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Objective: Leptin plays an important role in inflammation and liver fibrogenesis in viral liver diseases. In this study, determination of serum leptin level and the effect of leptin levels on liver inflammation and fibrosis in chronic hepatitis B (CHB) and chronic hepatitis C (CHC) cases were evaluated.Materials and Methods: The study groups consisted of 75 CHB, 36 CHC patients and 51 healthy subjects were included in the study as the control group. Liver biopsy specimens were scored using Ishak histological scoring system. Serum leptin levels were determined by ELISA method. Results: 39 of the chronic hepatitis B cases were female, 36 were male, 18 of the CHC cases were female, 18 were male, and 26 of the control group were female 25 one was male. Serum leptin levels were statistically significantly higher in CHB and CHC cases than in the control group (p: 0.001). However, there was no statistically significant difference in serum leptin level between CHC and CHB cases. There was no statistically significant difference between serum leptin levels and age, gender, and biochemical parameters (P> 0.05). Serum leptin levels were statistically significantly higher in patients with significant fibrosis in chronic hepatitis B and KHC patients compared to those with mild fibrosis.Conclusion: Leptin plays a role in liver inflammation and fibrosis in CHB and CHC. Leptin level indicates advanced fibrosis. In CHB and CHC patients, leptin levels can be used to evaluate the degree of advanced fibrosis and in clinical follow-up, but larger studies are needed., OBJECTIVE: Leptin plays an important role in inflammation and liver fibrogenesis in viral liver diseases. In this study, determination of serum leptin level and the effect of leptin levels on liver inflammation and fibrosis in chronic hepatitis B (CHB) and chronic hepatitis C (CHC) cases were evaluated.MATERIALS AND METHODS: In this prospective clinical research study, a total of 75 CHB patients, 36 CHC patients, and a 51 control group were included. Liver biopsy specimens were scored using Ishak histological scoring system. Serum leptin levels were determined by ELISA method.RESULTS: Overall, 39 of CHB cases were female while 36 was male, there were 18 female and 18 male cases of CHC, while the control group consisted of 26 female and 25 male. Serum leptin levels were statistically significantly higher in CHB (2.81±0.38) and CHC (2.97±0.35) cases than in the control group (1.39±0.08) (p: 0.001). However, there was no statistically significant difference in serum leptin level between CHC and CHB cases. There was no statistically significant difference between serum leptin levels and age, gender, and biochemical parameters (P> 0.05). Serum leptin levels were statistically significantly higher in patients with significant fibrosis in chronic hepatitis B and KHC patients compared to those with mild fibrosis (P

Moroz L.V., Melnyk T. O. The treatment dynamics assessment among patients with chronic viral hepatitis B, infected with human immunodeficiency virus. Journal of Education, Health and Sport. 2020;10(10): 393-409. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.10.038 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.10.038 https://zenodo.org/record/4891008 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 18.09.2020. Revised: 12.10.2020. Accepted: 30.10.2020. THE TREATMENT DYNAMICS ASSESSMENT AMONG PATIENTS WITH CHRONIC VIRAL HEPATITIS B, INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS L.V. Moroz, T. O. Melnyk National Pirogov Memorial Medical University, Vinnytsya, Ukraine Correspondence to: Tetiana Melnyk Email: kiriluktetyana@gmail.com ORCID ID (Tetiana Melnyk): https://orcid.org/0000-0003-4790-4931 Abstract Introduction: the article represents prospective study results of the treatment dynamics among patients with chronic viral hepatitis B, infected with human immunodeficiency virus. Particularly, the role of qHBsAg dynamics in the serum concerning CHB treatment effectiveness of CHB/HIV coinfected patients as well as clinical and laboratory factors influencing on this marker. The study purpose: To assess treatment dynamics of CHB/HIV coinfected patients basing on quantitative HBsAg determination and other clinical and laboratory test applying. Material and methods: 60 coinfected patients were examined – the main group, 60 CHB monoinfected patients – comparison group to reach established study purpose. Diagnosis of HIV and chronic hepatitis B were verified. A clinical, laboratory, serological, molecular-genetic methods were used. Statistical processing of results was held with applying parametric and nonparametric methods for the data analysis. Research results: There was a slight increase by 1.10 times in serum ALT in “a period of ≤ 6 months of antiviral therapy” with a subsequent decrease by 1.20-1.46 times in “a period of ˃ 6 months of therapy”. There was a decrease in the serum qHBsAg of coinfected patients in accordance with the duration of therapy by 1.56-21.10 times, and in case of the presence of "ALT flare" by 1.31-72.72 times. The greatest decrease in serum qHBsAg by 1.63-42.00 times during HAART was also observed in patients with an initial CD4 + count Conclusions: A serum qHBsAg possibly to be decreased by 2 log10 among CHB/HIV coinfected patients after starting HAART with dual activity against HBV and HIV which includes nucleoside reverse transcriptase analogs (Tenofovir Disoproxil Fumarate (TDF) and lamivudine (3TC)). Defined main influencing factors on qHBsAg decreasing included: “ALT flare”, CD4+ count, ΔCD4+ as a result of monofactorial analysis. It is necessary to conduct further multifactorial analysis to determine complex of factors which could influence on further HBsAg by 2 log10 and HBsAg clearance. Key words: CHB/HIV coinfection; quantitative determination of HBsAg (qHBsAg); HBV DNA; CD4+; ΔCD4+; “ALT flare”; hardly active antiretroviral therapy (HAART).

