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The Burden of Hepatitis B, Hepatitis C, and Human Immunodeficiency Viruses in Ovarian Cancer Patients in Nairobi, Kenya. Infect Dis Rep 2022; 14:433-445. [PMID: 35735757 PMCID: PMC9222280 DOI: 10.3390/idr14030047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
Ovarian cancer (OC) is a gynecological malignancy characterized by high morbidity and mortalities due to late-stage diagnosis because accurate early diagnostic biomarkers are lacking. Testing of Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human immunodeficiency virus (HIV) infections in OC patients is pertinent in light of the emerging evidence of their contribution to poor prognosis. We, for the first time, investigated the prevalence of HBV, HCV, and HIV infections in a Kenyan cohort of OC to inform optimal management. We recruited a cohort of women above 18 years of age, comprising 86 OC patients and 50 healthy controls. Participants’ blood samples were serologically screened for HBV, HCV, and HIV. We found seroprevalence rates of 29.1%, 26.7%, and 1.2% for HBV, HIV, and HCV, respectively, in OC patients. The healthy control group had HBV and HIV seroprevalence rates of 3.9% for each with no positive HCV case. HBV/HIV coinfection was noted only in the OC group with a positivity rate of 17.4%. In summary, we found higher HBV and HIV seroprevalence in Kenyan OC patients compared to the healthy control group, whereas HCV prevalence was reflective of the general population. Hence, we recommend screening for HBV and HIV among OC patients destined for anticancer treatment.
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Can Interferon therapy change natural course of Hepatitis Delta infection, A clinical and pathological study. Antimicrob Agents Chemother 2021; 66:e0158621. [PMID: 34694876 DOI: 10.1128/aac.01586-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Chronic delta hepatitis (CDH) has a worser outcome than other viral hepatitis. High dose, long-term Interferon-α (IFNα) is the approved treatment and may ameliorate course. We evaluated long-term histological outcomes of CDH patients treated with IFNα. Method: Histologically proved non-cirrhotic CDH patients treated with high dose IFNα for at least 1 year were grouped as cirrhotic and non-cirrhotic at the end of treatment. Non-cirrhotic patients had also post-treatment liver biopsies. Patients were grouped as histologically responsive and non-responsive regarding fibrosis status. Histological, virological and biochemical courses were analyzed. Results: 48 patients were treated with IFNα (conventional and/or pegylated) for median 24 months with a post-treatment follow-up of 5 years. During the follow-up, cirrhosis developed in 24 patients, 5 of whom were decompensated. There was no difference between pre- and post-treatment fibrosis scores of 24 non-cirrhotic patients at the end of follow-up. Among patients; 13% (n:6) had decreased, 21%(n:10) had steady and 16% (n:8) had increased fibrosis scores. Persistent viral response (PVR) was achieved in 16 patients (33%). 20% of entire group was histologically responsive (decreasing or steady fibrosis scores with improved necro-inflammatory score) while near 80% had histological progression/cirrhosis. PVR was significantly associated with histological response. Conclusions: Long-term natural course of patients who were treated with high dose IFNα for at least one year was evaluated clinically and histologically. Despite the association of PVR with histological response, IFNα treatment didn't change the natural course of CDH, clinical and histological progression continued in two-thirds of the cases despite treatment.
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Okoror LE, Ajayi AO, Ijalana OB. Elevated serum β2-microglobulin in individuals coinfected with hepatitis B and hepatitis D virus in a rural settings in Southwest Nigeria. BMC Res Notes 2017; 10:719. [PMID: 29221492 PMCID: PMC5721584 DOI: 10.1186/s13104-017-3015-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Coinfection of hepatitis B virus (HBV) with hepatitis D virus (HDV) has being reported to increase severity of progression to hepatocellular carcinoma (HCC) and liver cirrhosis (LC). Beta microglobulin (2βM) which is present on the surfaces of blood cells in acceptable levels is a tumor marker which may become elevated in disease conditions. This study hence observed the prevalence of HBV and HDV coinfection in a rural population and their 2βM concentration. RESULTS Of the 368 samples, 66 (17.9%) were positive to hepatitis B surface antigen (HBsAg) and 33 (50%) were coinfected with HDV, 8 (2.1%) were monoinfected with HDV. 2βM concentration increased beyond the normal level in individuals coinfected with HBV and HDV as compared with the monoinfected individuals. Coinfection resulted in the increased concentration of 2βM in HBV and HDV coinfection and the likelihood of progression to HCC and LC may not be ruled out. Monoinfection with HDV also had high 2βM concentration but this is due to having being infected with a non-detected HBV or chronic infection in which HBV is clearing.
