Health workers' perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia.

BACKGROUND: Experiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma. METHODS: Participants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia. RESULTS: Findings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services. CONCLUSIONS: Health promotion programs have the potential to reduce stigma by acting as a 'one stop shop' for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).

Exploring factors associated with hepatitis B screening in a multilingual and diverse population.

BACKGROUND: Racial/ethnic minorities bear a disproportionate burden of hepatitis B virus (HBV) infection and disease. Disparities in HBV screening contribute to worse outcomes for communities of color. We examined the impact of race/ethnicity, language preference, and having a usual place of care on HBV screening in a multilingual, urban cohort. METHODS: We used questions from the Health Information National Trends Survey and added validated questions about healthcare access and health literacy. We administered this survey in English, Spanish, and Chinese to a selected convenience sample of San Francisco city/county residents in 2017, with pre-specified targets for populations with known cancer disparities: 25% Spanish-speaking, 25% Chinese-speaking, and 25% Black Americans. Using weighted multivariable logistic regression analyses, we assessed how race/ethnicity, language preference, and having a usual place of care impacts self-report of HBV screening. RESULTS: Overall, 1027 participants completed the survey (50% of surveys administered in English, 25% in Spanish, and 25% in Chinese). Only 50% of participants reported HBV screening. In multivariable analysis, Black (OR = 0.20, 95% CI 0.08-0.49), Latinx (OR = 0.33, 95% CI 0.13-0.85), Asian (OR = 0.31, 95% CI 0.10, 0.94), and 'Other' race/ethnicity (OR = 0.17, 95% CI 0.05-0.53) respondents had lower odds of HBV screening compared to non-Hispanic White respondents. Participants who had insurance had increased odds of HBV screening (OR = 2.70, 95% CI 1.48-4.93). CONCLUSIONS: HBV screening disparities persist for Black Americans, Asian Americans, Latinx, and the uninsured. Future studies should explore reasons why current strategies have not been implemented or are not successful, particularly in addressing racial/ethnic and insurance disparities.

Molecular epidemiology of hepatitis B virus genotypes and subgenotypes in ethnic minority populations, Yunnan province, China.

The aim of our study was to determine the distribution of hepatitis B virus (HBV) genotypes and subgenotypes in ethnic minorities in Yunnan province to provide evidence supporting the theoretical basis for hepatitis B prevention and control. We obtained serum samples and demographic data from 765 individuals reported by Yunnan province who had either acute or chronic HBV infection and were from one of 20 ethnic minority populations: Achang, Bai, Brown, Tibetan, Dai, Deang, Dulong, Hani, Hui, Jingpo, Lahu, Yi, Lisu Miao, Naxi, Nu, Pumi, Wa, Yao, or Zhuang people. We sequenced the HBV DNA and determined the genotypes and subgenotypes of the isolated HBVs. We mapped the genotype and subgenotype distribution by ethnic minority population and conducted descriptive analyses. There were four genotypes among the 20 ethnic groups: genotype B (21.3% of samples), C (76.6%), D (1.8%) and I (0.3%). The most common subgenotype was C1. There were no genotype differences by gender (P = 0.954) or age (P = 0.274), but there were differences by region (P < 0.001). There were differences in genotype distribution (P < 0.001) and subgenotype distribution (P = 0.011) by ethnic group. Genotype D was most prominent in Tibet and most HBV isolates were C/D recombinant viruses. The only two genotype I virus isolates were in Zhuang people. Susceptibility and geographic patterns may influence HBV prevalence in different ethnic populations, but additional research is needed for such a determination.

Differences in prevalence of hepatitis B virus infection and genotypes between ethnic populations in Suriname, South America.

