Epidemiology of hepatitis C virus in Iran

In Iran, the prevalence of hepatitis C virus (HCV) infection is relatively low according to the populationb a s e d e p i d e m i o l o g i c a l s t u d i e s . H o w e ve r, t h e epidemiology of HCV is changing and the rate of HCV infection is increasing due to the growth in the number of injecting drug users in the society. In addition, a shift has occurred in the distribution pattern of HCV genotypes among HCV-infected patients in Iran. Genotype 1a is the most prevalent genotype in Iran, but in recent years, an increase in the frequency of 3a and a decrease in 1a and 1b have been reported. These variations in the epidemiology of HCV reflect differences in the routes of transmission, status of public health, lifestyles, and risk factors in different groups and geographic regions of Iran. Health policy makers should consider these differences to establish better strategies for control and prevention of HCV infection. Therefore, this review was conducted to present a clear view regarding the current epidemiology of HCV infection in Iran. Key words: Hepatitis C virus; Blood donors; Injecting drug users; Hemodialysis; Hemophilia; Thalassemia; Genotypes; Occult hepatitis C virus; Epidemiology; Ira

Epidemiology of hepatitis C virus in Iran

In Iran, the prevalence of hepatitis C virus (HCV) infection is relatively low according to the populationb a s e d e p i d e m i o l o g i c a l s t u d i e s . H o w e ve r, t h e epidemiology of HCV is changing and the rate of HCV infection is increasing due to the growth in the number of injecting drug users in the society. In addition, a shift has occurred in the distribution pattern of HCV genotypes among HCV-infected patients in Iran. Genotype 1a is the most prevalent genotype in Iran, but in recent years, an increase in the frequency of 3a and a decrease in 1a and 1b have been reported. These variations in the epidemiology of HCV reflect differences in the routes of transmission, status of public health, lifestyles, and risk factors in different groups and geographic regions of Iran. Health policy makers should consider these differences to establish better strategies for control and prevention of HCV infection. Therefore, this review was conducted to present a clear view regarding the current epidemiology of HCV infection in Iran. Key words: Hepatitis C virus; Blood donors; Injecting drug users; Hemodialysis; Hemophilia; Thalassemia; Genotypes; Occult hepatitis C virus; Epidemiology; Ira

Emergence of New Epidemiological Hepatitis B and C Profiles in High Risk Groups in Latin America

Latin America includes Mexico, the islands of the Caribbean and Central and South America, which possess a rich cultural and natural heritage. A narrative literature review was made to determine epidemiological hepatitis B and C profiles in high risk groups in Latin America, such as, drug users, hemophiliacs, and chronic kidney disease (CKD), human immunodeficiency virus (HIV) infected individuals. Using data from international databases that disseminate published quality studies. All studies with desired information regarding site and study population were included. It was observed that HBV prevalence diminished in several groups, probably due to implementation of HBV vaccination in various Latin America Countries (LACs). On the other hand, HCV prevalence is high among high risk groups compared to general population, but different values were observed in LAC, probably due to different access to education programs, assays evaluated, population size and type of recruitment. Due to chronicity of HBV and HCV, it is important to increase access to diagnosis, HBV vaccination and implementation of education programs to high risk groups to diminish burden of these infections

Prevalence and burden of HBV co-infection among people living with HIV:A global systematic review and meta-analysis

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV-HBsAg co-infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co-infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002-2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV-exposure category. The global burden of co-infection was estimated by applying regional co-infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta-analysis to estimate the odds of HBsAg among PLHIV compared to HIV-negative individuals. We identified 506 estimates (475 studies) of HIV-HBsAg co-infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV-HBsAg co-infection is 7.6% (IQR 5.6%-12.1%) in PLHIV, or 2.7 million HIV-HBsAg co-infections (IQR 2.0-4.2). The greatest burden (69% of cases; 1.9 million) is in sub-Saharan Africa. Globally, there was little difference in prevalence of HIV-HBsAg co-infection by population group (approximately 6%-7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%-16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV-negative individuals. There is therefore, a high global burden of HIV-HBsAg co-infection, especially in sub-Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth-dose. Findings also highlight the importance of targeting PLHIV, especially high-risk groups for testing, catch-up HBV vaccination and other preventative interventions. The global scale-up of antiretroviral therapy (ART) for PLHIV using a tenofovir-based ART regimen provides an opportunity to simultaneously treat those with HBV co-infection, and in pregnant women to also reduce mother-to-child transmission of HBV alongside HIV

