Prediction Modelling for Gastroesophageal Variceal Bleeding in Patients With Chronic Hepatitis B Using Four-dimensional Flow MRI.

Background/Aims: In this study, we aim to develop a model for predicting gastroesophageal varices (GEV) bleeding in patients with chronic hepatitis B (CHB) by utilizing hemodynamic parameters obtained through four-dimensional flow MRI (4D flow MRI). Methods: This study conducted a prospective enrollment of CHB patients suspected of GEV from October 2021 to May 2022. The severity of varices and bleeding risk were evaluated using clinical findings and upper gastrointestinal endoscopy, and patients were classified into high-risk and non-high-risk groups. The study utilized serological examination, ultrasonographic examination, and 4D flow MRI. Relevant parameters were selected through univariate and multivariate analyses, and a prediction model was established using binary logistic regression analysis. The model was combined with the Baveno Ⅵ/Ⅶ and Expanded Baveno Ⅵ/Ⅶ criteria to evaluate diagnostic efficacy and the risk of avoiding endoscopic examination. Results: A total of 40 CHB patients were enrolled and categorized into the high-risk group (n = 15) and the non-high-risk group (n = 25). The spleen diameter and regurgitant fraction (R%) were independent predictors of variceal bleeding and a predictive model was established. The combination of this prediction model and the Baveno Ⅵ/Ⅶ criteria achieved high diagnostic efficiency, enabling 45.00% (18/40) of patients to be exempted from the unnecessary endoscopic procedure and the high-risk misclassification rate (0%) was less than 5%. Conclusion: The prediction model generated by 4D flow MRI has the potential to assess the likelihood of varices and can be supplemented by the Baveno VI/VII criteria to improve diagnostic accuracy in CHB patients.

"Parvovirus B19-related Acute Hepatitis: Clinical Spectrum and Outcome in Children".

Background/Aims: Acute liver injury is a common manifestation of parvovirus B19 (PVB19) infection in immunocompromised patients. However, literature in immunocompetent children is scarce. We aimed to study the clinicolaboratory features and outcome of hepatic involvement by PVB19 infection in hospitalized children. Methods: We retrospectively analyzed our prospectively kept database of all children (<18 years old) admitted with acute viral hepatitis (AVH), acute liver failure (ALF) or acute-on-chronic liver failure (ACLF), and PVB19 infection between January 2010 and December 2023. Clinical features, laboratory parameters, and complications were evaluated. Poor outcome was defined as death or liver transplantation. Results: A total of 35 children (19 boys [54%], median age: 7.25 [interquartile range: 4-10.8] years) with PVB19-related hepatitis were studied (28 [80%] isolated PVB19 infection and 7 [20%] coinfections [3 with Epstein-Barr virus, 2 with hepatitis A, and 1 each with hepatitis-E and cytomegalovirus]). AVH (17, 49%) was the most common presentation, followed by ALF (13, 37%) and acute insult in ACLF (5, 14%). Patients with coinfection had significantly higher bilirubin (14.6 [9.4-21.5] vs 6.8 [4.3-10.9] mg/dl; P=0.004) and transaminases (ALT: 697 [428-1296] vs. 277 [157-478] U/L; P=0.02) but similar mortality (1/7 vs 6/23; P=1.0) than PVB19 alone. Nine cases (25.7%) had extrahepatic complications (hemophagocytic lymphohistiocytosis [HLH]: 3, acute kidney injury: 3, aplastic anemia: 2, and myocarditis: 1). Poor outcome occurred in 38% (5/13) ALF, 11.7% (2/17) AVH (HLH: 1, myocarditis: 1), and none (0/5) of the ACLF cases. Conclusion: PVB19 should be considered in children presenting with indeterminate acute liver injury, especially in younger children or those with complications such as aplastic anemia, HLH, or myocarditis.

The Impact of Gender and Race on Outcomes for Hospitalized Hepatitis A Patients Stratified by Liver Disease Severity.

