Evaluation of hepatitis E antigen kinetics and its diagnostic utility for prediction of the outcomes of hepatitis E virus genotype 1 infection.

HEV-Ag ELISA assay is a reliable diagnostic test in resource-limited areas. HEV genotype 1 (HEV-1) infections are either self-limited or progress to fulminant hepatic failure (FHF) and death if anti-HEV therapy is delayed. Limited data is available about the diagnostic utility of HEV Ag on HEV-1 infections. Herein wWe aimed to study the kinetics of HEV Ag during HEV-1 infections at different stages, i.e., acute HEV infection, recovery, and progression to FHF. Also, we evaluated the diagnostic utility of this marker to predict the outcomes of HEV-1 infections. Plasma of acute hepatitis E (AHE) patients were assessed for HEV RNA by RT-qPCR, HEV Ag, and anti-HEV IgM by ELISA. The kinetics of HEV Ag was monitored at different time points; acute phase of infection, recovery, FHF stage, and post-recovery. Our results showed that the level of HEV Ag was elevated in AHE patients with a significantly higher level in FHF patients than recovered patients. We identified a plasma HEV Ag threshold that can differentiate between self-limiting infection and FHF progression with 100% sensitivity and 88.89% specificity. HEV Ag and HEV RNA have similar kinetics during the acute phase and self-limiting infection. In the FHF stage, HEV Ag and anti-HEV IgM have similar patterns of kinetics which could be the cause of liver damage. In conclusion, the HEV Ag assay can be used as a biomarker for predicting the consequences of HEV-1 infections which could be diagnostically useful for taking the appropriate measures to reduce the complications, especially for high-risk groups.

Reduced incidence of hepatitis C in 9 villages in rural Egypt: Progress towards national elimination goals.

BACKGROUND & AIMS: Egypt has a major HCV burden and a well established treatment programme, with an ambitious goal of HCV elimination. Our aim was to assess the impact of a comprehensive HCV prevention, test and treat programme on the incidence of new HCV infections in 9 villages in rural Egypt. METHODS: An HCV "educate, test and treat" project was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. In 2018, in 9 of the villages we re-tested individuals who originally tested HCV antibody (HCV-Ab) and HBsAg negative using rapid diagnostic tests (RDTs); confirmatory HCV RNA testing was performed for positive cases. The incidence rate per 1,000 person-years (py) was calculated, and risk factors for incident HCV infections assessed through an interviewer-administered questionnaire in 1:3 age- and gender-matched cases and controls. RESULTS: Out of 20,490 individuals who originally tested HCV-Ab negative in the 9 villages during the 2015-2016 implementation of the "educate, test and treat" programme, 19,816 (96.7%) were re-tested in 2018. Over a median of 2.4 years (IQR 2.1-2.7), there were 19 new HCV infections all of which were HCV RNA positive (incidence rate 0.37/1,000 py) (95% CI 0.24-0.59). Compared to a previous estimate of incidence in the Nile Delta region (2.4/1,000 py) from 2006, there was a substantial reduction in overall incidence of new HCV infections. Exposures through surgery (odds ratio 51; 95% CI 3.5-740.1) and dental procedures (odds ratio 23.8; 95% CI 2.9-194.9) were significant independent predictors of incident infections. CONCLUSIONS: This is the first study to show a substantial reduction in incidence of new HCV infections in a sample of the general population in Egypt following attainment of high testing and treatment coverage. New infections were significantly associated with healthcare-associated exposures. LAY SUMMARY: Egypt has a major national HCV testing and treatment programme with the goal of eliminating HCV infection. We assessed the impact of a comprehensive HCV prevention, test and treat programme in 73 villages that achieved high coverage of testing and treatment on the subsequent incidence of new HCV infections in nine of the villages. We re-tested people who were previously HCV antibody negative and found that the rate of new HCV infections was greatly reduced compared to previous estimates. We also found that exposure through surgery and dental procedures were associated with these new infections. This highlights the importance of continued strengthening of infection control and prevention measures, alongside treatment scale-up.

No evidence of HEV genotype 1 infections harming the male reproductive system.

Extrahepatic disorders are recorded with hepatitis E virus (HEV) infection. The impact of HEV infection on the male reproductive system is a query. In this study, we retrospectively analyzed semen from infertile men and prospectively examined the semen from acute hepatitis E patients (AHE) for HEV markers. HEV RNA and HEV Ag were not detectable in the semen of infertile men nor the semen of AHE patients. Although HEV markers were detectable in the urine of patients infected with HEV-1, these markers were absent in their semen. There is no significant difference in the level of reproductive hormones between AHE patients and healthy controls. Semen analysis of AHE patients did not show a notable abnormality and there was no significant difference in the semen quality and sperm characteristics between AHE and healthy controls.

