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1.
Medicine (Baltimore) ; 98(51): e18442, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861015

RESUMO

Genetic variation and genotype of Hepatitis B virus (HBV) are related to the efficiency of interferon alpha (IFN-α)-based antiviral therapy. However, the correlation of variation in interferon-stimulated response element (ISRE) and HBV genotype response to IFN-α therapy remains elusive.Differences of ISRE between genotype B and C HBV were explored using the HBV sequences retrieved from GenBank, and further investigated by ISRE region cloning and sequencing from 60 clinical samples post-IFN-α therapy. Additionally, ISRE mutants were constructed and their relation to responsiveness of IFN-α was evaluated by real-time PCR and Southern blot analysis.ISRE pattern between genotype B and C were found based on both clinical sample sequencing and full-length sequence alignment. The primary difference is the fourth base within the ISRE region, with T and C for genotype B and C, respectively. HBV with genotype C-type ISRE had a higher replicative capability as compared to HBV with genotype B-type ISRE after IFN-α treatment in huh7 cells. CONCLUSION:: Preference of ISRE between genotype B and C HBV are distinct. Single nucleotide difference (C to T) within the HBV ISRE region may link to the efficacy of IFN-α therapy to genotype B and C HBV. Therefore, this study provides a clue for the determination of IFN-α therapy response to HBV treatment.


Assuntos
Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/tratamento farmacológico , Interferon-alfa/farmacologia , Elementos de Resposta , Adulto , Feminino , Genótipo , Vírus da Hepatite B/genética , Humanos , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mutação , Adulto Jovem
2.
Nature ; 574(7777): 200-205, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31582858

RESUMO

The responses of CD8+ T cells to hepatotropic viruses such as hepatitis B range from dysfunction to differentiation into effector cells, but the mechanisms that underlie these distinct outcomes remain poorly understood. Here we show that priming by Kupffer cells, which are not natural targets of hepatitis B, leads to differentiation of CD8+ T cells into effector cells that form dense, extravascular clusters of immotile cells scattered throughout the liver. By contrast, priming by hepatocytes, which are natural targets of hepatitis B, leads to local activation and proliferation of CD8+ T cells but not to differentiation into effector cells; these cells form loose, intravascular clusters of motile cells that coalesce around portal tracts. Transcriptomic and chromatin accessibility analyses reveal unique features of these dysfunctional CD8+ T cells, with limited overlap with those of exhausted or tolerant T cells; accordingly, CD8+ T cells primed by hepatocytes cannot be rescued by treatment with anti-PD-L1, but instead respond to IL-2. These findings suggest immunotherapeutic strategies against chronic hepatitis B infection.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Apresentação Cruzada/imunologia , Vírus da Hepatite B/imunologia , Hepatócitos/imunologia , Hepatócitos/virologia , Animais , Antígeno B7-H1/antagonistas & inibidores , Linfócitos T CD8-Positivos/citologia , Linfócitos T CD8-Positivos/metabolismo , Diferenciação Celular , Cromatina/metabolismo , Feminino , Hepatite B/tratamento farmacológico , Hepatite B/imunologia , Hepatite B/virologia , Humanos , Tolerância Imunológica , Interleucina-2/imunologia , Interleucina-2/uso terapêutico , Macrófagos do Fígado/imunologia , Ativação Linfocitária , Masculino , Camundongos , Transcriptoma/genética
3.
Zhonghua Gan Zang Bing Za Zhi ; 27(9): 721-724, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594101

RESUMO

Clinically, hepatocellular carcinoma (HCC) is one of the most common malignant tumors with a high rate of morbidity and mortality. Hepatitis B virus infection is the main cause of hepatocellular carcinoma in China and it is a serious threat to people's health. Antiviral drugs such as nucleos(t)ide analogues and interferon can inhibit viral replication and liver fibrosis progression and reduce the occurrence of hepatitis B-related HCC. This article reviews the effects of different antiviral therapy on the occurrence of hepatitis B-related hepatocellular carcinoma in recent years.


