Chronic hepatitis E infection: risks and controls.

Very recently, an unusual clinical presentation with an altered natural history associated with hepatitis E virus (HEV) infection has emerged in high-income industrialized nations. Although HEV infection does not develop into chronicity in general, viremia can persist for long periods of time in immunocompromised solid organ, bone marrow and stem cell transplant patients. Conceivably, the atypical clinical and virological outcomes in these cases could be related to immunosuppressive chemotherapy, resulting in suboptimal HEV-specific immune responses. In the absence of travel to endemic regions, foodborne autochthonous HEV infection due to viral genotypes 3 and 4 has been implicated in the chronic cases. Presently, pegIFN-α-2a and ribavirin, the commonly used drugs to treat chronic viral hepatitis, are proving very promising in hepatitis E patients. Nevertheless, the most-awaited HEV vaccine could be protective in naïve travelers or high-risk group populations. The mechanisms of establishing chronic HEV infection and the disease severity have hitherto not been clearly understood. Therefore, a comprehensive clinical, virological and molecular study is needed to understand and control the disease.

Management of chronic hepatitis in drug addicts: a systematic review.

Injection drug users constitute the largest group of person at high risk for acquiring chronic hepatitis C, B and Delta. In particular viral, host and environmental factors all seem to favour rapid spread of these infections among drugs addicts. Host factors include behaviours that expose individuals to hepatitis virus such as the shared use of drug preparation, injection equipment and not protected sexual relationship with other drugs users. While in some clinical studies adherence to treatment regimens was often poor and to treat chronic hepatitis in injection drug users was stated as futile, in other controlled clinical studies adherence and sustained biological response to antiviral treatment was slightly lower or similar to that reported in other groups of patients. In this review we describe the epidemiology, diagnosis and treatment of chronic hepatitis C, B and Delta in intravenous drug users.

Perfil clínico de pacientes portadores de hepatite B crônica / Clinical profile of patients with chronic hepatitis B

Objetivo: Conhecer as características e o perfil clínico dos indivíduos em tratamento de hepatite B crônica. Métodos: Participaram do estudo 65 pacientes com hepatite B crônica que iniciaram o tratamento entre os anos de 2010 a 2012. Resultados: Todos os pacientes eram da raça branca. Houve predomínio do sexo masculino (60%), e a maioria tinha entre 41 e 50 anos (32,8%). Grande parte dos pacientes (87,9%) não foi imunizada; 10,3% receberam as três doses da vacina e 43,1% possuíam familiar de primeiro grau ou parceiro com hepatite B crônica. A maioria (70,8%) relatou contato com algum fator de risco, sendo que 61,5% referiram ter realizado tratamento dentário. Conclusão: A implantação da vacina para toda população menor de 1 ano de idade, em 1996, pode ser uma explicação para a alta média de idade encontrada e pela inexistência de indivíduos menores de 23 anos no estudo. A vacinação completa, entretanto, ainda apresenta baixa adesão.(AU)

Objective: To get to know the characteristics and clinical profile of subjects being treated for chronic hepatitis B. Methods: Sixty-five patients with chronic hepatitis B who started treatment between the years 2010 to 2012 participated in the study. Results: All patients were white; there was a predominance of males (60%), and most of them were between 41 and 50 years (32.8%). Most patients (87.9%) were not immunized; 10.3% received all the three doses of the vaccine, and 43.1% had a first-degree relative or a partner with chronic hepatitis B. Most of them (70.8%) reported contact with a risk factor, with 61.5% reporting having had dental treatment. Conclusion: The implantation of the vaccine for all the population lower than 1 year of age, in 1996, can be an explanation for the high average age found, and the nonexistence of individuals younger than 23 years in the study. Complete vaccination, however, still presents low adherence.(AU)

Chronic viral hepatitis: epidemiology, molecular biology, and antiviral therapy.

