A surveillance for hepatitis C virus infection in northeastern, Thailand: a 10-year cohort.

Introduction: Hepatitis C virus (HCV) infection is an infection that may lead to cirrhosis and hepatocellular carcinoma. Most patients with HCV infection are asymptomatic. The previous study conducted in age group of 30-64 years and in two provinces. Additionally, most surveillance studies conducted in a point period; not longitudinally. This study aimed to evaluate HCV infection rate in all age groups in the northeastern, Thailand in a longitudinal fashion. Methods: This was a surveillance study conducted in 20 provinces of northeastern, Thailand. The study period was between July 2010 and November 2019. During the surveillance, demographic data of participants were collected. HCV screening test was performed in each participant by using a rapid point-of-care assay. Rates of HCV infection in each province and in overall were calculated. Results: During the surveillance period, there were 31,855 subjects who participated the project. Of those, 1,285 subjects (4.037%) were tested positive for HCV infection (Tab. I). The HCV infection rate was highest in 2011 (8.98%): ranges 1.28 to 9.59%. The age group of over 50 years had 690 subjects with HCV infection (5.45%) out of 12,660 subjected tested in this age group. There was significant different among age groups (p < 0.001) and difference of age over 30 years and sex (p 0.043). Conclusions: This longitudinal surveillance showed that HCV infection rates in northeastern, Thailand were varied across the provinces with the highest rate of 9.59%. The HCV infection should be aware in male with age over 30 years.

Comparison between using hepatocellular carcinoma (HCC) risk scores and the HCC national guideline to identify high-risk chronic hepatitis B patients for HCC surveillance in Thailand.

Background and Aim: Hepatocellular carcinoma (HCC) surveillance in hepatitis B virus (HBV) patients is currently based on age/sex/cirrhosis, uses ultrasound abdomen every 6-12 months, and is a resource burden. HCC risk scores have been developed to classify HCC risk for surveillance. The number of HBV patients needing surveillance when HCC risk scores are used may be different from the current recommendation with implications on the resources needed for HCC surveillance. Methods: HBV patients from the liver clinic were included and classified as non-cirrhotic/cirrhotic and untreated/treated for analysis. Each subgroup was analyzed using REACH-B, CU-HCC, LSM-HCC, GAG-HCC, and mPAGE-B risk scores as appropriate. The change in the number of patients needing HCC surveillance using the above risk scores was calculated. Results: Seven-hundred and thirteen HBV patients were included, of whom 361 (50.6%) were male with mean age 55.43 years, and 76 (10.7%) had cirrhosis. In the untreated, non-cirrhotic subgroup, the percentage change of patients needing HCC surveillance was -69.5, -58.9, -58.8, and -54.1% when GAG-HCC, LSM-HCC, CU-HCC, and REACH-B were used compared to traditional criteria, respectively. In the treated, non-cirrhotic subgroup, the percentage change of patients needing HCC surveillance decreased by -80, -75.2, -75.2, and -2.8% when GAG-HCC, CU-HCC, REACH-B, and mPAGE-B were used, respectively. For the cirrhotic group, HCC risk scores did not make much difference. Conclusion: The use of HCC risk scores in non-cirrhotic HBV patients reduced the number of patients needing surveillance greatly. HBV cirrhotic patients should have HCC surveillance without the need for risk score calculation. Patients with a family history of HCC should undergo surveillance until proven unnecessary in prospective trials.

Surveillance for hepatitis B virus seroprevalence nearly 30 years after the implementation of a national vaccination program.

INTRODUCTION: Hepatitis B virus (HBV) infection is associated with cirrhosis and hepatocellular carcinoma. Vaccination is one aspect of public health policy aimed at eliminating HBV infection. After the implementation of an HBV vaccination program for newborns in Thailand, the estimated residual infection rate was 3.5%. However, that study was conducted in only 5,964 participants in seven provinces and only 22 years after the start of the campaign. This study aimed to evaluate the HBV seroprevalence rate in Thailand in larger sample size and a longer duration after program implementation using HBV surveillance. METHODS: This was a surveillance study conducted in 20 provinces in northeast Thailand. The study period was between July 2010 and November 2019. Rates of HBV seroprevalence in each province and overall were calculated. Participants were divided into two groups: those vaccinated under the national campaign and those who were not. Participants aged 0-20 years were used as references, while other age groups (intervals of 10 years) were comparators. Residual HBV seroprevalence after the vaccination program was calculated with odds ratio for HBV seroprevalence in each age group. RESULTS: There were 31,855 subjects who participated in the project. Of those, 1,805 (5.7%) had HBV. The HBV seroprevalence rate in the national HBV vaccination group was significantly lower than that in those not vaccinated under the national program (1.0% vs 5.9%; p<0.001). Seroprevalence was 1.0% in participants ≤20 years of age. Participants 31-40 years of age had the highest odds ratio (10.41), followed those 21-30 years of age (7.42). CONCLUSIONS: This real-world surveillance study showed that residual HBV infection was 1.0% after nearly 30 years of nationwide HBV vaccination.

Diffuse gallbladder wall thickening in autoimmune hepatitis: an unusual presentation.

A 63-year-old woman presented with jaundice and epigastric pain for 2 weeks. Physical examination revealed marked jaundice, and palpable gallbladder with right upper quadrant tenderness. Liver function test was remarkable for hepatocellular injury pattern. Antinuclear antibody and anti-smooth muscle antibody were positive with high titre and serum IgG was elevated more than upper normal range. Ultrasound and CT scan demonstrated mildly diffuse periportal oedema of liver parenchyma and markedly diffuse gallbladder wall thickening up to 2 cm. Liver histology showed focal interface hepatitis with prominent plasma cell infiltration and cluster formation, moderate lobular spotty necrosis and emperipolesis consistent with autoimmune hepatitis. The patient was treated with steroid and azathioprine. She had complete resolution of symptoms and normal biochemical laboratory results. Diffuse gallbladder thickening was seen in acute hepatitis from definite autoimmune hepatitis.