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Background: Tenofovir disoproxil fumarate (TDF) is recommended for the prevention of perinatal transmission of the hepatitis B virus (HBV). This study aimed to systematically assess the efficacy and safety of TDF in pregnant women with chronic HBV and their infants., Material and Methods: Database searches were performed to identify studies blocking the mother-to-child transmission of the hepatitis B virus with tenofovir. The search included pregnant women with chronic HBV infection administered with TDF compared to the no treatment controls, and data from individual studies were pooled using RevMan v5.3 for meta-analysis., Results: Seven studies with a total of 911 patients met the inclusion criteria: 433 patients in the TDF group and 478 patients in the non-TDF group. The HBV mother-to-child transmission rate in the tenofovir group was effectively reduced compared to the control group (RR: 0.18, 95% CI: 0.08-0.40). HBV-DNA positivity was also significantly low in infants from TDF group (RR: 0.17, 95% CI: 0.10-0.30) and the TDF treatment resulted in significantly higher anti-HBs production (RR: 1.11, 95% CI: 1.04-1.18). Similarly, maternal HBV-DNA was suppression was significantly high in the TDF group (RR: 34.16, 95% CI: 16.40-71.13). Women treated with TDF and their infants did not result in serious adverse events that are statistically different as compared to the women who did not receive any treatment., Conclusion: Treatment of HBV infected pregnant women with TDF can effectively and safely prevent the perinatal transmission of chronic hepatitis B., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Objective: to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material., Method: cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model., Results: scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B., Conclusion: the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.

Objective: To determine the outcome of the vaccination against hepatitis, we determined the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections, eight years after introduction of the vaccination., Materials and Methods: A cross-sectional study was performed in 2 944 participants of 67 Kandozi and Chapra indigenous peoples in April 2010. Serological screening for hepatitis B surface antigen (HBsAg), antibody anti-HBc IgM and IgG, antibody anti-HBs and anti-HDV were determined by ELISA tests., Results: The prevalence rates of HBsAg, anti-HBc total, anti- HBs ≥10 mlUI/ml and anti-HDV were 2.3, 39.13, 50.95 and 2.11%, respectively. The prevalence rate of HBsAg in children <11 years was 0%. Among carriers of HBsAg, the prevalence rates of HDV and acute HBV infections were 2.11% (all were >14 years) and 11.94%, respectively. HBsAg and anti-HBc total were associated with individuals ≥10 years (p<0.001)., Conclusions: These findings show the elimination of HBVmcarriers in children <11 years, eight years following introduction of the vaccination against HBV., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Chronic hepatitis B is a major cause of morbidity and mortality worldwide. Approximately one third of the world's population has serological evidence of past or present infection by hepatitis B virus (HBV) and 350-400 million people are chronic HBV surface antigen carriers. The aim of therapy is to prevent the onset of liver fibrosis and development of cirrhosis or hepatocarcinoma by sustained suppression of viral replication. Currently there are 2 strategies for the treatment of chronic hepatitis B: the pegylated interferon and long-term treatment with nucleoside/nucleotide analogues. Pegylated interferon has the advantage of being a treatment of limited duration, and is particularly suitable for patients with chronic hepatitis with positive HBeAg (hepatitis B e antigen), but the unfavorable adverse event profile and route of parenteral administration makes it less used than nucleoside/nucleotide analogues. Tenofovir and entecavir have shown to be potent inhibitors of HBV with a high genetic barrier to resistance and few adverse effects, so are considered as the first line therapy., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Objective The main goal of this research was to assess the seroprevalence of antibodies against measles, rubella, mumps, hepatitis B and all three poliovirus serotypes among children in the Quindío Department, Colombia. Methods Blood samples were obtained from 170 healthy children aged 5-9 years from nine municipalities in Quindío. The presence of serum IgG antibodies against measles, rubella, mumps and Hepatitis B were determined using commercial indirect ELISA kits. Immunity to poliomyelitis was assessed through the presence of neutralizing antibodies following the method recommended by the World Health Organization. Results Among the 170 children enrolled, 169 (99.41%), 170 (100 %), and 167 (98.2 %) were seropositive to poliovirus 1, poliovirus 2, and poliovirus 3, respectively. The average reciprocal antibody titers were 178 for poliovirus type 1, 120 for type 2 and 56 for type 3. Of the 170 children, 96.47 % were protected against mumps and rubella, and 86.47 % against measles. Only 106 (62.35 %) of the studied subjects were proved to be seropositive to hepatitis B. Conclusion The immunization program in Quindío has provided seroprotection against all three poliomyelitis serotypes, rubella and mumps. However, the child population is not fully protected against measles and hepatitis B virus infections.