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Affiliation(s)
- Lawrence Ehis Okoror
- Department of Microbiology, Federal University, PMB 373, Oye-Ekiti, Ekiti State, Nigeria.
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Goyal A, Murray JM. The impact of vaccination and antiviral therapy on hepatitis B and hepatitis D epidemiology. PLoS One 2014; 9:e110143. [PMID: 25313681 PMCID: PMC4196970 DOI: 10.1371/journal.pone.0110143] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/17/2014] [Indexed: 12/18/2022] Open
Abstract
The major cause of liver cancer around the globe is hepatitis B virus (HBV), which also contributes to a large number of deaths due to liver failure alone. Hepatitis delta virus (HDV) is as potentially alarming as HBV since life threatening cases are 10 times more likely with HBV-HDV dual infection compared to HBV monoinfection. So far, there is no established effective treatment against HDV and the only preventive action suggested by the World Health Organization is to introduce HBV vaccination for children immediately after birth (newborns) and thus reduce the available pool for HDV infection. Here the main objective is to understand the complex dynamics of HBV-HDV infection in a human population that can inform public health policy makers on the level of different preventive measures required to eliminate HBV and HDV infections. Model simulations suggest that HBV vertical transmission and HBV vaccination rates for newborns are instrumental in determining HBV and HDV prevalence. A decrease in HBV prevalence is observed as vaccination coverage increases and it is possible to eradicate both HBV and HDV using high vaccination coverage of ≥80% in the long term. We further found that HDV presence results in lower HBV prevalence. An application of our model to China revealed that vaccinating every newborn in China will further prevent 1.69 million new infections by 2028 as compared to the current 90% vaccination coverage. Although, higher vaccination coverage of newborns should eliminate both HBV and HDV over a long time period, any short term strategy to eradicate HDV must include additional preventive measures such as HBV adult vaccination. Implementation of HBV adult vaccination programs at a rate of 10% per year over 15 years will further prevent 39 thousand new HDV infections in China by 2028 as compared to HBV vaccination programs solely for newborns.
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Affiliation(s)
- Ashish Goyal
- School of Mathematics and Statistics, University of New South Wales, Sydney, Australia
- * E-mail:
| | - John M. Murray
- School of Mathematics and Statistics, University of New South Wales, Sydney, Australia
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Manesis EK, Vourli G, Dalekos G, Vasiliadis T, Manolaki N, Hounta A, Koutsounas S, Vafiadis I, Nikolopoulou G, Giannoulis G, Germanidis G, Papatheodoridis G, Touloumi G. Prevalence and clinical course of hepatitis delta infection in Greece: a 13-year prospective study. J Hepatol 2013; 59:949-956. [PMID: 23850875 DOI: 10.1016/j.jhep.2013.07.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Hepatitis D virus (HDV) has decreased in Europe, but recent reports indicate a rising trend. We report the epidemiological changes, clinical progress, and effect of treatment on the natural course of HDV infection in Greece during the last 13 years. METHODS Prospective data were extracted from the HepNet.Greece Cohort-Study. RESULTS Since 1997, 4673 chronic HBV (CHB) cases (4527 adults, 146 children) have been followed prospectively. Two thousand one hundred thirty-seven patients were tested for anti-HDV [101 (4.7%) positive]. Anti-HDV testing in Greece decreased significantly (57.0% before 2003, 35.3% thereafter; p<0.001). Anti-HDV prevalence among HBsAg-positives was 4.2%; lower in native Greeks (2.8%) than in immigrants (7.5%) or in children (15.3%; p<0.001). Within 2.3 years of follow-up, HDV occurred in 11/2047 HBsAg-positive patients (2.2 new delta-infected adults and 8.7 children per 1000 HBsAg-positive annually). HDV-positive compared to CHB adults were younger (p=0.035) and had more active and advanced disease at baseline, as indicated by laboratory indices and the higher prevalence of cirrhosis at younger age. During a 4.2-year median observation, significantly more anti-HDV-positive than CHB adults developed a liver-related first event (20.0% vs. 8.5%, p Log-rank=0.014).Treatment was received by 46/90 (51.1%) patients, 40 of them interferon-based. In multivariable analysis, interferon significantly decreased disease progression in HDV-positive patients [HR=0.14 (95% CI: 0.02-0.86; p=0.033)]. CONCLUSIONS In Greece, HDV serology is currently tested in only one-third of HBsAg-positive patients. HDV prevalence is lower in native Greeks compared to immigrants, who may contribute >50% of the HDV infection burden in Greece. Data show that HDV infection is a rapidly progressive disease, but interferon-based treatment may alter its course.