Detection of occult HBV infection by nested PCR assay among chronic hepatitis C patients with and without hepatocellular carcinoma

Occult hepatitis B virus infection (OBI) has been reported among patients with chronic hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC). This study aimed to evaluate the prevalence of OBI in chronic hepatitis C patients with and without hepatocellular carcinoma. A total of 40 chronic hepatitis C patients who were negative for HBsAg, were enrolled into the study. They were classified into two groups: Group I which included 20 patients with chronic hepatitis C only whereas Group II included 20 patients with chronic hepatitis C and HCC. Detection of HBV DNA was done by nested-PCR using two sets of primers specific for surface and X viral genomes in serum and liver tissue of patients. Genotyping system based on PCR using type-specific primers was done for HBV-DNA positive intrahepatic samples. OBI was detected in the liver tissue in 23/40 (57.5%) of chronic HCV infected patients, 18 (78.3%) of whom belonged to group II, conferring a 90% prevalence of this group. In serum, HBV-DNA was detected in 9/40 patients (22.5%), 7 (77.8%) of whom belonged to group II. Among the 23 positive intrahepatic HBV-DNA samples studied, HBV-genotype D (34.8%) and B (26.1%) were more predominant, whereas HBV-genotype C (13.1%) and A (8.7%) infections were the least observed, respectively; mixed genotypes were detected in 17.4% (n= 4), 3 of them were with HBV-genotype D and B, and 1 was with HBV-genotype C and A. In conclusion OBI is a fact in our community; it was detected in liver tissue of chronic HCVinfected patients, especially in cases of chronic HCC. In addition, OBI might be related to severity of necroinflammatory activity and fibrosis. Large studies are needed to confirm that co-infection could determine a worse progress of chronic liver disease in this population. Also, detection of intrahepatic HBV-DNA is more useful in diagnosis of OBI.Keywords: Occult hepatitis B virus infection (OBI); Chronic hepatitis C virus infection (CHC); Hepatocellular carcinoma (HCC); HBV-DNA; Nested PC

Soroprevalência e fatores associados à infecção pelo vírus da hepatite B em população encarcerada no estado do Mato Grosso do Sul, Brasil

INTRODUÇÃO: O presente estudo teve como objetivo investigar a prevalência da infecção pelo HBV e os fatores associados a esta infecção em população encarcerada de Campo Grande, MS. MÉTODOS: Quatrocentos e oito encarcerados, provenientes das populações encarceradas do Instituto Penal de Campo Grande, Presídio de Segurança Máxima e Presídio Feminino Irmã Irma Zorzi, foram entrevistados sobre dados sociodemográficos e fatores associados à infecção pelo HBV. A seguir foram coletadas amostras sanguíneas para detecção dos marcadores HBsAg, anti-HBs e anti-HBc total por ensaio imunoenzimático. O HBV-DNA foi detectado pela reação em cadeia da polimerase nas amostras HBsAg e anti-HBc reagentes. RESULTADOS: A prevalência global para infecção pelo HBV foi de 17,9% (IC 95%: 14,4-22,0), 13,7% (56/408) para o anti-HBc total associado ao anti-HBs e em 15 (3,7%) indivíduos foi detectada a presença do anti-HBc isolado. HBsAg foi encontrado em 0,5% (2/408) dos indivíduos estudados, evidenciando uma baixa prevalência de casos crônicos. Em 24% (98/408) dos indivíduos, verificou-se positividade isolada ao marcador anti-HBs, sugerindo baixa cobertura vacinal ao HBV. Após análise multivariada, ter idade maior que 35 anos, baixo nível de escolaridade e uso de droga ilícita permaneceram associados significativamente à infecção pelo HBV. CONCLUSÕES: A prevalência da infecção pelo HBV encontrada foi similar às reportadas em outros estudos conduzidos em populações encarceradas do Brasil. Os fatores de risco associados a esta infecção foram aumento da idade, baixo nível de escolaridade e uso de droga ilícita.ABSTRACT - INTRODUCTION: This study aimed to estimate the prevalence of HBV infection and associated factors among prison inmates in Campo Grande, MS. METHODS: A total of 408 individuals were interviewed regarding sociodemographic characteristics, associated factors and HBV vaccination using a standardized questionnaire. Blood samples were collected from all participants and serological markers for HBV were detected by enzyme-linked immunosorbent assay. Hepatitis B surface antigen (HBsAg) and/or antibodies against hepatitis B core antigen (anti-HBc) positive samples were tested for HBV-DNA by polymerase chain reaction. RESULTS: The overall prevalence of HBV infection was 17.9% (95%CI: 14.4-22.0). The HBsAg carrier rate was 0.5%; 56 (13.7%) individuals had been infected and developed natural immunity and 15 (3.7%) were positive for anti-HBc only. Ninety eight (24%) prisoners had only anti-HBs, suggesting that they had low vaccine coverage. An occult HBV infection rate of 0% was verified among anti-HBc-positive individuals. Multivariate analysis of associated factors showed that age > 35 years-old, low schooling level and illicit drug use are significantly associated with HBV infection. CONCLUSIONS: Analysis of the data showed HBV infection prevalence similar or slightly lower than that reported in other of Brazilian prisons. Independent predictors of HBV infection in this population include older age, low schooling level and illicit drug use

