBsAg v2.0 assay (Diagnostics for the Real World™, Ltd., USA), in various patient populations, including those chronically infected with HBV, patients with severe acute hepatitis of unknown origin and pregnant women with unknown HBV serological status at delivery.ResultsThe lower limit of detection of the assay, evaluated in 21 clinical samples, ranged from 0.30 ± 0.07 to 0.97 ± 0.26 international units/mL (using Abbott Architect as a reference), depending on the HBV genotype. The assay tested positive in 100% of patients with chronic hepatitis B, 96.3% of HBsAg-positive acute hepatitis patients, and 95.2% of HBsAg-positive pregnant women. Its specificity was 98.8% in HBsAg-negative patients, 98.7% in HBsAg-negative patients with acute hepatitis of unknown origin and 97.8% in HBsAg-negative pregnant women. Amino acid substitutions in the HBsAg major hydrophilic region did not affect HBsAg detection by DRW-HBsAg v2.0.ConclusionsThe new DRW-HBsAg v2.0 assay is a simple, rapid, easy-to-run and highly sensitive assay that can be used in both high- and low-risk populations for the diagnosis of HBsAg carriage. It appears to be a promising new tool for large-scale screening and diagnosis of HBV infection.     

Hepatitis B infection prevalence by country of birth in migrant populations in a large UK city

BackgroundMany countries with low prevalence of Hepatitis B Virus (HBV) infection recommend that migrants born in countries with higher prevalence are HBV tested. The cost effectiveness depends on the prevalence of HBV infection in the migrant population. In the UK the National Institute for Health and Care Excellence recommended HBV testing of migrants born in countries with HBV infection prevalence >2%, but the prevalence in migrant populations in the UK is not routinely measured.ObjectivesTo estimate HBV infection prevalence by region of birth in migrant populations in a large UK city.Study DesignBy retrospective data linkage HBV infection prevalence in migrant women tested in pregnancy was determined by UN region and sub-region of birth.ResultsOf 5840 migrant women born in regions with HBV infection prevalence >2%, 101 were infected (prevalence 1.7%; 95% CI 1.4–2.1). Sub-regions of birth with low (<2%), intermediate (2–8%) and high (>8%) prevalence in the study population were: low – Northern Africa, Southern Asia, Western Asia, Eastern Europe, South Europe, Central America, Latin America and The Caribbean; intermediate – Eastern Africa, Middle Africa, Western Africa, and South Eastern Asia; high – Eastern Asia. Prevalence in the study populations, was generally lower than published estimates for the region of origin.ConclusionIn a large ethnically diverse city in the UK the hepatitis B prevalence in migrant populations for whom HBV screening is recommended is below the estimated cost effectiveness threshold. We recommend more targeted screening based on measured prevalence in migrant populations.     

The effect of Hepatitis D co-infection on the immunologic and molecular profile of Hepatitis B in asymptomatic Chronic Hepatitis B patients in southwest Nigeria

ABSTRACT

Introduction: Hepatitis D infection causes severe form of viral hepatitis in humans and only affects those with hepatitis B either as a co-infection or superinfection. The aim of this study was to determine the prevalence of Hepatitis D and its effect on the immunologic and molecular profile of Hepatitis B among asymptomatic Chronic Hepatitis B patients in Abeokuta.

Methodology: A cross-sectional study of 99 chronic HBV patient who met the inclusion criteria. All the patients were tested for HBsAg, anti HCV, HDV antigen, anti HDV, HBsAg quantification, and HBV DNA quantification. Associations were tested for and P value less than 0.05 was considered significant.

Results: The participants included 53 (58%) male and 38 (42%) females with ages ranging from 18 to 69 (means 39 ± 11) years. Ten (11%) participants were positive for HDV-Ag while 1 (1.1%) was positive for anti-HDV. Five (5.5%) were positive for HIV 1 &2 while 1 (1.1%) was positive for anti HCV. HBV DNA quantification ranged from 15 to 17,000,000 IU/ml while HBsAg quantification ranged from 0.25 to45,520 IU/ml. There was no statistically significant relationship between HDV-Ag and age (p = .51), sex (p = .73), HBV DNA (p = .8) and HBsAg quantification (p = 1).