Assuntos
Antivirais/uso terapêutico , Carcinoma Hepatocelular/virologia , Hepatite B/tratamento farmacológico , Neoplasias Hepáticas/virologia , China , Vírus da Hepatite B , Humanos , Cirrose Hepática/prevenção & controle , Cirrose Hepática/virologia
4.
Medicine (Baltimore) ; 98(43): e17664, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651893

RESUMO

RATIONALE: Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD), atherosclerotic stroke and peripheral vascular disease, has become the most deadly chronic noncommunicable disease throughout the world in recent decades, while plaque regression could reduce the occurrence of ASCVD. Traditional Chinese Medicine (TCM) has been widely used for prevention and treatment of these diseases. In the perspective of TCM, phlegm and blood stasis are considered to be leading pathogenesis for CHD. Hence, activating blood circulation and dissipating phlegm, which is of great benefit to regress plaque, have been regarded as general principles in treatment. PATIENT CONCERNS: A 36-year-old man presented with a 3-month history of intermittent exertional chest pain. Coronary angiography revealed 60% stenosis of the proximal left anterior descending coronary artery. Liver function showed: alanine transaminase (ALT):627U/L, aspartate transaminase (AST):243U/L. DIAGNOSES: CHD and hepatitis B with severe liver dysfunction. INTERVENTIONS: The patient should have been treated with high-intensity statin therapy. Actually, due to severe liver dysfunction, Huazhirougan granule instead of statins was administered. In addition, he was treated with TCM according to syndrome differentiation for two and a half years. OUTCOMES: The chest pain disappeared and other symptoms alleviated as well after treatment. Coronary computed tomographic angiography revealed no stenosis in the proximal left anterior descending coronary artery. ALT and AST level returned to normal (ALT:45U/L,AST:24U/L). LESSONS: For patients with CHD and severe hepatic dysfunction, antilipidemic drugs such as statins are not recommended. This case suggested that TCM might fill a gap in lipid-lowering therapy. Thus, we could see that statins were not the only drug for plaque regression and the effect of TCM in treating coronary artery disease cannot be ignored.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/tratamento farmacológico , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Medicina Tradicional Chinesa , Adulto , Diagnóstico Diferencial , Humanos , Testes de Função Hepática , Masculino
5.
Expert Rev Clin Pharmacol ; 12(9): 867-874, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456441

RESUMO

Introduction: Hepatitis B virus is an important cause of liver disease and has numerous extra-hepatic manifestations. HBV leads to important morbidity and mortality in the general population and recent evidence suggests a role of HBV in the incidence and progression of chronic kidney disease. Areas covered: The mechanisms underlying the link between HBV and CKD remain unclear. Nucleos(t)ide analogues for the antiviral treatment of HBV are currently available; these drugs are provided with high efficacy even in patients with CKD. Expert opinion: A recent meta-analysis of clinical studies showed that HBV results in a greater risk of CKD in the general population. According to an updated review (studies were identified from PubMed, EMBASE, and the Cochrane database), we retrieved six clinical studies (n = 1,034,773 unique patients), adjusted RR, 1.41 (95% CI, 1.09; 1.82, P < 0.001). The significant heterogeneity observed precluded more definitive conclusions. Various mechanisms have been cited to explain the greater risk of CKD among HBsAg positive carriers. Novel evidence shows that untreated HBV and therapy with nucleos(t)ide analogues are associated with increased and decreased risk of end-stage renal disease in CKD population, respectively. We recommend that patients with HBV are assessed for kidney function and urinary changes at baseline and over the follow-up.


Assuntos
Antivirais/administração & dosagem , Hepatite B/complicações , Insuficiência Renal Crônica/etiologia , Progressão da Doença , Hepatite B/tratamento farmacológico , Hepatite B/virologia , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Falência Renal Crônica/virologia , Testes de Função Renal , Nucleosídeos/administração & dosagem , Nucleotídeos/administração & dosagem , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/virologia , Fatores de Risco
6.
Phytother Res ; 33(11): 2960-2970, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410907