Background: Treatment of HBeAg-negative chronic hepatitis B (CHB) with nucleos(t)ide analogues (NA) is usually indefinite, since the loss of HBsAg, as a criterion for its discontinuation, is a rare event. Recent evidence suggests that discontinuing NA therapy may be feasible in selected patients., Objectives: To analyze the rate of virological relapse in patients with HBeAg-negative CHB who discontinued treatment with NAs., Methods: We performed a single-center observational study that included 140 patients with HBsAg-negative CHB. Twenty-two patients, who received only NAs, discontinued treatment for different reasons and were subsequently monitored. All had normal ALT and AST, undetectable DNA and absence of cirrhosis or significant comorbidities before stopping treatment., Results: Twelve patients showed virologic relapse (54.54%). The mean interval between discontinuation and relapse was 6.38 months (± 1.9) (75% relapsed during the first 12 months after discontinuation). Five received adefovir, 1 lamivudine and adefovir, 1 tenofovir and 5 lamivudine alone. The mean treatment duration in this group was 38.5 months (± 4.5). The sustained response group had a higher mean age and longer treatment duration than patients with virologic relapse but these differences were not statistically significant., Conclusions: The results suggest that NA treatment can be stopped in selected patients with CHB as long as they are not cirrhotic, have completed a minimum period of treatment, have normal ALT and sustained undetectable DNA. These patients should be closely monitored during the first year and then indefinitely., (Copyright © 2014 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.)

The hepatitis B virus (HBV) infection is a public health problem worldwide. Considering HBV morbidity and mortality and the economic consequences .of this infection, policies and strategies to control it have been implemented, especially in regions where HBV infection is endemic, with high rates of vertical and horizontal infection. One of these strategies is the development of the recombinant vaccine. A 92% of the countries in the world have implemented the vaccine with a global coverage of 69%. The escape variants of HBV correspond to isolates with mutations in the sequence coding for the "a" determinant; these mutations result in changes in the amino acid sequence of the surface antigen (HBsAg) that prevent neutralization of viral particles by antibodies generated in response to vaccination or infection. The escape variants can infect vaccinated individuals and have been identified in the population of countries with different epidemiological patterns.

The infection by hepatitis B virus often promotes chronic liver inflammation which progresses to cirrhosis and hepatocellular carcinoma in a high percentage of patients. The persistent activation of the immune system causes an incessant liver damage, which fosters a disorganized stimulation of tissue repair and remodelling phenomena. In turn, the viral protein X (HBx) is essential for virus replication and therefore for the maintenance of chronic infection. However, the important oncogenic potential of HBx seems to reside, on one hand, in its ability to integrate into cellular DNA and, additionally, in the transactivation of different cellular signaling pathways involved in cell growth regulation, apoptosis and DNA repair. HBx also interacts with proteasome subunits and notably affects mitochondrial electric potential, thus altering cellular calcium homeostasis. Finally, this review discusses the pathogenic role of HBx in the progression of chronic hepatitis B through its effects on angiogenic, fibrogenic and oncogenic processes., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Several studies have demonstrated that viral load is a key factor to determine the development of HBV infection and to assess treatment options for the disease. There is a lack of studies analyzing viral load levels in chronic hepatitis B patients in Argentina and the epidemiologic information is limited. The aim of this study was to determine viral load levels and its distribution in patients diagnosed with chronic hepatitis B from geographical areas with high prevalence for HBV in Argentina. Fifty-one per cent of the study population had HBV DNA levels > or = 10(4) copies/ml and a median viral load of 11,910 copies/ml. The viral load was significantly higher in HBeAg seropositive patients compared with those seronegative for HBeAg (P < 0.05). Salta and Entre Ríos provinces showed low viral loads, while Chaco, Misiones and Formosa provinces had a median viral load ranging between 10(4) and 10(5) copies/ ml. This is the first study providing detailed information on viral load in chronic hepatitis B patients from Argentina. Availability of viral load levels in chronic hepatitis B enables evaluation of implementation of actions to analyze follow-up and/or treatment options for preventing disease complications, improving health care and diminishing the potential burden on the health care system.

Introduction: Information is available regarding the prevalence and incidence of positive microbiological serology results both in the general population and in patients on haemodialysis in Spain. Nevertheless, little information is known regarding patients with diabetes attended in external nephrology consultations., Objective: To evaluate the percentage of patients with positive serology results for hepatitis B and C, Human Immunodeficiency Virus (HIV), and syphilis in the initial assessment of patients referred to diabetic nephropathy external consultations., Patients and Method: Retrospective study of 500 patients assessed over the course of 5 years with the diagnosis of diabetic nephropathy originating in external consultations and for which hepatitis B, C, HIV, and syphilis serology had been requested., Results: With regard to hepatitis B virus, 0.4% of patients had chronic hepatitis B, 10.2% had overcome the hepatitis and were in recovery, and 4.2% had received the hepatitis B vaccine. As for hepatitis C, 2.4% of the patients studied had antibodies against hepatitis C. With regard to syphilis, 0.8% of patients had positive serological results. No patients had positive HIV serology results., Conclusions: Despite major methodological limitations, this would be the first study to evaluate the microbiological serology of diabetic nephropathy patients treated in external consultations.

