Journal of Viral Hepatitis最新文献_第10页

Infectivity of Hepatitis B Virus Surface Antigen-Positive Plasma With Undetectable HBV-DNA: Can HBsAg Screening Be Discontinued in Egyptian Blood Donors? 乙型肝炎病毒表面抗原阳性但 HBV-DNA 检测不到的血浆的感染性：埃及献血者能否停止 HBsAg 筛查？

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-08-10 DOI: 10.1111/jvh.13990

Magdy El Ekiaby, Junko Tanaka, Harry van Drimmelen, Jean-Pierre Allain, Nico Lelie

Hepatitis B Virus (HBV) infectivity data were reviewed and the 50% infectious dose (ID₅₀) was reassessed in different HBsAg-positive infection stages enabling modelling of transfusion-transmitted (TT)-HBV infection risk if HBsAg donor screening was replaced by individual donation nucleic acid amplification technology (ID-NAT). Quantitative HBsAg and HBV-DNA assays were performed against international standards to compare the ratio between potential infectious HBV virions and subviral HBsAg particles in Egyptian HBsAg-positive blood donors as well as in Japanese chimpanzee samples of known infectivity. HBV-DNA load below the quantification limit of detection was estimated against a reference standard by replicate NAT testing (n = 25). Infectivity of chimpanzee samples collected during ramp-up and declining viremic phase were tested in a human liver chimeric mice (HLCM) model and compared with published infectivity data from different HBsAg-positive infection stages. Lowest estimates of ID₅₀ in HBsAg-positive plasma were 3–6 HBV virions in chimpanzee studies. Infectivity decreased approximately 10-100-fold in the declining viremic phase using HLCM. In acute phase samples, HBV to HBsAg particle ratios varied between 1:10²–10⁴ but in HBsAg-positive blood donors this particle ratio reached 1:10⁶–10¹² when viral load was below 100 HBV-DNA copies/mL. Modelled TT-HBV risk of an HBsAg-positive/ID-NAT nonreactive blood transfusion was estimated at 5.5%–27% for components containing 20–200 mL of plasma when assuming an ID₅₀ of 316 (point estimate between 100 and 1000) virions. It cannot be ensured that discontinuation of HBsAg donor screening and reliance on ID-NAT alone is safe.

回顾了乙型肝炎病毒（HBV）感染性数据，并重新评估了不同 HBsAg 阳性感染阶段的 50% 感染剂量 (ID50)，以便在以个体捐赠核酸扩增技术 (ID-NAT) 取代 HBsAg 捐赠者筛查的情况下，建立输血传播 (TT) -HBV 感染风险模型。根据国际标准进行了 HBsAg 和 HBV-DNA 定量检测，以比较埃及 HBsAg 阳性献血者和已知感染性的日本黑猩猩样本中潜在感染性 HBV 病毒与亚病毒 HBsAg 颗粒之间的比例。通过重复 NAT 测试（n = 25），对照参考标准估算出低于定量检测限的 HBV-DNA 载量。在人肝嵌合小鼠（HLCM）模型中检测了病毒血症上升期和下降期收集的黑猩猩样本的感染性，并与已发表的不同 HBsAg 阳性感染阶段的感染性数据进行了比较。在黑猩猩研究中，HBsAg 阳性血浆中 ID50 的最低估计值为 3-6 个 HBV 病毒。在病毒血症下降阶段，使用 HLCM 的感染率下降了约 10-100 倍。在急性期样本中，HBV 与 HBsAg 粒子比在 1:102-104 之间变化，但在 HBsAg 阳性献血者中，当病毒载量低于 100 HBV-DNA 拷贝/毫升时，粒子比达到 1:106-1012。在假设 ID50 为 316（点估计在 100 到 1000 之间）病毒时，对于含有 20-200 mL 血浆的成分，HBsAg 阳性/ID-NAT 非反应性输血的 TT-HBV 风险模型估计为 5.5%-27%。无法确保停止 HBsAg 献血者筛查和仅依靠 ID-NAT 是安全的。

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引用次数: 0

Post-Diagnosis HCV RNA Testing Rates Prior to HCV Treatment Among People Living With HIV With HCV Antibody Positivity in the Asia-Pacific Region 亚太地区 HCV 抗体阳性的 HIV 感染者在接受 HCV 治疗前的 HCV RNA 诊断后检测率。

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-08-08 DOI: 10.1111/jvh.13993

Dhanushi Rupasinghe, Jun Yong Choi, Nagalingeswaran Kumarasamy, Sanjay Pujari, Vohith Khol, I. Ketut Agus Somia, Man Po Lee, Thach Ngoc Pham, Sasisopin Kiertiburanakul, Cuong Duy Do, Anchalee Avihingsanon, Jeremy Ross, Awachana Jiamsakul, on behalf the International Epidemiology Databases to Evaluate AIDS (IeDEA) Asia-Pacific