Assessment of hepatitis E virus (HEV) in the edible goat products pointed out a risk for human infection in Upper Egypt.

Hepatitis E virus (HEV) infection is endemic in developed and developing countries. Although the seroprevalence of HEV among the Egyptians is high, the sources of HEV infection in Egypt are not completely identified. Zoonotic HEV transmission among Egyptians is underestimated. Recently, we detected HEV in the milk of cows, this suggests the possibility of HEV transmission through the ingestion of contaminated milk. However, the role of small ruminants especially the goats in HEV epidemiology in Egypt remains unclear. Herein, we screened HEV markers in the edible goat products, mainly the milk and liver and we assessed the risk factor for HEV infection to the goat owners. A total of 280 goat milk samples were collected from 15 villages in the Assiut governorate. Anti-HEV IgG and HEV Ag were detected in 7.14% and 1.8% of the samples, respectively. HEV RNA was detected in 2 milk samples, cladogram analysis revealed that the isolated viruses belonged to HEV-3 subtype 3a. One viral isolate showed high homology to HEV recently isolated from the cow milk in the same geographic area. The level of anti-HEV IgG and HEV Ag were comparable in the milk and matched blood samples. While the urine and stool of HEV seropositive goats tested negative for HEV markers. HEV RNA was also detectable in the fresh goat liver samples (n = 2) derived from HEV seropositive goats. Finally, we analyzed HEV seroprevalence in households (n = 5) that owned the seropositive goats and households (n = 5) that owned the seronegative goats. Interestingly, anti-HEV IgG was recorded in 80% of households owned and frequently consumed the products of HEV seropositive goats, while HEV markers were not detectable in the owners of the seronegative goats. In conclusion: Here, we report HEV in the milk and liver of goats distributed in the villages of Assiut governorate. Higher HEV seroprevalence was recorded in the households that owned the seropositive goats. Investigation of the goat products is pivotal to assess the risk factor of HEV transmission to villagers in the Assiut governorate.

Viral and host inflammation-related factors that can predict the prognosis of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC), a malignancy caused mainly by chronic infection with hepatitis B virus (HBV) and/or hepatitis C virus (HCV), is a highly fatal disease. Apart from clinical parameters like venous invasion and multinodularity, viral and host inflammation-related factors are important predictors of HCC prognosis after surgical treatment. The factors of prognostic value can be detected in the specimens of HCC patients. In preoperative peripheral blood, high HBV DNA and the genotypes and mutations of HBV or HCV, high neutrophil-to-lymphocyte ratio and high concentrations of macrophage migration inhibitory factor and osteopontin predict poor prognosis. In tumours, high ratios of neutrophil-to-CD8(+) T cell and Treg-to-CD8(+) T cell, high expression of pro-angiogenic factors such as hypoxia-inducible factor-1α and cell growth/survival factors such as CD24 and activation of inflammatory signalling pathways such as Wnt/ß-catenin, nuclear factor-kappa B and signal transducer and activator of transcription 3 predict early recurrence. In peritumoural hepatic tissues, high HBV DNA, HBV mutations, high densities of macrophages, activated stellates and mast cells, high expression of macrophage colony-stimulating factor/its receptor and placental growth factor, Th1/Th2-like cytokine shift, inflammation-related signature and activation of carcinogenesis-related pathways predict late recurrence. Further studies should be focused on the development of a robust strategy by integrating the viral factors, inflammatory factors and clinical factors of complementary prognostic value to ensure high validity of the assessment for postoperative HCC prognosis.

HBV infectivity among Nigerians.

The study involved 60 (non-immunized), 14 (immunized against HBV), healthy Nigerian adults and 28 Nigerian patients with hepatitis. Their sera were tested for HBsAg, HBeAg, anti-HBe, anti-HBc, anti-HBs and anti-HCV while only 15 subjects with chronic hepatitis had HBV DNA assay by PCR. The subjects aged 21 to 72 years and comprised 75 male and 27 female adults. The prevalence of HBV infection by HBsAg and/or anti-HBc sero-positivity was 55.9%. Only HBsAg and anti-HBs were detectable in 21% each among immunized while HBsAg, HBeAg, anti-HBe, anti-HBc, anti-HBs were present in 58%, 20%, 6%, 32%, and 42% respectively in the non-immunized subjects. HBV DNA was positive in 86.7% of the 15 subjects. About fifty five percent of all subjects were infectious of HBV with 13.7%, 3.9%. 32.3% and 4.9% accounting for high, medium, low and very low infectivity respectively while 44.1% and 1% of the subjects were susceptible and naturally immuned to HBV respectively. Coinfection with HCV tends to favour HBV infectivity. In conclusion, the infectivity of HBV among Nigeria is varied but high and a great proportion of the population is susceptible.