Objectives: To estimate the prevalence of antibodies against measles, rubella and hepatitis B in children aged between 1 and 4 years in Peru., Materials and Methods: A national survey was conducted based on a questionnaire and capillary blood sample taken on filter paper in order to study antibodies against measles, rubella and hepatitis B in children from 1 to 4 years of age. A stratified, multistage, probability sampling design was used to be representative at the national level and at level of seven ambits, including the Metropolitan Lima Area, the rest of the urban coast, the rural coast, the urban highlands, the rural highlands, the urban jungle and the rural jungle. The capillary blood samples were processed according to the standardized protocols for detection of antibodies using the ELISA technique and commercial reagents., Results: The survey showed a national prevalence of antibodies against measles, rubella and hepatitis B of 91.6% (CI 95%: 90.6%; 92.7%), 91.3% (CI 95%: 90.3%; 92.4%) and 95.9% (CI 95%: 95.0%; 96.8%) respectively. There was no evidence of significant differences in the prevalence among the ambits of study or among the socioeconomic strata of the conglomerates for any of the three types of antibodies., Conclusions: In children from 1 to 4 years of age, the national prevalence of antibodies against measles and Rubella was between 90-93%, while the prevalence of antibodies against Hepatitis B (anti-HBsAg) was between 95-97%.

Introduction: The risk of hepatitis B virus (HBV) transmission through donor organs with HBsAg(-) and anti-HBc(+) serology has not been extensively studied in lung transplantation. The objectives of this study are to ascertain the influence of the anti-HBc(+) on the acceptance of the lung for transplantation, to comment on the published literature and to suggest an algorithm for action., Methods: A survey conducted in the 7 Spanish lung transplantation teams. The updated search of the literature was performed using medical databases from 1994 to February 2012., Results: All of the teams vaccinate the lung recipients against HBV, although none quantify the anti-HBs titers. When given an anti-HBc(+) donor, 3 teams change their strategy: one does not accept the offer, one selects the receptor from among patients in emergency status and another adds pharmacological prophylaxis. Only 3 publications refer to the serologic evolution of the receptors. At the moment there have been no reported cases of hepatitis B or HBsAg positivity post-transplant, but 4 out of the 50 anti-HBc(-) receptors changed to anti-HBc(+) in the follow-up., Conclusions: The presence of anti-HBc in the donor influences the decision to accept a lung donor, although there is little information on its repercussions. To date, there has been no reported case of transmission of HBV, but post-transplant anti-HBc seroconversions have been described, which suggests contact with viral particles. Although rare, an anti-HBc(+) donor can harbor a hidden HBV infection. The risk of infection can be reduced with adequate anti-HBs titers or with appropriate pharmacological measures., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

The surface antigen of hepatitis B virus (HBsAg) is the main serological marker of HBV infection since its discovery almost 50 years ago. Currently the quantification of HBsAg has acquired special relevance as there are commercial tests to measure its levels. Several studies have shown that in patients treated with pegylated interferon alfa the fall of HBsAg levels predicts the loss of HBsAg and persistent virologic response. The role of the quantification of HBsAg in the treatment with nucleoside analogues is still not well understood and requires further studies., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Infection recurrence rates among hepatitis B virus infected liver allograft recipients, may be as high as 80%. Immunoprophylaxis with anti HBVgammaglobulin may reduce these rates and improve survival. The dose of anti HBV gammaglobulin that must be used is not clearly defined. The most commonly accepted protocol uses 10,000 units during the anhepatic phase and 10,000 units daily during one week, followed by weekly doses of 10,000 units during one month and maintenance with 10,000 units monthly, without measuring anti hepatitis B surface antigen antibodies (antiHBs). Some reports recommend the use of immunoglobulin on demand, to maintain antiHBs titers between 100 and 250 U/l. The infection recurrence rates among patients treated with immunoglobulin and Lamivudine fluctuates between 0 and 10%, during follow up periods of 13 to 30 months. We report three liver allograft recipients that received immunoglobulin on demand, using a mean of 41,000 units, maintaining adequate antiHBs titers.

Objective: To determine the prevalence of viral infections (HBV, HCV and HIV) in serological window period in blood donors screened with nucleic acid testing (NAT)., Materials and Methods: We assessed all blood donors from July 2008 to June 2009 at the Central Blood Bank of the Mexican Institute of Social Security. Medical history was made and provided an information brochure and self-exclusion questionnaire. All blood donors were tested with serological tests (Ag-HBVs, Anti-HCV and Anti-HIV) and molecular testing with NAT for HBV, HCV and HIV. The window period was defined with the positive NAT and negative serological test., Results: During one year, we evaluated 47 847 blood donors. None subject was identified with viral infection (HBV, HCV and HIV) in serological window period. Positive serological testing were found for HBV in 78 (0.2%), 318 (0.7%) for HCV and 155 (0.3%) for HIV. Positive NAT was demonstrated only in donors with positive serology: 26 of 78 with HBV, 56 of 318 with HCV and 16 of 155 with HIV., Conclusion: This is the first study in México showed no viral infections (HBV, HCV and HIV) during serological window period in blood donors; The medical history and the self-exclusion questionnaire help to improve blood transfusion safety.