Background: The incidence of hepatitis A virus (HAV) infection is on the rise, with a minority of patients at risk for poor outcomes. This study investigates the prognostic impacts of race and gender on hospital outcomes among admitted HAV-infected patients. Methods: Using the National Inpatient Sample from 2012 to 2017, patients admitted with HAV were selected and stratified by gender (male and female) and race (White, Black, Hispanic, Asian-Pacific Islander, Other). Propensity score-matching and statistical analysis were implemented with comparison to the controls ("Female" and "White"). Primary endpoints included mortality, length of stay (LOS), and hospitalization costs, while secondary endpoints consisted of hepatic-related medical complications such as ascites, hepatic encephalopathy, varices, and acute liver failure. Results: Females with compensated cirrhosis had increased odds of mortality (aOR 2.59, 95% CI: 1.14-5.91, P = 0.02). Otherwise, no other differences in mortality were detected between genders and races. Females had a shorter hospital LOS (aOR 0.97, 95% CI: 0.96-0.98, P < 0.001), lower adjusted cost ($12,241 vs. $13,510, aOR 0.92, 95% CI: 0.92-0.92, P < 0.001), lower odds of esophageal varices (aOR 0.74, 95% CI: 0.57-0.97, P = 0.03) and hepatic encephalopathy (aOR 0.67, 95% CI: 0.53-0.84, P < 0.001) compared to males. Black patients exhibited higher LOS (aOR 1.06, 95% CI: 1.04-1.08, P < 0.001) and adjusted costs ($13,392 vs $12,592, aOR 1.02, 95% CI: 1.02-1.03, P < 0.001). Hispanic patients exhibited higher rates of esophageal varices (aOR 2.19, 95% CI: 1.28-3.76, P = 0.005) and adjusted costs ($14,202 vs. $12,381, aOR 1.07, 95% CI: 1.07-1.07, P < 0.001), and Asian patients experienced higher adjusted costs ($18,426 vs. $13,137, aOR 1.10, 95% CI: 1.10-1.10, P < 0.001) compared to White patients. Conclusion: Various nuanced impacts of gender and race on hospitalization outcomes in HAV infection were observed, with only one subgroup analysis demonstrating a higher rate of mortality. Further research is warranted to better understand these findings and their implications.

Clinico-Pathological Spectrum of Hepatitis A Virus-Induced Autoimmune-Like Hepatitis in Children.

There is limited evidence that hepatitis A virus (HAV) infection can trigger hepatic autoimmunity, but this area remains largely unexplored. This study was thus planned with the aim to compare HAV-induced autoimmune-like hepatitis (HAV-ALH) with HAV-related liver dysfunction (HAV-acute viral hepatitis or HAV-AVH) and classical autoimmune hepatitis (AIH). This was a retrospective review of 46 patients with HAV infection who underwent liver biopsy (including 17 cases of HAV-ALH: diagnosis based on histopathology), and they were compared to 46 cases of age- and gender-matched classical AIH. Overall, HAV cohort (n = 46) had higher prevalence of pruritus, higher bilirubin levels, higher proportion of cholestasis, lower IgG levels, higher seronegativity and lack of disease recurrence, while the classical AIH group had higher proportion/severity of interface hepatitis, fibrosis, necrosis and pseudorosetting (p < 0.05). In comparison to the classical HAV-AVH group, HAV-ALH group had higher AST levels, higher presence of autoantibodies, and higher prevalence of severe zone 3 perivenulitis and marked pseudorosetting on histology (p < 0.05). Also, HAV-ALH group, in comparison to the AIH group, had more pruritus (OR 7.29, p < 0.004) and more seronegativity (41% vs. 13%, p < 0.031), while duration of illness (p < 0.003), IgG (p < 0.001) levels and liver stiffness measurement (p < 0.006) were significantly higher in AIH group (versus the HAV-ALH and HAV-AVH groups). Histologically, in comparison to AIH, HAV-ALH group had significantly less interface hepatitis (OR 0.03, p < 0.001) and fibrosis (OR 0.08, p < 0.001) and significantly more cholestasis (OR 4.5, p < 0.021). HAV infection can act as a potential trigger for immune-mediated hepatic damage, akin to drug-induced autoimmune-like hepatitis. Larger multicentric studies are needed to further explore this aspect.