Simultaneous determination of five-type hepatitis virus antigens in 5 min using an integrated automatic electrochemical immunosensor array.

An integrated automatic electrochemical immunosensor array has been designed for the simultaneous detection of 5-type hepatitis virus antigens (i.e. hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E). Initially, 5-type hepatitis virus antibodies were immobilized onto a self-made electrochemical sensor array using nanogold particles and protein A as matrices, and the immunosensor array was then used to capture their corresponding antigens from sample solution with a 1-step capture format. The detection is based on the potential change before and after the antigen-antibody reaction by using a 2-electrode system. The developed immunosensor array with allowed simultaneous determination of 5-type hepatitis virus antigens in 5 min. The detection limit of the sensor array was

Experimental infection of Balb/c nude mice with Hepatitis E virus.

BACKGROUND: Several animal species can reportedly act as reservoirs for Hepatitis E virus (HEV), a zoonotic pathogen. HEV and antibody to the virus have been detected in a variety of animals including rodents. Pig and rat models for HEV have been established for HEV, but a nude mouse has not yet been developed. METHODS: Balb/c nude mice were inoculated with swine HEV, both orally and via intravenous injection to insure infection. Negative control and experimental contact-exposed groups of mice were also included in the study. The liver, spleen, kidney, jejunum, ileum, cecum and colon of each mouse from all three groups were collected for reverse transcription nested polymerase chain reaction (RT-nPCR) detection, indirect immunofluorescence observation and histopathologic examination. The sera from nude mice were tested for anti-HEV IgG by enzyme linked immunosorbent assay (ELISA). Activities of liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP), as well as total bilirubin (TBIL) were also measured in the sera of the nude mice. RESULTS: HEV antigens and HEV RNA were detected in liver, spleen, kidney, jejunum, ileum and colon both by indirect immunofluorescence and by RT-nPCR in all of the inoculated and in one of the contact-exposed nude mice. Histopathological changes were observed in the liver and spleen of these mice. Infected mice showed increased levels of AST, ALP, and anti-HEV IgG in sera. The livers of contact-exposed mice showed obvious histopathological damage. CONCLUSION: Nude mice could be readily infected by HEV isolated from pigs. The nude mouse may therefore be a useful animal model for studying the pathogenesis of HEV.

Clevudine inhibits hepatitis delta virus viremia: a pilot study of chronically infected woodchucks.

In a small controlled study, clevudine, a potent inhibitor of hepadnaviruses, including hepatitis B virus and woodchuck hepatitis virus, suppressed hepatitis delta virus (HDV) viremia in chronically infected woodchucks. Suppression was correlated with the marked reduction of woodchuck hepatitis virus surface antigen in individual animals, consistent with the concept that repression of surface antigen expression may be a useful antiviral strategy for HDV.

[Clinicopathologic features and treatment outcomes of primary hepatic lymphoma: a report of four cases].

BACKGROUND & OBJECTIVE: Primary hepatic lymphoma (PHL), a rare malignancy, has seldom been reported. This article was to investigate clinicopathologic features and treatment of PHL. METHODS: Data of 4 patients with PHL, treated in Cancer Center, Sun Yat-sen University from Nov. 1994 to May 2004, were retrospectively analyzed. RESULTS: Of the 4 patients, 3 were men, and 1 was woman, with a median age of 53 years old; 3 had single focus, and 1 had multi-foci. All patents were positive for HBV antigen, 3 were misdiagnosed preoperatively, and 1 had no clear diagnosis before operation. Pathologic examination revealed that 3 were B-cell non-Hodgkin's lymphoma, and 1 was Hodgkin's lymphoma. Two patients received resection, and 2 received biopsy; all patients received adjuvant chemotherapy postoperatively. CONCLUSIONS: HBV infection might relate with the development of PHL. PHL should be considered for the patients presented liver mass and B-symptomatolgy. Resection followed by adjuvant chemotherapy with CHOP regiment seems to be the best option for PHL.

[Relationship between amount of HBV DNA in serum/liver tissue and hepatitis G virus (HGV) infection in patients with chronic hepatitis B].