Hepatitis B is a public health problem in the entire world, mainly among HIV infected people in whom the coinfection change the course, natural history and morbi-mortality of the disease. Because of this, it is imperative to design strategies to prevent hepatitis B infection in HIV patients. Vaccination is the most important tool for prevention, although its efficacy varies according to immunologic and virologic status of the patient.

In pregnant women and children, the hepatitis B virus can cause acute or chronic hepatitis or liver cirrhosis. Perinatally-acquired infection causes persistent infection in 90% of cases and can be avoided through administration of the hepatitis B vaccine and specific immunoglobulin in the first day of life. Prevention of mother-to-child transmission requires screening for hepatitis B surface antigen (HBsAg) in pregnant women to identify which newborns should be immunized. In some countries this strategy is substituted by universal vaccination of neonates. In infected children, inactivation of viral replication with conversion of HBeAG-positive to anti-HBe-positive status usually occurs. If this seroconversion does not take place and necroinflammatory activity persists in the liver, the use of antiviral agents such as interferon or nucleoside and nucleotide analogs is warranted.

Hepatitis B virus (HBV) infection is a worldwide public health problem. There are an estimated 350 million persons with chronic HBV infection that could progress to cirrhosis and hepatocarcinoma with nearly one million deaths per year. In the last few years the therapeutic options in chronic hepatitis B have increased and currently six treatments are authorized: standard interferon (IFN)-alpha, pegylated interferon-alpha (PEG-IFNalpha), lamivudine, adefovir, entecavir, and telbivudine. For the last 25 years, conventional IFNalpha has been used as the treatment of chronic hepatitis B (CHB) and currently PEG-IFNalpha is indicated due to its greater effectiveness. Both drugs are first line options for HBeAg(+) and HBeAg(-) CHB. The advantages of IFNalpha and PEG-IFNalpha are that these drugs are administered for a limited time period, they achieve a higher sustained response rate and do not induce HBV mutants with antiviral resistance. These drugs achieve greater HBeAG and HBsAG clearance due to their antiviral and immunomodulatory activity. PEG-IFNalpha induces sustained biochemical and virological response in approximately one third of patients with HBeAg(+) CHB. The best response to IFNalpha and PEG-IFNalpha is obtained in patients with elevated transaminase levels, moderate viral load and HBV genotypes A and B. The disadvantages of IFNalpha and PEG-IFNalpha are their adverse effects and contraindications. These drugs cannot be administered in patients with decompensated cirrhosis. The combination of nucleos(t)ide analogs with PEG-IFNalpha could achieve much higher sustained response rates; however, which treatment constitutes the most suitable therapeutic strategy requires investigation.

Introduction: Cancer patients can be asymptomatic carriers of the hepatitis B virus (HBV), which can be reactivated by chemotherapy. Our aim was to identify the serological markers of HBV in children with cancer who were asymptomatic carriers of the virus. Fifty two (52) children with cancer treated at the Maracaibo University Hospital in Venezuela were studied, 28 of these children (53.8%) were HBV positive, despite no clinical or biochemical signs or symptoms of hepatitis. The type of serological markers present in each of these children.were investigated. We found 7 cases (25%) with hepatitis B surface antigen (HBsAg) and 2 (7.1%) with anticore as the only markers. Multiple markers were found in the other children: 9 (32.1%) HBsAg and anticore; 7 (25%) HBsAg, e-antigen (HBeAg) and anticore; 3 (10.7%) HBsAg, HBeAg antibody and anticore. In total, of the 28 positive children 20 (71.4%) showed positive anticore and of these 4 (20%) were of the IgM type. Our results show a high level of positivity for HBV in the children with cancer studied. In spite of being asymptomatic carriers of the HBV, it is noticeable the presence of serological markers for acute disease. We recommend testing for HBV serological markers before starting chemotherapy. Should the test results be negative, vaccination is indicated and should they be positive, specialized care is indicated.