Forty years of successful national research collaboration in liver disease - the Swedish experience.

AIM: Sweden has historically provided a fruitful arena for research in clinical medicine. We here share 40 years of experience of collaboration in the Swedish hepatology research group (SWEHEP) (https://www.swehep.se). METHODS: We describe the way the Swedish hepatology pioneers started the group and how the network continuously developed over the years. Successful projects such as thorough studies of natural history and various clinical aspects of autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, and steatosis are described. RESULTS: Over the years, more than 80 publications have been published by the group. A summary of new and ongoing research programs includes the randomized placebo-controlled trial of simvastatin in PSC (PiSCATIN), the prospective BIGMAP (Biochemical and genetic markers for the assessment and prognostication of liver cirrhosis) initiative in patients with liver cirrhosis, and the DETECT-HCC, a prospective multicenter cohort study comparing abbreviated MRI and ultrasound for surveillance of hepatocellular carcinoma every six months over two years. The group philosophy, success factors for the longstanding collaboration as well as experience of failures are shared. CONCLUSION: The success of hepatology research in Sweden is based on longstanding collaboration over generations of hepatologists, where everyone contributes, regular research meetings, mutual trust, and perseverance.

The Role of Epigallocatechin Gallate (EGCG) in the Combating and Treat-ment of Sexually Transmitted Viral Infections.

Tea is obtained from the young leaves and shoots of the evergreen perennial plant Camellia sinensis (L.) Kuntze, the most popular and frequently consumed product using a natural beverage worldwide. Some kinds of tea, including green, black, and oolong, have assorted flavors depending on the manufacturing techniques. Green tea has been studied for many years for its important beneficial effects, such as anticancer, antiobesity, antidiabetes, antiinflammatory, neuroprotective, and cardiovascular effects. These effects are primarily as-sociated with tea polyphenols, and regular consumption has been reported to decrease the incidence of some chronic diseases. Current studies support that green tea catechins play an important role in curing and improving the pathology of many diseases. Epigallocatechin-3-gallate (EGCG) is the most highly found polyphenol in the leaves and is of great interest for its protective role in disease prevention. Therefore, this review presents the efficacy and pos-sible mechanisms of EGCG against sexually transmitted viruses. Moreover, EGCG and its derivatives are recognized as safe and bioactive phytochemicals for external and internal use in preventing and treating viral STIs and other concurrent infections. Multidisciplinary stud-ies are essential to discover cheaper, safer, and more effective treatments using EGCG and its derivatives to improve the toxicity and formulations of viral STI medications.

Multiscale modelling of hepatitis B virus at cell level of organization.

Multiscale modelling is a promising quantitative approach for studying infectious disease dynamics. This approach garners attention from both individuals who model diseases and those who plan for public health because it has great potential to contribute in expanding the understanding necessary for managing, reducing, and potentially exterminating infectious diseases. In this article, we developed a nested multiscale model of hepatitis B virus (HBV) that integrates the within-cell scale and the between-cell scale at cell level of organization of this disease system. The between-cell scale is linked to the within-cell scale by a once off inflow of initial viral infective inoculum dose from the between-cell scale to the within-cell scale through the process of infection; the within-cell scale is linked to the between-cell scale through the outflow of the virus from the within-cell scale to the between-cell scale through the process of viral shedding or excretion. The resulting multiple scales model is bidirectionally coupled in such a way that the within-cell scale and between-cell scale sub-models mutually affect each other, creating a reciprocal relationship. The computed reproductive number from the multiscale model confirms that the within-host scale and the between-host scale influence each other in a reciprocal manner. Numerical simulations are presented that also confirm the theoretical results and support the initial assumption that the within-cell scale and the between-cell scale influence each other in a reciprocal manner. This multiple scales modeling approach serves as a valuable tool for assessing the impact and success of health strategies aimed at controlling hepatitis B virus disease system.