Prevalence and Associated Risk Factors of Hepatitis B Virus Infections Among HIV-1 Infected Patients Attending the Comprehensive Care Clinic in Malindi Sub-County Hospital in Kenya

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infections are common all over the world. Infection with HIV increases rates of HBV chronicity, prolong the time the HBV stays in circulation and increase liver-related morbidity. Factors such as intravenous drug use, multiple blood transfusions, presence of tattoos, unsafe sexual practices and being health workers have been implicated as drivers of infection & transmission of HBV & HIV. This study aimed to determine the prevalence and genotypes of HBV associated risk factors among HIV infected patients in a descriptive cross-sectional study. Malindi was chosen as a suitable study site because of the high numbers of residents involved in sex tourism as well as intravenous drug use. A structured questionnaire was used to capture social demographic data such as age, gender, employment status, occupation, the level of education and marital status, clinical history information such as duration since diagnosis with HIV, ART drug history, duration taking ARVs and baseline CD4 count and risk factors associated with HBV infections such as intravenous drug use, history of blood transfusion, tattooing/scarification, and the sexual history from 446 consenting randomly selected HIV infected participants. Five millilitres of whole blood was obtained from each participant, 50µl of which was used for CD4 cell counts using a flow cytometer. HBsAg serology was done using Diaspot® rapid diagnostic test and confirmed by Hepanostika® HBsAg Ultra ELISA kit (BioMérieux SA) and HBV DNA was extracted from all HBsAg positive samples. Nested polymerise chain (PCR) reaction and sequencing of the Pre S1 region was done. Sample sequences were compared with published HBV genotypes sequences from GenBank and Phylogenetic trees were constructed using the NJ Plot software using a PHB file created through DNA Database of Japan (DDBJ) to determine the HBV genotypes. Out of the 446 HIV positive participants, 126 (28.3%) were males and 320 (71.7%) females. Only 19/446 (4.26%) participants were positive for HBV based on rapid strip test while 22/446 (4.93%) participants had HBV based on ELISA. Twelve of the 22 ELISA positive samples were successfully amplified by PCR. Out of the 12 PCR positive samples 10 were successfully sequenced. Phylogenetic analysis revealed that 9/10 (90%) samples belonged to genotype A while 1/10 (10%) belonged to genotype E. Males (p=0.028) and intravenous drug use (p= 0.08) were significantly associated HBV infections. The high prevalence (4.9%) of HBV among HIV patients attending Malindi Sub-county hospital is most likely highly driven by intravenous drug use and multiple sexual partners among the male gender and is predominantly genotypes A and E which is similar to the general population. Keywords: Hepatitis B virus, HIV, Co-infection, HBsAg, genotypes, intravenous drug us