Seroprevalence of anti-HEV and HEV RNA among volunteer blood donors and patients with Hepatitis B and C in Iran

Aim: To assess seroprevalence of antibodies to hepatitis E virus (HEV) in healthy blood donors and hepatitis B, C patients. Methods: 450 subjects consisted of 200 blood donors in Tehran blood transfusion center, 100 subjects with hepatitis C and 150 subjects with hepatitis B infection enrolled in this study. The A549 cell line was grown in mixed medium. Cells were infected with hepatitis E virus that was purified from stool sample of a patient confirmed for hepatitis E infection by reverse transcription-polymerase chain reaction (RT-PCR) method. Supernatant of infected cells was used as positive control in our RT- PCR assay. Results: In a total of 450 subjects, 33 (7.3%) had positive anti-HEV by enzyme-linked immunosorbent assay (ELISA). Anti-HEV was seen in (9/200) 4.5%, (7/100) 7%, and (17/150) 11.3% of healthy blood donors, hepatitis C, and hepatitis B subjects, respectively. Difference between two groups was statistically significance (P = 0.028). Difference between frequency of anti-HEV in hepatitis B in relation to healthy blood donors was significant (P = 0.014). Conclusions: HEV infection is more common in subjects with hepatitis B. Keywords: Hepatitis E virus, Seroprevalence, Transmission, Iran doi: 10.3329/blj.v1i1.2623 Bangladesh Liver Journal Vol.1(1) 2009 p.34-37

Chronic microbial infections: Manipulation of host immunity as interventional approach

Chronic viral infections represent major challenges in contemporary medicine, virology and pharmacology. The virus-bearing hosts are commonly found in every parts of the world and it is extremely difficult to manage these patients. In addition, considerable numbers of these patients develop progressive diseases and severe complications. Finally, most of these patients act as permanent reservoirs of virus. Understandings of viral life cycle during the last decade of 20th century and the first decade of 21st century have allowed development of hundreds of antiviral agents for different diseases. But, the clinical efficacy of these drugs is not yet satisfactory. In addition, virologists have provided conclusive evidences suggesting that eradication of most chronic virus from infected hosts may an unachievable goal. In this context, it is essential to develop alternative, novel, and evidence-based therapeutic maneuver for these patients. Manipulation of host immune system may be one of these approaches. We would discuss about scopes, limitations, and strategies for manipulation for controlling of chronic viral infections. The primary function of the host's immune system is to mount responses that protect the individual from various microbial infections including viruses. Host's immune responses also control the spread and virulence of the viruses [1]. This is applicable to viruses that cause acute infection. After entering the hosts, these viruses are localized in host's tissues, proliferate and induce antiviral immunity. These cellular events may cause damage and destruction of tissues and the host exhibit features of acute inflammatory diseases. However, the viruses are either almost completely eliminated from the hosts or adequately controlled in situ by host's immune systems. However, chronic infection is established by many viruses because the hosts induce improper and uncoordinated immune responses against these viruses. Most viruses cause persistent infection by evading the host immune surveillance mechanism. Both virus-related factors and host-dependent factors are primarily responsible for viral persistency in subjects with chronic viral infections. doi: 10.3329/blj.v1i1.2620 Bangladesh Liver Journal Vol.1(1) 2009 p.13-19

Seroprevalence of Hepatitis C Virus in HIV/AIDS Patients in Jos, Nigeria

Introduction: Hepatitis C Virus (HCV) infection is a life threatening infection and is more serious in people living with HIV/AIDS (PLWHA). It leads to liver damage more quickly and may also affect the treatment of HIV infection. This study was aimed at determining the seroprevalence of HCV, possible risk factors for HCV infection and highlighting the importance of HCV screening in PLWHA in Jos, Nigeria. Materials and Methods: One hundred and eighty two blood samples were collected from confirmed HIVpositive patients attending clinics at the Faith Alive Hospital in Jos for the detection of anti-hepatitis C antibodies. An enzyme linked immunosorbent assay (ELISA), DIALABTM HCV Ab test kit (DIALAB GmbH, Australia) was used for the analysis. Results: Sixty one of the 182 samples tested positive giving a co-infection rate of 33.9%. Old age and low educational levels of the patients were found to be associated with HCV/HIV co-infection (P<0.05). However, the patient's occupation and marital status and the possible risk factors analyzed which included: histories of blood transfusion, sexually transmitted infection (STIs) apart from HIV, surgery, multiple sex partners and injecting drug use were not associated with HCV infection (P>0.05) for the subjects screened. Also, the CD4 cell count ranges of patients and the use of antiretroviral therapy were not associated with HCV infection (P>0.05). Conclusion: The high HCV/HIV co-infection rate observed indicates a possible increase in the development of chronic liver diseases and hepatocellular carcinoma in these patients. Therefore, increasing education on HCV infection and routine screening of HIV patients for anti-HCV antibodies is critical. Key words: Hepatitis C virus, people living with HIV/AIDS (PLWHA), anti-hepatitis C antibodies, chronic liver diseases, hepatocellular carcinoma. doi: 10.3329/blj.v1i1.2622 Bangladesh Liver Journal Vol.1(1) 2009 p.28-33