RESUMO

Although the approved hepatitis B virus (HBV)-polymerase inhibitors (e.g., lamivudine) often lead to drug-resistance, several natural products have shown promising efficacies. Though Aloe vera (AV) gel and its constituents are shown inhibitors of many viruses, their anti-HBV activity still remains elusive. We therefore, tested the anti-HBV potential of AV extract and its anthraquinones in hepatoma cells, including molecular docking, high-performance thin layer chromatography (HPTLC), and cytochrome P450 (CYP3A4) activation analyses. Our anti-HBV assays (HBsAg/HBeAg Elisa) showed maximal inhibition of viral antigens production by aloe-emodin (~83%) > chrysophanol (~62%) > aloin B (~61%) > AV extract (~37%) in HepG2.2.15 cells. Interestingly, the effect of aloe-emodin was comparable with lamivudine (~86%). Moreover, sequential treatment with lamivudine (pulse) followed by aloe-emodin (chase) enhanced the efficacy of monotherapy by ~12%. Docking (AutoDock Vina) of the anthraquinones indicated strong interactions with HBV-polymerase residues that formed stable complexes with high Gibbs's free energy. Further, identification of aloe-emodin and aloin B by validated HPTLC in AV extract strongly endorsed its anti-HBV potential. In addition, our luciferase-reporter gene assay of transfected HepG2 cells showed moderate induction of CYP3A4 by aloe-emodin. In conclusion, this is the first report on anti-HBV potential of AV-derived anthraquinones, possibly via HBV-polymerase inhibition. Of these, although aloin B exhibits novel antiviral effect, aloe-emodin appears as the most promising anti-HBV natural drug with CYP3A4 activating property towards its enhanced therapeutic efficacy.


Assuntos
Aloe/química , Antraquinonas/uso terapêutico , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Antraquinonas/farmacologia , Antivirais/farmacologia , Antivirais/uso terapêutico , Linhagem Celular , Emodina/análogos & derivados , Emodina/farmacologia , Emodina/uso terapêutico , Células Hep G2 , Humanos , Fitoterapia/métodos , Extratos Vegetais/farmacologia
7.
Infect Dis Poverty ; 8(1): 57, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31269994

RESUMO

BACKGROUND: Mother to child transmission of hepatitis B virus (HBV) remains the most common form of HBV infection in China. Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine (HepB) series and hepatitis B immunoglobulin. Post-vaccination serological testing (PVST) is utilized to determine an infant's outcome after HBV exposure and completion of HepB series. We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up (LTFU). METHODS: We conducted a retrospective cohort review of previously collected data in Fujian, Jiangxi, Zhejiang and Chongqing provinces in China from 1 June 2016-31 December 2017. The study population included all HBV-exposed infants and their mothers. SAS software was used for statistical analyses. Bivariate and multivariate regression analyses (presented in odds ratio [OR] with 95% confidence intervals [CI]) were used to compare the proportional differences of factors associated with PVST not being completed. RESULTS: Among enrolled 8474 target infants, 40% of them transferred out of the study provinces without further information and 4988 were eligible for PVST. We found 20% (994) of infants were not compliant with the testing cascade: 55% of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field, 16% transferred out after 6 months of age, and 10% of families chose to have independent, confidential PVST completed without reporting results. High PVST noncompliance rates were more likely to be from Fujian (aOR = 17.0, 95% CI: 9.7-29.9), Zhejiang (aOR = 5.7, 95% CI: 3.2-10.1) and Jiangxi (aOR = 1.9, 95% CI: 1.0-3.4), and from HBV e antigen positive mother (aOR = 1.2, 95% CI: 1.1-1.4). CONCLUSIONS: This study found that the LTFU rate reached 20% in PVST program, which was a significant problem. We recommend implementing a national electronic information system for tracking HBV at risk mother-infant pairs; encourage further research in developing a less invasive means of completing PVST, and take effective measures nationally to reduce HBV stigma. Without reducing the loss to follow up rate among infants eligible for PVST, elimination of vertical HBV transmission will be impossible.


Assuntos
Vírus da Hepatite B/fisiologia , Hepatite B/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Testes Sorológicos/estatística & dados numéricos , Vacinação/estatística & dados numéricos , China , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Perda de Seguimento , Masculino , Estudos Retrospectivos
8.
Acta Gastroenterol Belg ; 82(2): 279-284, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314189