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Affiliation(s)
- Emanuel K Manesis
- Division of Internal Medicine, Athens University Medical School, Greece.
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Jochum C, Gerken G. [Clinical features and diagnosis of hepatitis B, C and D. Acute or chronic process?]. ACTA ACUST UNITED AC 2011; 40:30-5. [PMID: 21194079 DOI: 10.1002/pauz.201100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Christoph Jochum
- Klinik für Gastroenterologie und Hepatologie, Zentrum für Innere Medizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122 Essen
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Viral Hepatitis. ATLAS OF SEXUALLY TRANSMITTED DISEASES AND AIDS 2010. [DOI: 10.1016/b978-0-7020-4060-3.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Xiridou M, Borkent-Raven B, Hulshof J, Wallinga J. How hepatitis D virus can hinder the control of hepatitis B virus. PLoS One 2009; 4:e5247. [PMID: 19381302 PMCID: PMC2668760 DOI: 10.1371/journal.pone.0005247] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 02/25/2009] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis D (or hepatitis delta) virus is a defective virus that relies on hepatitis B virus (HBV) for transmission; infection with hepatitis D can occur only as coinfection with HBV or superinfection of an existing HBV infection. Because of the bond between the two viruses, control measures for HBV may have also affected the spread of hepatitis D, as evidenced by the decline of hepatitis D in recent years. Since the presence of hepatitis D is associated with suppressed HBV replication and possibly infectivity, it is reasonable to speculate that hepatitis D may facilitate the control of HBV. Methodology and Principal Findings We introduced a mathematical model for the transmission of HBV and hepatitis D, where individuals with dual HBV and hepatitis D infection transmit both viruses. We calculated the reproduction numbers of single HBV infections and dual HBV and hepatitis D infections and examined the endemic prevalences of the two viruses. The results show that hepatitis D virus modulates not only the severity of the HBV epidemic, but also the impact of interventions for HBV. Surprisingly we find that the presence of hepatitis D virus may hamper the eradication of HBV. Interventions that aim to reduce the basic reproduction number of HBV below one may not be sufficient to eradicate the virus, as control of HBV depends also on the reproduction numbers of dual infections. Conclusions and Significance For populations where hepatitis D is endemic, plans for control programs ignoring the presence of hepatitis D may underestimate the HBV epidemic and produce overoptimistic results. The current HBV surveillance should be augmented with monitoring of hepatitis D, in order to improve accuracy of the monitoring and the efficacy of control measures.
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Affiliation(s)
- Maria Xiridou
- Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
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Detection of antibody to hepatitis delta virus in human serum by double antigen sandwich ELISA. Virol Sin 2009. [DOI: 10.1007/s12250-009-2981-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Moatter T, Abbas Z, Shabir S, Jafri W. Clinical presentation and genotype of hepatitis delta in Karachi. World J Gastroenterol 2007; 13:2604-2607. [PMID: 17552010 PMCID: PMC4146823 DOI: 10.3748/wjg.v13.i18.2604] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 01/21/2007] [Accepted: 03/01/2007] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the clinical presentation and genotypes of delta hepatitis in local population. METHODS In this prospective study, 39 consecutive patients who were positive for HBsAg and hepatitis D virus (HDV) antibody were included. The patients were divided in two groups on the basis of presence or absence of HDV RNA and a comparative study was done. Genotype of HDV was determined in PCR positive patients. RESULTS Overall there is male dominance, in which 34 patients out of 39 (87.2%) were male. Twenty (51%) patients were from the adjacent areas of three provinces; Sindh, Punjab and Balochistan indicating the higher prevalence of delta hepatitis in this mid region of Pakistan. Patients of all age groups were affected with delta hepatitis (median 31.5 years, range 12-75). HDV RNA was detectable in 23 patients (59%). All the HDV strains belonged to genotype I. HBV DNA was detectable only in 3 cases who were also HBeAg and HDV RNA positive. Patients with detectable HDV RNA were younger than patients with undetectable RNA; mean age 29.7 +/- 12.8 years vs 36.8 +/- 15.2. There were no statistically significant differences in the clinical presentation and routine biochemical profile of patients with detectable or undetectable HDV RNA. Clinical cirrhosis was present in 19 (49%) patients; 12 with detectable RNA and 7 with undetectable HDV RNA (P = 0.748). Decompensated disease was seen in eight patients; five and three respectively from each group. Four patients with undetectable RNA and two patients with detectable RNA had normal ALT and ultrasound abdomen. CONCLUSION HDV may infect at any age, usually young adult males. Genotype I is prevalent. With time some of the patients become HDV RNA negative or asymptomatic carrier. Most of the patients have suppressed HBV DNA replication. Significant numbers of patients have cirrhosis.
