Hepatitis B and C viruses and hepatocellular carcinoma

Although it is now accepted that both HBV and HCV are carcinogenic in humans, uncertainty still exists as to the exact pathogenetic mechanisms involved. Direct and indirect carcinogenic mechanisms are probable, and there is persuasive evidence that both are involved in HBV-induced HCC. The direct effect of HBV appears to be mediated through insertional mutagenesis, with the transactivating properties of products of the X gene and perhaps a truncated preS/S gene being a likely component. Direct carcinogenicity is less certain in HCV/induced HCC, although indirect evidence does suggest such an effect. The two viruses almost certainly interact in HCC, and each probably interacts with alcohol in inducing chronic hepatic parenchymal disease that in turn is complicated by malignant transformation.     

Hepatitis B and C infection among drug abusers in Nepal

Prevalence of hepatitis B and C virus infection amongst intravenous drug users (IDU) in Nepal is not known. To estimate such prevalence 72 IDU individuals were tested for HBV and HCV markers. About 80% of the drug abusers are both anti-HBc (59/72) and anti-HCV (58/72) sero-positive. However persistent infection with hepatitis B, as indicated by positive HBsAg, was detected in only 5.5% (n = 4). Active hepatitis C infection, as indicated by HCV RNA positivity, was documented in 74% (42/58) of those who were anti-HCV positive. Importance of awareness of this observation among the healthcare workers in the prevention of hepatitis C in the community is stressed.     

Hepatitis B vaccination status among Danish physicians

As part of a nation-wide questionnaire survey among Danish doctors, the incidence of hepatitis B vaccination was studied. For each specialty the findings were related to the risk of hepatitis B exposure assessed by the incidence of percutaneous and mucocutaneous blood exposure (PCE and MCE). A total of 6256 of 9375 doctors (67%) responded and 6005 (64%) questionnaires were eligible for analysis. Only 34.3% of the doctors had been vaccinated against hepatitis B, ranging from 8.9% in Psychiatry to 56.9% in Obstetrics-Gynaecology. The annual incidence of PCE and MCE was high in surgical as well as non-surgical specialties with an average of 3.0 PCE and 3.9 MCE per person. In conclusion all doctors must be considered at risk of exposure to hepatitis B during part of or the entire career. The current level of hepatitis B vaccination is insufficient. Hepatitis B vaccination of all doctors before entering clinical work seems to be indicated.     

Hepatitis G and C viruses respond to interferon-alpha with different virologic kinetics

The aim of this work was to specify the time course of response to interferon (IFN) of hepatitis G virus (HGV) and hepatitis C virus (HCV) in coinfected individuals. A group of 33 patients, undergoing 12 months of IFN therapy for chronic hepatitis C, was screened for the presence of both HGV and HCV RNAs to select seven coinfected patients. Spontaneous recovery from HGV infection was excluded through the detection of antibodies to the envelope-2 protein of HGV and HCV isolates were genotyped. Within three months of treatment, we found that HGV RNA was transiently cleared in 6/7 patients, but the rate of long-term favorable response was very low (1/7). In addition, considering the same individuals separately, it was shown that HGV and HCV responded to IFN with different kinetics in 5/7 patients. Taken together, these results underscore the importance of the virological basis of the resistance to IFN treatment.     

Seroprevalence of hepatitis B and C viruses in eastern Nepal

The seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in 303 serum samples collected from that apparently healthy population inhabitating different areas in eastern Nepal was studied. Samples were collected at Dharan Municipality, Sunsari85), Pancha Kanya Village Development Committee, Ilam86), Dhankuta Hile, Dhankuta82) and Basantapur Village Development Committee, Tehrathm50). HBsAg and anti-HBsAg antibody was screened by reverse passive haemagglutination (RPHA) and passive haemagglutination (PHA) respectively and positivity was confirmed by enzyme linked immunosorbent assay (ELISA). Anti-HCV antibody was detected by ELISA. None of the samples were positive for HBsAg. Anti-HBsAg antibody was positive in 1.9% (6/303). The positive rate increased with age reaching 25% positivity among the elderly. The anti-HBsAg antibody positivity was 2.35, 2.32, 1.22 and 2.00 in Dharan, Ilam, Dhankuta and Tehrathum respectively Anti-HCV antibody was detected only in one sample (15-year-old boy) collected in Dharan. These findings indicate that the HBV and HCV infections are not active in eastern Nepal.     