Hepatitis B is an important cause of morbidity and mortality around the world. One-third of the world's population has been estimated to be infected with hepatitis B virus (HBV). A significant amount of evidence suggests that both humoral and cellular immune responses are important to eliminate the virus and that, cellular immunity is involved in the pathogenesis of the disease. Vaccination with HBsAg is considered as the main strategy for effective control of the infection and viral transmission. However, approximately 5-10% of immunized individuals fail to elicit detectable specific antibodies and remain at risk for hepatitis B infection. In this work we have reviewed the current status in the pathogenesis of the disease and the mechanisms described to explain nonresponsiveness to the vaccine as well. Since nonresponders to the vaccine are at risk for the infection, a common mechanism to explain the absence or inappropriate immune response to virus components is proposed. Within the suggested model an impaired activation of T lymphocytes against viral antigens, both in nonresponders to vaccination and chronically infected patients, is described. These observations could be consistent with potential differences in the MHC/Ag presentation; therefore contributing to our understanding of the altered T helper response as an underlying mechanism for the lack of protective immunity against VHB.

Unlabelled: Viruses might be one of the environmental agents that trigger systemic lupus erythematosus (SLE)., Objective: To determine the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) antibodies in patients with SLE., Methods: We investigated 110 SLE patients (106 women and 4 men, mean age 35.1 years) who fulfilled the criteria for SLE of the American College of Rheumatology. Three hundred blood donors served as controls. Antibodies against HCV and HBV were tested by a third generation ELISA. Positive results for anti-HCV were further studied by a third generation recombinant immunoblot assay (RIBA 3.0) and polymerase chain reaction (PCR). A positive ELISA assay was considered when the result was positive on two consecutive determinations., Results: Antibodies to HCV were present in 3 blood donors (1%), compared with 2 SLE patients (p = 0.4, Fisher's test). One SLE patient was RIBA positive and was lost for follow-up, and the another was confirmed by PCR. This patient had chronic hepatitis and a history of blood transfusion. No patient or control was HBV positive., Conclusions: The prevalence of antibodies against HCV and HBV was not higher than in blood donors and the relation between these viruses and SLE could not be established.

Frequently Blood Bank donors are found to have a presence of Total Anti-Bc in the serum in the absence of the Hepatitis B surface antigen (HBsAg) and the Hepatitis B Surface Antigen (Anti-Bs) antibody. This study was designed to determine the serological response to the vaccination against the Hepatitis B virus, and evaluate the effectiveness of the vaccine in such cases, taking into consideration that the protective antibody titers for Hepatitis B are measured in levels above 10 mUl/ml.Thirty-one patients with the HBsAg negative/Anti-Bs negative/Antil-Bc positive serological patterns received three doses of the recombinant DNA vaccine (Hepavax Gene 20 microg), in a 0, 1, 2 months vaccination schedule. Anti-HBs levels were taken 30 days after the application of the last dose. After the 3 doses of the vaccine, the Anti-HBs levels were > 100 mUl/ml in 89% of the cases, > 500 in 50% and > 1000 in 14.3% of the vaccinated patients. Only 3 patients (9.7%) did not show serological response 30 days after the application of the last dose of the vaccine. In conclusion, 90% of the patients administered the HBsAg negative/Anti-HBs negative/Anti-HBc positive serological patterns, obtained Anti-HBs levels considered protectors ( > 10 mUl/m).

Introduction: Little is known about the clinical significance of the "anti-HBc alone" serological profile (absence of HBsAg and anti-HBs) in HBV infections. The objective of the present study was to estimate the prevalence of the anti-HBc alone immunological profile and the clinical-epidemiological characteristics of patients with this profile., Methods: Prospective, cross-sectional, descriptive study performed in 2002 and including patients with anti-HBc alone (HBsAg-negative, anti-HBs-negative and anti-HBc-positive). All the cases identified underwent the following microbiological tests: IgM anti-HBc, HBeAg, anti-HBe, anti-HDV, anti-HCV, anti-HIV, as well as HBV-DNA testing by qualitative nested-PCR. Furthermore, studies of serum biochemical parameters, blood counts and coagulation, as well as a clinical-epidemiological interview were performed in all patients., Results: Among 3900 patients studied, 195 (5%) presented the anti-HBc alone profile (48% were > 65 years old). Residual anti-HBs (< 10 mUI/mL) was found in 44% of cases and 33% were anti-HBe positive. HCV or HIV coinfection were seen in 38% and 8%, respectively. HBV-DNA was detected in 4.2% (5/120) of cases. Epidemiologically, detection of anti-HBc alone was casual in 60% of patients, whereas the remaining cases had a history of chronic liver disease (82% of these were anti-HCV positive). In a high percentage (63%) the transmission mechanism of HBV infection was unknown (11% intravenous drug abuser, 10% surgery, 6% transfusions)., Conclusion: The anti-HBc alone pattern is a frequent finding, particularly in patients > 65 years old and in HCV or HIV coinfected patients. Although HBV-DNA was detected in a small percentage of cases, this test could be indicated in certain clinical situations (liver disease, coinfection, donors). Furthermore, this profile seems to be related with HCV infection; hence, we consider anti-HCV detection necessary in all patients with anti-HBc alone.