Hepatocellular carcinoma in HBsAg seroclearance: clinical features, recurrence, and prognosis following curative hepatectomy.

Aim: To explore clinical features and prognosis of hepatocellular carcinoma (HCC) in hepatitis B virus surface antigen (HBsAg)-serocleared patients and identify risk factors associated with postoperative recurrence after curative hepatectomy. Methods: Patients who had undergone initial hepatectomy for HCC from January 2010 through December 2022. Clinicopathological data were compared between HBsAg-seropositive and HBsAg-serocleared patients. Furthermore, risk factors associated with early and late postoperative HCC recurrence (early and late recurrences (ER and LR), respectively) were analyzed for HBsAg-serocleared HCC patients treated by curative hepatectomy. Results: A total of 2184 consecutive patients undergoing initial hepatectomy for HCC were enrolled, including 339 (15.5%) HBsAg-serocleared and 1845 (84.5%) HBsAg-seropositive cases. Tumor characteristics were comparable between the two groups. After curative hepatectomy, the ER rate was lower in the HBsAg-serocleared group than in the HBsAg-seropositive group (16.2% vs 26.3%; p = 0.000). LR rates in the HBsAg-seropositive and HBsAg-serocleared groups were similar (8.3% vs 6.9%, respectively, p = 0.418). Multivariate analysis showed that among HBsAg-serocleared patients, Hong Kong Liver Cancer stage and microvascular invasion were risk factors associated with postoperative ER, while γ-glutamyl transferase level and neutrophil-to-lymphocyte ratio were associated with LR. Conclusion: HBsAg-serocleared and HBsAg-seropositive HCC patients exhibited similar tumor characteristics. Curative hepatectomy-treated HBsAg-serocleared HCC patients experienced a lower ER rate and better short-term (⩽3 years) overall survival (OS) rates than their HBsAg-seropositive counterparts. LR, very late recurrence, and long-term (4-, and 5-year) OS rates were similar between the two groups.

Rapidly Progressive Glomerulonephritis Associated With IgA Nephropathy and C3 Deposits in a Patient With Chronic Hepatitis B.

Hepatitis B-associated glomerulonephritis (GN) has been recognized for decades. However, only a few cases of IgA nephropathy (IgAN) in a setting of rapidly progressive glomerulonephritis (RPGN) associated with chronic hepatitis B virus (HBV) have been described. Herein, we report the case of a 42-year-old Asian female with a past medical history significant for chronic HBV on entecavir, hypertension, chronic kidney disease, and newly diagnosed breast cancer, who underwent elective bilateral mastectomy and breast augmentation. Post-operatively, she developed non-oliguric acute kidney injury and proteinuria. Renal biopsy revealed active focal crescentic and necrotizing GN with IgA and C3 deposits. Systemic autoimmune-associated and other infection-related GN were ruled out. IgAN in a setting of RPGN associated with chronic HBV was suspected.

The Camden and Islington Viral Hepatitis Identification Tool (CIVHIT): Use of a Clinical Database Case-Finding Tool for Hepatitis B, Hepatitis C and HIV in Primary Care.

Despite the availability of effective treatment and vaccines for hepatitis B virus (HBV) and C virus (HCV), many people are still infected and remain unaware of their infection. The Camden and Islington Viral Hepatitis Identification Tool (CIVHIT), a computer-based search tool, was introduced in 60 general practices (GPs) in April 2014 to support identification, testing and treatment of individuals at high risk for blood-borne viruses (BBVs). CIVHIT searched electronic medical records (EMRs), flagging all those with codes linked to risk factors or medical conditions associated with BBVs. CIVHIT was associated with a 78.5% increase in BBV tests in primary care in both boroughs. This translated to a 55.8% rise in new diagnoses. HBV testing saw the largest increase resulting in twice as many people diagnosed. Only 23.2% of HBV and 14.9% of HCV-positive tests were referred to secondary care. In an index practice, the most common flag was a history of STIs (477/719, 66.3%). Individuals with previous or current drug use and those with a known hepatitis contact were more likely to be offered a test compared to those flagged due to a history of STI. HIV and HBV testing was lower in males following a test offer. There was an increased likelihood of testing for HBV and HCV with increasing age. Additionally, individuals with previous or current drug use and individuals with a known hepatitis contact were more likely to test for HCV compared to individuals flagged due to STI history. CIVHIT shows promise to assist with the elimination of BBVs.