Objective: To study the effect of kushenin combined with entecavir therapy on hepatic fibrosis and immune response in patients with chronic hepatitis B. Methods: Patients who were diagnosed with chronic viral hepatitis B in First Affiliated Hospital of PLA General Hospital between March 2015 and June 2017 were enrolled in the study and randomly divided into the experimental group who kushenin combined with entecavir therapy and the control group who received entecavir monotherapy. The levels of hepatic fibrosis indexes and immune cytokines in serum as well as the number of immune cells in peripheral blood were measured before treatment as well as 3 months and 6 months after treatment. Results: Compared with the corresponding indexes of same group before treatment, serum PC-III, C-IV, TGF-β1, AngII and IFN-γ levels as well as peripheral blood Th1 cell number of both groups of patients were significantly lower whereas Th2, mDC and pDC cell number as well as CD80 and CD86 expression intensity in peripheral blood as well as IL-5 and IL-10 levels in serum were significantly higher 3 months and 6 months after treatment; serum PC-III, C-IV, TGF-β1, Ang-II and IFN-γ levels as well as peripheral blood Th1 cell number of experimental group 3 months and 6 months after treatment were significantly lower than those of control group whereas Th2, mDC and pDC cell number as well as CD80 and CD86 expression intensity in peripheral blood as well as IL-5 and IL-10 levels in serum were significantly higher than those of control group. Conclusions: kushenin combined with entecavir treatment of chronic hepatitis B can delay hepatic fibrosis progression and improve immune response.

Objectives. We evaluated platelet counts in end-stage renal disease and chronic viral hepatitis. Materials and Methods. We studied 70 patients with end-stage renal disease and chronic viral hepatitis and compared them to a control group of 45 patients without hepatitis. Results. The presence of viral hepatitis was associated with a higher prevalence of thrombocytopenia. Correlations between age, C-reactive protein, liver stiffness measurement, and platelet count were observed. C-reactive protein levels > 10 mg/dl were associated with a lower risk of thrombocytopenia in patients with end-stage renal disease and chronic viral hepatitis, yet age > 60 years, dialysis vintage > 10 years, aspartate and alanine aminotransferase levels > 20 IU/L, albumin levels < 3.5 g/dl, and fibrosis stage ≥ 3 were not related. Conclusions. Chronic viral hepatitis leads to a higher prevalence of thrombocytopenia. Platelet counts in these patients begin to decrease significantly once liver fibrosis reaches stage III.

Objectives: To determine the frequency of liver fibrosis by non invasive markerin patients with chronic viral hepatitis B. Study Design: Cross sectional clearly investigate aboutchronic viral hepatitis population. Setting: Liaquat University Hospital Hyderabad. Period: Sixmonths, 09-Jan-2014 to 08-July-2014. Patients and Methods: All the patients of 16-50 years ofage, of either gender with chronic viral hepatitis B infection for more than 6 months duration wereadmitted and evaluated for liver fibrosis through non invasive marker (APRI). The SPSS was usedto manipulate the data. Results: During six month study period, total 140 patients with chronicviral hepatitis B infected patients were evaluated for liver fibrosis. Majority of patients were fromurban areas 112/140 (80%). The mean ±SD for age of patients with chronic viral hepatitis Binfection was 37.95±9.77. The mean age ±SD of hepatic fibrotic patients was 35.72±7.62.The mean ±SD for age of male and female population was 35.83±8.74 and 33.83 ± 6.53respectively. The mean ± SD for APRI score in hepatic fibrotic subjects was 1.31±0.31 while inrelation to liver fibrotic male and female patients it was 0.91±0.21 and 1.00±0.32 respectively.Majority of the subjects were 30-39 years of age and the male population predominant (p=0.02)whereas the liver fibrosis was identified in 89/140 (63.5) [p=