Viral hepatitis is a major cause of chronic liver disease, liver failure, and hepatocellular carcinoma worldwide, resulting in significant morbidity and mortality. New insights into the pathogenesis and molecular biology of hepatitis viruses have led to the discovery of novel antiviral agents. Likewise, a greater understanding of the natural history of chronic infection, predictors of disease progression, and predictors of virologic response to therapy has resulted in more effective treatment strategies. Recent data have increasingly demonstrated that the ability to achieve a successful response to antiviral therapy may significantly reduce the risk of progressive liver disease and hepatocellular carcinoma. Immunization practices and the use of potent antiviral therapy may have a major impact in reducing the burden of chronic liver disease and the incidence of hepatocellular carcinoma associated with chronic hepatitis B and chronic hepatitis D. Individualized treatment strategies and the development of direct acting antiviral agents may lead to further improvements in the ability to achieve a sustained virologic response to therapy in chronic hepatitis C. With new advances in the treatment of chronic hepatitis, efforts to optimize viral suppression while reducing the potential for antiviral drug resistance will become increasingly important.

Molecular analysis of intraspousal transmission of hepatitis C virus.

BACKGROUND/AIMS: Although intraspousal transmission of hepatitis C virus (HCV) has been speculated, there is no direct evidence. METHODS: To investigate whether transmission of HCV occurs by this route, 295 spouses of persons diagnosed with HCV were studied. Of these, 25 (8.8%) tested positive for anti-HCV. Next, the HCV genotype was determined by polymerase chain reaction using a mixed primer set, and cDNA was obtained in 17 of the 25 couples for comparison of the genotypes. RESULTS: Of these 17, 14 (82.4%) spouses were shown to be infected with HCV of the same genotype. Analysis of the nucleotide sequences of putative E1 gene of eight couples having the same HCV genotype revealed that five couples had remarkably high nucleotide sequence homologies (> 97%), whereas samples obtained from the remaining three couples showed relatively low homology (91-92%). Nucleotide sequence homologies were significantly higher between spouses than between non-spouse pairs of isolates. Phylogenetic analysis using the neighbor-joining method suggests that infection in these five couples probably occurred after marriage. Furthermore, none of the five couples had shared other possible transmission routes such as intravenous drug use, dental treatment or acupuncture. CONCLUSION: These data strongly suggest the occurrence of intraspousal transmission of HCV.

Transmission of hepatitis C virus between spouses: the important role of exposure duration.

OBJECTIVES: Although interspousal transmission of hepatitis C virus (HCV) has been studied, the factors responsible for it remain unclear. METHODS: To investigate the transmission of HCV between spouses and the related risk factors, 100 anti-HCV-positive index patients and their spouses were studied. RESULTS: Overall, anti-HCV was detected in 17 (17%) spouses, 15 of whom were also positive for HCV RNA, and 11 couples were infected with the same genotype. The anti-HCV-positive rate was higher in spouses married longer than 20 yr compared with those married less than 20 yr (22 vs 6%, p < 0.05), and the infection was correlated with the duration of their actual exposure to the index patients but not with serum HCV titers. The infected couples had more frequent sexual contacts and more commonly shared tooth-brushes than those with uninfected spouses. CONCLUSION: Spouses of patients with chronic hepatitis C have a higher risk of acquiring HCV that increases with longer marriage and duration of exposure, and they should be educated about how to avoid contracting HCV infection from their spouses.

Incidence of deep fascial space infection after surgical removal of the mandibular third molars.

Nine hundred and ninety-three patients who underwent surgical removal of the mandibular third molars with oral antibiotic prophylaxis were examined to determine the incidence of postoperative deep fascial space infection and its background factors. Postoperative deep fascial space infection was observed in 8 of the patients (0.8%; 4 males and 4 females), and submandibular spaces were involved in all infected patients. Only 1 of these 8 patients was an immune compromised host. Patients aged 30 years or more had a significantly higher incidence of deep fascial space infection than those aged under 30. Five patients had partial bony impactions and 3 had complete bony impactions. However, the incidence of infection according to the molar positions was not significantly different between partial bony impaction and complete bony impaction. The 8 patients had not had pericoronitis preoperatively. The clinical courses of all were favorable after antibiotics were administered intravenously. In conclusion, the incidence of deep fascial space infection after removal of the mandibular third molars was low, at 0.8%. However, it may be desirable to remove the molars, if applicable, at a younger age because of the higher incidence of infection in patients aged over 30. The results of this study also offer information that will be useful as a basis for obtaining informed consent from patients whose mandibular third molars are to be removed.