De novo hepatitis B was diagnosed in a 47-year-old man 15 months after liver transplantation for end-stage alcoholic cirrhosis. Serum antibodies to hepatitis B core antigen (anti-HBc) were negative, and remained undetectable over 20 months of follow-up. The possible causes of negative serum anti-HBc despite of active hepatitis B virus infection are reviewed. Immunosuppression may underlie this phenomenon in similar cases.

Background: To study the hepatitis B virus (HBV) transmission from donors HBsAg-/AntiHBc+ to liver transplant recipients., Patients and Method: We studied retrospectively the HBV serological markers in 43 donors from our center and also the serological condition of the 41 recipients. The HBV serological markers were analyzed by ELISA and HBV DNA was detected by hybridation assays., Results: 13 donors samples showed some HBV serological markers: 6 anti-HBc and anti- HBs (13.9%), 4 anti-HBc (9%) and 3 anti- HBs (6.9%). There were no cases of hepatitis B among liver recipients from donors with negative serological markers. Among the 13 recipients with HBV serological markers, 9 were followed during 39 (SD 17) months. The 5 recipients with no HBV markers, who received an anti- HBc+ with or without anti- HBs (100%) developed hepatitis B. The two liver recipients with anti-HBs solely, did not developed infection (0%). Of the 41 recipients, 15 had some HBV markers before transplant and two of them received an anti-HBc+ and did not develop the infection (0%)., Conclusions: In our study, the prevalence of serological HBV infection in donors and recipients was of 30.2 and 31.7%, respectively. Anti-HBc with or without anti-HBs donors transmitted the HBV infection in all the cases (100%) to the susceptible recipients. The presence of anti-HBs in recipients protected these against the infection. Only the anti-HBs positive donors did not trasmit the HBV infection.

Objective: In our Center the disposal of blood with HBV positive markers is approximately 6%, being 90% AgsHB negative and anti HBc positive. With the purpose of knowing the infected capacities of these donations and to consider the possibility of using them for transfusion, the presence of the viral genoma was investigated by PCR, in a group of samples with these characteristics that were also anti sHB positive. They were correlated with the readings of the anti cHB total, with the anti cHB-IgM and with the titration of the anti sHB., Materials and Methods: 87/100 random samples, from February to June 1996, were frozen at -30 degrees C for their later evaluation. In the serological screening were used Auszyme Monoclonal of Abbott and the Heprofile anti cHB, ADI-Diagnostic. The readings of the anti cHB was considered strong, moderate or weak according to its distance to the cut off. For the determination of the anti sHB, Hepanostika anti sHB, Organon Technika was used. They were considered with low titers (< 10 UI/L), high (> or = 10 UI/L) and very high (> or = 100 UI/L). In the determination of the anti cHB-IgM, Heprofile ADI-Diagnostic was used. For the investigation of the viral genoma, it was carried out with double PCR-ADN, using two internal and two external primers for the core-precore region., Results: 70/87 (80.45%) of the samples presented high readings of anti cHB with high titers of anti sHB, being positive for anti cHB-IgM seven of them and one was HBV-ADN positive (1.42%) suggesting the possibility to be cronic carrier. In the remaining 19.55% of the samples we didn't detect positive results in the amplification assays., Conclusions: 1. The donors showed high levels of immunocompetence. 2. High titer of anti sHB doesn't guarantee the absence of viral genoma and therefore the absence of infectivity can not be sure. This doesn't allow us to come in like donors neither to use their blood in the transfusional therapy.

The results of a study of markers of infection/immunity by hepatitis B virus in a community of the health area in "Cristobal Labra" polyclinics, City of Habana in 1995. The studied healthy adult population was not included in any vaccination strategy with hepatitis B vaccine. Two markers were studied: Hepatitis B surface antigen and its corresponding antibody (anti-HBs). HBsAg-positivity was 1.05% and anti-HBs positivity was 13.39%. Of anti-HBs-positive cases, 13.39% had titers from 10-50 UI/L and the rest (43.68%) had titers over 50 UI/L.

With the immunologic rationale exposed in the first part of this paper, the authors analyze a new experimental treatment which includes the combination of an antiviral (ribavirin) and an immunomodulator (AM3) in a model of hepatotoxic viral-infection in mice. Rationale for this associated treatment is based on the ability of AM3 to restore the natural immunity through the induction of IL-12 and IFN-gamma. Furthermore, the treatment with AM3 decreases factor C3 of the complement system which appears to be implied in IL-12 downregulation. Experimental and clinical results showed herein suggest a new approach to the treatment of viral hepatitis which combines the use of antivirals in combination with immunomodulators able to restore the "immunologic chaos" induced by some viruses.

In this paper, the authors update on the immunopathology of hepatitis B virus (HBV) infection, with special reference to the roles of inflammatory and natural immune responses (macrophages and NK cells) in the viral clearance. The role of specific immune responses being related to the influence of the environment of the antigen presentation (macrophages, NK cells, and their related cytokines IL-12 and IFN-gamma) on Th cells within the liver. The viral scape leading to chronic hepatitis B is thought to be due (a) to the suppressive actions of the virus on NK cells and IFN-gamma production (b) to the downregulation of IL-12/IL-15 production provoked by the inflammatory response (factor C3 of the complement system) on IL-12-producing macrophages: immunologic chaos.