Survey of Hepatitis B Vaccination Coverage and Surface Antibody-Positive Rates in People Aged 1-59 Years in 2006 and 2024.

Background: Implementing hepatitis B vaccination is an important strategy to reduce hepatitis B virus infection and disease burden. Suboptimal adult hepatitis B vaccination coverage limits the further reduction of hepatitis B virus infection. Methods: A multistage stratified random sampling method was adopted to survey the permanent population aged 1-59 in 2006 and 2024. We calculated the vaccination coverage rate, hepatitis B surface antibody (HBsAb)-positive rate, rate difference, and their 95% confidence intervals (CIs) of the 2 survey populations, and used the 95% CI and χ2 test to determine whether the difference in rate was statistically significant. Results: Six hundred twenty-three people were surveyed in 2006 and 606 people were surveyed in 2024. From 2006 to 2024, the hepatitis B vaccination coverage among people aged 1-59 years increased from 54.1% to 78.9%, and the HBsAb-positive rate increased from 46.2% to 57.6%. There was no significant difference in vaccination coverage in the population <15 years of age, but the antibody-positive rate increased significantly. The vaccination coverage rate of the 15-59 age group increased significantly, but there was no statistical difference in the antibody positivity rate of the 15-49 age group, and the antibody positivity rate of the 50-59 age group increased significantly. Conclusions: Hepatitis B vaccination coverage among adults was still insufficient. Hepatitis B vaccine-mediated immunity was low in adults aged 30-49 years. It is recommended to update the guidelines for hepatitis B vaccination of adults in China, cancel the assessment of risk factors and prevaccination serological screening, and emphasize universal vaccination of all unvaccinated adults to increase coverage.

The Mechanism of APOBEC3B in Hepatitis B Virus Infection and HBV Related Hepatocellular Carcinoma Progression, Therapeutic and Prognostic Potential.

Hepatocellular carcinoma (HCC) is one of the most prevalent malignant tumors globally. Prominent factors include chronic hepatitis B (CHB) and chronic hepatitis C (CHC) virus infections, exposure to aflatoxin, alcohol abuse, diabetes, and obesity. The prevalence of hepatitis B (HBV) is substantial, and the significant proportion of asymptomatic carriers heightens the challenge in diagnosing and treating hepatocellular carcinoma (HCC), necessitating further and more comprehensive research. Apolipoprotein B mRNA editing catalytic polypeptide (APOBEC) family members are single-stranded DNA cytidine deaminases that can restrict viral replication. The APOBEC-related mutation pattern constitutes a primary characteristic of somatic mutations in various cancer types such as lung, breast, bladder, head and neck, cervix, and ovary. Symptoms in the early stages of HCC are often subtle and nonspecific, posing challenges in treatment and monitoring. Furthermore, this article primarily focuses on the established specific mechanism of action of the APOBEC3B (A3B) gene in the onset and progression of HBV-related HCC (HBV-HCC) through stimulating mutations in HBV, activating Interleukin-6 (IL-6) and promoting reactive oxygen species(ROS) production, while also exploring the potential for A3B to serve as a therapeutic target and prognostic indicator in HBV-HCC.

Contamination of Hepatitis E Virus in Pig Livers of Different Market Types Collected from Seven Provinces of China.

