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Introduction: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and ...
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Introduction: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV. Here, we present the first report of occult HBV following adult vaccination.
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Hepatitis B Virus (HBV) infection remains an important cause of liver disease in renal transplant (RT) recipients and the outcome of HBV infected RT recipients is less favorable than that of noninfected RT recipients. The concern ...
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Hepatitis B Virus (HBV) infection remains an important cause of liver disease in renal transplant (RT) recipients and the outcome of HBV infected RT recipients is less favorable than that of noninfected RT recipients. The concern about graft loss induced by interferon (IFN) therapy precludes its use; lamivudine, a second-generation analog, has been recently approved for the treatment of hepatitis B and promises to be highly effective in this setting. Several uncontrolled trials have reported a high rate of biochemical (ranging between 80% and 100%) and virological (ranging between 67% and 100%) response in RT recipients, comparable to immunocompetent patients. Lamivudine has an excellent safety profile in RT recipients. However, the emergence of viral mutations leading to resistance has been reported during lamivudine therapy in RT recipients. In addition, numerous issues remain to be clarified about lamivudine use after RT including the management of viral resistance, the role of HBV genotypes in the response to lamivudine, and the duration of therapy and response. The combination of newer nucleoside analogues with lamivudine, analogous to HIV, may further improve the efficacy of antiviral therapy against HBV after RT.
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Background and Aim Hepatitis B core-related antigen (HBcrAg) has been shown to correlate with various viral markers in chronic hepatitis B, but its role in defining natural history is not well studied. We aimed to investigate the ...
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Background and Aim Hepatitis B core-related antigen (HBcrAg) has been shown to correlate with various viral markers in chronic hepatitis B, but its role in defining natural history is not well studied. We aimed to investigate the use of HBcrAg to define different phases of chronic hepatitis B.
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Technical advances in the measurement of hepatitis B surface (HBs) antigenHBs protein is encoded by the pre-S and S genome, and the detection of HBs antigen (HBsAg) in sera is an initial step for the diagnosis of hepatitis B virus...
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Technical advances in the measurement of hepatitis B surface (HBs) antigenHBs protein is encoded by the pre-S and S genome, and the detection of HBs antigen (HBsAg) in sera is an initial step for the diagnosis of hepatitis B virus (HBV) infection. The “a” determinant region (amino acid residues 124–147) is the main epitope for inducing a protective immune response. Mutations in the “a” determinant region, known as escape mutants, affect antigenicity and hinder attempts to detect HBV in serum [1]. HBsAg mutation is usually induced by immune escape of postexposure prophylaxis. In the 1970s, the introduction of the reversed passive hemagglutination (R-PHA) test revolutionized the detection of HBV [2]. Several enzyme immunoassays were then developed and showed increased sensitivity for the detection of HBV. However, it was still difficult to detect escape mutants using these methods [3]. Currently, chemiluminescent immunoassays (CLIA) and chemiluminescent enzyme immunoassays (CLEIA) are commonly used for HBV screening because they show higher sensitivities and specificities than the previous methods. In addition, CLIA and CLEIA allow us to quantify HBs-Ag, in terms of the HBs-Ag titer. The HBsAg titer in HB extracellular antigen (HBeAg)-positive chronic hepatitis B is positively correlated with serum HBV-DNA, intrahepatic double-stranded covalently closed circular DNA (cccDNA), and total HBV-DNA [4]. The HBsAg-HQ assay, the most recently introduced system, allows us to measure HBsAg at titers of > 0.005 IU/ml [5]. Advanced methods showing high sensitivity and low false-positive rates will become standard methods of measuring the HBsAg titer.
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Introduction: Hepatitis B virus vaccination (HBVV) in the HIV-infected population has poor reported completion rates and immunological response rates. At our HIV clinic, we established a vaccine clinic to improve HBVV outcomes usi...