HCV RNA test determines current active infection and is a requirement prior to initiating HCV treatment. We investigated trends and factors associated with post-diagnosis HCV RNA testing rates prior to HCV treatment, and risk factors for first positive HCV RNA among people living with HIV (PLHIV) with HCV in the Asia-Pacific region. PLHIV with positive HCV antibody and in follow-up after 2010 were included. Patients were considered HCV-antibody positive if they ever tested positive for HCV antibody (HCVAb). Repeated measures Poisson regression model was used to analyse factors associated with post-diagnosis HCV RNA testing rates from positive HCVAb test. Factors associated with time to first positive HCV RNA from positive HCVAb test were analysed using Cox regression model. There were 767 HCVAb positive participants included (87% from LMICs) of whom 11% had HCV RNA tests. With 163 HCV RNA tests post positive HCVAb test, the overall testing rate was 5.05 per 100 person-years. Factors associated with increased testing rates included later calendar years of follow-up, HIV viral load ≥1000 copies/mL and higher income countries. Later calendar years of follow-up, ALT >5 times its upper limit of normal, and higher income countries were associated with shorter time to first positive HCV RNA test. Testing patterns indicated that uptake was predominantly in high income countries possibly due to different strategies used to determine testing in LMICs. Expanding access to HCV RNA, such as through lower-cost point of care assays, will be required to achieve elimination of HCV as a public health issue.

HCV RNA 检测可确定当前的活动性感染，是开始 HCV 治疗前的必要条件。我们调查了亚太地区感染 HCV 的艾滋病病毒感染者（PLHIV）在接受 HCV 治疗前进行诊断后 HCV RNA 检测的趋势和相关因素，以及 HCV RNA 首次阳性的风险因素。研究纳入了2010年后随访的HCV抗体阳性的艾滋病病毒感染者。如果患者曾检测出 HCV 抗体 (HCVAb) 阳性，则被视为 HCV 抗体阳性。重复测量泊松回归模型用于分析与HCVAb检测阳性诊断后HCV RNA检测率相关的因素。使用 Cox 回归模型分析了从 HCVAb 检测阳性到首次 HCV RNA 阳性时间的相关因素。共纳入了 767 名 HCVAb 阳性参与者（87% 来自低收入国家/地区），其中 11% 进行了 HCV RNA 检测。HCVAb检测阳性后进行了163次HCV RNA检测，总体检测率为每百人年5.05次。与检测率增加相关的因素包括随访日历年数较晚、HIV 病毒载量≥1000 拷贝/毫升以及收入较高的国家。较晚的随访年份、ALT >正常值上限的 5 倍以及较高收入国家与较短的首次 HCV RNA 阳性检测时间有关。检测模式表明，接受检测的主要是高收入国家，这可能是由于低收入与中等收入国家在确定检测时采用了不同的策略。要消除 HCV 这一公共卫生问题，就必须扩大 HCV RNA 的检测范围，例如通过成本较低的医疗点检测。

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引用次数: 0

Sustained Virological Response After Early Discontinuation of Hepatitis C Treatment 早期停止丙肝治疗后的持续病毒学反应

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-08-07 DOI: 10.1111/jvh.13991

Robert Flisiak, Dorota Zarębska-Michaluk, Ewa Janczewska, Anna Parfieniuk-Kowerda, Włodzimierz Mazur, Marek Sitko, Justyna Janocha-Litwin, Rafał Krygier, Beata Lorenc, Anna Piekarska, Barbara Sobala-Szczygieł, Krystyna Dobrowolska, Łukasz Socha, Jerzy Jaroszewicz

To date, the effectiveness of direct-acting antivirals (DAAs) discontinued before 4 weeks has not been analysed in routine clinical practice. The study aimed to determine whether such a short therapy will enable achieving a sustained virological response under real-world experience. The study population of 97 patients who discontinued DAA therapy and had data enabling analysis of patient and disease characteristics, and assessment of treatment effectiveness was selected from 16,815 patients registered in the EpiTer-2 database. The most common reason for discontinuation was hepatic decompensation (20.6%) or the patient's personal decision (18.6%). Patients who discontinued treatment were significantly older, more frequently therapy-experienced, more likely to have cirrhosis, a history of decompensation and a Child–Pugh B or C classification than those who completed treatment. SVR was achieved by 93.5% of patients who discontinued treatment after 4 weeks, 60.9% if discontinued at 3 or 4 week and 33.3% at Week 1 or 2. Patients receiving pangenotypic but not genotype-specific treatment who discontinued after 4 weeks were as likely to achieve SVR as those who completed therapy. Patients who responded to treatment that lasted no longer than 2 weeks had a low baseline viral load (<400,000 IU/mL). Despite discontinuation of therapy after Week 4, the chances of SVR are high. Very early discontinuation does not preclude therapeutic success, especially in patients with low baseline viral load.