Epidemiological data on hepatitis B virus (HBV) are needed to benchmark HBV elimination goals. We recently assessed prevalence of HBV infection and determinants in participants attending the Emergency Department in Paramaribo, Suriname, South America. Overall, 24.5% (95%CI = 22.7-26.4%) of participants had anti-Hepatitis B core antibodies, which was associated with older age (per year, adjusted Odds Ratio [aOR] = 1.03, 95%CI = 1.02-1.04), Afro-Surinamese (aOR = 1.84, 95%CI = 1.52-2.19) and Javanese ethnicity (aOR = 1.63, 95%CI = 1.28-2.07, compared to the grand mean). 3.2% of participants were Hepatitis B surface Ag-positive, which was also associated with older age (per year, aOR = 1.02, 95%CI = 1.00-1.04), Javanese (aOR = 4.3, 95%CI = 2.66-6.95) and Afro-Surinamese ethnicity (aOR = 2.36, 95%CI = 1.51-3.71). Sex, nosocomial or culturally-related HBV transmission risk-factors were not associated with infection. Phylogenetic analysis revealed strong ethnic clustering: Indonesian subgenotype HBV/B3 among Javanese and African subgenotypes HBV/A1, HBV/QS-A3 and HBV/E among Afro-Surinamese. Testing for HBV during adulthood should be considered for individuals living in Suriname, specifically with Javanese and Afro-Surinamese ancestry.

Differences in risk factors for hepatitis B, hepatitis C, and human immunodeficiency virus infection by ethnicity: A large population-based cohort study in British Columbia, Canada.

OBJECTIVES: Addressing the needs of ethnic minorities will be key to finding undiagnosed individuals living with hepatitis B (HBV), hepatitis C (HCV), or human immunodeficiency virus (HIV). To inform screening initiatives in British Columbia (BC), Canada, the factors associated with HBV and/or HCV and/or HIV infection among different ethnic groups within a large population-based cohort were assessed. METHODS: Persons diagnosed with HBV, HCV, or HIV in BC between 1990 and 2015 were grouped as East Asian, South Asian, Other Visible Minority (African, Central Asian, Latin American, Pacific Islander, West Asian, unknown ethnicity), and Not a Visible Minority, using a validated name-recognition software. Factors associated with infection within each ethnic group were assessed with multivariable multinomial logistic regression models. RESULTS: Participants included 202 521 East Asians, 126 070 South Asians, 65 210 Other Visible Minorities, and 1 291 561 people who were Not a Visible Minority, 14.4%, 3.3%, 4.5%, and 6.3% of whom had HBV and/or HCV and/or HIV infections, respectively. Injection drug use was most prevalent among infection-positive people who were Not a Visible Minority (22.1%), and was strongly associated with HCV monoinfection, HBV/HCV coinfection, and HCV/HIV coinfection, but not with HBV monoinfection among visible ethnic minorities. Extreme material deprivation and social deprivation were more prevalent than injection drug use or problematic alcohol use among visible ethnic minorities. CONCLUSIONS: Risk factor distributions varied among persons diagnosed with HBV and/or HCV and/or HIV of differing ethnic backgrounds, with lower substance use prevalence among visible minority populations. This highlights the need for tailored approaches to infection screening among different ethnic groups.

How Semiphysiological Population Pharmacokinetic Modeling Incorporating Active Hepatic Uptake Supports Phase II Dose Selection of RO7049389, A Novel Anti-Hepatitis B Virus Drug.

The pharmacokinetics (PK) of RO7049389, a new hepatitis B virus (HBV) core protein allosteric modulator of class I, and of its active metabolite M5 were studied in fasted and fed conditions after single and multiple once-a-day and twice-a-day doses in healthy subjects and patients with HBV. The nonlinearity of the pharmacokinetics, the large variability, the small sample size per dose arms, the higher plasma exposure in Asians, and the heterogeneity in patient baseline characteristics seen in phase I studies made the ethnic sensitivity assessment and the selection of the recommended phase II dose difficult. A population PK model, simultaneously modeling RO7049389 and M5, was developed to characterize the complex PK, quantify ethnicity (i.e., Asian vs. non-Asian) and gender effects on the PK of RO7049389 and M5, and infer the quantity of RO7049389 in liver relative to plasma. Exposures in the liver are of particular importance for dose selection since the liver is the site of action of the compound. The model described and reproduced the population PK profiles as well as the between-subject variability of RO7049389 and its metabolite. It could show that the PK is similar between healthy subjects and in HBV patients, once the ethnicity and gender effects are accounted for. The model predicts that, despite a large difference in the plasma exposure of RO7049389 between Asians and non-Asians, the exposure in the liver is comparable, allowing the use of the same dose to treat Asian and non-Asian patients. This model provides a valuable basis to develop this new anti-HBV drug and to define optimal dosing.