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Introduction: Hepatitis B virus vaccination (HBVV) in the HIV-infected population has poor reported completion rates and immunological response rates. At our HIV clinic, we established a vaccine clinic to improve HBVV outcomes using interventions such as SMS text reminders and double-dose (DD) HBVV for standard-dose non-responders (SD NRs). Methods: A five-year (2003-2008) retrospective review of the completion rates and immunological response rates for HBVV after the establishment of the dedicated vaccine clinic was conducted. Statistical significance was assumed at p<. 0.05, and the analysis was performed using SPSS (v16). Results: A total of 354 HIV-infected patients were included. Seventy-five percent (268/354) of patients completed the SD HBVV, an 84% (226/268) returned for the hepatitis B surface antibody evaluation. Only 47.3% (107/226) responded to standard-dose hepatitis B vaccination. Responders had higher absolute numbers (. p=. 0.017) and percentages of CD4 cells (. p<. 0.001) and were more likely to be receiving HAART (. p=. 0.001). There was a 70% (48/69) response rate to DD HBVV among SD NRs. On-treatment analysis showed an 88% (155/176) overall immunological response to SD HBVV and DD HBVV, if required. Conclusion: High HBVV completion and response rates in this HIV cohort were enabled through the use of multiple interventions, including the use of SMS text message reminders and routine referral for DD vaccination.
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Background/Aims We investigated the efficiency of the indirect ratio of anti-HBc IgG at predicting HBsAg seroclearance in patients with nucleos(t)ide analogue (NA)-induced HBeAg seroclearance. Methods We performed a retrospective ...
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Background/Aims We investigated the efficiency of the indirect ratio of anti-HBc IgG at predicting HBsAg seroclearance in patients with nucleos(t)ide analogue (NA)-induced HBeAg seroclearance. Methods We performed a retrospective study that included 366 chronic hepatitis B patients (March 2007 to December 2016) at a single tertiary hospital. These patients were HBsAg seropositive, and experienced NA-induced HBeAg seroclearance. The indirect ratio of light absorbance of anti-HBc IgG levels were measured with chemiluminescent microparticle immunoassay using the Architect Anti-HBc assay (Abbott Laboratories, IL, USA) as a qualitative method prior to antiviral therapy. We calculated the cumulative incidences of HBsAg seroclearance based on the anti-HBc IgG levels. Results After a 10-year follow-up, 48 patients experienced HBsAg seroclearance (13.1%). Thirty-three of 179 patients who had an indirect ratio of light absorbance of anti-HBc IgG < 11 RLU (relative light unit) showed HBsAg seroclearance (18.4%); 15 of 187 patients who had an indirect ratio of light absorbance of anti-HBc IgG >= 11 RLU showed HBsAg seroclerance (8.0%) (p = 0.003). In multivariate analysis, age, and ALT at the time of HBeAg seroclearance were predictors of HBsAg seroclearance. Especially, the relative risk of HBsAg seroclearance in patients with baseline anti-HBc IgG levels < 11 RLU was 2.213 (95% CI, 1.220-4.014), compared to that in patients with higher levels of anti-HBc IgG at baseline (p = 0.009). Conclusion Using an indirect method for anti-HBc IgG levels, baseline anti-HBc IgG levels (< 11RLU), age (>= 50 years), and ALT (>= 40 IU/L) might be associated with HBsAg seroclearance in patients with NA-induced HBeAg seroclearance.
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Achieving hepatitis B e antigen (HBeAg) seroconversion is a satisfactory endpoint during antiviral treatment for chronic hepatitis B (CHB). This study aimed to develop and validate a novel scoring system to predict HBeAg seroconve...