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Affiliation(s)
- Tariq Moatter
- Department of Pathology, The Aga Khan University Hospital, Karachi, Pakistan
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Murhekar MV, Murhekar KM, Arankalle VA, Sehgal SC. Hepatitis delta virus infection among the tribes of the Andaman and Nicobar Islands, India. Trans R Soc Trop Med Hyg 2005; 99:483-4. [PMID: 15910893 DOI: 10.1016/j.trstmh.2004.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2004] [Revised: 09/30/2004] [Accepted: 10/15/2004] [Indexed: 10/25/2022] Open
Abstract
Hepatitis B virus infection is highly endemic among the tribes of Andaman and Nicobar Islands, India. We screened 223 hepatitis B surface antigen-positive members of these tribes for hepatitis delta virus infection (HDV). The infection was observed only among the Nicobarese. Considering the serious consequences of HDV infection, we suggest that the tribes of these islands should be monitored for HDV infection.
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Affiliation(s)
- M V Murhekar
- Regional Medical Research Centre, Indian Council of Medical Research, Post Bag-13, Port Blair-744 101, Andaman and Nicobar Islands, India
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Bialek SR, Bower WA, Mottram K, Purchase D, Nakano T, Nainan O, Williams IT, Bell BP. Risk factors for hepatitis B in an outbreak of hepatitis B and D among injection drug users. J Urban Health 2005; 82:468-78. [PMID: 16049202 PMCID: PMC3456050 DOI: 10.1093/jurban/jti094] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
During January-April, 2000, 12 cases of acute hepatitis B were reported in Pierce County, Washington, compared with seven in all of 1999. Seven (58.3%) case patients were injection drug users (IDUs), three of whom were coinfected with hepatitis D virus (HDV) and died of fulminant hepatitis. Vaccination clinics were implemented at the local health department and needle exchange program to control the outbreak. We investigated this outbreak to determine risk factors for hepatitis B virus (HBV) transmission among IDUs. Hepatitis B cases were ascertained through routine surveillance and prevaccination testing at vaccination clinics. We conducted a case-control study comparing IDU case patients with HBV-susceptible IDUs identified at the vaccination clinics. Fifty-eight case patients were identified during January-December, 2000, 20 (34.5%) of whom were coinfected with HDV. Thirty-eight case patients (65.5%) reported current IDU. In the case-control study, the 17 case patients were more likely than the 141 controls to report having more than one sex partner [odds ratio (OR) =4.8, 95% confidence interval (CI) =1.5-15.0], injecting more than four times a day (OR = 4.5, 95% CI =1.2-15.6) and sharing drug cookers with more than two people (58.8% vs. 14.0%, OR =14.0, 95% CI =2.4-81.5). Results were similar after controlling for syringe sharing in multivariable analysis. IDUs should be vaccinated against hepatitis B and should be advised against sharing drug injection equipment.
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Affiliation(s)
- Stephanie R Bialek
- United States Public Health Service, Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mail Stop G-37, Atlanta, GA 30333, USA.
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Gunsar F, Akarca US, Ersoz G, Kobak AC, Karasu Z, Yuce G, Ilter T, Batur Y. Two-Year Interferon Therapy with Or without Ribavirin in Chronic Delta Hepatitis. Antivir Ther 2005. [DOI: 10.1177/135965350501000603] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The only beneficial agent for the treatment of chronic delta hepatitis (CDH) is interferon (IFN). However, there is no consensus on the best dosage or duration of IFN therapy. As ribavirin (RBV) increases the sustained response when added to IFN in chronic hepatitis C, probably because of its immunomodulatory effect, we aimed to investigate the efficacy of 2-year IFN treatment and whether RBV had any additive effect to IFN in CDH. Methods Patients ( n=31) with CDH were randomized with a 1:2 ratio as 10 patients (3 females/7 males, age 39 ±9) receiving IFN monotherapy (9 MU IFN-α2a three times weekly) and 21 patients (8 females/13 males, age 38 ±11) receiving IFN plus RBV for 2 years (IFN at the same dosage and RBV at 1000–1200 mg/day). Alanine transferase normalization and hepatitis delta virus (HDV) RNA negativity at the end of treatment and at the end of the follow-up period (at least 6 months following 2-year treatment) were primary endpoints of the study. In addition, virological response and biochemical response were determined separately. Results Eight of 31 patients (25%) had cirrhosis in liver biopsies. Six patients from the IFN monotherapy group and 12 patients from the combination group had biochemical response. Five patients from the IFN monotherapy group and 11 patients from the combination group had virological response at the end of therapy. Two patients from the IFN group and five patients from the combination group had sustained biochemical response at the end of the follow-up period. Hepatitis B virus (HBV) activations with HBV DNA positivity were observed in two patients (one from the IFN monotherapy group, one from the combination group). Two patients (20%) in the IFN group and five patients (23.5%) in IFN plus RBV group remained as virological responders at the end of the follow-up period ( P>0.05). None of the patients with liver cirrhosis were responsive at the end of the follow-up period. Conclusion Almost 20% of the patients with CDH were responsive to 2-year IFN treatment at the end of the follow-up period and no additional effect of RBV was observed. Patients with advanced liver disease failed to respond to treatment.