Foodborne transmission of the Hepatitis E virus (HEV) is becoming an important public health problem in China, but the food associated with the HEV transmission route remains unclear. Pig liver is among the suspected food products involved in HEV transmission. Our research aimed to survey the contamination rate and genotype identification of HEV in pig livers from different types of markets in selected provinces of China. reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to screen for HEV in pig livers, nest RT-PCR was used for partial amplification of opren reading frame (ORF) 2, followed by sequencing, and phylogenetic analysis to determine the genotype of positive samples. A total of 787 pig liver samples from 7 provinces were collected. The average positive rate of HEV was 8.13% (64/787), Inner Mongolia (14.29%, 1/7) and Hebei province (14.29%, 23/161) showed the highest positive rate. There was a significant difference among the provinces (p < 0.01). Three major market types (wholesale market, supermarket, and butcher's shop) were included in this study, and the positive rates were 5.28% (21/398), 15.86% (23/145), and 8.20% (20/244), respectively. There was no significant difference among the three market types. Eleven of the positive samples were partially sequenced and identified genotypes 4a, 4d, and 3a.

A National Survey of Pharmacist Involvement in Hepatitis C Virus Management in the United States.

Models estimate that the United States will not meet its 2030 hepatitis C virus (HCV) elimination goal. Engagement of healthcare providers including pharmacists is critical for HCV elimination efforts. We aimed to characterise the involvement of pharmacists in HCV management. The study design was a cross-sectional survey. Investigators sent the questionnaire to pharmacy and HCV organisations' listservs and limited responses to licensed pharmacists with direct patient care. Questions assessed setting, HCV screening, prescribing, and management; and opinions, and perceived barriers and facilitators to pharmacists' HCV management. Two hundred and nine survey respondents across 45 states reported managing 24 patients/month, with 5.3 (±4.4) years' experience in HCV, and identified pharmacist-managed HCV at their site since 2013 (±5.8 years). Most practice at academic medical centres (29%, 58/203) under collaborative practice agreements (67%, 127/189), as ambulatory care pharmacists (70%, 131/187), in primary care (50%, 65/131). Many pharmacists provide screening, linkage to care, and/or referral (81%, 157/194); 99.5% (190/191) perform treatment evaluation and selection; 98% (180/183) provide treatment education, 93% (171/183) initiate treatment, and 90% (162/180) provide on- and/or post-treatment monitoring. Respondents indicated collaboration with prescribers as most helpful in their role in HCV management, whereas lack of reimbursement was a main barrier. Satisfying components include HCV cure, care and education provision; frustrations include socioeconomic factors impeding patients' follow-up and prior authorisations/insurance barriers. Survey results show the variety of pharmacists' roles in direct HCV patient care and may be used to increase other providers' awareness of pharmacists' services and contributions to HCV elimination efforts.

Mass screening of hepatitis B and C in Burkina Faso: seroprevalence update and impact of hepatitis B vaccine.

INTRODUCTION: Updated data on the seroprevalences of hepatitis B and C viruses (HBV, HCV) are required to enable the adaptation of control strategies. In this study, we aimed to: (i) estimate the seroprevalences of HBsAg carriers and HCV exposure in the general population, and (ii) determine the impact of vaccination on HBV circulation since its introduction in 2006 in the Expanded Program on Immunization (EPI). METHODOLOGY: From October 2020 to October 2022, a mass screening campaign was conducted in 10 cities across Burkina Faso. Individuals of all ages and genders who consented to participate were screened for viral markers (HBsAg, anti-HCV) using rapid diagnostic tests. The proportions of HBsAg carriers and HCV exposure were calculated using Stata, and logistic regression was used to assess the impact of HBV vaccination on HBsAg carriage. RESULTS: A total of 15,650 participants were enrolled in the study. Of these, 51.4% were women and the age range was from 1 to 97 years. All participants were screened for HBsAg and 7,507 were also screened for anti-HCV. Overall, the seroprevalence of HBsAg was 8.8% and 2.6% for anti-HCV. The results indicated that age, gender, and place of residence were associated with HBV infection. CONCLUSIONS: The prevalence of HBV and HCV infections remains high in Burkina Faso. Prevention strategies, including initial mass screening with rapid diagnostic tests and vaccination, need to be intensified.

Hepatitis B surface antigen reverse seroconversion after hematopoietic stem cell transplantation according to the baseline serological marker levels and vaccination status: a single-center database analysis.