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Achieving hepatitis B e antigen (HBeAg) seroconversion is a satisfactory endpoint during antiviral treatment for chronic hepatitis B (CHB). This study aimed to develop and validate a novel scoring system to predict HBeAg seroconversion during entecavir (ETV) treatment. A total of 526 patients with HBeAg-positive CHB treated with ETV for at least 1 year were randomly assigned to the training and validation cohorts. Baseline parameters including hepatitis B virus DNA, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (HBcAb), and alanine aminotransferase level were quantified. Patients who achieved HBeAg seroconversion were compared with those without HBeAg seroconversion. A prediction model was established to predict HBeAg seroconversion during ETV treatment. After a median follow up of 2.67 years, 93 (36.0%) and 87 (32.5%) patients in the training and validation cohorts developed HBeAg seroconversion. A prediction score composed of age, HBsAg and HBcAb quantification was derived. Areas under receiver operating characteristic curve at 5 years of this prediction score were 0.70 and 0.72 in the training and validation cohorts. By using the dual cutoff values of 0.28 and 0.58, the model was endowed with high sensitivity and specificity to exclude or identify patients developing HBeAg seroconversion (90.3% sensitivity and 90.2% specificity in the training cohort as well as 92.8% sensitivity and 84.4% specificity in the validation cohort, respectively). A novel prediction score that uses baseline clinical variables was developed and validated. The score accurately estimates the probabilities of developing HBeAg seroconversion at 5-years ETV therapy in patients with CHB.
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The goal of this study was to investigate the prevalence of occult HBV infection in a reference center for the Northern Brazil from 2005 to 2015 and to identify mutations associated with occult hepatitis B. Molecular analysis was ...
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The goal of this study was to investigate the prevalence of occult HBV infection in a reference center for the Northern Brazil from 2005 to 2015 and to identify mutations associated with occult hepatitis B. Molecular analysis was performed on 110 serum samples in which anti-HBc was the only positive serological marker. Regions of the HBV genome were amplified by polymerase chain reaction to detect HBV DNA. A prevalence of 4.1% (793/18,889) for anti-HBc alone was identified. Molecular analysis revealed a prevalence of occult HBV infection of 0.04%. HBV DNA detected were identified in individuals who underwent hemodialysis,infected with the hepatitis C virus and from area of high endemicity for HBV. Direct DNA nucleotide sequencing and phylogenetic analysis identified that genotypes A and D and mutations E164D,I195M,P217L and P120S were associated with occult HBV infection in the S gene. This study contributed with epidemiological and molecular information on Northern Brazil samples with a suggestive profile of occult HBV infection in addition to reinforcing the importanceof molecular diagnosis in this type of infection.
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The natural course of hepatitis B virus infection and the resulting hepatic injury is determined by the degree of virus replication and the intensity of host immune response. Upon exposure to hepatitis B virus (HBV), individuals w...
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The natural course of hepatitis B virus infection and the resulting hepatic injury is determined by the degree of virus replication and the intensity of host immune response. Upon exposure to hepatitis B virus (HBV), individuals with a vigorous and broad immune response develop acute self-limited infection, which may result in acute hepatitis. However, with stringent testing for HBV and universal precautions, acute HBV is rather rare. Reactivation of HBV most often presents as acute hepatitis B (AVH-B) and clinically, it is difficult to differentiate AVH-B from reactivation of chronic hepatitis B (CHB) and it requires a high index of suspicion. In the presence of high HBV DNA (>2 × 104 IU/ml) underlying liver disease should be investigated by liver biopsy, endoscopy and/or imaging. The degree of liver failure often depends on the severity of acute insult and the stage of underlying chronic liver disease. Mutations in the HBV genome, immunosuppressive therapy and viral or drug induced injury are common causes of reactivation. As most patients with AVH-B resolve the infection spontaneously, antiviral therapy is not indicated in them. However, the use of a potent oral nucleoside(tide) analogue is necessary as soon as possible in patients with CHB reactivation. Liver transplantation should be considered in patients who develop liver failure secondary to severe acute exacerbation. If this is not feasible, supportive therapy with the addition of granulocyte colony stimulating factor (GCSF) therapy could be beneficial.
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