RESUMO

BACKGROUND AND AIM: Hepatitis B Virus (HBV) screening before starting immunosuppressive treatment is of vital importance in order to prevent HBV reactivation and its associated clinical consequences. Despite all recommendations by international organizations, screening rates are far below desired. The aim of this study was to assess the efficacy of a computer alert programme 'HBVision' for increasing HBV screening rates. MATERIAL AND METHODS: 'HBVision' identifies patients at risk of HBV reactivation by specific ICD-10 codes and immunosuppressive medication reports and sends sequential alert messages to screen for HBsAg, anti-HBc IgG and consult a specialist if one of them is positive. The demographic variables, treatment protocols, HBV screening and consultation rates of oncology and hematology patients who started immunosuppressive treatments within one year before (control group) and after "HBVision" (study group) were retrospectively compared. RESULTS: HBsAg and anti-HBc IgG screening rates (68.6% and 13.1%, respectively) were significantly higher in the study group (n=602) compared to control group (n=815) (55% and 4.3%, respectively) (p<0.001, for both). Subgroup analysis revealed significant improvements in the screening rates of HBsAg (65.8%) and anti-HBc IgG (5.1%) in oncology patients (p<0.001), anti-HBc IgG (89.1%) in hematology patients (p<0.001). CONCLUSION: The computer alert programme significantly increased HBV screening rates before starting immunosuppressive treatments, however the results were still below ideal. Additional efforts, such as modifying the computer programme according to feedbacks, are probably needed.


Assuntos
Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/sangue , Hepatite B/virologia , Imunossupressores/efeitos adversos , Ativação Viral/efeitos dos fármacos , Hepatite B/induzido quimicamente , Hepatite B/tratamento farmacológico , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/patogenicidade , Humanos , Imunossupressores/uso terapêutico , Programas de Rastreamento/métodos , Estudos Retrospectivos , Software
9.
Eur J Pharm Sci ; 136: 104958, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31212018

RESUMO

Alternative formulations of entecavir, a once daily oral hepatitis B antiretroviral, may improve treatment adherence by patients. We explored the use of biocompatible polymers to control entecavir dissolution in two formats suitable for subcutaneous implantation. Hot melt extrudates were prepared by extruding entecavir-polymer blends at specified weight ratios. Dip-coated tablets were prepared by compressing entecavir in a multi-tip tooling. Tablets were dip-coated in solutions of polymer and dried. In rodents, entecavir-poly(caprolactone) extrudates demonstrated >180 days of continuous drug release, although below the estimated efficacious target input rate. Drug pharmacokinetic profiles were tunable by varying the polymer employed and implant format. The rank order trends of drug input rates observed in vitro were observed in vivo in the detected plasma concentrations of entecavir. In all dose groups entecavir was not tolerated locally at the site of administration where adverse event severity correlated with drug input rate. These polymer-based implantable formats have applicability to long-acting formulations of high solubility compounds beyond entecavir.


Assuntos
Antivirais/química , Antivirais/farmacologia , Guanina/análogos & derivados , Hepatite B/tratamento farmacológico , Animais , Química Farmacêutica/métodos , Portadores de Fármacos/química , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos/efeitos dos fármacos , Excipientes/química , Feminino , Guanina/química , Guanina/farmacologia , Masculino , Polímeros/química , Ratos , Ratos Wistar , Solubilidade/efeitos dos fármacos , Comprimidos/química , Comprimidos/farmacologia
10.
BMC Public Health ; 19(1): 829, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242901

RESUMO

BACKGROUND: International sustainable development goals for the elimination of viral hepatitis as a public health problem by 2030 highlight the need to optimize strategies for prevention, diagnosis and treatment of hepatitis B virus (HBV) infection. An important priority for Africa is to have affordable, accessible and sustainable prevention of mother to child transmission (PMTCT) programmes, delivering screening and treatment for antenatal women and implementing timely administration of HBV vaccine for their babies. METHODS: We developed a decision-analytic model simulating 10,000 singleton pregnancies to assess the cost-effectiveness of three possible strategies for deployment of tenofovir in pregnancy, in combination with routine infant vaccination: S1: no screening nor antiviral therapy; S2: screening and antiviral prophylaxis for all women who test HBsAg-positive; S3: screening for HBsAg, followed by HBeAg testing and antiviral prophylaxis for women who are HBsAg-positive and HBeAg-positive. Our outcome was cost per infant HBV infection avoided and the analysis followed a healthcare perspective. RESULTS: Based on 10,000 pregnancies, S1 predicts 45 infants would be HBV-infected at six months of age, compared to 21 and 28 infants in S2 and S3, respectively. Relative to S1, S2 had an incremental cost of $3940 per infection avoided. S3 led to more infections and higher costs. CONCLUSION: Given the long-term health burden for individuals and economic burden for society associated with chronic HBV infection, screening pregnant women and providing tenofovir for all who test HBsAg+ may be a cost-effective strategy for South Africa and other low/middle income settings.