A mixed-methods approach to understanding perceptions of hepatitis B and hepatocellular carcinoma among ethnically diverse Black communities in South Florida.

PURPOSE: Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC), disproportionately affects minorities. Compared to other races, Blacks more often present with advanced HCC and have decreased survival. We observed higher HBV-associated HCC rates among Blacks than reported nationally. In our center, Haitian Blacks had the highest rates of HBV-associated HCC and shorter survival compared to other Blacks. We investigated knowledge and perceptions regarding HBV and HCC among Blacks born in the United States or Haiti. METHODS: Using community partnerships, participants were recruited via word of mouth, email, social media or from Hepatology clinic. Focus groups were conducted in Haitian Creole or English and stratified by birthplace, gender and infection status. Discussions were audio-recorded and transcribed verbatim. A constant comparative method was used for data analysis; themes are based on conversational details. RESULTS: There were 55 participants; 49% were male and 27% had chronic HBV. Only 42% of Haitian Blacks knew about HBV prior to participation vs. 78% of African Americans, p 0.03. Both groups expressed that fear, mistrust of the medical establishment, denial and stigma might compel persons to avoid seeking care. Both groups attributed higher rates of late stage HCC diagnosis in Blacks to inadequate financial resources and education. Those with HBV reported confusion regarding their infection and suboptimal communication with healthcare providers. CONCLUSIONS: In two communities disproportionately affected by HBV, misconceptions about disease transmission, stigma, low health literacy and decreased access to care may limit detection for HBV. Culturally relevant community-based interventions are needed to increase HBV detection.

Prevalence of retrovirus, hepatitis B and D infection in the Matsés ethnic group in Loreto, Peru. / Prevalencia de infección por los virus de la hepatitis B, D y por retrovirus en la etnia Matsés (Loreto, Perú).

Observational, cross-sectional, populational study to determine the prevalence of infection by hepatitis B virus (HBV), hepatitis D virus (HDV), human immunodeficiency virus (HIV) and human T-lymphotropic virus type 1 and 2 (HTLV-1/2) in the Matsés ethnic group, after immunization against HBV. ELISA and qPCR tests were used in 963 residents. The prevalence of HBsAg, Anti-HBc and Anti-HBs was 3.32%, 36.03% and 58.67% respectively. In 3.1% of the population the viral load was greater than 2000 IU/mL. In children under 10 years, the prevalence of HBsAg and anti-HBc was 0.0% and 2.6%, respectively, while protective antibodies were found in 94.4%. The prevalence of HIV and HTLV-1/2 infection was 1.5% and 0.6%, respectively. It is therefore concluded that there are low rates of HBV and HDV infection in the Matsés child population. Likewise, the presence of HIV and HTLV-1/2 infection is confirmed.

Para determinar la prevalencia de infección por los virus de la hepatitis B y D (VHB y VHD, respectivamente), VIH y HTLV-1/2 en la etnia matsés, después de la inmunización contra el VHB se realizó un estudio transversal y poblacional, utilizando pruebas de ELISA y qPCR en 963 pobladores. Las prevalencias de HBsAg, anti-HBc y anti-HBs fueron 3,3%, 36,0% y 58,7%, respectivamente. En el 3,1% de la población la carga viral fue mayor a 2000 UI/mL. En menores de 10 años, la prevalencia de HBsAg y anti-HBc fue 0,0% y 2,6%, respectivamente, mientras que en el 94,4% se encontraron anticuerpos protectores. La prevalencia de infección por el VIH y el HTLV-1/2 fue 1,5% y 0,6%, respectivamente. Se concluye que existen tasas bajas de infección por el VHB y el VHD en la población infantil de la etnia matsés. Asimismo, se confirma la presencia de infección por el VIH y el HTLV-1/2.

Improving uptake of hepatitis B and hepatitis C testing in South Asian migrants in community and faith settings using educational interventions-A prospective descriptive study.

