Frequency of detecting viral hepatitis B markers in the patients of a hemodialysis ward

The data, obtained as the result of the examination of 22 patients with chronic renal insufficiency and analysis of 105 samples of transfusion blood at the department of chronic hemodialysis, are presented. To detect the markers of hepatitis B (HBsAg, anti-HBs, anti-HBc), a complex of biochemical investigations was carried out with the use of counter-current immunoelectrophoresis, the passive hemagglutination test, enzyme immunoassay, and solid-phase radioimmunoassay. The markers of hepatitis B were detected in 72.6% of patients with chronic renal insufficiency and in 21% of healthy persons. Changes in the activity of biochemical characteristics of hepatic samples were detected only in one patient. In no case clinical symptoms of the disease were observed. Out of 105 samples of transfusion blood, 9.5% contained HBsAg. The results of our investigations indicate that the markers of hepatitis B are widely spread among patients with chronic renal insufficiency, which makes it possible to consider them as a "high risk group" with respect to hepatitis B infection. To decrease the risk of hepatitis B among patients with chronic renal insufficiency, it is very important that highly sensitive tests be introduced into practice for the selection of donors and the detection of patients with the asymptomatic forms of hepatitis B and carriers at the department of chronic hemodialysis.     

Prevalence of hepatitis B viral markers in Vietnamese blood donors

Serum samples were assayed using radioimmunoassay in 573 Vietnamese blood donors living in Hano? (North Viet Nam). 66 (11.5%) subjects were HBsAg-positive. Of these 66 HBsAg carriers, 17 (25,8%) were positive for hepatitis B e antigen (HBeAg) and 43 (65.1%) for antibody to HBeAg (anti-HBe). 22 (3.8%) subjects were positive for antibody to hepatitis B core antigen (anti-HBc) alone. 402 (70.2%) subjects were positive for antibody to HBsAg (anti-HBs). This anti-HBs percentage increased with age. Only 83 (14.5%) subjects were negative for all hepatitis B viral (HBV) markers. This no HBV markers percentage decreased with age. The chi 2 test showed a non significant difference for frequencies of HBsAg, anti-HBc alone, anti-HBs but a significant one for frequencies of no HBV markers in men and women.     

Detection of Epstein-Barr viral antibodies in patients with acute viral hepatitis

Serum samples obtained from 44 patients with virus A hepatitis, 23 patients with virus B hepatitis, 65 patients with virus non A, non B hepatitis and 100 healthy adults were studied for the presence of Epstein-Barr (EB) virus in the indirect immunofluorescence test. In this work lymphoblastoid cell lines PH3-J-1 and CN37 were used. Among patients with different forms of hepatitis, the statistically significant elevation of the titers of antibodies to EB virus was detected only in the group of patients with virus non A, non B hepatitis, and in 6 cases the etiological role of EB virus was confirmed by serological and hematological methods.     

Immunoglobulin level in viral hepatitis patients]

The results of studying the dynamics of serum immunoglobulins in patients with viral hepatitis varying in severity are presented. At the acute stage of the disease pronounced shifts in the content of all the three classes of immunoglobulins were found to occur in the patients irrespective of their age. Higher levels of IgM detected in women seem to be due to the physiological peculiarities of the female organism. Gamma globulin prophylaxis, when carried out at the incubation period, has been shown to exert a negative influence on humoral immunity.     

The rate of detection of hepatitis B markers in persons with chronic alcoholism

A total of 707 males suffering from chronic alcoholism and 447 male donors not abusing alcohol have been surveyed in different regions of the USSR. The presence of HBsAg, as well as anti-HBs and anti-HBc antibodies, has been determined by the enzyme immunoassay. The survey has revealed a high rate of hepatitis B virus infection in chronic alcoholics in comparison with the control group, which gives grounds for including such persons into a high risk group with respect to viral hepatitis B infection.     

