Seroprevalence of Hepatitis B Virus infection and its risk factors in the west of Iran: a population-based study

Hepatitis B virus [HBV] infection is a serious global public health problem affecting billions of people globally. The lack of information of its seroprevalence among the general population is an obstacle for formulating effective policies to reduce the burden viral hepatitis. Therefore, this population based serological survey was conducted in Kurdistan province, where no epidemiological data was available to determine the prevalence and risk factors of HBV infection. 1613 healthy subjects were selected from all districts of Kurdistan province [in the western of Iran] using random cluster sampling. The subjects' age ranged from 6 to 65 years old. Serum samples were tested for HBcAb, HBsAg and anti HDV antibody. Screening tests were carried out by the third generation of ELISA. Various risk factors were recorded and multivariate analysis was performed. The prevalence of HBsAg and HBcAb in Kurdistan was before 0.80% [95% CI 0.44; 1.34] and 5.02% [95% CI 4.03; 6.17], respectively. None of HBsAg carriers had positive anti HDV antibody. Predictors of HBsAg or HBcAb in multivariate analysis were: older age and marriage. We did not find any significant differences between males and females. Our population based study suggests that intrafamilial HBV transmission plays a major role in HBV transmission in Kurdistan province. Furthermore, approximately 5% of general population in this province has prior exposure to HBV and less than 1% is HBsAg carriers. However, we could not find any case of HDV infection among them

Lipid Profiles and Hepatitis C Viral Markers in HCV-Infected Thalassemic Patients

BACKGROUND/AIMS: The distribution of blood lipids, glucose and their determinants in thalassemic patients with chronic hepatitis C virus (HCV) infection has rarely been investigated. Thus, we aimed to investigate the relationship between both liver histologic findings and viral markers and serum lipids in thalassemic patients chronically infected with HCV. METHODS: We enrolled 280 polytransfused thalassemic patients with chronic hepatitis C. HCV viral load was determined using the Amplicor test. Genotyping was performed using genotype specific primers. Fasting serum lipid, glucose, ferritin and liver function enzyme concentrations were measured. A modified Knodell scoring system was used to stage liver fibrosis and to grade necroinflammatory activity. Perls' staining was used to assess hepatic siderosis. RESULTS: Just one subject had total cholesterol >200 mg/dL, and 7% had triglycerides >150 mg/dL. The mean high-density lipoprotein cholesterol (HDL-C) and glucose levels were 37 and 104 (97-111) mg/dL, respectively. Viral markers, liver histological findings and aminotransferase activity were not associated with serum lipid levels. Serum triglycerides, total cholesterol and ferritin were independent risk factors for impaired glucose tolerance or diabetes in these patients. CONCLUSIONS: The majority of the patients had blood lipid levels (with the exception of HDL) within the defined normal range; viral and liver histological factors do not appear to play a significant role in changing the levels of serum lipids or glucose in these patients.

Meta-analysis of factors associated with sustained viral response in patients on hemodialysis treated with standard or pegylated interferon for hepatitis C infection

The efficacy and safety of pegylated and standard interferon [IFN] have been scrutinized in meta-analyses; however, factors associated with hepatitis C viral response in patients on hemodialysis are not well investigated. We evaluated factors that could be associated with sustained virological response [SVR] to pegylated or standard IFN monotherapy in patients on hemodialysis with chronic hepatitis C virus [HCV] infection, by performing a systematic review of the literature with a meta-analysis of clinical trials. We used both Mantel-Haenszel and DerSimonian and Laird random effects models, with heterogeneity and sensitivity analyses. Twenty-one studies on IFN-alfa2a or IFN-alfa2b [491 patients] and 12 on pegylated-IFN-alfa2a or PEG-IFN-alfa2b [279 patients] were evaluated. The pooled SVR for standard and pegylated IFN monotherapy in random effects model was 39.1% [95% confidence interval [CI], 32.1 to 46.1] and 39.3% [95% CI, 26.5 to 52.1], respectively. Pooled dropout rates were 22.6% [95% CI, 10.4 to 34.8] and 29.7% [95% CI, 21.7 to 37.7], respectively. Female gender, HCV-RNA copies per milliliter, HCV genotype, alanine transaminase pattern, duration of infection, liver fibrosis stage, and treatment duration were not associated with SVR. Only an age less than 40 years was significantly associated with SVR in both models [odds ratio, 2.17; 95% CI, 1.03 to 4.50]. Additional benefit of monotherapy with pegylated IFN in patients on hemodialysis with HCV infection in terms of viral response and adverse events is still unclear. According the current literature, younger age was the only determinant of SVR

Safety and efficacy of pegylated interferon alfa-2a for the treatment of hepatitis c in patients with major thalassemia

Hepatitis C virus [HCV] infection is the most common transfusion transmitted disease in poly-transfused patients worldwide. In this study we aimed to evaluate the effects of pegylated interferon alfa-2a [PEG-IFN A-2a] in reducing serum ALT and eradicating serum hepatitis C virus [HCV] RNA in HCV infected polytransfused thalassemic patients. A cohort of 51 HCV-RNA positive thalassemic patients were enrolled to our study and received 180 u,g PEG-IFN A-2a once-weekly for 48 weeks. The primary end point was sustained virological response [SVR]. The secondary outcome was normalization of ALT. Patient safety was assured by monthly, and if needed, weekly laboratory assessment and visits. Of 52 patients, 42 participants completed the treatment schedule. A sustained virological response [SVR] was attained in 22/51 [43%] cases. Among non-responders or relapsers to previous HCV antiviral therapy, 9/27 [33%] attained an SVR. Five patients died during treatment and 3 subjects discontinued the therapy because of adverse effects. Adverse events were generally mild, and laboratory abnormalities were rare. A course of 48-week PEG-IFN A-2a monotherapy is effective in eradicating HCV-RNA during treatment. But about one third of thalassemic patients would relapse within 6 months of treatment schedule completion, in whom combination therapy is needed