Conclusion: The prevalence of HDV-Ag among asymptomatic treatment naïve chronic hepatitis B patients in Abeokuta was 11% and there was no significant difference in the levels of HBV DNA and HBsAg among those with or without hepatitis D.     

Hepatitis B virus infection among pregnant women in Haiti: A cross-sectional serosurvey

BackgroundHepatitis B vaccine administered shortly after birth is highly effective in preventing mother to child transmission (MTCT) of infection. While hepatitis B vaccine was introduced in Haiti as part of a combined pentavalent vaccine in 2012, a birth dose is not yet included in the immunization schedule.ObjectivesDetermine the seroprevalence of hepatitis B virus (HBV) infection among pregnant women to evaluate the risk of MTCT.Study designWe selected 1364 residual serum specimens collected during a 2012 human immunodeficiency virus (HIV) sentinel serosurvey among pregnant women attending antenatal care clinics. Haiti was stratified into two regions: West, which includes metropolitan Port-au-Prince, and non-West, which includes all other departments. We evaluated the association between demographic and socioeconomic characteristics and HIV infection with HBV infection.ResultsOf 1364 selected specimens, 1307 (96%) were available for testing. A total of 422 specimens (32.7%) tested positive for total anti-HBc (38.2% in West vs. 27% in non-West, p < 0.001), and 33 specimens (2.5%) were HBsAg positive (2.1% in West vs. 3% in non-West, p = 0.4). Of HBsAg positive specimens, 79% had detectable HBV DNA. Women aged 30 and older had more than double the odds of positive total anti-HBc than women aged 15–19 years (p < 0.001). Women with secondary (adjusted odds ratio (aOR) = 0.54; 95% CI: 0.36–0.81) and post-secondary education (aOR = 0.40, 95% CI: 0.19–0.79) had lower odds of total anti-HBc positivity compared with women with no education. HIV-status was not associated with HBV infection.ConclusionsHaiti has an intermediate endemicity of chronic HBV infection with high prevalence of positive HBV DNA among chronically infected women. Introduction of a universal birth dose of hepatitis B vaccine might help prevent perinatal HBV transmission.     

Prevalence of parenterally transmitted hepatitis viruses in clinically diagnosed cases of hepatitis

Hepatitis B virus (HBV) is the most important causative agent of blood borne hepatitis in humans. Hepatitis D Virus (HDV) infection occurs either as a coinfection or superinfection in HBV carriers. Hepatitis C virus (HCV) is the major cause of transfusion non-A, non-B hepatitis and continues to be a major cause of human liver disease throughout the world. The present study was conducted on 70 clinically diagnosed cases of viral hepatitis to study the prevalence of parenterally transmitted viral hepatitis. The serum samples were tested for HBsAg, HBeAg, IgM anti-HBc, anti-HBe, anti-HCV and anti-HDV using separate ELISA kits. Of the 70 serum samples tested, 28 (40%) were positive for HBsAg out of which 3 (4.28%) were positive for HBeAg also. Five (7.1%) of the HBsAg positive cases tested positive for IgM anti-HBc also. HBsAg alone was found in 17 (24.28%) cases. The prevalence of anti-HCV was 3 (4.28%) in 70 cases. Thus early screening of clinically diagnosed cases of viral hepatitis is essential for establishing diagnosis and treatment to prevent long term sequelae.     

Seroepidemiological studies on hepatitis B and D viruses infection among five ethnic groups in southern Taiwan

In order to compare the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infection among five ethnic groups in Pingtung County of southern Taiwan, a total of 240 serum samples were collected from September to October, 1985, from the following five ethnic groups: Taiwanese, Hakka, Mainland Chinese, aboriginal Paiwanese, and aboriginal Rukaiese. Ages of subjects ranged from 5 to 69 years. All sera were tested for hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs), and core antibody (anti-HBc) by radioimmunoassay (RIA). Hepatitis B e antigen (HBeAg) and antibody to hepatitis D antigen (anti-HDV) were also tested for those with HBsAg-positive sera. Results showed that 44.1% of all sera examined were negative for HBsAG but positive for both anti-HBs and anti-HBc; additionally, 24.6% were negative for both HBsAg and anti-HBs but positive for anti-HBc. Only 134 serum samples showed negative results for HBV markers, indicating an HBV infection rate of 88.8%. The anti-HDV positive rate was estimated to be 2.7% among HBsAg-positive subjects. The HBsAg-positive rates among Rukaiese, Paiwanese, Hakka, Taiwanese, and Mainland Chinese were 25.8, 22.5, 16.7, 12.9, and 10.0%, respectively; while the prevalence rates of HBV infection among the above five groups were 94.2, 94.6, 85.4, 87.5, and 82.5%, respectively. Differences in the HBsAg-positive rate and HBV infection rate among these ethnic groups were statistically significant. We conclude that people living in Pingtung County are more frequently infected with HBV when compared with inhabitants in northern Taiwan.     