BACKGROUND: Chronic viral hepatitis (CVH) is a leading contributor to the UK liver disease epidemic, with global migration from high prevalence areas (e.g., South Asia). Despite international guidance for testing high-risk groups in line with elimination targets, there is no consensus on how to achieve this. The objectives of this study were to assess the following: (1) the feasibility of recruiting South Asian migrants to view an educational film on CVH, (2) the effectiveness of the film in promoting testing and increasing knowledge of CVH, and (3) the methodological issues relevant to scale-up to a randomized controlled trial. METHODS: South Asian migrants were recruited to view the film (intervention) in community venues (primary care, religious, community), with dried blood spot CVH testing offered immediately afterwards. Pre/post-film questionnaires assessed the effectiveness of the intervention. RESULTS: Two hundred and nineteen first-generation migrants ≥18 years of age (53% female) were recruited to view the film at the following sites: religious, n = 112 (51%), community n = 98 (45%), and primary care, n = 9 (4%). One hundred and eighty-four (84%) underwent CVH testing; hepatitis B core antibody or hepatitis C antibody positivity demonstrated exposure in 8.5%. Pre-intervention (n = 173, 79%) and post-intervention (n = 154, 70%) questionnaires were completed. CONCLUSIONS: This study demonstrated the feasibility of recruiting first-generation migrants to view a community-based educational film promoting CVH testing in this higher risk group, confirming the value of developing interventions to facilitate the global World Health Organization plan for targeted case finding and elimination, and a future randomized controlled trial. We highlight the importance of culturally relevant interventions including faith and culturally sensitive settings, which appear to minimize logistical issues and effectively engage minority groups, allowing ease of access to individuals 'at risk'.

["Heparjoc-Actúa": educational tool created through a process of participatory action research with vulnerable immigrant groups to improve accessibility to diagnosis of hepatitis B.] / "HEPARJOC-ACTÚA": herramienta educativa creada a través de un proceso de investigación-acción participativa con colectivos inmigrantes vulnerables para mejorar la accesibilidad al diagnóstico de la hepatitis B.

OBJECTIVE: The World Health Organization estimates that 257 million people suffer from chronic infection by the hepatitis B (HB) virus. It is common for diagnosis to be delayed or never given at all. In Spain, immigrants that come from endemic areas present a prevalence of infection of around 8%. In the year 2015, this study was begun with the aiml of improving accessibility to hepatitis B diagnoses in immigrant communities. METHODS: A descriptive qualitative study was carried out, based on participatory action research (IAP). It was divided into two cycles: in the first cycle, after forming a motor group (GIAP), a participatory community assessment (DCP) was performed with the population, through a descriptive-interpretative qualitative study (ECDI) with 3 focal groups (n=17). A narrative analysis was then performed of thematic content. In the second cycle, two collaborative workshops (coworking) were held to create an educational tool (HEPARJOC) and to co-create an action plan (PDA). As a pilot test, the PDA was put into practice through eight workshops (n=56). A knowledge questionnaire was used to compare the median number of correct responses before and after the workshop, using the t of Student for paired data. RESULTS: A GIAP was formed with 8 members of different sectors and community spaces. In the DCP it was observed that there was a lack of knowledge about different aspects of hepatitis B. Visual, interactive materials were proposed as educational tools, and "HEPARJOC" was created as the final product. In the pilot test of the PDA, the median of correct responses to the knowledge questionnaire about HB was 7.7 (DE=3) before the workshop, and 10.6 (DE=0.2) afterward. The improvement of the median was 2.9 points (IC 95% 2.2-3.6), which is statistically significant (p<0.001). 30 people sought screening (53.6% of participants), and 23 of those people were screened (41% of participants). CONCLUSIONS: "HEPARJOC-ACTUA" is a strategy that could contribute to transforming knowledge and improving accessibility to hepatitis B diagnosis in immigrant communities. Key words: Infectious diseases, hepatitis B, community health, community health agents, health education, participatory action research, immigration. Key words: Infectious.