PURPOSE: Hepatitis B is a major prognostic factor after hematopoietic stem cell transplantation (HSCT). Currently, no consensus exists regarding the management of various scenarios that can lead to reverse seroconversion of the hepatitis B surface antigen (HBsAg-RS). This study focused on HBsAg-RS, which serves as an indicator of active hepatitis, and aimed to obtain exploratory information on the associated patient and treatment factors. METHODS: This single-center retrospective study utilized clinical data extracted from the electronic medical records of Seoul St. Mary's Hospital, Korea. Patients who underwent HSCT between January 2013 and December 2018 and tested negative for hepatitis B surface antigen (HBsAg) before undergoing HSCT were included. The associations between HBsAg-RS and demographic information, baseline hepatitis B serological markers, and vaccination status were statistically analyzed. RESULTS: This study included 1,344 patients, of whom 83.3% tested positive for the hepatitis B surface antibody (HBsAb) during HSCT. HBsAg-RS occurred in 2.2% of HBsAb-negative patients and 3.0% of HBsAb-positive patients, indicating no significant difference in reactivation rates according to HBsAb status. However, positivity for hepatitis B core antibody (HBcAb) was significantly associated with hepatitis B reactivation (HBsAg-RS rate: 8.0%). The vaccination rates were highest in patients who were negative for both HBsAb and HBcAb and had a transient protective effect. CONCLUSION: The sufficient patient population enabled the identification of an association between baseline HBcAb positivity and the development of HBsAg-RS. Further prospective studies are warranted to determine optimal vaccination strategies for preventing HBsAg-RS.

The Efficacy of Post-Exposure Prophylaxis in Infants Born to HBsAg-Positive Mothers: A Single Center Experience in Saudi Arabia.

Objectives. Post exposure prophylaxis (PEP) with the hepatitis B vaccine (HBVac) in combination with HBV immunoglobulins (HBIG) significantly minimizes the odds of vertical transmission of HBV to newborn infants. In this retrospective study, we aimed to evaluate the compliance and efficacy of PEP in a tertiary care center in Saudi Arabia. Methods. Infants were tested with HBV serological markers at 7 months of age to assess their PEP protection rate. Results. Out of 13,125 mothers who delivered in KAMC, 105 (0.8%) mothers were found to have HBsAg positive, with a prevalence of 8 per 1000 live births. All infants (n = 100) completed their PEP as per protocol before discharge from the hospital (2 days after delivery). Among infants (n = 59; 56.2%) who were tested at 7 months of age, all (100%) were found to be negative for HBV. Conclusion. PEP achieved 100% efficacy among infants who complied with the study protocol at 7 months of follow-up. The prevalence of hepatitis B among pregnant women was 8 per 1000 live births.

The Levels of Serum HBV Pre-Genomic RNA and Its Associated Factors Among HBV-Infected Patients: A Retrospective Cohort Study in Hangzhou, Zhejiang, China.