Assuntos
Antivirais/uso terapêutico , Análise Custo-Benefício , Vírus da Hepatite B/imunologia , Hepatite B/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Tenofovir/uso terapêutico , Adulto , Criança , Países em Desenvolvimento , Feminino , Hepatite B/sangue , Hepatite B/diagnóstico , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/sangue , Vacinas contra Hepatite B/administração & dosagem , Antígenos E da Hepatite B/sangue , Hepatite B Crônica/sangue , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/virologia , Humanos , Lactente , Programas de Rastreamento , Modelos Biológicos , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , África do Sul , Tenofovir/economia , Vacinação , Adulto Jovem
11.
Medicine (Baltimore) ; 98(18): e15412, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045797

RESUMO

BACKGROUND: Hepatitis B virus (HBV) infection is an important public health problem in the Turkish population, that is, one of the largest migrant populations in Europe. With the introduction of cost-effective antiviral treatments in the past decade, there is a need to identify HBV-infected patients who may benefit from treatment. This study describes the design of a study to assess the HBV prevalence in the Turkish population living in Belgium. Additionally, we will determine the risk factors of HBV infection and the uptake of screening, vaccination, and antiviral treatment in this hard-to-reach Turkish population. METHODS: A longitudinal, epidemiological study will be conducted in the region Middle Limburg Belgium, where the Turkish adult population, 18 years of age and older, will be screened for hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and antibodies against hepatitis B core antigen (anti-HBc). Educational meetings concerning viral hepatitis B will be organized and there will be 3 ways to be screened for HBV: immediately after the educational meetings, at the Outpatient Hepatology Department of Ziekenhuis Oost-Limburg, and at home visits. Subsequently, participants will be asked to fill in a questionnaire regarding sociodemographic factors, migration history, risk factors for HBV infection (e.g., sharing toothbrushes, HBV-infected family member), and HBV vaccination status. Six months after screening, HBsAg-positive patients will be assessed whether they are under follow-up at the general practitioner or hepatologist. We will also gather information regarding the uptake of vaccination in nonimmunized subjects. DISCUSSION: This study will provide information about the HBV prevalence and distribution of the stages of liver disease in the Turkish population in Belgium. By determining the risk factors for HBV infection, subgroups with an increased prevalence of HBV infection can be identified. CLINICAL TRIAL NUMBER: This clinical trial is registered at clinicaltrials.gov (NCT03396458).


Assuntos
Emigrantes e Imigrantes , Hepatite B/diagnóstico , Hepatite B/etnologia , Programas de Rastreamento/organização & administração , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Bélgica/epidemiologia , Métodos Epidemiológicos , Feminino , Educação em Saúde/organização & administração , Hepatite B/tratamento farmacológico , Hepatite B/prevenção & controle , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Turquia/etnologia , Vacinas contra Hepatite Viral/administração & dosagem , Adulto Jovem
12.
PLoS One ; 14(5): e0216293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071145

RESUMO

BACKGROUND: Hepatitis B virus (HBV) co-infection in HIV-infected individuals increases the risk of hepatic complications and mortality. Further, the risk of perinatal HBV transmission increases among HBV/HIV co-infected pregnant women. Although HBV is endemic in the Democratic Republic of Congo, there is little data on HBV/HIV co-infection. We aimed to assess the burden and risk factors of HBV surface antigen (HBsAg) positivity among HIV-infected pregnant and post-partum women. METHODS: This cross-sectional study was conducted as part of an ongoing trial to assess the effect of data-driven continuous quality improvement interventions (CQI) for optimal prevention of mother-to-child transmission (PMTCT) of HIV (CQI-PMTCT study, NCT03048669). In each of the 35 health zones of Kinshasa province, all HIV-infected pregnant or breastfeeding women (≤1 year post-delivery) presenting for care in one of the three busiest maternal and child health clinics of the health zone were tested for HBsAg using Alere Determine, Japan. We used logistic regression with general estimating equation accounting for within-clinic clustering to assess risk factors of HBsAg positivity. RESULTS: Between November 2016 and June 2018, a total of 1377 women, all on antiretroviral therapy, were tested for HBsAg. Overall, 4.7% [95% binomial confidence interval (CI): 3.7%-5.7%] tested positive for HBsAg. HBsAg prevalence was 3.3% (95% CI: 2.1%-4.8%) for women tested during pregnancy, 4.5% (2.5%-7.4%) for those tested at delivery, and 8.5% (5.6%-12.2%) for those tested post-partum (Ptrend = 0.001). In multivariate models including socio-economic status (SES), type of care facility, duration of antiretroviral therapy, HIV viral load, and self-reported intimate partner violence (IPV), lowest tertile of SES, ≤ 6 months of ART, and IPV were all consistently and positively associated with higher prevalence of HBsAg across pregnancy, delivery, and postpartum period while been tested in a health centre or having a viral load ≥ 1000 copies/mL were consistently associated with lower prevalence. However, only the association with IPV (OR = 2.74, 95% CI: 1.10-6.84) and viral load between 40-1000 copies/ml (OR = 4.28, 95% CI: 1.22-15.01) achieved statistical significance among pregnant women. CONCLUSION: This study revealed an overall high prevalence of HBsAg among HIV-infected pregnant and post-partum women in Kinshasa with the latter showing the highest HBsAg prevalence. Among pregnant women, intimate partner violence was independently and statistically associated with HBsAg positivity, requiring further investigation.