迄今为止，尚未对常规临床实践中停用 4 周前的直接作用抗病毒药物 (DAAs) 的有效性进行分析。这项研究旨在确定在实际经验中，如此短的治疗时间是否能够实现持续的病毒学应答。这项研究从EpiTer-2数据库中登记的16815名患者中筛选出97名停止DAA治疗的患者，这些患者的数据可用于分析患者和疾病特征以及评估治疗效果。最常见的停药原因是肝功能失代偿（20.6%）或患者个人决定（18.6%）。与完成治疗的患者相比，中止治疗的患者年龄明显偏大，治疗经验更丰富，更有可能患有肝硬化、有肝功能失代偿病史以及Child-Pugh B或C分级。93.5%在4周后停止治疗的患者达到了SVR，60.9%在3周或4周停止治疗，33.3%在第1周或第2周停止治疗。接受泛基因型治疗而非基因型特异性治疗的患者如果在 4 周后停止治疗，获得 SVR 的几率与完成治疗的患者相同。对持续时间不超过 2 周的治疗有反应的患者的基线病毒载量较低 (

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引用次数: 0

Assessment of HBV variants and novel viral and immune biomarkers in chronic hepatitis B patients with metabolic dysfunction associated steatotic liver disease 评估代谢功能障碍伴脂肪性肝病慢性乙型肝炎患者的 HBV 变体以及新型病毒和免疫生物标记物。

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-08-07 DOI: 10.1111/jvh.13979

Nishi H. Patel, Aaron Lucko, Alicia Vachon, Karen E. Doucette, Alnoor Ramji, Laura Sycuro, Trushar R. Patel, Kris Chadee, Maitreyi Raman, Guido van Marle, Carla Osiowy, Carla S. Coffin

Co-existing chronic hepatitis B virus (CHB) infection and metabolic dysfunction associated steatotic liver disease (MASLD) can exert complex effects on hepatic metabolism, requiring mechanistic study. CHB participants were assessed for MASLD and the impact of hepatic steatosis/metabolic syndrome (MetS) on novel viral and immunological markers. In this prospective, cohort study, untreated CHB subjects were assessed for liver disease by non-invasive tests (i.e. FibroScan, controlled attenuation parameter, CAP). Subjects were tested for cytokines and IFN-γ ELISPOT assay to HBV Surface (S) and Core (C) proteins. Standard HBV serological, exploratory biomarkers and deep sequencing of HBV S and C genes were performed. In 53 subjects (median age 45 years [SD = 10.6], 35% F, 56% Asian, 20% Black, 3% White), 94% (50) HBeAg negative, 63% genotype B/C, mean HBV DNA 3.2 log₁₀ IU/mL (SD = 1.8), quantitative HBsAg 2.9 log₁₀ IU/mL (SD = 1.2) and HBV pgRNA 2.1 log₁₀ copies/mL (SD = 1.3). In enrolled subjects, the mean ALT was 41.9 U/L (SD = 24.0), FibroScan was 5.7 kPa (SD = 1.9) and CAP was 306.4 dB/m (SD = 49.0). The mean BMI was 28.2 kg/m² (SD = 4.2), 20% (11/53) had diabetes, 35% (19/53) dyslipidaemia and 24% (13/53) hypertension. Subjects with MetS and steatosis showed lower HBV markers (p < .01), higher HBV S diversity (p = .02) and greater frequency of HBV variants associated with host-anti-viral immune escape. Pro-inflammatory cytokine levels and HBV-specific cellular responses were higher in participants with hepatic steatosis. In CHB, MASLD/hepatic steatosis was associated with HBV variants and systemic immune responses potentially impacting liver disease progression despite low-level viraemia.