Background: Viral hepatitis is a contagious disease. Patients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), may be either chronically symptomatic or asymptomatic, and suffer cirrhosis and high risk of hepatic carcinoma., Aims: Asymptomatic carriers of HBV surface antigen (HBs-Ag) or with anti-HCV antibodies are potentially infectious, and therefore a risk to public health., Methods: This work seeks to establish the frequency of seropositivity for HBs-Ag and anti-HCV antibodies in a population of 774 newly accepted students of the Medical School of the Autonomous University of Nuevo Leon, whose average age was 18 years. Second generation ELISA test were used to screen for HBs-Ag and anti-HCV antibodies. HBs-Ag was confirmed by a neutralization test and anti-HCV antibodies were confirmed by a RIBA test., Results: Three sera were positive for HBs-Ag by ELISA and only one serum (0.13% of analyzed samples) was confirmed by the neutralization technique. On the other hand 12 sera were positive for anti-HCV antibodies by ELISA, and eight of these were confirmed by RIBA (1.03% of the analyzed samples). Intensive reactivity bands were found in two sera, and weak reactivity bands were found in six sera. ELISA screening for anti-HCV antibodies showed 0.5% of false positives., Conclusions: This study shows that the frequency of anti-HCV antibodies is 7.95% times higher than that found for HBs-Ag. All seropositive patients were asymptomatic and potentially infective. This demonstrates the need to routinely screen for HBs-Ag and anti-HCV antibodies to establish the prevalence of these diseases in our area.

Aim: To investigate serologic changes and risk of reactivation in hepatitis B chronic carriers., Patients and Methods: Two hundred chronic HBs-Ag positive patients were included (follow-up greater than 18 months). According to the HBeAg/Anti-HBe status at the moment of inclusion they were classified in 3 groups: I: 40 patients HBeAg positive, II: 158 anti-HBe positive and III: 2 HBeAg/Anti-HBe negatives. All patients were screened in the follow-up for biochemical test, hepatitis B, C and D virus serology, DNA.HBV by hybridization, alpha fetoprotein and abdominal ultrasound., Results: Mean age was 35 +/- 12 years (14-61), and mean follow-up 71 +/- 35.1 months (18-252). In the follow-up 28 patients in group I seroconverted HBeAg/Anti-HBe, 18 spontaneously (annual rate 10%). In group II four patients out off 158 were DNA HBV positive. Only 3 chronic HBV carriers lost HBsAg and developed Anti-HBs (annual rate 0,25%). Reactivation of viral activity was detected in 13 patients Anti-HBe positive, DNA.HBV negative. HBeAg appeared during reactivation in six, both HBeAg/Anti-HBe were negative in one, and six were unchanged. Reactivation was significantly more frequent in chronic carriers with high GPT activity (13 out off 75, 17.3%) than in patients with normal GPT (0 out off 107, 0%) (p < 0.0005)., Conclusions: Reactivation of HBV activity is frequent in HBsAg chronic carriers Anti-HBe positive, DNA.HBV negative and who are abnormal GPT levels; these patients should be considered at risk of reactivation. The control in the follow-up of HBV chronic carriers with persistently normal GPT, without advanced liver disease, may not be so frequent. The increased infectiousness during reactivation of HBV activity must be taken account for prophylaxis of HBV infection in chronic carriers contacts.

Background: The prevalence of HBV and HCV infections in patients with hepatocellular carcinoma may be related to variations in the geographic area of study. For this reason, we have analized the relative prevalence of HBV and HCV infections in 94 patients with hepatocellular carcinoma from Cantabria (North of Spain)., Patients and Methods: We have studied 94 patients with hepatocellular carcinoma from January 1988 to December 1993. Commercially available radioimmunoassay or ELISA were used for detection of HBsAg, anti-HBs and anti-HBc. The HBV DNA was analized by PCR. The HCV infection was assayed by ELISA-2 and RT-PCR., Results: The HBV infection was detected in 27 patients: 19 patients were HBsAg positive and 8 patients HBsAg negative, anti-HBc positive, DNA HBV positive by PCR. The HCV infection was found in 57 patients. Forty patients were infected with both viruses. Of the remain twenty-four, forty were alcoholics. We found in 61 patients more than one etiological factor. Hepatoma was the first manifestation of liver disease in 24 cases and these were more frequently in HCV than in those with HBV infection. Moreover, the first group were older and have lower alcohol intake., Conclusions: 1) In Cantabria, Spain, the majority of cases of hepatocellular carcinoma are related to HBV, HCV and alcohol. 2) Analysis of DNA HBV and RNA HCV by PCR allows the diagnosis of cryptic infections by both viruses, especially in the cases of HBV and HCV coinfection. 3) Hepatoma is the first manifestation of liver disease in a high percentage of cases.