Clinical and pathological characteristics of 5 children with HBV surface antigen (HBsAg)-negative hepatitis B virus-associated glomerulonephritis

BackgroundHepatitis B virus-associated glomerulonephritis (HBV-GN) mainly occurs in children. Patients with HBV-GN are frequently positive for serum HBV surface antigen (HBsAg), but they are rarely negative.ObjectiveTo explore the clinical and pathological characteristics of patients with HBV-GN who are serum HBsAg negative.Study designFive children with HBV-GN who are negative for HBsAg were included in this study. Their clinical and pathological characteristics were collected and analyzed.ResultsAll 5 children presented with different levels of proteinuria and microscopic hematuria. Renal biopsies showed membranous nephropathy accompanied by HBsAg and/or HBcAg deposits in glomeruli in all of the children. Steroids and/or other immunosuppressants were administered in all cases without antiviral therapy during the early stages of treatment. Two children achieved complete remission but relapsed after the drugs were tapered down. The other 3 children were initially non-responsive but achieved remission after lamivudine was added.ConclusionsTreatment of HBsAg-negative HBV-GN patients with immunosuppressants alone could not achieve satisfactory effects. Antiviral treatment is effective and may be necessary in this type of patient.     

Clinical characteristics of hepatitis B virus infection in middle school students born after the universal infant vaccination program in Shanghai,China

The aim of this study was to investigate the prevalence of hepatitis B surface antigen (HBsAg) and clinical characteristics of middle school students infected with hepatitis B virus (HBV) after initiation of the HBV immunization program in China. A total of 82,156 serum samples were collected from students in 33 junior schools and 25 senior schools. HBsAg was tested by ELISA. Samples from HBsAg-positive students were collected and analyzed for HBV serum markers, alanine aminotransferase (ALT), HBV DNA levels, and HBV genotypes. The overall prevalence of HBsAg was 1.11% in middle school students in Shanghai, China. The prevalence of HBsAg in students born during the immunization program to HBsAg-positive mothers was significantly higher than that in students born during the universal vaccination program (1.47% vs 0.78%, P < 0.01). Only HBV genotypes B and C were found in these infections, and genotype C was the dominant one. Twenty-one (13.0%) of 162 HBsAg-positive students had active hepatitis B, and 18 were hepatitis B e antigen (HBeAg) positive. The universal infant vaccination program has reduced the prevalence of HBsAg significantly. HBeAg-positive hepatitis B, however, needs to be monitored among the students in whom vaccination failed.     

Hepatitis B infection in Vietnamese families

The occurrence of hepatitis B infection as measured by sensitive serological tests for HBsAg, HBeAg and hepatitis B-specific antibodies was studied in Vietnamese refugee families. HBsAg was found in 10% of 301 children studied. Totally 74% of all HBsAg-positive children had an HBsAg-positive mother or father and an additional 7% had a positive sibling. The distribution of these cases indicated that the risk of HBs-antigenemia was increased 11-fold for those who had an HBsAg-positive mother compared with all other children. The presence of HBeAg in the HBsAg-positive parents was associated with a threefold higher risk of HBs-antigenemia in children as compared with the presence of anti-HBe. It was thus documented that HBV in this population is spread primarily by intrafamilial routes and prophylactic measures within risk families should largely be able to control the appearance of new HBsAg carriers.     