OBJETIVO: La Organización Mundial de la Salud estima que 257 millones de personas padecen infección crónica por el virus de la hepatitis B (HB). Es habitual que el diagnóstico se retrase o que nunca se llegue a realizar. En España, los inmigrantes procedentes de áreas endémicas presentan prevalencias en torno al 8%. En el año 2015, se inició este estudio con el objetivo de mejorar la accesibilidad al diagnóstico de la hepatitis B en colectivos inmigrantes. METODOS: Se realizó un estudio cualitativo descriptivo, basado en la investigación acción participativa (IAP). Se dividió en dos ciclos: en el primer ciclo, después de configurar un grupo motor (GIAP), se realizó un diagnóstico comunitario participativo (DCP) con la población, a través de un estudio cualitativo descriptivo-interpretativo (ECDI) con 3 grupos focales (n=17). Se llevó a cabo un análisis narrativo de contenido temático. En el segundo ciclo, se realizaron 2 talleres de trabajo colaborativo (coworking) para crear una herramienta educativa (HEPAJOC) y coconstruir un plan de acción (PDA). Como prueba piloto se llevó a cabo este PDA a través 8 talleres (n=56). Se utilizó un cuestionario de conocimientos para comparar la media de respuestas correctas pre y post taller utilizando el t de Student para datos apareados. RESULTADOS: Se configuró un GIAP con 8 miembros de diferentes sectores y espacios comunitarios. En el DCP se observó que existía un desconocimiento en diferentes aspectos sobre la hepatitis B. Se propusieron, como herramientas educativas, materiales visuales e interactivos, elaborando como producto final el "HEPARJOC". En la prueba piloto del PDA, la media de las respuestas correctas al cuestionario de conocimientos sobre la HB fue de 7,7 (DE=3) previamente, y de 10,6 (DE=0,2) posteriormente. La mejoría de la media fue de 2,9 puntos (IC 95% 2,2-3,6), siendo estadísticamente significativa (p<0,001). Solicitaron el cribado 30 personas (53,6%), siendo cribadas 23 (41%). CONCLUSIONES: "HEPARJOC-ACTUA" es una estrategia que puede contribuir a transformar conocimientos y a mejorar la accesibilidad al diagnóstico de la hepatitis B en colectivos inmigrantes.

Prevalence and Trends in Hepatitis B Virus Infection in the United States, 2015-2018.

Hepatitis B virus (HBV) is a type of viral hepatitis transmitted through sexual contact, contaminated blood, or from an infected mother to her newborn (1). HBV may cause a liver infection that is acute or short-term, but may also cause chronic or long-term infection. Vaccination was targeted to high-risk groups in 1982, and universal vaccination of newborns was recommended beginning in 1991 in the United States (2). This report provides 2015-2018 prevalence estimates of past or present HBV infection and evidence of hepatitis B vaccination, based on blood collected in the National Health and Nutrition Examination Survey (NHANES).

Identification of mutations in the S gene of hepatitis B virus in HIV positive Mexican patients with occult hepatitis B virus infection.

INTRODUCTION AND AIM: Occult hepatitis B virus infection (OBI) is characterized by the presence of replication-competent hepatitis B virus (HBV) DNA in the liver and/or serum of patients with undetectable levels of the HBV surface antigen (HBsAg). Due to the shared infection routes HIV positive patients are at higher risk of developing OBI, thus, the aim of this study was to determine the frequency of OBI in Mexican HIV-infected patients and to identify mutations in the HBV S gene that could be associated to the development of OBI. MATERIALS AND METHODS: Plasma samples from 50 HIV-infected patients with undetectable levels of the HBsAg were obtained and analyzed. The Core, PreS and S genes were amplified by nested PCR and sequenced by the Sanger method. To analyze HBV diversity in the OBI-positive patients, ten sequences of 762bp from the HBV S gene were selected, cloned, and subsequently sequenced for mutational analyses. RESULTS: OBI infection was found with a frequency of 36% (18/50). All the HBV sequences corresponded to the H genotype. The most common mutations were: C19Y, Q129H, E164D, and I195M, with a frequency of 44%, 36%, 39% and 48% respectively. CONCLUSIONS: In this study, we report the presence of OBI in a cohort of Mexican HIV-infected patients with an overall prevalence of 36%. Mutational analyses revealed that four non-silent mutations were frequent in different regions of the HBsAg gene, suggesting that they might be associated to the development of OBI in this population, nevertheless, further studies are required to determine their role in the pathogenesis of OBI.