慢性乙型肝炎病毒（CHB）感染和代谢功能障碍相关性脂肪性肝病（MASLD）并存会对肝脏代谢产生复杂的影响，需要进行机理研究。对 CHB 参与者进行了 MASLD 评估，并评估了肝脏脂肪变性/代谢综合征（MetS）对新型病毒和免疫标记物的影响。在这项前瞻性队列研究中，未经治疗的慢性阻塞性肺病受试者通过非侵入性检测（即纤维扫描、受控衰减参数、CAP）来评估肝脏疾病。受试者接受了细胞因子和 IFN-γ ELISPOT 检测，以检测 HBV 表面（S）和核心（C）蛋白。还进行了标准的 HBV 血清学检测、探索性生物标志物检测以及 HBV S 和 C 基因的深度测序。53 名受试者（中位年龄 45 岁 [SD = 10.6]，35% 女性，56% 亚洲人，20% 黑人，3% 白人）中，94%（50 人）HBeAg 阴性，63% 基因型为 B/C，平均 HBV DNA 为 3.2 log10 IU/mL（SD = 1.8），定量 HBsAg 为 2.9 log10 IU/mL（SD = 1.2），HBV pgRNA 为 2.1 log10 copies/mL（SD = 1.3）。入组受试者的平均谷丙转氨酶（ALT）为 41.9 U/L（SD = 24.0），纤维扫描（FibroScan）为 5.7 kPa（SD = 1.9），CAP 为 306.4 dB/m（SD = 49.0）。平均体重指数为 28.2 kg/m2（SD = 4.2），20%（11/53）患有糖尿病，35%（19/53）患有血脂异常，24%（13/53）患有高血压。患有 MetS 和脂肪变性的受试者显示出较低的 HBV 标志物（p

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引用次数: 0

Clinical Prevalence of Hepatitis D Virus Among Hepatitis B Patients in Sulaymaniyah Governorate, Northern Iraq 伊拉克北部苏莱曼尼亚省乙肝患者中 D 型肝炎病毒的临床流行率。

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-08-07 DOI: 10.1111/jvh.13987

Salih A. Hama, Raz Sirwan, Muhsin Abubakr, Gasha S. Ahmed, Hawbash M. Rahim

Hepatitis D virus (HDV), which occurs as a co-infection with the hepatitis B virus (HBV), is a significant public health burden. Currently, there is a scarcity of data regarding this co-infection in the developing countries. This study aims to address the clinical prevalence of HDV among HBV-infected patients in Sulaymaniyah Governorate, Iraq. This prospective cross-sectional study, conducted from May to November 2022, screened HBV DNA-positive patients visiting Sulaimani Teaching Hospital in Sulaymaniyah governorate, Iraq, for anti-HDV antibodies and HDV RNA. The study included 150 confirmed HBV DNA-positive patients. Of these, 54.7% were male. The mean age of the patients was 49.1 ± 10.1 (18–68). Serological assessment found that 23 (15.3%) of the patients had anti-HDV IgG antibodies, suggesting past or chronic HDV infection, while 16 (10.7%) tested positive for anti-HDV IgM, indicating recent/acute infection. Further molecular analysis confirmed HDV RNA in 15 (10%) of HBV patients, indicating real HDV prevalence. The prevalence of anti-HDV and HDV RNA did not significantly differ by age, gender, marital status, residency, medical, family or medical history (p > 0.05). In conclusion, this study demonstrated a relatively high HDV prevalence among HBV patients in Sulaymaniyah Governorate, Iraq, at 10%, which stresses the need for better screening, health strategies and focused research to combat its impact.

丁型肝炎病毒（HDV）是乙型肝炎病毒（HBV）的合并感染，对公共卫生造成了巨大负担。目前，发展中国家有关丁型肝炎病毒合并感染的数据很少。本研究旨在探讨伊拉克苏莱曼尼亚省 HBV 感染者中 HDV 的临床流行情况。这项前瞻性横断面研究于 2022 年 5 月至 11 月进行，对前往伊拉克苏莱曼尼亚省苏莱曼尼教学医院就诊的 HBV DNA 阳性患者进行了抗 HDV 抗体和 HDV RNA 筛查。该研究包括 150 名确诊的 HBV DNA 阳性患者。其中 54.7% 为男性。患者的平均年龄为 49.1 ± 10.1 (18-68)岁。血清学评估发现，23 名（15.3%）患者体内有抗 HDV IgG 抗体，表明他们曾感染或慢性感染过 HDV；16 名（10.7%）患者的抗 HDV IgM 检测呈阳性，表明他们近期/急性感染过 HDV。进一步的分子分析证实，15 例（10%）HBV 患者体内存在 HDV RNA，表明 HDV 确实存在。抗 HDV 和 HDV RNA 的流行率在年龄、性别、婚姻状况、居住地、医疗史、家族史或病史方面没有明显差异（P > 0.05）。总之，这项研究表明，伊拉克苏莱曼尼亚省的 HBV 患者中 HDV 感染率相对较高，达到 10%，这强调了更好的筛查、健康策略和重点研究的必要性，以消除其影响。

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引用次数: 0

Outcomes of a 1-Year Pilot Study Implementing Universal Hepatitis Delta Virus Testing Among Veterans With Chronic Hepatitis B 在慢性乙型肝炎退伍军人中普及 Delta 病毒检测的 1 年试点研究结果。

