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49 S96 S102 Moucari, R., Lada, O., Marcellin, P.: Chronic hepatitis B: back to the future with HBsAg. Expert Rev. Anti Infect. Ther

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Hungarian Medical Journal
Authors: Oche O. Agbaji, Nimzing G. Ladep, Patricia Agaba, Bitrus P. Badung, Monday L. Danung, Godwin Imade, John A. Idoko, Rob Murphy and Phyllis Kanki

Background: There is a rising trend of hepatitis B co-infection among HIV positive individuals and this may negatively impact their morbidity and mortality. This study analyzed HBsAg prevalence, its demographic distribution and relationship to the immunological and viral load status of HIV positive cohort in Jos. Methods: This was a cross-sectional study conducted at the antiretroviral treatment centre in Jos between August 2004 and April 2005. Biodata of 1042 consenting HIV positive patients were obtained. Blood samples obtained from them were tested for hepatitis B surface antigen by Enzyme Linked Immunosorbent Assay. CD4 cell count was done by flow cytometry (Partec, Germany) and viral load by PCR techniques (Roche Amplicor 1.5). The data obtained were analyzed using Epi Info 2004 statistical software. Results: One hundred and sixty seven (16%) of the 1042 patients were reactive to HBsAg. Thirteen (22.4%) of 58 divorced patients had the highest co-infection rate. Ninety-seven (14.2%) out of 681 females were co-infected with hepatitis B, while seventy (19.4%) out of 361 males had the co-infection. Most of the patients at the AIDS stage of the HIV infection were co-infected with hepatitis B. The median HIV viral load of HBsAg-positive patients was higher than that of non-HBV co-infected patients. Conclusion: This study showed a high HBsAg prevalence among our patients with a significant male preponderance. This may have a negative impact on the CD4 recovery and viral load reduction of the patients on treatment.

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Hungarian Medical Journal
Authors: Fazal Karim, Salimur Rahman, Mobin Khan, AKM Khorshed Alam, Nooruddin Ahmed, KMJ Zaki, Mamun-Al-Mahtab and Chitta Ranjan Debnath

Hoofnagle, J. H, Shafritz, D. A., Popper, H.: Chronic type B hepatitis and the healthy HBsAg carrier state. Hepatology, 1987, 7 , 758–763. Popper H. Chronic type B hepatitis and

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Absztrakt:

Világszerte több mint 200 millió, a hepatitis B-vírus felületi antigénre (HBsAg-) pozitív, hepatitis B-vírus (HBV)-hordozó él. Az egészségügyi dolgozók a munkájuk miatt fokozottan ki vannak téve a hepatitis B-fertőzés veszélyének. A fertőzés elkerülésére hatékony védőoltás áll rendelkezésünkre, de sajnos az oltás után bizonyos tényezőktől függően eltérő arányban alakul ki védettség. A rizikónak kitett egészségügyi dolgozóknál ezért az oltottság mellett a védettség ellenőrzése (anti-HBs) is rendkívül fontos. A védőoltásra nonreszpondereket érdemes megpróbálni védetté tenni további alternatív oltási sorokkal. Javaslatunk végén az egészségügyi dolgozók posztexpozíciós profilaxisát is tárgyaljuk a HBV-fertőzés tekintetében. Korábban magyar nyelvű javaslat a jelen témában nem állt rendelkezésre. Orv Hetil. 2019; 160(41): 1607–1616.