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Affiliation(s)
| | | | - Galip Ersoz
- Ege University Medical School Gastroenterology
| | | | - Zeki Karasu
- Ege University Medical School Gastroenterology
| | - Gul Yuce
- Pathology Department, Izmir, Turkey
| | | | - Yucel Batur
- Ege University Medical School Gastroenterology
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Yamaguchi Y, Deléhouzée S, Handa H. HIV and hepatitis delta virus: evolution takes different paths to relieve blocks in transcriptional elongation. Microbes Infect 2002; 4:1169-75. [PMID: 12361917 DOI: 10.1016/s1286-4579(02)01641-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The elongation step of transcription by RNA polymerase II (RNAPII) is controlled both positively and negatively by over a dozen cellular proteins. Recent findings suggest that two distinct viruses, human immunodeficiency virus type 1 and hepatitis delta virus, encode proteins that facilitate viral replication and transcription by targeting the same cellular transcription elongation machinery.
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Affiliation(s)
- Yuki Yamaguchi
- Graduate School of Bioscience and Biotechnology, 4259 Nagatsuta, Yokohama 226-8503, Japan
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Affiliation(s)
- W. Keith Paver
- PHLS North West, Public Health Laboratory, Withington Hospital, Manchester, UK; and
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Abstract
Infection with hepatitis delta virus (HDV), a satellite virus of hepatitis B virus (HBV), is associated with severe and sometimes fulminant hepatitis. The traditional methods for the diagnosis of HDV infection, such as detection of serum anti-HD antibodies, are sufficient for the clinical diagnosis of delta infection. However, such techniques lack the sensitivity and specificity required to more accurately characterize the nature of HDV infection and to assess the efficacy of therapies. Recent improvements in molecular techniques, such as HDV RNA hybridization and RT-PCR, have provided increased diagnostic precision and a more thorough understanding of the natural course of HDV infection. These advances have enhanced the clinician's ability to accurately evaluate the stage of HDV infection, response to therapy, and occurrence of reinfection after orthotopic liver transplant. This review focuses on the recent advances in the understanding of the molecular biology of HDV and in the laboratory diagnosis of HDV infection.
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Affiliation(s)
- L E Modahl
- Department of Molecular Microbiology and Immunology, Howard Hughes Medical Institute, Los Angeles, CA, USA
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Sakugawa H, Nakasone H, Nakayoshi T, Kawakami Y, Miyazato S, Kinjo F, Saito A, Ma SP, Hotta H, Kinoshita M. Hepatitis delta virus genotype IIb predominates in an endemic area, Okinawa, Japan. J Med Virol 1999; 58:366-72. [PMID: 10421403 DOI: 10.1002/(sici)1096-9071(199908)58:4<366::aid-jmv8>3.0.co;2-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatitis delta virus (HDV) infection is relatively common in the Miyako Islands, Okinawa, Japan, where the infection has been reported to be associated with low pathogenicity. HDV RNA extracted from each of 6 patients with HDV-related chronic liver disease living in the islands was amplified by reverse transcription-polymerase chain reaction and examined genetically to determine the HDV genotype. All isolates from the 6 patients were classified as genotype II by the neighbor-joining method. However, these isolates had relatively low homology (75-81%) to the HDV genotype II isolate reported from Japan, and showed relatively high identity (83-95%) to the novel genotype II isolate (HDV genotype IIb) recently reported from Taiwan. Phylogenetic analysis showed that the 6 isolates form a novel group within HDV genotype II. Furthermore, there was notable variation in sequence among the 6 isolates compared with the relatively close clustering of HDV isolates within limited areas (e.g., United States, Archangelos, Turkey, Albania, Peru). HDV genotype II in the Miyako Islands is therefore unique, and HDV infection may have been introduced at a relatively early time in this area.