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-08-05 DOI: 10.1111/jvh.13992

Robert J. Wong, Meimei Liao, Yu Chen, Miki Kwan, Ji-Hyung Lee, Janice H. Jou, Joseph K. Lim, Ramsey Cheung

Current US guidelines recommend risk-based testing for hepatitis delta virus (HDV) in persons with chronic hepatitis B (CHB). While there is debate as to whether a risk-based or universal testing approach is most effective, limited data exist on universal HDV testing programs in the United States. We performed a 1-year pilot study evaluating the outcomes of a universal HDV testing approach among US veterans with CHB. All consecutive adults with CHB receiving care at hepatology clinics at a single-centre Veterans Affairs Health System from 1 October 2022 to 30 September 2023 were prospectively tested for anti-HDV antibody (anti-HDV). Patients who were anti-HDV Ab-positive were subsequently tested for HDV RNA. Comparison of HDV testing between groups utilised chi-square testing. A total of 91 consecutive CHB patients (90.0% male, mean age 60.9 ± 14.1 years, 73.9% Asian, 26.1% non-Asia, 16.5% cirrhosis and 17.1% with active or past history of drug use) had anti-HDV ordered. Overall, 76.9% (n = 70) completed anti-HDV testing; 4.3% (n = 3) were positive. HDV RNA testing was ordered in all three patients; two patients completed HDV RNA testing and one had detectable HDV RNA. No significant differences in completion of anti-HDV testing was observed by age, sex, race/ethnicity, cirrhosis status or drug use history. Among a single-centre prospective cohort study piloting a universal HDV testing approach, one patient with viremic HDV was identified. Implementing true reflex testing of all CHB patients with anti-HDV, followed by automated HDV RNA testing for anti-HDV-positive patients would improve the HDV testing cascade and timely diagnosis of HDV.

美国现行指南建议对慢性乙型肝炎（CHB）患者进行基于风险的乙型肝炎病毒（HDV）检测。关于基于风险的检测方法最有效还是普遍检测方法最有效还存在争议，但美国有关普遍 HDV 检测计划的数据却很有限。我们在患有慢性乙型肝炎的美国退伍军人中开展了一项为期 1 年的试点研究，评估普及 HDV 检测方法的效果。从 2022 年 10 月 1 日至 2023 年 9 月 30 日，在退伍军人事务卫生系统的单中心肝病诊所接受治疗的所有慢性阻塞性肺病成年患者均接受了抗 HDV 抗体（anti-HDV）前瞻性检测。抗 HDV 抗体阳性患者随后接受 HDV RNA 检测。通过卡方检验比较不同组间的 HDV 检测结果。共有 91 名连续的慢性阻塞性肺病患者（90.0% 为男性，平均年龄（60.9 ± 14.1）岁，73.9% 为亚洲人，26.1% 为非亚洲人，16.5% 为肝硬化患者，17.1% 有活跃的吸毒史或既往吸毒史）接受了抗 HDV 检测。总体而言，76.9%（70 人）完成了抗 HDV 检测；4.3%（3 人）呈阳性。所有三名患者都接受了 HDV RNA 检测；其中两名患者完成了 HDV RNA 检测，一名患者检测到了 HDV RNA。不同年龄、性别、种族/民族、肝硬化状况或吸毒史的患者在完成抗 HDV 检测方面没有明显差异。在一项试行普遍 HDV 检测方法的单中心前瞻性队列研究中，发现了一名 HDV 病毒血症患者。对所有抗 HDV 的慢性阻塞性肺病患者进行真正的反射检测，然后对抗 HDV 阳性患者进行 HDV RNA 自动检测，这将改善 HDV 检测级联和 HDV 的及时诊断。

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引用次数: 0

Self-reported hepatitis B testing among noninstitutionalized adults in the United States before the implementation of universal screening, 2013–2017: A nationwide population-based study 2013-2017 年，美国非住院成年人在实施普遍筛查前的自我报告乙肝检测情况：一项基于全国人口的研究。

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-07-30 DOI: 10.1111/jvh.13985

George A. Yendewa, Robert A. Salata, Temitope Olasehinde, Frank Mulindwa, Jeffrey M. Jacobson, Amir M. Mohareb