Impact of universal vaccination on intrafamilial transmission of hepatitis B virus

To control hepatitis B virus (HBV) infection, a nationwide vaccination program was launched in 1984 and resulted in a significant reduction in the rate of persistent infection of children. However, the relative contribution of vaccination to the intrafamilial clustering of HBV infection remains unclear. The rate of intrafamilial HBV transmission in vaccinated children was investigated. Eighty-four sera from vaccinated children were enrolled and HBV serum markers were determined. The modes of intrafamilial HBV transmission were investigated by history taking and serological assay, and confirmed by genotyping and phylogenetic analysis. The results showed 66 (78.6%) vaccinated children born to hepatitis B surface antigen (HBsAg)-negative parents were HBsAg-negative. Eighteen vaccinees were born to HBsAg-positive parents; four (21.4%) of the children were HBsAg-positive. According to the parents' HBsAg status, three patterns of HBsAg-positive parents were identified. Serological analysis showed that three of 15 children born to HBsAg-positive mother (pattern I) and one of two children born to HBsAg-positive father became infected (pattern II). The remaining one child was HBsAg negative with both parents positive for HBsAg (pattern III). Genotyping and phyogenetic analysis confirmed the mode of intrafamilial transmissions. Sequence analysis of S and pre-S genes showed that HBV isolates of HBsAg-positive vaccinees were variants; no G145R but G145A and other substitutions were found. In conclusion, this small study showed that both maternal and paternal transmissions are important of the intrafamilial spread of HBV infection. In addition, the introduction of HBV vaccination has resulted in a reduction of intrafamilial transmission, but a study of a large population is needed.     

Prevalence of hepatitis B and C and relationship to liver damage in HIV infected patients attending Joint Clinical Research Centre Clinic (JCRC), Kampala,Uganda

Background

Hepatitis B and C viruses cause death due to liver disease worldwide among Human Immunodeficiency Virus (HIV) positive individuals. Hepatitis B (HBV) and HIV have similar routes of transmission primarily; sexual, intravenous injections and prenatal while hepatitis C (HCV) is transmitted mainly through blood transfusion. Human immunodeficiency virus increases the pathological effect of hepatitis viruses and potentiates re-activation of latent hepatitis infections as a result of reduced immunity. The increase in use of antiretroviral (ARVs) drugs has led to longer period for patient survival and apparent increase in liver disease among HIV positive individuals.

Objective

This study aimed at determining the prevalence of HBV, HCV, their co-infection with HIV and their effect on liver cell function

Method

This was a cross sectional study conducted at the Joint Clinical Research Centre (JCRC) among HIV positive individuals attending the clinic. Patients were enrolled after obtaining a signed informed consent or assent for children below 17 years. Serum samples were collected for detection of Hepatitis B surface antigen (HBsAg), HCV specific antibodies and alanine aminotransferase (ALT) liver enzyme.

Results

Of the 89 patients enrolled, 20 (22.5%) had at least one hepatitis virus, 15 tested positive for HBsAg (16.9%) and 5 for HCV (5.6%), one had both viruses. Hepatitis B was more prevalent among women (13 out of 57, 22.8%) than men, (2 out of 32, 6.2%), while HCV was higher among men (4 out of 32, 12.5%) than women (1 out of 57, 1.8%). Seven of 89 patients (7.9%) had elevated ALT, indicative of liver cell injury. Of these with liver cell injury, one individual tested positive for HBsAg and another one individual tested positive for HCV specific antibodies.

Conclusion

The prevalence of HBV is high in HIV positive individuals with more women commonly infected. The Prevalence of HCV is lower than that of HBV with more men commonly infected. Co-infection of Hepatitis B and C viruses was uncommon. This study reveals a high prevalence of liver cell injury among HIV positive individuals although the injury due to HBV or HCV infection was lower than that which has been documented. From this study, the high prevalence of HBV and HCV among HIV positive individuals point to a need for screening of HIV positive individuals for the hepatitis viruses.     

Prevalence and genetic diversity of hepatitis B and delta viruses in pregnant women in Gabon: molecular evidence that hepatitis delta virus clade 8 originates from and is endemic in central Africa

Hepatitis B virus (HBV) surface antigen (HBsAg) was found in 9.2% of 1,186 pregnant women from Gabon, of whom 10.1% had the HBe antigen and 89.9% had anti-HBe antibodies. Antibodies to the hepatitis delta virus (HDV) were found in 15.6% of the HBsAg-positive women. The HBV strains were of the A3 and E genotypes. The HDV strains belonged to HDV clades 1 and 8. These results provide clear evidence that HDV clade 8 is indigenous to Africa.     