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Affiliation(s)
- H Sakugawa
- First Department of Internal Medicine, Faculty of Medicine, School of Medicine, University of the Ryukyus, Okinawa, Japan.
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Abstract
BACKGROUND This article provides dental personnel with a brief overview of the different types of viral hepatitis, including their epidemiology, clinical features, prevention and treatment. It also explores the ramifications of these diseases for the practice of dentistry. DESCRIPTION OF THE CONDITION: Viral hepatitis is an inflammation of the liver caused by one of at least six distinct viruses. The hepatitis A and E viruses, or HAV and HEV, are enterically transmitted viruses that produce acute disease only. The hepatitis B, C and D viruses, or HBV, HCV and HDV, are most efficiently transmitted by infected blood, but also can be transmitted by exposure to other infectious bodily fluids. These three viruses can cause acute or chronic hepatitis. People with chronic viral hepatitis can develop chronic liver disease, cirrhosis and hepatocellular carcinoma. The hepatitis G virus was recently identified, and its ability to cause clinically significant acute or chronic hepatitis is unknown. CONCLUSIONS Dental health care workers, or DHCWs, should be concerned primarily with HBV, HCV and HDV, as occupational exposure to these pathogens places them at risk of developing acute or chronic infections. Vaccines and immune globulins are available and effective in protecting against infections with HAV, HBV and HDV, but not HCV. CLINICAL IMPLICATIONS DHCWs should become knowledgeable about viral hepatitis. They should be vaccinated against hepatitis B. Adherence to infection control measures will help prevent occupational transmission of all bloodborne pathogens, including hepatitis viruses.
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MESH Headings
- Antiviral Agents/therapeutic use
- Dental Staff
- Hepatitis Viruses
- Hepatitis, Chronic/drug therapy
- Hepatitis, Viral, Human/pathology
- Hepatitis, Viral, Human/prevention & control
- Hepatitis, Viral, Human/transmission
- Hepatitis, Viral, Human/virology
- Humans
- Infection Control, Dental/legislation & jurisprudence
- Interferon-alpha/therapeutic use
- Occupational Exposure
- United States
- United States Occupational Safety and Health Administration
- Viral Hepatitis Vaccines
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Affiliation(s)
- J A Gillcrist
- Oral Health Services Section, Tennessee Department of Health, Nashville 37247, USA
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Lo K, Hwang SB, Duncan R, Trousdale M, Lai MM. Characterization of mRNA for hepatitis delta antigen: exclusion of the full-length antigenomic RNA as an mRNA. Virology 1998; 250:94-105. [PMID: 9770424 DOI: 10.1006/viro.1998.9364] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hepatitis delta virus (HDV) encodes a single protein, the hepatitis delta antigen (HDAg), which is thought to be translated from a 0. 8-kb RNA of antigenomic sense. This subgenomic RNA species is present in very small amounts in HDV-infected liver tissues and in cultured cells infected or transfected with HDV, and in some cases it cannot be detected at all. In contrast, HDAg protein is present in large amounts in all natural and experimental models of HDV infection. This study addresses whether other HDV RNA species, such as the antigenomic-sense, genome-size HDV RNA can also serve as the mRNA for HDAg synthesis. Taking advantage of the ability of herpes simplex virus (HSV) to degrade only polyadenylated mRNAs, we examined the effect of HSV coinfection on HDAg synthesis. It was shown that HSV infection did degrade the subgenomic 0.8-kb HDV mRNA but not HDV genome-length RNA. Under such conditions, HDAg synthesis was completely inhibited. Furthermore, the genome-length HDV RNA was found not to be associated with polysomes. Finally, in vitro translation studies demonstrated that HDAg could not be translated directly from the genome-length antigenomic-sense HDV RNA. These results suggest that only the subgenomic RNA species of HDV possesses properties characteristic of the mRNA for HDAg and that the genome-length RNA cannot be used for translating HDAg. In addition, we found that HDV RNA replication did not depend on de novo HDAg synthesis.