In 2023, the US Centers for Disease Control and Prevention recommended universal screening for hepatitis B virus (HBV); however, the proportion of US adults screened before implementing this recommendation is unknown. We analysed nationally representative data from the National Health Interview Survey (2013–2017) on self-reported HBV testing among noninstitutionalized US adults ≥18 years. We employed Poisson logistic regression to identify factors associated with self-reported testing, using a conceptual framework that included four overarching factors: sociodemographic characteristics, healthcare access, health-seeking behaviours and experiences, and access to internet-based health information. Among 149,628 survey respondents, the self-reported HBV testing rate was 27.2% (95% CI 26.2–28.7) and increased by 1.7% from 2013 to 2017 (p = .006). In adjusted analysis, health-seeking behaviours and experiences had the strongest associations of self-reported testing including a history of hepatitis (AOR 2.68, 95% CI 1.92–3.73), receipt of hepatitis B vaccination (AOR 5.11, 95% CI 4.61–5.68) and prior testing for hepatitis C (AOR 9.14, 95% CI 7.97–10.48) and HIV (AOR 2.69, 95% CI 2.44–2.97). Other factors associated with testing included being male (AOR 1.14, 95% CI 1.03–1.26), ages 30–44 years (AOR 1.37, 95% CI 1.17–1.61), 45–60 years (AOR 1.55, 95% CI 1.30–1.80) and ≥60 years (AOR 1.53, 95% CI 1.28–1.84), residence in the Western US region (AOR 1.23, 95% CI 1.06–1.43), and access to internet-based health information (AOR 1.32, 95% CI 1.18–1.47). Being Hispanic was associated with lower odds of testing (AOR 0.80, 95% CI 0.66–0.97). These findings may help guide optimal HBV screening in the universal testing era.

2023 年，美国疾病控制和预防中心建议普及乙型肝炎病毒（HBV）筛查；然而，在实施该建议之前，美国成年人接受筛查的比例尚不清楚。我们分析了全国健康访谈调查（2013-2017 年）中具有全国代表性的数据，这些数据涉及年龄≥18 岁的美国非住院成年人自我报告的 HBV 检测情况。我们采用泊松逻辑回归来确定与自我报告检测相关的因素，使用的概念框架包括四个主要因素：社会人口学特征、医疗保健途径、寻求健康的行为和经历以及获取基于互联网的健康信息的途径。在149628名调查对象中，自我报告的HBV检测率为27.2%（95% CI为26.2-28.7），从2013年到2017年增加了1.7%（p = .006）。在调整后的分析中，寻求健康的行为和经历与自我报告的检测有最强的相关性，包括肝炎病史（AOR 2.68，95% CI 1.92-3.73）、接种过乙肝疫苗（AOR 5.11，95% CI 4.61-5.68）以及之前检测过丙肝（AOR 9.14，95% CI 7.97-10.48）和 HIV（AOR 2.69，95% CI 2.44-2.97）。与检测相关的其他因素包括男性（AOR 1.14，95% CI 1.03-1.26）、30-44 岁（AOR 1.37，95% CI 1.17-1.61）、45-60 岁（AOR 1.55，95% CI 1.30-1.80）和年龄≥60 岁（AOR 1.37，95% CI 1.17-1.61）。80）和≥60 岁（AOR 1.53，95% CI 1.28-1.84）、居住在美国西部地区（AOR 1.23，95% CI 1.06-1.43）以及获得基于互联网的健康信息（AOR 1.32，95% CI 1.18-1.47）。西班牙裔与较低的检测几率相关（AOR 0.80，95% CI 0.66-0.97）。这些发现可能有助于指导在全民检测时代进行最佳的 HBV 筛查。

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引用次数: 0

Severe acute hepatitis of unknown origin in children: Is it still a mystery? What role does adenovirus play? 原因不明的儿童重症急性肝炎：它仍然是个谜吗？腺病毒起什么作用？

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-07-29 DOI: 10.1111/jvh.13978

Cristina Stasi, Martina Pacifici, Monia Puglia, Fabio Voller

On March 31, 2022, severe acute hepatitis of unknown origin was first reported from the Royal Glasgow Children's Hospital in Scotland. According to the criteria by WHO-ECDC, a probable case of unknown acute hepatitis in children is defined as a subject under 16 years of age, who tested negative for viral hepatitis and transaminases >500 U/L, starting from the 1st of October 2021. WHO invites Member States to participate in the global effort to collect anonymized clinical data on probable cases of severe acute hepatitis of unknown aetiology. As of May 26, 2021, 650 cases were already registered on the platform worldwide, of whom at least 38 cases have required liver transplants. Several hypotheses such as previous SARS-CoV-2 infection or coinfection or infection with another virus were examined and a strong association was found between adenovirus (41F) and acute hepatitis of unknown aetiology cases. This review article summarizes the global epidemiological evidences on acute hepatitis of unknown origin in children, analysing their incidence and characteristics.