Study of serological and biological markers in viral hepatitis. 157 hemophiliacs

We observed for a two years period 157 hemophiliacs (138 with hemophilia A whose 13 were severe and 19 with hemophilia B whose 13 were severe) and we studied the incidence of liver dysfunction and the role played by HB and non-A, non-B, viruses. Whereas 32 patients not related had no evidence of serological HB virus markers (by radioimmunoassay), 88 (70,4 %) among the 135 hemophiliacs with large or small exposure to blood products were "HB positive". 90,9 % were positive for anti-HBs and anti-HBc antibodies and only two patients had persistent antigenemia. These results appeared independent of the kind of treatment (factor VIII or factor IX concentrates). Six among 17 children born since 1974, when the antigen was detected by RIA, had the serological HB virus markers, showing that this method is not sufficient to completely eliminate the HB virus. However the amount of viruses injected is too small to induce an acute hepatitis and rather produces specific antibodies which protect hemophiliacs against reinfection. An elevated level of serum transaminases (SGPT) was observed in 9,4 % of non treated hemophiliacs, 15,1 % of treated hemophiliacs with no serological markers of HB virus and 27,7 % of treated hemophiliacs "HB positive". This shows that the use of concentrates and the occurring of HB virus in the patients are not the only factors producing liver dysfunction. The role of non-A, non-B viruses has been recognized in 7 patients out of 9 with transient elevation of serum transaminase levels, by Trepo with an immunodiffusion technique.     

The immune response of viral hepatitis patients who use narcotic preparations

The characteristics of cell-mediated and humoral immunity were studied in 611 patients with different etiological forms of acute virus hepatitides (HB, HC, HB + C, HC + HBsAg). As the result of the systematic abuse of psychoactive preparations, introduced by intravenous injection, in 166 patients (27.2%) drug addiction developed, ehile 445 (72.8%) patients had no addiction. The study revealed that in drug users with HB the secondary T-cell immunodeficiency of the hyposuppressor type in combination with depression in B-cell-mediated immunity (a decrease in the absolute number of B lymphocytes) could be registered, and in patients having no drug addiction the secondary T-cell immunodeficiency characterized by a decrease in the content of T helpers simultaneously with the increased content of T suppressors and B lymphocytes.     

Immunopathogenesis of viral hepatitis C. Immunological markers of the disease progression

Results of studies of immune response during hepatitis C virus (HCV) infection were reviewed in order to reveal immunologic markers of the disease progression. Genetic heterogeneity of HCV and immunogenetic features of the host determine heterogeneity of immune response to the virus and differences in the course of the disease and outcomes. Spontaneous elimination of HCV-infection in acute phase occurs due to vigorous and sustained multispecific Th1-response toviral antigens. During such response proliferation of virus-specific CD4+ T-cells and secretion of IFN-gamma by them are observed, otherwise chronic hepatitis develops. Great importance in persistence of HCV as well as in quantitative and functional suppression of HCV-specific CD8+ T-cells has increased number of CD4+ CD25+ regulatory T-cells. Cellular immune response plays a key role not only in the elimination of HCV, but also in liver pathology associated with HCV-infection. Progression of the process and shift to its chronic form are also associated with decrease of production of IFN-gamma, alpha, IL-2 by peripheral blood mononuclear cells and increase of TNF-alpha, IFN-gamma, IL-4, IL-2r levels in blood serum.     

The prevalence of regulatory T cells in lymphoid tissue is correlated with viral load in HIV-infected patients

Inadequate local cell-mediated immunity appears crucial for the establishment of chronic HIV infection. Accumulation of regulatory T cells (Treg) at the site of HIV replication, the lymphoid organs, may influence the outcome of HIV infection. Our data provide the first evidence that chronic HIV infection changes Treg tissue distribution. Several molecules characteristics of Treg (FoxP3, CTLA-4, glucocorticoid-induced TNFR family-related receptor, and CD25) were expressed more in tonsils of untreated patients compared with antiretroviral-treated patients. Importantly, most FoxP3+ cells expressed CTLA-4, but not CD69. Furthermore, a direct correlation between FoxP3 levels and viral load was evident. In contrast, FoxP3 expression was decreased in circulating T cells from untreated patients, but normalized after initiation of treatment. Functional markers of Treg activity (indoleamine 2,3-dioxygenase, TGF-beta, and CD80) were markedly increased in the tonsils of untreated patients. Our data could provide a new basis for immune-based therapies that counteract in vivo Treg and thereby reinforce appropriate antiviral immunity.     

