Sera from 521 residents of an institution for the mentally retarded near Helsinki, Finland were examined by a hemagglutination assay to determine the distribution and titers of antibodies to hepatitis B surface antigen (anti-HBs). 36.1% were found to contain anti-HBs. Factors were identified which are related to the presence or absence of anti-HBs in this population. A documented past history of hepatitis, living in "asocial" wards in which at least one HBsAg carrier was present, long institutionalization (is greater than 10 yrs.), admission to the institution between ages 5 and 19, a present age between 20 and 39, and being male were associated with the presence of anti-HBs. 43.5% of the males but only 22.2% of the females had antibody. Down's syndrome patients had lower titers but not lower frequencies of anti-HBs than the non Down's patients.
Around a quarter of individuals infected with hepatitis C virus (HCV) are spontaneously able to clear the virus. Correlates of spontaneous HCV clearance are not well established and the aim of this study was to characterize factors associated with spontaneous HCV clearance in a human immunodeficiency virus (HIV)-co-infected cohort.
We analyzed 327 anti-HCV-positive HIV-1-infected patients using multivariate logistic regression. HCV clearance was defined as the presence of anti-HCV with undetectable HCV RNA from at least 2 measurements more than 6 months apart.
We included 327 HIV-1-infected individuals, predominantly of Caucasian race; 112 (34%) were females, 258 (79%) were injecting drug users (IDU), 25 (8%) were men who have sex with men (MSM), and 20 (6%) were hepatitis B surface antigen (HBsAg)-positive. Seventy-six (23%; 95% confidence interval (CI) 18-28) had cleared their HCV infection and 251 (77%; 95% CI 72-82) had a chronic infection. The clearance rate in HBsAg-positive individuals was 65%. Being female, HBsAg-positive, or belonging to HIV exposure groups IDU and MSM predicted higher HCV clearance rates (adjusted odds ratio (aOR) 1.8, 95% CI 1-3.2; aOR 7.6, 95% CI 2.7-21; aOR 5.2, 1.2-23.5; and aOR 10.2, 95% CI 1.8-58, respectively). Race, acquired immunodeficiency syndrome (AIDS), and antiretroviral therapy were not associated with HCV clearance.
The HCV clearance rate in this HIV-1 cohort was 23%. MSM and IDUs may have higher clearance rates due to their repeated exposure to low-dose HCV, leading to immune memory. Our data suggest an interaction of hepatitis B virus and HCV that influences the outcome of acute HCV infection.
The occurrence of the delta (delta) agent was analyzed in 89 patients with acute hepatitis B infection during 1976-1979 in Gothenburg, Sweden, and in 46 patients (16 drug addicts) with chronic HBsAg-positive liver disease. Four of the patients with acute hepatitis B had transiently detectable anti-delta antibodies in serum. At least three of these four cases were associated with intravenous drug abuse. Eleven of the HBsAg carriers (24%) were anti-delta-positive, and all of them were drug addicts. One of the drug addicts transmitted hepatitis B infection without detectable anti-delta in serum to two other non-addicts via parenteral routes. Apparently, in Sweden today delta-infection is mostly restricted to drug addicts and seldom found in other groups of hepatitis B patients.
A program of twice yearly testing of Alaska Native carriers of hepatitis-B surface antigen (HBsAg), for alpha-fetoprotein elevations as an indicator of early hepatocellular carcinoma has been established in Alaska. Because many HBsAg carriers live in remote regions of Alaska, logistical and cost considerations complicate the efficiency of this program. We evaluated the feasibility of using blood spotted onto mail-in cards as a system of blood collection and commercial assays for alpha-fetoprotein and HBsAg testing. We compared alpha-fetoprotein levels and the detection of HBsAg in both plasma and blood spots from HBsAg-positive carriers, normal volunteers, and pregnant females. There was good correlation between serum and blood spot AFP levels (r = 0.94, p
Serum levels of alpha-fetoprotein (AFP) may be raised for up to 2 years before clinical presentation of primary hepatocellular carcinoma (PHC). A group of people judged to be at high risk of PHC because of long-term serological positivity for hepatitis B surface antigen, ethnicity, location of residence, and a strong family history of PHC were screened for increasing levels of AFP. After 1 1/2 years of twice-yearly screening, one of them, a 19-year-old Eskimo man, had a raised AFP level, which continued to rise rapidly over the next 3 months, although the patient remained symptomless and ultrasonography, 99mTc-scan, and computerised tomography of the liver were negative. Hepatic angiography suggested a small tumour in the periphery of the right lobe of the liver, but at laparotomy the right lobe was normal. Instead a tumour was found in the lateral tip of the left lobe. The tumour, a PHC, was resected surgically, and the patient has been well in the 11 months since his operation. His serum AFP level returned to normal 2 weeks after the operation and has remained normal.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2204.
A 4-year continuous screening for hepatitis B antigen (HBAg) in all patients admitted to a Copenhagen general hospital revealed 253 antigen-positive cases among 99000 patients (2.5%). 97 of the patients had acute or chronic hepatitis, while there were no signs of liver disease in 156. The "healthy" carriers showed a wavy age distribution, indicating an increased transmission of HBAg in age groups born 1920-30 and 1940-60. Hepatitis B antibody (HBAb), measured by a radioimmunoassay, occurred in 8.6% of 1000 patients. HBAb also showed an uneven age distribution with a peak prevalence of 17.5% in the age group born 1910-30. These figures indicate that the prevalence of HBAg and hence presumably also the hepatitis B virus has fluctuated within this homogeneous population, probably related to changes in the sociohygienic conditions. Determination of HBAg subtypes D and Y in 161 patients indicated that the Y-subtype is now being introduced into a formerly subtype D area by means of drug addiction, tourism or workers of East-Mediterranean origin.