OBJECTIVE: To observe the relationship between the amount of HBV DNA in serum/liver tissue and HGV infection in patients with chronic hepatitis B (CH-B) for exploring the effect of HGV infection on hepatitis B virus (HBV) replication of CH-B. METHODS: HGV RNA in serum, HGV nonstructural region 5 (NS5) antigen (HGV Ag) in liver tissue and the amount of HBV DNA in serum, liver tissue were detected for 56 patients with CH-B by reverse transcription-polymerase chain reaction (RT-PCR) assay, peroxidase antiperoxidase (PAP) immunohistochemical method and fluorescence quantitative PCR assay, respectively. Then the relationship between HGV Ag expression in liver tissue and HGV RNA expression in serum was analysed and the amount of HBV DNA in serum and liver tissues from the serum HGV RNA or liver tissue HGV Ag positive patients were compared with those of the serum HGV-RNA or liver tissue HGV Ag negative patients, respectively. RESULTS: Ten (17.9%) and eight (14.3%) patients were positive for serum and liver tissues,respectively.HGV RNA expression in serum was closely related to HGV Ag expression in liver tissues, but there was HGV RNA in serum from some of the liver tissues HGV Ag negative patients ?cases of HGV RNA and HGV Ag positive or negative,HGV RNA positive but HGV Ag negative, HGV RNA negative but HGV Ag positive, respectively: 5,43,5,3,(P<0.01). There was no significant difference in the amount of HBV DNA in serum and liver tissues between HGV RNA or HGV Ag positive and negative patients (P>0.05). CONCLUSIONS: HGV infection may not affect HBV replication. Liver is the site of HGV replication, but HGV probably also replicates in extrahepatic tissues. HGV hepatic pathogenicity is probably mild and further studies are still needed.

[Fas and ICE expression in the hepatocytes of tupaia with HDV/HBV infection].

OBJECTIVE: To investigate the relationship between Fas and ICE expression and HDV infection. METHODS: HDAg, Fas, and ICE were determined in 45 liver tissue specimens of tupaia with HDV/HBV infection by immunohistochemistry. RESULTS: Fas was detected in 39 out of 45 liver tissue specimens (86.7%), and ICE in 43 (95.6%). Fas and ICE were located in the cytoplasm or/and the membrane of hepatocytes, especially in the cytoplasm. There was significant correlation between the expression of HDAg and the expression of Fas and ICE (chi(2)=29.2 and 36.2, respectively, P<0.01). CONCLUSIONS: The expression of Fas and ICE may be induced by HDAg in hepatocytes.

[Expression of bcl-2, bax and hepatocyte apoptosis in the liver tissues of hepatitis D patients].

OBJECTIVE: To study the role of bcl-2, bax and hepatocyte apoptosis in the pathogenesis of hepatitis D. METHODS: Expression of HDAg, bcl-2, bax, and hepatocyte apoptosis in liver specimens of 77 patients with hepatitis D were studied by immunohistochemistry, double labelling and serial sections, and TUNEL assay. Six-seven hepatitis B patients served as control. RESULTS: Bcl-2 and bax were mainly expressed in the cytoplasm of hepatocytes, and HDAg mainly in the nucleus of hepatocytes. A large number of HDAg and bax positive cells were distributed among infiltrating lymphocytes at the periportal region in which many apoptosis hepatocytes were found. There were positive correlations between the expression of bax, HDAg and hepatocyte apoptosis (P<0.05). CONCLUSIONS: The distribution and the expression of bax, HDAg and hepatocyte apoptosis are significantly correlated with the activity of inflammation and the severity of the liver damage. Hepatitis D virus infection may induce the expression of bax in the hepatocytes and exacerbate hepatocyte apoptosis through which take a part in the pathogenesis of hepatitis D.

Antiviral activity of clevudine [L-FMAU, (1-(2-fluoro-5-methyl-beta, L-arabinofuranosyl) uracil)] against woodchuck hepatitis virus replication and gene expression in chronically infected woodchucks (Marmota monax).