Prevalencia de infección por los virus de la hepatitis B, D y por retrovirus en la etnia Matsés (Loreto, Perú) / Prevalence of retrovirus, hepatitis B and D infection in the Matsés ethnic group in Loreto, Peru

RESUMEN Para determinar la prevalencia de infección por los virus de la hepatitis B y D (VHB y VHD, respectivamente), VIH y HTLV-1/2 en la etnia matsés, después de la inmunización contra el VHB se realizó un estudio transversal y poblacional, utilizando pruebas de ELISA y qPCR en 963 pobladores. Las prevalencias de HBsAg, anti-HBc y anti-HBs fueron 3,3%, 36,0% y 58,7%, respectivamente. En el 3,1% de la población la carga viral fue mayor a 2000 UI/mL. En menores de 10 años, la prevalencia de HBsAg y anti-HBc fue 0,0% y 2,6%, respectivamente, mientras que en el 94,4% se encontraron anticuerpos protectores. La prevalencia de infección por el VIH y el HTLV-1/2 fue 1,5% y 0,6%, respectivamente. Se concluye que existen tasas bajas de infección por el VHB y el VHD en la población infantil de la etnia matsés. Asimismo, se confirma la presencia de infección por el VIH y el HTLV-1/2.

ABSTRACT Observational, cross-sectional, populational study to determine the prevalence of infection by hepatitis B virus (HBV), hepatitis D virus (HDV), human immunodeficiency virus (HIV) and human T-lymphotropic virus type 1 and 2 (HTLV-1/2) in the Matsés ethnic group, after immunization against HBV. ELISA and qPCR tests were used in 963 residents. The prevalence of HBsAg, Anti-HBc and Anti-HBs was 3.32%, 36.03% and 58.67% respectively. In 3.1% of the population the viral load was greater than 2000 IU/mL. In children under 10 years, the prevalence of HBsAg and anti-HBc was 0.0% and 2.6%, respectively, while protective antibodies were found in 94.4%. The prevalence of HIV and HTLV-1/2 infection was 1.5% and 0.6%, respectively. It is therefore concluded that there are low rates of HBV and HDV infection in the Matsés child population. Likewise, the presence of HIV and HTLV-1/2 infection is confirmed.

The Roma Population Living in Segregated Settlements in Eastern Slovakia Has a Higher Prevalence of Metabolic Syndrome, Kidney Disease, Viral Hepatitis B and E, and Some Parasitic Diseases Compared to the Majority Population.

Background: The Roma population is one of the largest marginalized population groups in Europe. The aim of our work was to summarize the morbidity of lifestyle-related diseases and infectious diseases in the Roma population living in segregated settlements. Methods: We used data from the cross-sectional study HepaMeta, in which we examined 452 Roma subjects with an average age of 34.7 ± 9.1 years, 35.2% of which were men, and 403 non-Roma subjects with an average age of 33.5 ± 7.4 years, 45.9% of which were men. We collected data by means of a questionnaire, anthropometric measures, and we analyzed blood and urine samples. Results: Roma subjects had a higher incidence of metabolic syndrome (RR: 1.478 (1.159-1.885), p < 0.0001), obesity or waist circumference >94 cm in men/80 cm in women (RR: 1.287 (1.127-1.470), p < 0.0001), and HDL-C < 1.03 mmol/L in men or <1.29 in women (RR: 2.004 (1.730-2.321), p < 0.0001) than their non-Roma counterparts. Subjects of the Roma population were more frequently diagnosed with kidney disease (RR: 1.216 (1.096-1.349), p < 0.0001), HBsAg positivity (RR: 4.468 (2.373-8.415), p < 0.0001), anti HBc IgG positivity (RR: 3.13 (2.598-4.224), p < 0.0001), and anti HEV positivity (RR: 2.972 (1.226-7.287), p < 0.0001). Serological markers of Toxoplasma gondii infection and Toxocara spp. were observed much more frequently among Roma than non-Roma subjects (RR: 1.868 (1.520-2.296), p < 0.0001, for Toxoplasma gondii; and RR: 21.812 (8.097-58.761), p < 0.0001, for Toxocara spp.). Conclusions: Poor socio-economic conditions, an unhealthy lifestyle, and barriers precluding access to healthcare are factors that affect the Roma population in settlements and lead to an increased prevalence of metabolic syndrome and its components, kidney disease, viral hepatitis B and E, and some parasitic diseases.