Hepatitis B immunization and exposure to blood among surgical staff

A questionnaire was sent to all 158 staff of the operating department of a London teaching hospital to confirm their hepatitis B immunization status and establish the number of incidents involving exposure to blood during the preceding 4 weeks. Of these personnel, 104 (66 per cent) were known to be immune to hepatitis B either through immunization (97) or previous infection (seven). A further 23 (15 per cent) had completed a course of immunization but their seroconversion had not been checked. There were 26 sharps injuries sustained by 14 (12 per cent) of 119 staff and 240 other exposures to blood. Four of the sharps injuries had been reported. Staff known to be immune were more likely than those with unknown or negative immunity to report incidents (20 versus 0 per cent (95 per cent confidence interval of difference 2-38 per cent)). Doctors sustained more non-sharps exposures to blood than others (47 versus 23 per cent (95 per cent confidence interval of difference 7-40 per cent)). An important minority of operating department staff remains unimmunized against hepatitis B, although exposure to blood is common. Incidents are rarely reported and staff with unknown or negative immunity seem less likely to report than those known to be immune.     

Hepatitis C virus infection among cryoglobulinemic and non-cryoglobulinemic B-cell non-Hodgkin's lymphomas

BACKGROUND AND OBJECTIVE: Since hepatitis C virus (HCV) infection has been associated with different histotypes of B-cell non-Hodgkin's lymphoma (NHL), with or without concomitant production of cryoglobulins (cryolg), we have investigated the prevalence of the infection among NHL with the aim of defining its relationship with the histotype and with the production of cryolg. METHODS: Four-hundred and seventy unselected, consecutive patients with a diagnosis of B-cell NHL were investigated. Anti-HCV antibodies (Ab) and cryolg were sought in all while HCV RNA and rheumatoid factor were detected on HCV-Ab positive samples. RESULTS: Overall, the prevalence of HCV infection was 8.9% (42/470). It was 95.4% (#21) among the 22 patients with, and 4.6% (#21) among the 448 without production of cryoIg. The most common histotype among the HCV-positive, cryoIg-producing cases, was the immunocytoma (16/21, 76%). Among the HCV-positive, non cryoIg-producing cases, the marginal zone and the follicle center lymphomas were the commonest. INTERPRETATION AND CONCLUSIONS: Close association between HCV infection and cryoIg production, already described in mixed cryoglobulinemia, is confirmed also among B-cell NHL. Nevertheless, 50% of HCV-related lymphomas are non-cryoIg producers. Low-grade lymphomas (in particular the immunocytoma) are the most frequent HCV-related lymphomas. Since new therapeutic strategies might be necessary if the virus is detected, screening for cryoIg and for HCV-Ab among B-cell NHL at diagnosis is mandatory.     

Hepatitis B and C virus infections in Turkish children with haemophilia

We examined 41 Turkish children with haemophilia for evidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections using the enzyme-linked immunosorbent assay (ELISA). Hepatitis B surface antigen was found to be positive in 11 patients (26.8%) and HCV-specific antibody (anti-HCV) was detected in 10 (24.4%) patients. There was a close relationship of the number of transfusions of blood plasma to the presence of HCV specific antibody, but not to the serum markers of HBV infection. In countries where HBV infection is commonly seen and problems in transfusion practice continue, as in Turkey, children with haemophilia are at greater risk for HBV and HCV infections.     

Prevalence of hepatitis B and C viruses in healthy Indonesian blood donors

Blood samples were collected from 7572 healthy volunteer blood donors from 21 of the 27 Indonesian provinces, and tested for antibodies to hepatitis C virus (anti-HCV) using the new second-generation enzyme immunosorbent assay, and also tested for hepatitis B surface antigen (HBsAg). We detected anti-HCV in 2.1% of the blood donors. No statistically significant difference was found between males and females or between locations, but there was a statistically significant increasing likelihood of anti-HCV prevalence with increasing age. HBsAg was found in 8.8% of the 3839 tested donors. There was no statistically significant difference between sexes or age groups, but there was a statistically significant higher prevalence in the islands of Sulawesi and eastern Indonesia. Only 7 individuals, from 5 locations, were both anti-HCV and HBsAg positive. Based on responses to a questionnaire, a history of surgery, blood transfusion, intravenous medication, and acupuncture were identified as risk factors for the presence of anti-HCV. No such risk factor was identified for HBsAg prevalence. The combined data suggest separate modes of transmission for the 2 viruses, and indicate the need for continued surveillance for these agents in Indonesian blood banks.     

Hepatitis B and C virus infections in children with congenital coagulation disorders

The prevalence of hepatitis B and C virus infections, transmitted by blood transfusions, was studied in 79 children with congenital coagulation disorders. Twenty nine percent had evidences of hepatitis B virus infection and 52% evidences of hepatitis C virus infection. Older children and those with the higher number of transfusions had the highest rates of infections. It is concluded that children with congenital coagulation disorders constitute a high risk group for hepatitis B and C virus infections.