2022 年 3 月 31 日，苏格兰格拉斯哥皇家儿童医院首次报告了不明原因的重症急性肝炎。根据世卫组织-欧洲疾病预防控制中心的标准，自 2021 年 10 月 1 日起，16 岁以下、病毒性肝炎检测阴性且转氨酶>500 U/L的受试者被定义为儿童不明原因急性肝炎疑似病例。世卫组织邀请会员国参与全球努力，收集病因不明的重症急性肝炎疑似病例的匿名临床数据。截至2021年5月26日，全球已有650个病例在该平台上登记，其中至少有38个病例需要进行肝移植。研究人员对多种假说进行了分析，如曾感染过 SARS-CoV-2 或合并感染或感染了其他病毒，结果发现腺病毒（41F）与病因不明的急性肝炎病例之间存在密切联系。这篇综述文章总结了全球儿童急性不明原因肝炎的流行病学证据，分析了其发病率和特点。

引用次数: 0

Hepatitis C epidemiology and treatment outcomes in Italy: Impact of the DAA era and the COVID-19 pandemic 意大利的丙型肝炎流行病学和治疗效果：DAA时代和COVID-19大流行的影响

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-07-27 DOI: 10.1111/jvh.13983

Maria Paola Tramonti Fantozzi, Luca Ceccarelli, Davide Petri, Erica De Vita, Antonello Agostini, Piero Colombatto, Cristina Stasi, Barbara Rossetti, Maurizia Brunetto, Lidia Surace, Antonio Salvati, Alessia Calì, Danilo Tacconi, Claudia Bianco, David Redi, Massimiliano Fabbiani, Francesca Panza, Sauro Luchi, Sara Modica, Sara Moneta, Sarah Iacopini, Cesira Nencioni, Silvia Chigiotti, Giulia Ottaviano, Anna Linda Zignego, Pierluigi Blanc, Piera Pierotti, Elisa Mariabelli, Roberto Berni, Caterina Silvestri, Lara Tavoschi

HCV infection poses a global health threat, with significant morbidity and mortality. This study examines HCV trends in a large Italian region from 2015 to 2022, considering demographic changes, evolving clinical profiles, treatment regimens and outcomes, including the impact of the COVID-19 pandemic. This multicentre retrospective study analysed demographics, clinical histories and risk factors in 6882 HCV patients. The study spanned before and after the direct-acting antiviral (DAA) era, and the COVID-19 period, focusing on treatment outcomes (SVR12, non-SVR12 and patients lost to follow-up). Statistical methods included ANOVA, multinomial logistic regression, Kruskal–Wallis test and chi-square analysis, and were conducted adhering to the intention-to-treat (ITT) principle. The cohort, mainly Italian males (average age 58.88), showed Genotype 1 dominance (56.6%) and a high SVR12 rate (97.5%). The pandemic increased follow-up losses, yet SVR12 rates remained stable, influenced by factors like age, gender, cirrhosis and comorbidities. Despite COVID-19 challenges, the region sustained high SVR12 rates in HCV care, emphasising the importance of sustained efforts in HCV care. Continuous screening and targeted interventions in high-risk populations are crucial for achieving WHO elimination targets. The study highlights the resilience of HCV care during the pandemic and provides insights for future public health strategies.

丙型肝炎病毒感染对全球健康构成威胁，发病率和死亡率都很高。本研究考察了 2015 年至 2022 年意大利一个大区的 HCV 趋势，考虑了人口变化、不断发展的临床特征、治疗方案和结果，包括 COVID-19 大流行的影响。这项多中心回顾性研究分析了 6882 名 HCV 患者的人口统计学特征、临床病史和风险因素。研究跨越了直接作用抗病毒药物（DAA）时代前后和 COVID-19 期间，重点关注治疗结果（SVR12、非 SVR12 和失去随访的患者）。统计方法包括方差分析、多项式逻辑回归、Kruskal-Wallis 检验和卡方分析，并遵循意向治疗（ITT）原则。研究对象主要为意大利男性（平均年龄 58.88 岁），基因型 1 占主导地位（56.6%），SVR12 率高（97.5%）。受年龄、性别、肝硬化和合并症等因素的影响，大流行增加了随访损失，但 SVR12 率保持稳定。尽管 COVID-19 带来了挑战，但该地区的丙型肝炎病毒治疗仍保持了较高的 SVR12 率，这强调了持续开展丙型肝炎病毒治疗的重要性。对高危人群进行持续筛查和有针对性的干预对于实现世卫组织的消除目标至关重要。这项研究强调了丙型肝炎病毒护理在大流行期间的恢复能力，并为未来的公共卫生战略提供了启示。

