Update of chronic hepatitis B

Correlation of hepatitis B surface antigen expression with clinicopathological and biochemical parameters in liver biopsies: A comprehensive study

BACKGROUND

Chronic viral B hepatitis (CHB) is a potentially life-threatening liver disease that may progress to liver failure and cirrhosis. Currently, although combinations of different laboratory methods are used in the follow-up and treatment of CHB, the failure of these procedures in some cases has led to the necessity of developing new approaches. In CHB, the intrahepatic expression pattern of viral antigens, including hepatitis B surface antigen (HBsAg), is related to different phases of inflammation. However, many studies have focused on the intracytoplasmic properties of HBsAg staining, and HBsAg positivity in liver tissue has not been evaluated by objective quantitative methods.

AIM

To investigate the relationship of image analysis-based quantitative HBsAg expression and its staining patterns with clinicopathological factors and treatment in CHB.

METHODS

A total of 140 liver biopsies from treatment-naïve cases with CHB infection were included in this study. Following diagnosis, all patients were treated with entecavir (0.5 mg) and followed up at three-month intervals. The percentage of immunohistochemical HBsAg (p-HBsAg) expression in the liver was determined in whole tissue sections of biopsies from each case by image analysis. The immunohistochemical staining pattern was also evaluated separately according to 3 different previously defined classifications.

RESULTS

A positive correlation between p-HBsAg and serum levels of hepatitis B virus (HBV) DNA and HBsAg was observed (P < 0.001). The p-HBsAg value was significantly higher in younger patients than in older patients. When the groups were categorized according to the hepatitis B e antigen (HBeAg) status in HBeAg-positive cases, p-HBsAg was correlated with HBV DNA, hepatitis activity index (HAI) and fibrosis scores (P < 0.001). In this group, p-HBsAg and HBsAg expression patterns were also correlated with the viral response (VR) and the serological response (SR) (P < 0.001). Multivariate analysis revealed that p-HBsAg was an independent predictor of either VR or SR (P < 0.001). In HBeAg-negative patients, although HBsAg expression patterns were correlated with both HAI and fibrosis, no relationship was observed among p-HBsAg, clinicopathological factors and VR.

CONCLUSION

In pretreatment liver biopsies, the immunohistochemical determination of HBsAg expression by quantitative methods, beyond its distribution within the cell, may be a good predictor of the treatment response, especially in HBeAg-positive cases.

Potential strategies for "cure" of hepatitis B

Hepatitis B is a worldwide health problem and the main cause of liver cirrhosis, liver failure, and liver cancer. The steady state of hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) in HBV infected hepatocytes and virus specific immune tolerance contribute to the chronic persistent infection and hard-to-cure of hepatitis B. The presently available therapeutics for hepatitis B can control viral replication, but rarely eliminate HBV surface antigen (HBsAg) or HBV cccDNA. The "cure" of hepatitis B, which is characterized by the HBsAg loss or HBsAg seroconversion, and cccDNA clearance, has been the goal of researchers for years. In recent years, with the robust progress in understanding the HBV pathogenesis and the rapid development of gene editing technology, the "cure" of hepatitis B becomes prospective. This paper aims to summarize the potential strategies for the "cure" of hepatitis B.

Chronic hepatitis B: Are we close to a cure?

Approximately 300 million people worldwide are persistently infected with the hepatitis B virus and are at risk of developing hepatocellular carcinoma and liver cirrhosis, which can progress to end-stage liver disease. Despite the effectiveness of the current vaccination policy, the prevalence of the disease remains high, and the burden for health services is considerable. The currently available antiviral strategies are either poorly effective or only effective for non-curative suppression of viral replication. Recent efforts have been focused on improving the cure rate for chronic hepatitis B and developing strategies to eliminate infected cells. Several approaches are under evaluation, and these include targeting the virus at different stages of its life cycle and boosting the antiviral immune response. This article reviews these latest approaches and comments on their feasibility and potential translation into clinical applications.

Clinical effects of different antiviral treatments for chronic hepatitis B

AIM: To compare the clinical effects of different antiviral treatments for chronic hepatitis B (CHB).