Cirrhosis of liver with third trimester of pregnancy: First report of two cases from Bangladesh

Pregnancy is uncommon in cirrhosis. This is however not related to the aetiology of cirrhosis and rather results from hepatic dysfunction, reduced hepatic blood flow and reduced end organ sensitivity to sex hormones in these patients. Pregnancy in cirrhosis is associated with high incidence of foetal loss as well as higher maternal mortality both during pregnancy and in the post-partum period. Here we report two cases of cirrhosis of liver with third trimester of pregnancy for the first time from Bangladesh. doi: 10.3329/blj.v1i1.2626 Bangladesh Liver Journal Vol.1(1) 2009 p.51-54

Seroprevalence of HBsAg among blood donar’s in Sher-E-Bangla Medical College, Barisal

Hepatitis B virus infection is a global health problem. About 350 to 400 million people are chronically infected with hepatitis B in the world. This is a retrospective study carried out in the department of transfusion medicine, Sher- E-Bangla Medical College Hospital, Barisal, during the period 1st January to 31st December 2007, among the blood donors who attended for blood donation. During this period 12,914 patients attended the department for transfusion. Among them 12,014 were male and 900 were female, age range was 18 to 60 years. Among them professional donors were 955, voluntary donors were 4494 and replacement donors were 7556 and HBsAg was positive in 0.42%, 0.87% and 1.11% respectively. Overall prevalence was 0.98%. The aim of this study was to determine the prevalence of HBsAg among blood donors at Sher-E-Bangla Medical College, Barisal. Blood samples were collected from 12914 healthy donors. All donors were pre-screened by a questionnaire provided by the institution and passed the physical examination conducted by the medical officer in charge. Blood donors data and results of HBsAg were analyzed using the blood bank's records. There was an overall prevalence of 0.98% of HBsAg(+) among all the tested blood donors. There was statistically significant difference between sexes. These results stress the importance of screening programs that must be implemented. doi: 10.3329/blj.v1i1.2624 Bangladesh Liver Journal Vol.1(1) 2009 p.38-40

Guideline for treating hepatitis B virus infection in Bangladesh

Over 350 million people worldwide are infected with Hepatitis B virus (HBV) and globally around 1 million die due to consequences of this infection annually. Bangladesh belongs to the intermediate prevalence region for HBV infection. Here the lifetime risk of acquiring HBV is between 20-60%. Studies from our as well as other groups have shown that HBV is responsible for 31.25% cases of acute hepatitis, 76.3% cases of chronic hepatitis, 61.15% cases of cirrhosis of liver and 33.3% cases of hepatocellular carcinoma (HCC) in Bangladesh. doi: 10.3329/blj.v1i1.2619 Bangladesh Liver Journal Vol.1(1) 2009 p.6-12

Characterization of incidentally detected asymptomatic hepatitis B positive subjects in Egypt