L: -FMAU [1-(2-fluoro-5-methyl-beta,L-arabinofuranosyl) uracil] has been shown to be an effective inhibitor of hepatitis B virus (HBV) and duck hepatitis B virus replication in cell culture and duck hepatitis B virus replication in acutely infected Peking ducks. The woodchuck hepatitis virus (WHV) and its natural host, the Eastern woodchuck (Marmota monax), have been established as a predictive model for the evaluation of antiviral therapies against chronic HBV infection. In this report, the antiviral activity of l-FMAU against WHV replication in chronically infected woodchucks is described. Four weeks of once-daily oral administration of L-FMAU significantly reduced viremia, antigenemia, intrahepatic WHV replication, and intrahepatic expression of woodchuck hepatitis virus core antigen (WHcAg) in a dose-dependent manner. At the highest dose administered (10 mg/kg/d), significant reductions of intrahepatic WHV RNA and covalently closed circular (ccc)WHV-DNA levels also were observed. The reduction in viremia was remarkably rapid at the higher doses of L-FMAU, with greater than 1,000-fold reductions in WHV-DNA serum levels observed after as little as 2 to 3 days of therapy. Following the withdrawal of therapy, a dose-related delay in viremia rebound was observed. At the highest doses used, viremia remained significantly suppressed in at least one half of the treated animals for 10 to 12 weeks' posttreatment. No evidence of drug-related toxicity was observed in the treated animals. L-FMAU is an exceptionally potent antihepadnaviral agent in vitro and in vivo, and is a suitable candidate for antiviral therapy of chronic HBV infection.

Hepatitis E virus infection in chimpanzees: a retrospective analysis.

Different patterns of disease were observed among 11 chimpanzees who were inoculated intravenously with hepatitis E virus (HEV) positive fecal specimens from four different outbreaks (Nepal 1981, Uzbekistan 1981, Pakistan 1985, and Mexico 1986). Five chimpanzees had marginal or no liver enzyme elevations within 70 days of inoculation. Two of the chimpanzees had limited viremia, but did not produce detectable antibody. The four remaining chimpanzees had liver enzyme elevations, viral shedding, viremia, seroconversion to anti-HEV, and detectable HEV antigen in liver biopsy specimens. These results may reflect the range of infection patterns that develop in humans after natural exposure to the HEV.

Temporal pathogenesis of experimental neonatal woodchuck hepatitis virus infection: increased initial viral load and decreased severity of acute hepatitis during the development of chronic viral infection.

Acute hepatitis B virus (HBV) infections either resolve or progress to chronicity. Identification of early deviations in host-virus responses associated with these outcomes can further differentiate cause-effect mechanisms that initiate and maintain chronicity. Neonatal woodchucks were infected experimentally with the woodchuck hepatitis virus (WHV) at 3 days of age. At 8 or 14 weeks of age (i.e. , the early- or mid-acute stage of infection), whole blood and large surgical biopsies of the liver were obtained from infected animals and uninfected controls. These were stored for later correlating histopathologic responses and viral load with the subsequently determined outcome of infection. As of 1 year postinfection, half of the surgically treated infected woodchucks had developed self-limited infections, while the other half developed chronic infections. The self-limited outcome was characterized by decreased viral load in acute-phase liver and plasma and a generally robust acute hepatic inflammatory response. Comparisons at the same early time points revealed that the chronic outcome was characterized by increasing initial viral load in liver and plasma, and a detectable, but diminished, acute hepatic inflammation. These cotemporal comparisons indicate that there is an early host-response deviation during the acute phase of a developing chronic infection. Continued analysis of the tissues banked from this study will facilitate further temporal characterization of acute-phase mechanisms that determine resolution versus chronicity in WHV infection. Understanding such mechanisms may be useful in the rational design of therapy for established chronic HBV infection.

Detection of hepatitis C virus RNA sequences in B-cell non-Hodgkin lymphoma.

Serologic testing shows that hepatitis C virus (HCV) may have a role in the pathogenesis of B-cell non-Hodgkin lymphomas (B-cell NHLs). We tried to demonstrate HCV RNA sequences in paraffin-embedded tissue from B-cell NHLs by reverse-transcription double polymerase chain reaction (RT-PCR) and Southern blotting. We studied 31 consecutive cases of B-cell NHLs; lymph nodes from 32 patients with diseases other than B-cell NHL were negative controls. Positive-strand HCV RNA was tested with primers for the 5' untranslated region. Replicative negative strand HCV RNA was tested with strand-specific RT-PCR for the 5' untranslated region. Immunohistochemical staining for HCV was done using an antibody to HCV core protein. Positive-strand HCV RNA was detected in 8 patients with B-cell NHL; negative-strand HCV RNA was detected in 6 of these cases, indicating viral replication. All control cases were negative for HCV RNA. Immunohistochemistry showed no staining of lymphoma cells for HCV core proteins in any case. HCV and B-cell NHLs may be associated. RT-PCR on paraffin-embedded lymphoma tissue is an alternative method of testing for HCV. The value of immunohistochemistry could not be ascertained. The exact role of HCV in the pathogenesis of B-cell NHL needs to be studied further.