Introduction: This study aimed to explore serum HBV pre-genomic RNA (pgRNA) levels and its associated factors among HBV-infected patients in the real world. Methods: This retrospective cohort study was conducted from May 10, 2023, to January 15, 2024. Univariate logistic analysis for positive serum HBV pgRNA was performed first, and variables with statistical significance were included in a multivariate logistic model. A decreasing trend of serum HBV pgRNA and HBV DNA levels was also detected first by univariate logistic regression and then by multivariate logistic regression. Results: 482 patients were included in our analysis at baseline, and 191 patients were followed up. Multivariate logistic regression revealed that positive HBV DNA (AOR: 2.63, 95% CI: 1.46-4.75, P=0.001), ≥1000 hBsAg (AOR: 2.29, 95% CI: 1.08-4.89, P=0.03), positive HBeAg (AOR: 28.26, 95% CI: 15.2-52.55, P<0.001), and ALP (AOR: 1.01, 95% CI: 1.001-1.02, P=0.03) were positively correlated with positive HBV pgRNA at baseline. Two independent multivariate logistic regression models were constructed for the decreasing trend of serum HBV pgRNA and HBV DNA for the 191 follow-up patients. Results showed that the decreasing trend of HBV pgRNA was positively correlated with positive baseline HBV DNA (AOR: 4.60, 95% CI: 1.84-11.51, P=0.001), baseline HBsAg ≥1000 IU/mL (AOR: 8.74, 95% CI: 1.09-70.10, P=0.04), and HDL (AOR: 5.01, 95% CI: 1.28-19.66, P=0.02). The decreasing trend of HBV DNA was positively correlated with positive baseline HBV pgRNA (AOR: 3.80, 95% CI: 2.00-8.83, P<0.001) and AST (AOR: 1.06, 95% CI: 1.03-1.08, P<0.001). Conclusion: Our study revealed that HBV DNA, HBsAg, HBeAg, and ALP were significantly correlated with positive HBV pgRNA at baseline. The baseline HBV DNA, HBsAg, and HDL were significantly correlated with decreasing levels of HBV pgRNA. A decreasing trend of HBV DNA significantly correlated with patients' baseline HBV pgRNA and AST.

Spectrum of hepatitis B and hepatitis C-related cancers in India.

Introduction: Hepatitis-B virus infection contributes to 40%-50% of the Hepato-cellular carcinomas (HCC) in India, while hepatitis-C virus infection accounts for 12%-32% of cases. This study aimed at determining the patterns of cancers among patients with hepatitis B and C. Materials and methods: This was a retrospective study of cancer patients with histologically proven diagnoses of cancer registered at Tata Memorial Hospital in Mumbai between 2017 and 2018. The proportional incidence ratio (PIR) was computed by dividing the observed number of site-specific cancer cases by the expected number. Results: The study participants' mean (SD) age was 48.69 (±16.91) years with a male-to-female ratio of 1.36. The prevalence of hepatitis B and C was 1.93% and 1.17%, respectively. Liver cancer showed the highest occurrence rate with notably increased PIR among individuals positive for hepatitis B (males: 14.41, females: 10.89) and hepatitis C (males: 7.15, females: 10.42). Furthermore, hepatitis B-positive patients showed elevated PIR for haemato-lymphoid malignancies such as multiple myeloma and non-Hodgkin's lymphoma. Limitation: The correlation between HBsAg and specific cancer types (PIRs) is limited by small case numbers, requiring careful interpretation of these findings. Implications and conclusion: The PIR for liver cancer was heightened in both hepatitis B and C patients. Strengthened surveillance, including pre-screening for hepatitis B and C positive infection among cancer patients, as well as screening for HCCs among hepatitis seropositive individuals, is crucial to mitigate the incidence of HCC.

Role of viral hepatitis in pregnancy and its triggering mechanism.

Hepatitis viral infection can cause severe complications, even mortality in pregnant women and their offspring. Multiple studies have shown that vertical transmission can cause viral hepatitis infections in newborns, especially in hepatitis B, C, and E. Screening for hepatitis viral infection in pregnant women is essential. Once infected, pregnant women should be given timely antiviral treatments, which could effectively alleviate the disease progression and reduce adverse outcomes. Besides, the mechanism of viral hepatitis mediating adverse pregnancy outcomes has been a hot topic. Hepatitis B virus has been found to mediate both mother- to-child and parent-child transmission. Liver injury in hepatitis C virus infection is associated with immune-mediated mechanisms, which can be regulated by hormonal factors as well. The mediating mechanism of adverse maternal and infant outcomes caused by hepatitis E virus infection is mainly related to viral replication in the placenta and changes in cytokine and estrogen. Nevertheless, the specific mechanisms related to hepatitis A virus and hepatitis D virus remain unclear, and more research is needed. This review shows that the existence of viral hepatitis during pregnancy can pose certain risks for pregnant women and infants, and different interventions have been used to treat pregnant women infected with viral hepatitis. It may provide deep insight into adverse pregnancy outcomes caused by viral hepatitis and give guidance on treatment.