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Introduction: Acute hepatitis in pregnancy in not uncommon in Bangladesh. There has been a rise in acute viral E hepatitis in Bangladesh after the 2004 floods. At that time most of the country was under water for more than a month leading to sewerage contamination of water supply. The aim of this study was to see the aetiology of acute hepatitis in pregnant women in the third trimester in Bangladesh. Materials and Methods: In this retrospective study, 31 pregnant women in their third trimester with acute hepatitis were included. Only those patients who presented with prodromal features like icterus, nausea and vomiting, fever and raised serum bilirubin and raised serum transaminase levels were included in this study. They were all previously healthy and came to the Unit from all over Bangladesh. Patients were tested for markers for common hepatotrophic viruses. Relevant history was taken. Patient Record Book of the Unit was reviewed and patients who fulfilled the criteria were included in this retrospective study. Results: 45.16% (14/31) had HEV infection. They were all anti-HEV IgM positive by ELISA. HBV infection was detected in 6.45% (2/31). All these later patients tested positive for either HBsAg or anti-HBs IgM by ELISA. Both anti-HEV IgM and HBsAg were positive in 9.38% (3/31) patients. No viral marker could be detected in 38.7% (12/31) patients. Overall 54.84% (17/31) patients had HEV and 16.12% (5/31) had HBV infection. No patient had history of drug or alcohol intake. Conclusion: Acute viral E hepatitis is the leading cause of acute hepatitis in pregnancy in Bangladesh. Sewerage contamination of water supply following flood contributed to the higher incidence of HEV infections. Hepatitis B virus infection is also important.

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A krónikus hepatitis B-vírus-fertőzés igen jelentős, globális közegészségügyi probléma. Hazánkban a HBsAg-pozitivitás prevalenciája 0,5–0,7%. Kezelés nélkül a fertőzöttek 15–40%-ában fejlődik ki májcirrhosis és/vagy hepatocellularis carcinoma. A kezelés célja a vírusreplikáció megszüntetése vagy csökkentése, amely a májbetegség progressziójának és így a májcirrhosis és a hepatocellularis carcinoma kialakulásának kockázatát is csökkenti. Jelenleg két különböző kezelési stratégia áll rendelkezésre: a határozott idejű interferon- vagy nukleoz(t)idanalóg-kezelés, illetve a hosszú távú nukleoz(t)idanalóg-terápia. A nukleoz(t)idanalóg-csoport két leghatékonyabb, igen kedvező rezisztenciaprofilú, már hazánkban is elérhető képviselője az entecavir és a tenofovir, amelyeket a hazai és a nemzetközi szakmai ajánlások is az interferonkezeléssel egyenrangúként, első választandó kezelési módnak ajánlják. A korábban széles körben alkalmazott lamivudin igen kedvezőtlen rezisztenciaprofilja miatt ma már új kezelésként nem indítható. Hasonlóan nem ajánlott az adefovir sem új kezelés indítására. Lamivudinrezisztencia esetén egyértelműen tenofovirra váltás szükséges, mert ezekben az esetekben az entecavir rezisztenciaprofilja lényegesen kedvezőtlenebb. Terhesség alatt lehetőség szerint kezelést nem végzünk. Ilyenkor az interferon ellenjavallt, azokban az esetekben, amikor a krónikus hepatitis B-vírus-fertőzés kezelése terhesség alatt szükséges, az FDA B osztályba tartozó tenofovir adható. Magas anyai vírustiter esetén a perinatalis átvitel megelőzésére – a kötelező aktív és passzív immunizáláson túl – a harmadik trimeszterben nukleoz(t)idanalóg-kezelés is szükséges lehet, ilyen esetekben is tenofovir választandó. Kemoterápia, immunszuppresszív vagy biológiai kezelés, csontvelő- vagy őssejt-transzplantáció esetén (különösen, ha rituximabot kap a beteg) a krónikus hepatitis B-vírus-fertőzés fellángolása, az okkult hepatitis B-vírus-fertőzés reaktivációja fordulhat elő, ezért minden ilyen kezelés előtt hepatitis B-vírus-szerológiai vizsgálat szükséges. HBsAg-pozitivitás vagy okkult hepatitis B-vírus-fertőzés esetén nukleoz(t)idanalóg-kezelés indokolt. Az alapellátásban és a foglalkozás-egészségügyben dolgozó kollégáknak alapvető szerepük van a hepatitis B-vírus-fertőzés felismerésében, illetve a pre- és posztexpozíciós profilaxisban. A szerző ismerteti a hepatitis B-vírus-fertőzés szempontjából veszélyeztetettek, illetve az immunizálandóak körét, valamint az aktív és passzív immunizálás szabályait. Orv. Hetil., 2013, 154, 1142–1150.