Long-term observation on hepatitis B surface antigen seroclearance in therapy experienced HIV/HBV co-infected Chinese.

The aim of this retrospective study was to observe hepatitis B surface antigen (HBsAg) seroclearance and explore predictors of HBsAg loss in HIV/HBV-co-infected patients receiving long-term lamivudine or both tenofovir and lamivudine containing therapies. Quantification of HBsAg, hepatitis B e antigen and HBV DNA before and after initiation of HBV-active antiretroviral therapy in a total of 268 HIV/HBV-co-infected patients started treatment between 2005 and 2017 were performed. Over a median of 65.63 months of follow-up, 10 (3.7%) were observed HBsAg loss and the quantification of HBsAg in 7 (2.6%) patients were less than 50 IU/mL. With the prolongation of antiretroviral therapy duration time, the rates of HBsAg seroclearance tended to increase gradually, rising from 1.8% (3/163) during 2-4 years treatment to 29.4% (10/34) after antiretroviral therapy for up to 10 years. Lower baseline qHBsAg and HBV DNA levels and strong 12-month declines in qHBsAg were significantly associated with HBsAg seroclearance. The event of HBsAg seroclearance is uncommon among Chinese individuals with HIV/HBV co-infection who have been treated with anti-HBV containing antiretroviral therapy, and lifelong therapy for HBV is needed for HIV/HBV co-infected patients. Baseline qHBsAg and HBV DNA levels and qHBsAg decline rate were predictors for HBsAg seroclearance.

Meta-regression Analysis of Sex- and Birth Year-Specific Prevalence of HBsAg and Anti-HCV Among Un-diagnosed Japanese: Data From the First-time Blood Donors, Periodical Health Checkup, and the Comprehensive Health Checkup With Lifestyle Education (Ningen Dock).

BACKGROUND: This study was aimed to precisely estimate the prevalence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus antibody (anti-HCV) stratified by sex and birth year in Japan. METHODS: Three large-scaled cohorts: first-time blood donors, periodic health check-up, and comprehensive health check-up with lifestyle education (Ningen dock) were used for pooled prevalence of HBsAg and anti-HCV using meta-regression. RESULTS: Trends of birth year-specific prevalence of HBsAg and anti-HCV among the three cohorts were similar to one another, while birth year-specific pooled prevalence of HBsAg peaked in the 1941-1950 birth cohort. Prevalence of anti-HCV showed a decreasing trend by birth year. CONCLUSION: We could estimate the pooled prevalence of HBsAg and anti-HCV based on nationwide data. The results can be used as reference data for various countermeasures for hepatitis eradication.

Hepatitis B virus infection: Epidemiology and seroprevalence rate amongst Negrito tribe in Malaysia.

INTRODUCTION: Prevalence of Hepatitis B virus (HBV) infection among the non-indigenous people in Malaysia has been well established and range between 3% and 5%. However, data from the indigenous (Orang Asli) people is still lacking. The Negrito population is the most remotely located Orang Asli tribe with limited access to health care facilities. This study was undertaken to determine the epidemiology and seroprevalence of HBV infection among the Negrito. METHODS: Surveys were conducted in five Negrito settlements in Kelantan and Perak states in Malaysia. A total of 150 participants were recruited. Clinical history was taken and physical examination was performed. Five millilitres of whole blood were collected and tested for hepatitis B surface antigen (HBsAg) using electrochemiluminescence immunoassay. RESULTS: Participants were mainly from the Bateq (49.3%) and Mendriq (29.4%) sub-tribes. Overall, 13 subjects (8.7 %); nine males and four females were HBsAg positive. Nine of the HBsAg positive subjects were ≥35 years old. All of them had history of home deliver without evidence of antenatal record. Six (46%) of the HBsAg positive subjects had tattoo and body piercing in the past. CONCLUSION: The prevalence of HBV infection rate amongst the Negrito tribe is almost three-fold compared to the national rates. The reason for this finding remains unclear. Tattooing, body piercing and vertical transmission could be the main possible routes of transmission of HBV among the Negrito population in Malaysia.

Antibody Affinity, Total Antibody Activity, and Protein Content to Anti-HBs Antigen Among Sudanese and Chinese Using Terminal Antibody Method.