Liver stiffness measurement and biochemical markers in Senegalese chronic hepatitis B patients with normal ALT and high viral load

Background and Aims

Despite the high prevalence of chronic hepatitis B (CHB) in Africa, few studies have been performed among African patients. We sought to evaluate liver stiffness measurement by FibroScan® (LSM) and two biochemical scores (FibroTest®, Fibrometer®) to diagnose liver fibrosis in Senegalese CHB patients with HBV plasma DNA load ≥3.2 log₁₀ IU/mL and normal alanine aminotransferase (ALT) values.

Methods

LSM and liver fibrosis biochemical markers were performed on 225 consecutive HBV infected Senegalese patients with high viral load. Patients with an LSM range between 7 and 13 kPa underwent liver biopsy (LB). Two experienced liver pathologists performed histological grading using Metavir and Ishak scoring.

Results

225 patients were evaluated (84% male) and LB was performed in 69 patients, showing F2 and F3 fibrosis in 17% and 10% respectively. In these patients with a 7–13 kPa range of LSM, accuracy for diagnosis of significant fibrosis according to LB was unsatisfactory for all non-invasive markers with AUROCs below 0.70. For patients with LSM values below 7 kPa, FibroTest® (FT), and Fibrometer® (FM) using the cut-offs recommended by the test promoters suggested a fibrosis in 18% of cases for FT (8% severe fibrosis) and 8% for FM. For patients with LSM values greater than 13 kPa, FT, FM suggested a possible fibrosis in 73% and 70%, respectively.

Conclusion

In highly replicative HBV-infected African patients with normal ALT and LSM value below 13 kPa, FibroScan®, FibroTest® or Fibrometer® were unsuitable to predict the histological liver status of fibrosis.     

The epidemiological differential diagnostic signs of viral hepatitis A and viral hepatitis E]

A retrospective epidemiologic analysis of cases diagnosed as hepatitis A (HA) has been made in territories characterized by high intensity (4 towns in Central Asia) and low intensity (Novomoskovsk, Tula Province) of the epidemic process development. Morbidity structures for different age and social groups of the population, as well as the morbidity time course, both annual and over many years, were analyzed over 1973-1986. Specific features in the development of the epidemic process in HA and hepatitis E (HE), formerly called hepatitis non-A, non-B with the fecal/oral mechanism of the infection transmission, were studied. Twelve epidemiological differential diagnostic signs of these two infections were formulated, classified, and validated. Contribution of centralized water supply and sewage systems to the development of HE epidemic process and the regulating role of infectious immunological mechanisms in the development of HA epidemic process were demonstrated.     

The role of viral mutation in the pathogenesis of chronic viral hepatitis

The quasispecies nature of hepatitis B and C virus (HBV, HCV) plays an important role in the pathogenesis, immune escape and drug resistance during chronic infection. Although there is still a lack of effective treatment for hepatitis C, a series of nucleoside analogs (NA) have been developed for the treatment of hepatitis B. NA resistant HBV mutants can accumulate during prolonged therapy and lead to the failure of anti-HBV therapy. Switching to other sensitive NAs can inhibit the emerged resistant mutants. Therefore, understanding the evolution of viral quasispecies under drug pressure is crucial for the establishment of antiviral strategy and the monitoring of antiviral process. Immune response and escape are complicated process, during which both host and virus factors may play their roles. Further understanding of the interaction and interrelationship between host and these viruses may lead to optimized prevention, diagnosis and treatment for chronic hepatitis.