Assuntos
Antirretrovirais/administração & dosagem , Infecções por HIV , HIV-1 , Vírus da Hepatite B , Hepatite B , Período Pós-Parto/sangue , Complicações Infecciosas na Gravidez , Adulto , Estudos Transversais , República Democrática do Congo , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Hepatite B/sangue , Hepatite B/tratamento farmacológico , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B/sangue , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos
14.
Pol J Microbiol ; 68(1): 139-143, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31050262

RESUMO

The Beckman Coulter DxN VERIS system is a fully automated, closed molecular diagnostic instrument for viral load quantification of hepatitis B virus and hepatitis C virus. In this study, the analytical performance of this new system was compared to routine diagnostic Qiagen PCR kit by using the same clinical samples. The DxN VERIS system demonstrated a high analytical performance. The DxN VERIS allows random access, which means that samples can be uploaded straight on to the system at any time; so, it provides an improvement of workflow, staff productivity and allows faster turn-around of viral load results.The Beckman Coulter DxN VERIS system is a fully automated, closed molecular diagnostic instrument for viral load quantification of hepatitis B virus and hepatitis C virus. In this study, the analytical performance of this new system was compared to routine diagnostic Qiagen PCR kit by using the same clinical samples. The DxN VERIS system demonstrated a high analytical performance. The DxN VERIS allows random access, which means that samples can be uploaded straight on to the system at any time; so, it provides an improvement of workflow, staff productivity and allows faster turn-around of viral load results.


Assuntos
Hepacivirus/genética , Vírus da Hepatite B/genética , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Técnicas de Diagnóstico Molecular/instrumentação , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase/instrumentação , Reação em Cadeia da Polimerase/métodos , Genótipo , Hepatite B/tratamento farmacológico , Hepatite C/tratamento farmacológico , Humanos , RNA Viral/genética
15.
Pharmazie ; 74(3): 179-185, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30961686

RESUMO

Aim of the study: Adjuvants can increase the efficiency and reduce the number of required doses for hepatitis B vaccination. Thus the study was designed to investigate whether V. amygdalina leaf extract may be used as an adjuvant to the conventional hepatitis B surface antigen-based vaccine through humoral response analyses. Methodology: The toxicity/safety margin of V. amygdalina was determined using Lorke's method. Immunization was carried out in mice in two phases, phase 1 employed a 3-times vaccination schedule while phase 2 tested 2-times vaccination schedule. The humoral immune response was determined using ELISA test. The total white blood count, different white blood count, aspartate aminotransferase level, alanine aminotransferase level were determined and the body weight of the mice periodically monitored. Results: Our data show that V. amygdalina was not toxic up to the dose of 5000 mg/kg bodyweight (bw). At a concentration of 250 mg/kg bw as an adjuvant in a three times vaccination schedule, it increased IgM, IgG1 and IgA antibody responses. In a 2-times vaccination schedule, 1000 mg/kg of V. amygdalina as an adjuvant to hepatitis B vaccine was able to elicit effective antibody production (0.174±0.002) significantly (P <0.05) higher than the conventional hepatitis B vaccine group (0.109±0.002) which received 3-times vaccine dose. It equally enhanced innate cell-mediated immune response by increasing total white blood cell, neutrophil and lymphocyte counts. The adjuvant-vaccine combination did not produce side effects as the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were within the normal ranges. The liver excised from the sacrificed mice at the end of the vaccination series showed no sign of congestion, inflammation or colour change. Periodic mice body weight monitoring showed similar growth pattern between the treatment and control groups. Conclusion: Results obtained suggest that V. amygdalina may serve as an effective adjuvant to hepatitis B virus vaccine.