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Acta Microbiologica et Immunologica Hungarica
Authors: Ágnes Dencs, Ágnes Farkas, Mónika Gyugos, Andrea Kurcz, Erzsébet Puskás, B. Tresó, Erzsébet Rusvai, Erzsébet Barcsay and Mária Takács

A nosocomial Hepatitis B virus (HBV) outbreak at a paediatric onco-haematology unit was investigated using molecular biological methods to determine the origin of the infections. The National Reference Laboratory of Hepatitis Viruses received seven HBsAg positive sera from patients and one from the brother of a patient. A fragment of the preS1/preS2/S genes from all samples was amplified, the PCR products were sequenced and a rooted phylogenetic tree was constructed. All nucleotide sequences from the different patients were very similar and 6 of the 8 sequences were identical, suggesting a common origin of the infections. These sequences were closely related to those amplified from a nosocomial HBV epidemic in another hospital in Hungary. The on-scene investigation revealed several malpractices. The two hospital departments had close connections and some of the patients were treated in both institutions. Present report underlines the importance of developing screening protocols for hepatitis viruses and that of the introduction of regular training programs for health care professionals in the field of hospital hygiene.

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Acta Microbiologica et Immunologica Hungarica
Authors: Elaheh Gholami-Parizad, Morovat Taherikalani, Noor-Amir Mozaffar-Sabet, Mahdi Asmar, Skandar Gholami-Parizad, Afra Khosravi, Mohammad Emaneini and Parisa Asadollahi

Hepatitis B virus (HBV) transmission via blood and other body fluids from infected individuals to healthy people has been largely demonstrated. However, in the current literature, there is little information available on the potential role of cerumen in HBV transmission.Cerumen and blood were collected from 70 patients infected with HBV and 70 volunteer healthy people were selected as the control group, and the samples were evaluated by ELISA and Real-time PCR.All the patients proved positive for HBsAg and anti HBc total. Sixty-one of the 70 cerumen samples of cases (82.1%) and 5 (7%) of controls were positive for HBV DNA with ranges from 1.53 × 102 to 2.9 × 108 and 1.3 × 102–2.6 × 105/ml, respectively. In three patients, the level of HBV DNA in cerumen was higher than that in the serums. The patients who were positive for HBeAg showed a higher rate of HBVDNA in the serum and cerumen.The results of this study showed the level of HBV DNA as a probably indicator of high risk transmission factor, which was present in the cerumen of chronic hepatitis B patients in west of Iran.

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Acta Microbiologica et Immunologica Hungarica
Authors: A. Pár, Mária Takács, Judit Brojnás, Gy. Berencsi, Mária Paál, Margit Horányi, A. Miseta, G. Hegedűs, Gy. Mózsik and B. Hunyady

The significance of co-infections with novel hepatitis viruses Hepatitis G (GBV-C, HGV) and TT virus (TTV) in chronic hepatitis C is not clear. We determined the prevalence of HGV RNA and TTV DNA in chronic hepatitis C patients and in asymptomatic hepatitis C virus (HCV) carriers, and assessed the influence of these agents on the course of HCV infection.  Seventy-seven patients with chronic hepatitis C - 50 of them treated with interferon (IFN) - and 33 HCV carriers with normal alanine aminotransferase have been investigated. Previous HBV infection was detected by testing serum HBsAg and aHBc. HGV RNA and TTV DNA were detected by PCR. In the healthy population, the prevalence of anti-HCV was 0.3%, HGV RNA 8.0% and TTV DNA 18.5%. In chronic hepatitis C HGV RNA occurred in 9.09% and TTV DNA in 40.25% of cases. In IFN-treated patients with sustained remission, the frequency of TTV was 20% vs. 45.7% found in non-responders. Among asymptomatic HCV-carriers, the prevalence of HGV RNA was 9.09% and TTV DNA 75.7%. Neither HGV RNA nor TTV DNA had apparent effect on the HCV infection. TTV was detected with the lowest frequency in persons with sustained remission due to IFN, suggesting antiviral effect of IFN on TTV.

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Jaroszewicz, J., Calle Serrano, B., Wursthorn, K. és mtsai: Hepatitis B surface antigen (HBsAg) level in the natural history of hepatitis B virus (HBV) -infection: a European perspective. J. Hepatol., 2010, 52 , 514

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