Increased detection of HBV DNA in HBsAg‐positive and HBsAg‐negative South African HIV/AIDS patients enrolling for highly active antiretroviral therapy at a Tertiary Hospital

This retrospective study investigated the prevalence of hepatitis B virus (HBV) in 192 stored sera from human immunodeficiency virus (HIV) positive South African patients initiating antiretroviral therapy (ART), and explored the implications of HBV–HIV co‐infection on laboratory diagnosis of HBV. HBV serology (HBsAg, anti‐HBs and anti‐HBc) and nested HBV PCR assays targeting the HBV polymerase gene were performed, with HBV DNA positive samples being quantified with Cobas Taqman HBV test 48 assay (Roche Diagnostics). The study found that 63% (121/192) of patients had past or present HBV infection, and 40.6% (78/192) had detectable HBV DNA. Also, 22.9% (44/192) of patients were HBsAg positive and HBV DNA positive, while 23% (34/148) of HBsAG negatives had occult HBV infections. Of the 78 HBV DNA positive samples, 62.8% had viral loads ranging from 10² to ≥10⁸ IU/ml, and 37.2% had HBV viral loads <200 IU/ml. There was a statistically significant positive association between HBsAg‐positivity and high viral loads, with 27% (12/44) of HBsAg positives having HBV viral loads between 10⁴ and ≥10⁸ IU/ml, compared to only 5.9% (2/34) of HBsAg negatives (relative risk: 4.64; 95% confidence interval: 1.11, 19.35; chi‐square P‐value = 0.015). The study shows that the majority of HIV/AIDS patients initiating ART have either acute or chronic HBV infections, and further confirms that HIV remains a risk factor for occult HBV infections in South African patients as previously shown. The findings strongly support HBV screening in all HIV‐positive patients initiating ART in South Africa, considering that current ART regimens include drugs with anti‐HBV activity (e.g., lamivudine). J. Med. Virol. 81:406–412, 2009. © 2009 Wiley‐Liss, Inc.     

A study on the perinatal transmission of the hepatitis B virus

The purpose of this study was to determine the age wise prevalence of Hepatitis B virus (HBV) in children under five years and to analyze the relative importance of horizontal or vertical transmission. This study included 400 children in the age group of less than five years attending the outpatient department of pediatrics with minor complaints. History of HBV immunization was taken as the exclusion criteria. All the samples were tested for Hepatitis B surface antigen (HBsAg) and anti HBs using commercial ELISA kits. Liver function tests were performed on all the HBsAg positive patients. Hepatits B nucleocapsid antigen (HBeAg) was detected in few HBsAg positive mothers. Overall HBsAg positivity in children below five years was 2.25%. There was no statistically significant difference in HBsAg positivity in the different age groups by chi square test. HBsAg positivity in mothers was 4.25%. However only in three cases the pair of mother and child were both positive for HBsAg. The mean anti HBs positivity in children was 23.75%. There was no statistically significant difference in the anti HBs positivity in different age groups of children. The observation that there is no statistically significant difference in the prevalence of HBV infection (HBsAg and HBs) amongst different age groups of children below five years signifies that a large proportion of HBV infection in children of this age is acquired via vertical transmission. It is also indicated that this mode of disease transmission is responsible for the majority of chronic carriers. Universal immunization of all infants is desirable to decrease the carrier pool and it is inferred from the present study that Hepatitis B immunization should begin at birth to have greater impact.     

A low rate of hepatitis B virus vaccine breakthrough infections in Mongolia

A nation-wide hepatitis B virus (HBV) immunization program of all newborn babies was launched in Mongolia in 1991. However, the continuation of clinical icteric viral hepatitis infections in children led to the investigation to determine whether HBV breakthrough infections were occurring and if any were due to hepatitis B surface antigen (HBsAg) mutants. Hepatitis A virus (HAV) infections accounted for most of these cases with 3% of the jaundiced children shown to have acute hepatitis B. Hepatitis B vaccine protection was 93% against HBV infection and 97% against HBV carriage. A G145A "escape mutant" was found in one HBV carrier child only. Anti-HBs levels, however, were low with 85% having titers less than 100 IU/L, 46% of whom had levels less than 10 IU/L. The results from this study demonstrate that the HBV immunization program in Mongolia provides an effective level of protection. However, continued surveillance of breakthrough infections and close monitoring of "vaccine escape" mutants is required.     