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引用次数: 0

Changes in the prevalence of hepatitis B and C viral infections in Sindh province, Pakistan: Findings from two sero-surveys in 2007 and 2019 巴基斯坦信德省乙型肝炎和丙型肝炎病毒感染流行率的变化：2007年和2019年两次血清调查的结果。

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis

Pub Date : 2024-07-26 DOI: 10.1111/jvh.13986

Tesfa Sewunet Alamneh, Josephine G. Walker, Aaron G. Lim, Ejaz Alam, Saeed Hamid, Graham R. Foster, Naheed Choudhry, M. Azim Ansari, Huma Qureshi, Peter Vickerman

Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. We utilised repeat sero-surveys to assess progress achieved towards hepatitis elimination in Pakistan. Multilevel logistic regression evaluated the change in HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV exposure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveys from 2007 and 2019 for Sindh province and associated risk factors. Adjusted odds ratios (aORs) were estimated and population-attributable fractions (PAF) for modifiable risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and 6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals (95% CI): 2.2–2.9) in 2007 to 1.1% (95% CI: 0.8–1.3) in 2019, while HCV-Ab prevalence increased from 5.1% (95% CI: 4.6%–5.5%) to 6.2% (95% CI: 5.6%–6.8%). The age and gender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1–0.4) among children and 60% (aOR = 0.4, 95% CI: 0.3–0.6) among adults over 2007–2019, while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2–0.7) in children and increased by 40% (aOR = 1.4, 95% CI: 1.2–1.7) in adults. HCV-Ab prevalence was lower in adults with secondary (aOR = 0.6, 95% CI: 0.5–0.8) and higher (aOR = 0.5, 95%CI:0.3–0.8) education compared to illiterates and higher among adults reporting blood transfusion (aOR = 1.7, 95% CI: 1.2–2.4), family history of hepatitis (aOR = 2.5, 95% CI: 1.9–3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6–2.7), being tattooed (aOR = 1.4, 95% CI: 1.0–1.9) and shaved by traditional barber (aOR = 1.2, 95% CI: 1.0–1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medical injection(s) accounting for 38% (95%CI,25.7–48.4%). Overall HCV has increased over 2007–2019 in Sindh province, while HBV prevalence has decreased. Medical injections should be an important focus of prevention activities.

巴基斯坦的乙型肝炎病毒 (HBV) 和丙型肝炎病毒 (HCV) 感染率很高。我们利用重复血清调查来评估巴基斯坦在消除肝炎方面取得的进展。多层次逻辑回归评估了信德省 2007 年至 2019 年两次血清调查之间 HBV 感染（HBV 表面抗原 (HBsAg) 阳性）流行率和 HCV 暴露（HCV 抗体 (HCV-Ab) 阳性）流行率的变化以及相关风险因素。估算了调整后的几率比（aORs），并估算了HCV暴露的可改变风险因素的人口可归因分数（PAF）。2007 年和 2019 年的调查分别包括 8855 人和 6672 人。HBsAg 患病率从 2007 年的 2.6%（95% 置信区间 (95%CI)：2.2-2.9）下降到 2019 年的 1.1%（95% CI：0.8-1.3），而 HCV-Ab 患病率则从 5.1%（95% CI：4.6%-5.5%）上升到 6.2%（95% CI：5.6%-6.8%）。在 2007-2019 年期间，经年龄和性别调整的 HBsAg 患病率在儿童中下降了 80%（aOR = 0.2，95%CI：0.1-0.4），在成人中下降了 60%（aOR = 0.4，95%CI：0.3-0.6），而 HCV-Ab 患病率在儿童中下降了 60%（aOR = 0.4，95%CI：0.2-0.7），在成人中上升了 40%（aOR = 1.4，95%CI：1.2-1.7）。与文盲相比，受过中等教育（aOR = 0.6，95% CI：0.5-0.8）和高等教育（aOR = 0.5，95% CI：0.3-0.8）的成年人的 HCV-Ab 感染率较低；报告输血的成年人的感染率较高（aOR = 1.7，95% CI：1.2-2.4）。与文盲相比，报告输血（aOR = 1.7，95% CI：1.2-2.4）、肝炎家族史（aOR = 2.5，95% CI：1.9-3.3）、过去一年医疗注射（aOR = 2.1，95% CI：1.6-2.7）、纹身（aOR = 1.4，95% CI：1.0-1.9）和传统理发师剃须（aOR = 1.2，95% CI：1.0-1.5）的成年人中，可改变的风险因素占 45%。可改变的风险因素占接触 HCV 的 45%，医疗注射占 38%（95%CI,25.7-48.4%）。信德省的 HCV 感染率在 2007-2019 年间总体呈上升趋势，而 HBV 感染率则有所下降。医疗注射应成为预防活动的重点。

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引用次数: 0