BACKGROUND: Generally, HBV infection serum markers have been globally measured, and the analysis of entire an-tibody details include the affinity, total protein content and antibody activity are rarely measured between two different ethnic groups. We detected and determined the entire characteristics of anti-HBs (antibody to HBs anti-gen) among Sudanese and Chinese HBV resolved patient's using a terminal antibody (TA) method. METHOD: Serum samples of Sudanese and Chinese resolved HBV infection positive anti-HBs were collected. All se-rum samples were diluted in serial dilutions (20, 40, 80, and 160 dilutions). Anti-HB markers were measured with enzyme-linked immunosorbent assay (ELISA), antibody affinity, total protein content, and total antibody activity to anti-HBs were calculated according to the results obtained for each dilution. RESULTS: The antibody affinity to HBV statistically showed higher significance among Sudanese than Chinese (p < 0.05). The total antibody activity to HBV among Sudanese was higher statistically than Chinese patients (p < 0.05). Statistically, there was a high correlation between age and antibody affinity to HBV among Sudanese compared to the Chinese group (p < 0.05). CONCLUSIONS: The measurement of the antibody affinity, total antibody activity, and protein content of anti-HBs among Sudanese and Chinese, two different ethnic groups, may predict HBV infection status among African race and Asian race, and in addition, may play an important role in a high or a low incidence of the disease between different ethnicities.

Screening for infectious diseases in newly arrived asymptomatic immigrants in southern Italy.

BACKGROUND: Screenings for infectious diseases in asymptomatic immigrants currently takes place when receiving new arrivals. AIMS: We describe the frequency of infections in a cohort of newly arrived asymptomatic immigrants in Southern Italy. METHODS: We studied a cohort of 238 Sub-Saharan African and Asian men hosted at a reception centre (CARA) in Foggia between January and December 2015. The tuberculin skin test for diagnosis of latent tuberculosis infection (LTBI) and serology/virology testing for HBV, HCV, HIV were performed. RESULTS: From this cohort, 205 individuals agreed to be tested for serological/virological markers only, while 82 agreed to be tested for LTBI only; 49 people agreed to have both tests. Among those tested for virological markers, 23/205 (11.2%) were HBsAg positive; 12/23 (52.2%) individuals had chronic active hepatitis; 77/205 (37.6%) individuals had only anti-HBc positivity. HCV infection was present in 8/205 (3.9%) individuals, and chronic HCV infection, was diagnosed in only two people. Only 2/205 (1.0%) individuals presented with anti-HIV and HIV-RNA positivity. We found LTBI in 29.6% of TB-tested individuals. CONCLUSIONS: Asymptomatic immigrants are at increased risk for some infections, mainly HBV and tuberculosis.

Hepatitis B Virus Screening and Vaccination in First-generation African Immigrants: A Pilot Study.

Foreign-born African immigrants bear a large burden of hepatitis B virus (HBV)-related liver disease in the U.S. However, HBV awareness and knowledge of HBV screening and vaccination among this population is limited. This study aimed to provide a better understanding of HBV burden in this vulnerable population and to identify risk factors for the implementation of more effective prevention and treatment programs. We conducted a cross-sectional survey among 71 first-generation African Americans in New York City. Participants' sociodemographic characteristics, HBV screening and vaccination history, knowledge of HBV transmission, and other related issues were asked. The study sample included 46 men and 23 women, with an average age of 32.75. Of the sample, 87.50% participants migrated from sub-Saharan Africa and 79.10% had lived in the U.S. for 10 or fewer years. Almost half of participants never underwent HBV screening (44.29%) or HBV vaccination (49.23%). About two-thirds (60.87%) of participants never received any HBV screening or vaccination recommendation from doctors. Multivariable analysis results showed that having a college degree and being currently married were significantly associated with HBV screening, while having health insurance was significantly associated with HBV vaccination. Survey data further indicated that first-generation African immigrants had very limited knowledge of HBV transmission, suggesting that this population would benefit from greater awareness of HBV risk factors and modes of transmission. The influence of education, marriage and spousal support, and access to health insurance on HBV screening and vaccination should be noted and further examined in future public health interventions and research.