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Affiliation(s)
- K Lo
- Howard Hughes Medical Institute, University of Southern California School of Medicine, Los Angeles, California, 90033-1054, USA
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Miller WC, Shao JF, Weaver DJ, Shimokura GH, Paul DA, Lallinger GJ. Seroprevalence of viral hepatitis in Tanzanian adults. Trop Med Int Health 1998; 3:757-63. [PMID: 9754673 DOI: 10.1046/j.1365-3156.1998.00289.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a cross-sectional study in Dar es Salaam, Tanzania, we determined the seroprevalence of markers for hepatitis A, B, C and E viruses and examined associated risk markers. Among 403 healthy adults, the seroprevalence of antibodies to hepatitis A virus was 99.0% (95% confidence interval: 97.5-99.7). Prior exposure to hepatitis C and E viruses was rare (hepatitis C: 0.7% (0.2-2.1); hepatitis E: 0.2% (< 0.1-1.4)). The prevalence of all markers of hepatitis B was 70.7% (66.0-75.1). Hepatitis B surface antigen was identified in 6.0% (3.9-8.7) of subjects. Independent predictors of hepatitis B infection identified by logistic regression included older age, male gender, Muslim religion and type of abode. Given the high prevalence of hepatitis B and the low prevalence of hepatitis C, the majority of chronic viral hepatitis is likely to be associated with hepatitis B. Control efforts should focus primarily on hepatitis B.
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Affiliation(s)
- W C Miller
- Department of Epidemiology, University of North Carolina at Chapel Hill 27599-7400, USA
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21
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Blum HE. Hepatitis viruses: genetic variants and clinical significance. INTERNATIONAL JOURNAL OF CLINICAL & LABORATORY RESEARCH 1998; 27:213-24. [PMID: 9506264 DOI: 10.1007/bf02912461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Variants of hepatitis B, C, and delta virus have been identified in patients both with acute and chronic infections. In the hepatitis B virus genome, naturally occurring mutations have been found in all viral genes, most notably in the genes coding for the structural envelope and nucleocapsid proteins. In the hepatitis C virus genome, the regions coding for the structural envelope proteins E1 and E2, as well as the 3'-contiguous non-structural region NS1, were found to be hypervariable. Viral variants may be associated with a specific clinical course of the infection, e.g., acute, fulminant or chronic hepatitis. Specific mutations may reduce viral clearance by immune mechanisms ('vaccine escape' and 'immune escape'), response to antiviral therapy ('therapy escape'), as well as detection ('diagnosis escape'). The exact contribution, however, of specific mutations to the pathogenesis and natural course of hepatitis B, C, or delta virus infection, including hepatocellular carcinoma development, and the response to antiviral treatment remains to be established.
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Affiliation(s)
- H E Blum
- Department of Internal Medicine II, University of Freiburg, Germany
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22
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Schlueter V, Schmolke S, Stark K, Hess G, Ofenloch-Haehnle B, Engel AM. Reverse transcription-PCR detection of hepatitis G virus. J Clin Microbiol 1996; 34:2660-4. [PMID: 8897160 PMCID: PMC229381 DOI: 10.1128/jcm.34.11.2660-2664.1996] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Hepatitis G virus (HGV) was recently identified as a new member of the Flaviviridae, but its clinical significance is still unclear. Since no immunoassay for the diagnosis of HGV is available, we developed a sensitive reverse transcription-PCR (RT-PCR) assay to facilitate the detection of the viral genome by mass screening in the clinical laboratory. Sequences within the 5'-noncoding region and within the putative NS5a region are independently amplified in the presence of digoxigenin-11-dUTP and are detected by hybridization with biotinylated capture probes binding to a streptavidin-coated matrix. Semiquantitative Enzymun-Test DNA detection via chemiluminescence can be performed either in a microtiter plate format or on fully automated ES 300 machines. We were able to detect at least 8 x 10(2) genome equivalents per ml of serum using both primer pairs. HGV was shown to be present in 43 of 130 (33%) serum samples from intravenous drug abusers with a high risk of parenteral exposure. However, only two of the patients were positive when the NS5a primers only were used, and only one patient was positive when only the 5'-noncoding region primers were used, demonstrating the increased sensitivity of HGV detection with two sets of primers. Among these patients, there was no obvious correlation with other viral infections like hepatitis B virus, hepatitis C virus, or human immunodeficiency virus. Within a blood donor panel, 3 of 92 (3%) samples were found to be HGV positive, suggesting that donated blood may need to be screened for HGV.