Background: Although chronic hepatitis B virus infection is relatively common in Egypt, the incidental discovery of asymptomatic forms have not been well studied. Aim: To characterize the clinical, serological and histological liver damage among incidentally detected asymptomatic hepatitis B surface antigen (HBsAg)-positive subjects (IDAHS) in Egypt. Methods:We prospectively studied 70 consecutive IDAHS patients. Tests for liver function, serological markers for HBV, HCV, HDV and schistosomiasis were performed for all patients. HBV DNA was determined by the branched DNA technique and PCR. Liver biopsy specimens from 44 patients were studied and scored for activity and fibrosis stage by modified Knodell score and the METAVIR score. HBsAg and HBcAg were immunohistochemically evaluated in the liver tissue. Results: Of the studied 70 patients, 57 (81.6%) were HBeAg-negative and 13 (18.4%) were HBeAg-positive. Hepatic transaminases in HBeAg-positive patients were significantly elevated when compared to HBeAg-negative patients. HBV DNA was detected in only 3% of patients by the b-DNA technique and in 97% by PCR. Pathological examination of liver tissue revealed mild activity in 21 (47.7%) patients. Additionally, 21 patients (47.7%) revealed mild to moderate expansion of portal areas by fibrosis while 7 patients (15.9%) of them showed bridging fibrosis. None of the patients were cirrhotic. Conclusion: The majority of IDAHS subjects are HBeAg negative without elevation of hepatic transaminases. However, they should be considered as patients since viremia is detected in almost all cases using PCR technique, and histopathological evidence of chronic hepatitis B virus infection is present in varying degrees. Key words: Asymptomatic hepatitis B, histopathology, Modified Knodell, METAVIR. doi: 10.3329/blj.v1i1.2621 Bangladesh Liver Journal Vol.1(1) 2009 p20-27

Dyslipidemia, C-reactive protein and leptin levels in non diabetic obese subjects

Introduction: The objective of the study is to find the relationship of obesity with dyslipidemia and Leptin levels. Material and Methods: The study was carried out in the Department of clinical Biochemistry, Bangalore Medical College. Cases and controls were chosen from the subjects attending the out patient department of Victoria hospital for their routine check up.The protocol of the study was to study and compare the linear relationship of obesity, dyslipidemia, CRP and Leptin levels is Non Diabetic obese persons to Non Diabetic persons with normal weight. The protocol was based on inclusion and exclusion criteria and is approved by local ethical committee Serum samples were stored at -200C for estimation of Leptin and CRP levels. The samples were thawed on one stretch for the estimation. Leptin was analyzed by DRG Leptin sand witch ELISA method by using kit from DRG Company. Results: About 8.0% of patients had elevated Total cholesterol in normal subjects when compared to 84.0% in Obese subjects, indicates that patients with obesity are 60.37 times more likely to have elevated Total cholesterol (>200 mg/dl) when compared to Normal. Patients with obesity (98.0%) are 46.23 times more likely to have elevated Triglycerides when compared to normal subjects (52.0%). Subjects in Obese groups, 76.0% had decreased HDL when compared to only 12.0% on Normal group, which 8.14 times more likely in obsess group. Subjects with obesity (80.0%) are 29.33 times more likely to have elevated LDL (>150 mg/dl) when compared to Normal subjects (12.0%). The elevated VLDL is 21.0 times more likely in obese subjects (84.0%) when compared to normal subjects (20.0%). Subjects in obese are 46.58 times more likely to have elevated LP (a) when compared to normal subjects. Conclusions: Present study has shown a strong link between obesity, dislipidemia and cardiovascular disease in accordance with other studies. The role of Leptin associated with cardiovascular disease is not well established, so prospective study should be carried out to elucidate the role of Leptin in cardio vascular disease and Diabetes to establish its role as, whether it is causative, additive risk factor or a protective factor. Leptin may play a role to prevent metabolic syndrome by its interaction with neuroendocrine systems to maintain metabolic homeostasis, similar to the role played by Insulin in homeostasis of blood sugar level. doi: 10.3329/blj.v1i1.2625 Bangladesh Liver Journal Vol.1(1) 2009 p.41-50

Case Report of Autoimmune Hepatitis from a Tertiary Centre in Bangladesh

Autoimmune hepatitis is defined as chronic liver disease of unknown aetiology with aberrant autoreactivity and genetic predisposition, characterized by female predominance, circulating auto-antibodies, hypergammaglobulinaemia and association with HLA DR3 and HLA DR4 [1]. We present two patients with autoimmune. The first patient is a young lady who was diagnosed with autoimmune chronic hepatitis. The second patient, on the other hand, is an elderly gentleman who presented to us with autoimmune hepatitis related decompensated cirrhosis of liver. doi: 10.3329/blj.v1i1.2652 Bangladesh Liver Journal Vol.1(1) 2009 p.53-54

Editorial

Bangladesh Liver Journal Vol.1(1) 2009 p.5