METHODS: A total of 266 patients with chronic CHB were included. They all underwent optimized treatment, including 97 patients treated with telbivudine tablets, 92 with entecavir tablets, and 77 with adefovir dipivoxil tablets. The undectable rates of HBV DNA at 12, 24 and 108 wk, the recovery rate of alanine aminotransferase (ALT), the disappearance rate of hepatitis B e antigen (HBeAg), and the conversion rate of HBeAg were compared. The Child-Pugh stage prior treatment and at 108 wk posttreatment as well as adverse reactions were also compared.

RESULTS: The undectable rates of HBV DNA at 12 and 24 wk and the recovery rate of ALT in the telbivudine group and entecavir group were significantly higher than those in the adefovir dipivoxil group (60.82%, 57.61% vs 35.06%; 73.20%, 73.91% vs 45.45%; 50.52%, 51.09% vs 31.17%; 59.79%, 61.96% vs 40.26%; P < 0.05). There was no significant difference in the unpredictable rate of HBV DNA at 108 wk and the recovery rate of ALT in the three groups. The disappearance rate of HBeAg at 108 wk and the conversion rate of HBeAg in the telbivudine group were significantly higher than those in the adefovir dipivoxil group (39.18% vs 20.78%, 28.87% vs 9.09%, P < 0.05). The proportions of Child-Pugh stage A at 108 wk posttreatment for the three groups were significantly higher than those prior treatment (57.73% vs 28.87%, 51.09% vs 21.74%, 54.55% vs 24.68%, P < 0.05), and there was no significant difference for the three groups in the proportions of Child-Pugh stage A at 108 wk posttreatment (57.73% vs 51.09% vs 54.55%, P > 0.05).

CONCLUSION: Telbivudine can improve liver function, reduce HBV DNA copies, improve the conversion rate of HBeAg, and reduce the score of Child-Pugh, representing a preferred treatment for patients with CHB.

Prevalence of HBc-Ab among HBs-Ag negative healthy blood donors in south of Iran

Background:

The risk of infection with transfusion-transmitted viruses, such as Hepatitis B virus (HBV), has been reduced markedly. However, a zero-risk blood supply remains a popular goal. Anti-hepatitis B core antigen (anti-HBc) is considered to be an effective marker for occult HBV infection, and it has served a significant role in improving blood safety. The purpose of this study was to determine the seroprevalence of anti-HBc antibodies among blood donors.

Methods:

During a period of six months in 2012, 1000 blood donors in Bandar Abbas were investigated for the presence of HBV infection markers. We used ELISA for the detection of HBsAg and chemiluminescence for the detection of HBsAb and anti-HBc antibodies.

Results:

The prevalence of positive anti-HBc among the 1000 donors was 8.3%. Almost 2.3% of the donors were reactive for anti-HBc and negative for HBsAg.

Conclusions:

The study showed that more than 2% of healthy blood donors in Bandar Abbas already have been exposed to HBV, although their HBsAg tests were negative. We suggest screening for anti-HBc to improve the safety of the blood supply.

Hepatitis B Infection among high risk population: a seroepidemiological survey in Southwest of Iran

BACKGROUND

Hepatitis B virus (HBV) infection remains a major global health problem. This study aimed to assess the prevalence and risk behaviors for HBV infection among high risk groups in Kohgiloyeh and Boyerahmad province, in Southwest of Iran.

METHODS

Blood samples were collected from 2009 subjects, between 2009 and 2010 in Kohgiloyeh and Boyerahmad province, in southwest of Iran. Recruited subjects were the high risk groups for HBV infection, including inmates, injecting drug users, health care workers, patients on maintenance haemodialysis, hemophilic patients and patients with a history of blood transfusion. Their serum samples were tested for the presence of antibodies to hepatitis B core antigen (HBc IgM, IgG) by enzyme-linked immunosorbent assay (ELISA). Seropositive specimens were tested for HBsAg. Demographic features of participants were recorded during sample collecting.

RESULTS

HBsAg was detected in 24 of the 2009 subjects, giving an overall prevalence of 1.2%. All HBsAg positive cases were males. The prevalence of HBsAg among injection drug users was 3.2%. Significant correlation was found between HBV infection and drug abuse, level of education and place of residence (p<0.05), while no significant correlation was found between HBV infection and previous history of blood transfusion, unprotected sexual behavior, and thalassemia.

CONCLUSION

Based on the findings of this study, incarceration and drug abuse are the most important risk factors for acquiring HBV infection in this region. Modifying behavior, improving the individual education and expanding the HBV vaccination coverage may reduce the rate of infection in the region.