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MESH Headings
- Base Sequence
- DNA Primers/genetics
- DNA, Viral/genetics
- Europe/epidemiology
- Evaluation Studies as Topic
- Flaviviridae/genetics
- Flaviviridae/isolation & purification
- Hepatitis, Viral, Human/complications
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/epidemiology
- Humans
- Molecular Sequence Data
- Polymerase Chain Reaction/methods
- Polymerase Chain Reaction/statistics & numerical data
- RNA, Viral/genetics
- RNA, Viral/isolation & purification
- Sensitivity and Specificity
- Substance Abuse, Intravenous/complications
- Transcription, Genetic
- Virology/methods
- Virology/statistics & numerical data
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Affiliation(s)
- V Schlueter
- Boehringer Mannheim GmbH, R&D Infectious Diseases, Penzberg, Germany
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Branch AD, Levine BJ, Polaskova JA. An RNA tertiary structure of the hepatitis delta agent contains UV-sensitive bases U-712 and U-865 and can form in a bimolecular complex. Nucleic Acids Res 1995; 23:491-9. [PMID: 7885846 PMCID: PMC306702 DOI: 10.1093/nar/23.3.491] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Genomic RNA of the hepatitis delta agent has a highly conserved element of local tertiary structure. This element contains two nucleotides which become covalently crosslinked to each other upon irradiation with UV light. Using direct RNA analysis, we now identify the two nucleotides as U-712 and U-865 and show that the UV-induced crosslink can be broken by re-exposure to a 254 nm peak UV light source. In the rod-like secondary structural model of delta RNA, nucleotides U-712 and U-865 are off-set from each other by 5-6 bases, a distance too great to permit crosslinking. This model needs to be modified. Our data indicate that bases U-712 and U-865 closely approximate each other and suggest that the smooth helical contour proposed for delta RNA is interrupted by the UV-sensitive element. The nucleotide sequence shows that the UV-sensitive site does not have a particularly high density of conventional Watson-Crick base pairs compared to the rest of the genome. However, this element may have a number of non-Watson-Crick bonds which confer stability. Following UV-crosslinking and digestion with 1 mg/ml of RNase T1 at 37 degrees C for 45 min in 10 mM Tris-HCl, 1 mM EDTA (conditions expected to give complete digestion), this element can be isolated as part of a 54 nucleotide long partial digestion product containing at least 16 internal G residues. UV-crosslinking analysis shows that this unusual tertiary structural element can form in a bimolecular complex.
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Affiliation(s)
- A D Branch
- Center for Studies of the Addictive Diseases, Rockefeller University, New York, NY 10021
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Porter S, Scully C, Samaranayake L. Viral hepatitis. Current concepts for dental practice. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 78:682-95. [PMID: 7898904 DOI: 10.1016/0030-4220(94)90082-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The transmission of blood-borne viruses in the dental office is a potential hazard to patients and dental staff, particularly to oral and maxillofacial surgeons. Hepatitis B virus has been a recognized hazard for several years, and in the past oral surgeons and other dental health care staff have been infected as a result of occupational exposure. Hepatitis C virus in contrast does not appear to be a major occupational hazard to dental staff, nevertheless, infection with this virus can lead to significant morbidity and may have oral manifestations. Hepatitis D virus can be nosocomally transmitted, but vaccination against the hepatitis B virus minimizes this problem. Hepatitis E virus is not of clinical relevance to dentistry, although dental staff who are in areas of endemic infection can become infected as a result of enteric transmission. A number of other putative viral agents may also cause hepatitis, but additional data is awaited, and their significance to dental practice is unknown. This article summarizes current data on hepatitis viruses A, B, C, D, and E.
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Affiliation(s)
- S Porter
- Joint Department of Oral Medicine, Eastman Dental Institute, London, U.K
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Freij BJ, Wiedbrauk DL, Sever JL. IMMUNOLOGIC ASSESSMENT OF INFECTIOUS DISEASES. Immunol Allergy Clin North Am 1994. [DOI: 10.1016/s0889-8561(22)00784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Abstract
Conventional serologic methods of antigen or antibody detection are now widely applied for diagnosis of hepatitis viruses A, B, C, and D. Nucleic acid quantitation has become very useful for monitoring response to antiviral therapy in cases of hepatitis B and C. Special confirmatory testing of HCV serologies can be quite specific, but overall serologies for HCV lack sensitivity for early diagnosis. Thus HCV RNA detection may ultimately be the preferred method for HCV diagnosis and for screening blood donors. Unfortunately, HEV diagnosis may rest on the efforts of research laboratories for electron microscopy, Western blot, or nucleic acid detection.
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Affiliation(s)
- R A McPherson
- Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Hospitals, Richmond 23298-0662
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