Preimmunization epidemiology of hepatitis B virus infection in South African children.

The prevalence of hepatitis B surface antigen (HBsAg) was determined in a community-based, cross-sectional, age-stratified sample of children from 0 to 6 years of age (n = 2,299) from the Eastern Cape Province of South Africa. The purpose of the study was to investigate the epidemiology and the age of acquisition of hepatitis B virus (HBV) infection in children, thus providing a preimmunization baseline measure of this infection in the population targeted for HBV immunization in South Africa. Overall, 10.4% (95% CI, 9.2-11.7) of the children tested were HBsAg-positive. There was a high rate of positivity in the 0-6- and 7-12-month age groups at 8.1% (95% CI, 5.5-11.7) and 8.9% (95% CI, 6.1-12.7), respectively, suggesting a higher rate of early acquisition of this infection than previously reported in South Africa. The proportion of HBsAg-positive children increased significantly with increasing age (chi2trend = 5.9, df = 1, P = 0.02), reaching 15.7% in the 61-72-month age group. This is the highest rate of HBV infection reported in community-based children from South Africa, indicating a significant burden of this infection. The difference in HBsAg prevalence between urban and rural children was not statistically significant (chi2 = 0.32, df = 1, P = 0.57). There was also no difference in positivity between males (10.5%; 95% CI, 8.7-12.5) and females (9.8%; 95% CI, 8.1-11.7), (chi2 = 0.006, df = 1, P = 0.94). This study provides the most recent preimmunization, community-based baseline investigation of the epidemiology of HBV infection in children targeted for universal immunization in South Africa.     

Primary hepatocellular carcinoma and hepatitis B virus infection in korea

Serological evidence of hepatitis B virus (HBV) infection and serum alphafetoprotein (AFP) were assayed in sera from 112 Korean patients with primary hepatocellular carcinoma (PHC) and from 63 age- and sex-matched controls. Serological evidence of HBV infection was found in 100% of PHC patients and in 97% of controls. The majority of PHC patients (87%) were positive for hepatitis B surface antigen (HBsAg). In contrast, only 14% of control individuals were positive for HBsAg, but 82% were positive for antibody to HBsAg (anti-HBs). Hepatitis B e antigen (HBeAg) was detected in a high percentage (38%) of HBsAg-positive PHC patients, but in none of the nine HBsAg-positive control individuals. Serum AFP was detectable in 83% of PHC patients but in only one of 63 controls (1.5%). These results document that HBV infection may be the mjor factor in the development of PHC in this country.     

Characterization of Hepatitis Delta Virus in Sub-Saharan Africa

Hepatitis D virus (HDV) is a satellite of hepatitis B virus (HBV), and infection with this virus aggravates acute and chronic liver disease. While HBV seroprevalence is very high across sub-Saharan Africa, much less is known about HDV in the region. In this study, almost 2,300 blood serum samples from Burkina Faso (n = 1,131), Nigeria (n = 974), Chad (n = 50), and the Central African Republic (n = 118) were screened for HBV and HDV. Among 743 HBsAg-positive serum samples, 74 were positive for HDV antibodies and/or HDV RNA, with considerable differences in prevalence, ranging from <2% (pregnant women from Burkina Faso) to 50% (liver patients from Central African Republic). HDV seems to be much more common in chronic liver disease patients in the Central African Republic (CAR) than in similar cohorts in Nigeria. In a large nested mother-child cohort in Burkina Faso, the prevalence of HDV antibodies was 10 times higher in the children than in their mothers, despite similar HBsAg prevalences, excluding vertical transmission as an important route of infection. The genotyping of 16 full-length and 8 partial HDV strains revealed clade 1 (17/24) in three of the four countries, while clades 5 (5/24) and 6 (2/24) were, at least in this study, confined to Central Nigeria. On the amino acid level, almost all our clade 1 strains exhibited a serine at position 202 in the hepatitis D antigen, supporting the hypothesis of an ancient African HDV-1 subgroup. Further studies are required to understand the public health significance of the highly varied HDV prevalences in different cohorts and countries in sub-Saharan Africa.