Pre S1 antigen was measured using an ELISA technique in patients with different forms of hepatitis B virus infection. It was detected in 10 of 19 patients with acute hepatitis B (53%), 12 of 15 chronic hepatitis B virus carriers (80%), 9 of 11 patients with chronic hepatitis B (82%) and 3 of 4 patients with hepatoma and positive markers of hepatitis B virus infection. Pre S1 remained positive beyond 150 days in two patients with acute hepatitis that evolved to chronicity. Among subjects with chronic hepatitis B that received interferon, pre S1 antigen negativized only in the patient that had a complete response. Pre S1 detection is an index of hepatitis B virus replication and its persistence determines chronicity. Its negativization after antiviral therapy should have a predictive value.

Aim: To study the prevalence of hepatitis C virus infection (HCV) and the associated risk factors in an institution for the mentally retarded, in addition to its relation with hepatitis B infection (HBV)., Methods: The presence of antibodies against the HCV (anti-HCV) and markers for the HBV was evaluated in 94 mentally retarded subjects admitted to a single institution. Information concerning the sex, age, length of admission, type and degree of mental retardation, history of sexual promiscuity, surgery and blood transfusions was collected in every individual., Results: The prevalence of infection by HBV was 22.3%. Only one individual was detected as being positive for the HCV.

Background: Hepatitis B vaccine has demonstrated to be very effective and safe preventing hepatitis B virus infection. Long term protection induced by hepatitis B vaccination depends on the initial immune response and the declining rate of anti-HBs titers. AIM. To investigate early and late response to hepatitis B vaccine in a sample of high risk Chilean population., Material and Methods: Thirty one subjects (20 relatives of hepatitis B chronic carriers, 10 health service workers and one HIV seropositive) were vaccinated with a plasma derivated hepatitis B vaccine. Early and late response were estimated by anti-HBs titers., Results: Twenty eight subjects (90%) produced protective titers of anti-HBs after 2 months from the third dose of vaccine (early response), and they remained at these levels in 75% of vaccinated individuals after three years (late response). All the subjects without protective titers after the three year follow up had produced anti-HBs levels lower than 300 UI at the early response. Hepatitis B vaccination was not associated with significant side effects., Conclusions: This experience confirms that hepatitis B vaccine is safe and effective inducing immunity in high risk subjects. Our data suggest that the early response to hepatitis B vaccine is able to identify those subjects requiring closer surveillance for boosters.

HBV infection has been investigated in 47 anti-human HIV positive patients in relation to a similar group of 33 anti-HIV negative patients. Serological HBV markers were found in 87% of anti-HIV positive patients. The difference in markers of viral replication (HBeAg, HBV-DNA) was not statistically significant between the two groups. It has been suggested that HBV infection of peripheral blood mononuclear cells could be a cofactor implicated in the development of immunodeficiency due to HIV. For this reason we have investigated the presence of HBV-DNA in peripheral blood mononuclear cells by in situ hybridization. Although its detection was more frequent in anti-HIV positive patients than in anti-HIV negative ones (p < 0.05), it was not related to clinical state of immunodeficiency. With regard to serological HBV markers, HBV-DNA was detected in peripheral blood mononuclear cells from antiHBc w/o antiHBs patients. This fact means the virus may persist in this cells after recovery and suggest they could serve as additional reservoirs of HBV. These cells, that contain the HBV genome, could be implicated in the perpetuation, reactivation of the infection and in its transmission.

Background: The incidence of hepatitis B is on the increase despite immunization of people susceptible to risk populations. After the introduction of a recombinant vaccine in 1986, it has become possible to evaluate different alternatives of immunization, from the point of view of efficacy, with the aim of controlling the disease., Methods: A cost-effectiveness analysis was performed with the use of decision trees and calculation of the cost per avoided case of infection in the different strategies evaluated, vaccination to risk groups, pubescent youth, newborns, and communicated accidental exposure. An evaluation of the different alternatives was carried out in a simple model associated to a passive and active immunization program of newborns of mothers who are carriers of HbsAg and finally, the possibility of revaccination is added., Results: Costs and future profits are presented in pesetas for 1990 and rates of social discounts of 4% and 7% are applied actualizing the same. For the prevalence estimated in the bibliography consulted, the cost per avoided case oscillated between 115,000 and 310,000 ptas in the most numerous risk groups (those living with carriers and ADVP) with lower covering; in massive immunization of pubescent youth the costs are from 30,000 to 130,000 ptas; the costs for newborns is of about 400,000 ptas; and accidental exposure rises to 500,000 ptas per avoided case., Conclusions: In vaccination versus the hepatitis B virus systematic vaccination of adolescents is proposed as most efficient and with the aim of disease control a program of passive and active immunization of newborns of carrier mothers should be included.