Assuntos
Adjuvantes Imunológicos/farmacologia , Vacinas contra Hepatite B/farmacologia , Hepatite B/tratamento farmacológico , Hepatite B/imunologia , Extratos Vegetais/farmacologia , Vernonia/química , Animais , Peso Corporal/efeitos dos fármacos , Citocinas/imunologia , Feminino , Imunidade Humoral/efeitos dos fármacos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Camundongos , Folhas de Planta/química , Distribuição Aleatória , Vacinas de Subunidades/farmacologia
16.
Bull World Health Organ ; 97(3): 230-238, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30992636

RESUMO

Hepatitis B virus (HBV) infection is a major public health problem worldwide. China has the world's largest burden of HBV infection and will be a major contributor towards the global elimination of hepatitis B disease by 2030. The country has made good progress in reducing incidence of HBV infection in the past three decades. The achievements are mainly due to high vaccination coverages among children and high coverage of timely birth-dose vaccine for prevention of mother-to-child transmission of HBV (both > 95%). However, China still faces challenges in achieving its target of 65% reduction in mortality from hepatitis B by 2030. Based on targets of the World Health Organization's Global health sector strategy on viral hepatitis 2016-2021, we highlight further priorities for action towards HBV elimination in China. To achieve the impact target of reduced mortality we suggest that the service coverage targets of diagnosis and treatment should be prioritized. First, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Second, the government needs to reduce the financial burden of health care on patients. Third, better coordination is needed across existing national programmes and resources to establish an integrated prevention and control system that covers prevention, screening, diagnosis and treatment of HBV infection across the life cycle. In this way, progress can be made towards achieving the target of eliminating hepatitis B in China by 2030.


Assuntos
Erradicação de Doenças/organização & administração , Saúde Global , Programas Governamentais/organização & administração , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Antivirais/uso terapêutico , China/epidemiologia , Erradicação de Doenças/economia , Programas Governamentais/economia , Redução do Dano , Gastos em Saúde , Prioridades em Saúde/organização & administração , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Vacinas contra Hepatite B/administração & dosagem , Humanos , Programas de Imunização/organização & administração , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Programas de Rastreamento/organização & administração , Cobertura Vacinal/organização & administração , Organização Mundial da Saúde
17.
J Med Case Rep ; 13(1): 99, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31003599

RESUMO

BACKGROUND: Adefovir dipivoxil is a nucleotide analogue that is approved for treatment of chronic hepatitis B. Adefovir dipivoxil is associated with proximal tubular dysfunction, resulting in Fanconi syndrome, which can cause secondary hypophosphatemic osteomalacia. We describe a case of a patient with hypophosphatemic osteomalacia secondary to Fanconi syndrome induced by adefovir dipivoxil concomitantly with osteoporosis in whom clinical symptoms were improved by adding denosumab (a human monoclonal antibody targeting the receptor activator of nuclear factor-κB ligand) to preceding administration of vitamin D3. CASE PRESENTATION: A 60-year-old Japanese man had been receiving low-dose adefovir dipivoxil (10 mg/day) to treat chronic hepatitis B for approximately 5 years. He presented to an orthopedic surgeon with severe pain of the right hip and no trauma history, and fracture of the neck of the right femur was identified. In addition, 99mTc-hydroxymethylene diphosphate scintigraphy revealed significantly abnormal uptake in the bilateral ribs, hips, and knees, and he was therefore referred to our university hospital for evaluation of multiple pathological fractures. We diagnosed hypophosphatemic osteomalacia due to Fanconi syndrome induced by adefovir dipivoxil therapy. Although we reduced the patient's adefovir dipivoxil dose and added calcitriol (active vitamin D3), he did not respond and continued to complain of bone pain. Several bone resorption markers and bone-specific alkaline phosphatase were also persistently elevated. Therefore, we added denosumab to vitamin D3 supplementation for treatment of excessive bone resorption. Two months after initiation of denosumab, his hip and knee pain was relieved, along with a decrease in serum alkaline phosphatase and some bone resorption markers. CONCLUSIONS: Although denosumab is not generally an appropriate treatment for acquired Fanconi syndrome, it may be useful for patients who have hypophosphatemic osteomalacia due to adefovir dipivoxil-induced Fanconi syndrome associated with excessive bone resorption. However, clinicians should keep in mind that if denosumab is administered to patients with hypophosphatemic osteomalacia accompanied by excessive bone resorption, adequate vitamin D and/or phosphate supplementation should be done before administration of denosumab.


Assuntos
Conservadores da Densidade Óssea/administração & dosagem , Denosumab/administração & dosagem , Síndrome de Fanconi/induzido quimicamente , Hipofosfatemia , Osteomalacia , Adenina/efeitos adversos , Adenina/análogos & derivados , Adulto , Antivirais/efeitos adversos , Síndrome de Fanconi/tratamento farmacológico , Hepatite B/tratamento farmacológico , Humanos , Hipofosfatemia/induzido quimicamente , Hipofosfatemia/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Organofosfonatos/efeitos adversos , Osteomalacia/induzido quimicamente , Osteomalacia/tratamento farmacológico , Tomografia Computadorizada de Emissão , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(14): e15092, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946367

RESUMO

To evaluate the efficacy and safety of telbivudine (LdT) and tenofovir (TDF) for preventing hepatitis B virus (HBV) vertical transmission for HBV-positive pregnant women.Pregnant women (n = 145) from January 2013 to June 2017 were enrolled when they met inclusion criteria, which included HBV DNA ≥1.0 × 10 copies/mL and increased alanine aminotransferase (ALT) levels. Groups A (n = 58) and B (n = 51) were treated with LdT and TDF, respectively. Group C (n = 36) received no antiviral treatment. All infants were vaccinated with hepatitis B immunoglobulin and HBV vaccine. Vertical transmission of HBV was indicated by the presence of hepatitis B surface antigen (HBsAg) in infants 6 months and 12 months after birth.There is no difference of clinical characteristics of patients among the 3 groups. Serum HBV DNA levels of the 3 groups were similar at baseline (Group A vs. Group B vs. Group C, 7.88 ±â€Š0.65 vs. 7.91 ±â€Š0.75 vs. 7.69 ±â€Š0.53 P = .25). In addition, the after anti-HBV treatment in Groups A and B were significantly decreased. Also, the serum HBV DNA levels in both Groups A and B were lower than that of Group C (P < .01, both). The HBV infection rate in Group A treated with LdT was not different from Group B treated with TDF. The dynamic changes of serum ALT level were similar. ALT levels were similar among the 3 Groups (P = .171), while there is statistically significant difference between A and C, and between B and C before delivery (P < .01). For the infants, there were no significant differences among body weight, height, head circumference, or Apgar score. However, the HBsAg positivity rates of infants in Groups A, B, C at postpartum 24 weeks and 48 weeks was 0%, 0%, and 11.1%, respectively (P < .001).Administration of LdT or TDF to HBV-infected mothers are effective and safe to block mother-to-infant HBV transmission.


Assuntos
Antivirais/administração & dosagem , Hepatite B/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Telbivudina/administração & dosagem , Tenofovir/administração & dosagem , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Hepatite B/tratamento farmacológico , Antígenos de Superfície da Hepatite B/efeitos dos fármacos , Vacinas contra Hepatite B/imunologia , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Resultado da Gravidez , Estudos Retrospectivos , Carga Viral , Adulto Jovem
19.
Nurs Clin North Am ; 54(2): 277-284, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31027666

RESUMO

Hepatitis B and C are complex and dynamic viral infections. An infected individual spreads the viruses to an uninfected individual in contaminated blood and body fluids. Acute hepatitis B and C infections may or may not produce mild symptoms and spontaneously resolve. Some individuals will progress to chronic hepatitis B and C, which can lead to liver fibrosis, cirrhosis, hepatocellular carcinoma, and possibly death. Choosing medications available to treat chronic hepatitis B and C is based on individual serology results, including genotype and level of liver damage. Treatment has been successful in inducing remission and complete recovery in many individuals.


Assuntos
Antivirais/uso terapêutico , Hepatite B/diagnóstico , Hepatite B/tratamento farmacológico , Hepatite B/fisiopatologia , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Hepatite C/fisiopatologia , Humanos , Guias de Prática Clínica como Assunto
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