Objective: To study the effect of Compound Biejiaruangan Tablets combined with entecavir therapy on liver fibrosis process and immune response state in patients with chronic hepatitis b. Methods: Patients with chronic viral hepatitis b who were treated in the Affiliated Hospital of Inner Mongolia Medical University between May 2015 and March 2017 were selected as the research subjects and divided into the combined group who accepted Compound Biejiaruangan Tablets combined with entecavir therapy and the control group who accepted entecavir monotherapy. The contents of collagen metabolism indexes and inflammatory response molecules in serum as well as the contents of immune cells in peripheral blood were determined before treatment and 24 weeks after treatment. Results: 24 weeks after treatment, PC-III, C-IV, MMP1, MMP2, TIMP1, IL-1β, IL-18, MIF, RANTES, MIP-1α and MIP-1β contents in serum as well as Th2, Treg and Th17 contents in peripheral blood of both groups of patients were significantly lower than those before treatment whereas Th1 contents in peripheral blood were significantly higher than those before treatment, and PCIII, C-IV, MMP1, MMP2, TIMP1, IL-1β, IL-18, MIF, RANTES, MIP-1α and MIP-1β contents in serum as well as Th2, Treg and Th17 contents in peripheral blood of combined group of patients were significantly lower than those of control group whereas Th1 content in peripheral blood was significantly higher than that of control group. Conclusion: Compound Biejiaruangan Tablets combined with entecavir therapy can delay the liver fibrosis process and improve the immune response state in patients with chronic hepatitis b.

The role of proinflammatory cytokines IL-2, IL-6, and TNF-a in the pathogenesis of chronic hepatitis B and C infection was studied in 49 children ages 3 to 18 years. There has been concluded that high IL-2 and low IL-6 serum levels related to hepatic inflammatory activity did not depend on viremia levels. Slow progression of the disease was associated with an insignificant increase of IL-6 and normal TNF-a serum levels. The study results show the importance of proinflammatory cytokines as diagnostic and prognostic indicators in the pathogenesis of chronic hepatitis B and C in children.

Introduction: Viral hepatitis B (VHB) is a serious and global public health issue, particularly in sub-Saharan Africa where it is endemic. The objective of this work was to evaluate the effectiveness and safety of tenofovir disoproxil fumarate (TDF) in the treatment of chronic VHB in Cotonou. Methods: This was a descriptive cross-sectional study with a retrospective collection of data from January 1st, 2015 to December 31st, 2016 (24 months) and prospective from May to August 2017 (4 months). Chronic VHB patients treated with TDF for at least 6 months were included. The non-detectability of HBV DNA and the normalization of aminotransferases defined the virological and biochemical responses, respectively. The evaluation of the treatment response on liver fibrosis was done by using APRI score. Renal impairment was assessed by a reduction in glomerular filtration rate according to MDRD (Modifications of the Diet in Renal Disease) formula below 90 mL/min/1.73 m2. Results: In all, 42 patients treated with TDF were included. The average age was 46.7 ± 13.8 years. The study population was predominantly male with a sex ratio of 2.5. Among the 42 patients treated with TDF for an average of 60 weeks (24 to 96 weeks), 36 patients (85.7%) had a virological response; 21 patients (50%) had a biochemical response. Virologic response was 70% at week 24 (W24), 92.6% at W48, 87.5% at W72 and 100% at W96 without significant difference between W24 and W48; between W48 and W72 then between W72 and W96. There was a regression of fibrosis and cirrhosis but not significantly. Renal involvement occurred in 3 out of 19 cases (15.8%) including a case of chronic end stage renal failure and 2 cases of mild chronic renal failure. Conclusion: The treatment with TDF is effective and globally safe in our patients with chronic viral hepatitis B in Cotonou.

Prevalence of hepatitis B in Pointe-Noire is 23%. The objective of this study was to evaluate the level of therapeutic management of patients with hepatitis B in Pointe-Noire. Methods: A retrospective, cross-sectional, descriptive and analytical study. Results: 302 patients included: 217 (72%) men and 85 (28%) women of median age 40 years. The viral load was measured in 140 (46%) patients and in 162 (54%), the viral load was not measured. Their distribution according to the viremia was as follows: 0 - 1 log = 1 (0.7%) patients; 1.5 to 2 log = 23 (16%) patients; 2.5 to 3 log = 49 (35%) patients; >3log = 55 (39%) patients. Of the 302 patients included, 36 (11%) patients were treated with antivirals and 253 (83%) patients were not. Conclusion: The number of patients treated for chronic viral hepatitis B was low. Our results show interest for improved preventive and curative management of hepatitis B in Congo in order to reduce the existing high prevalence.

Patients with malignancies may develop hypercalcemia due to bone metastases or paraneoplastic reasons. Hepatocellular cancer should be considered in liver masses detected in chronic viral hepatitis B patients with delta agents. However, in our case, we detected cholangiocellular carcinoma in the etiology of hypercalcemia.

Detecting new units of pathogenesis in the liver fibrosis due to alcoholism, chronic viral Hepatitis B and C, non-alcoholic fatty liver disease (NAFLD), autoimmune, parasitic and metabolic diseases and other, reveals perspective for new non-invasive serum biomarkers. In fibrosis, from the wide variety of markers enzymes, proteins and cytokines are mainly used. While direct biomarkers reflect the stage of fibrosis and fibrinogenesis, indirect markers allow assessment of the general liver functions. The combination of direct and indirect markers increases the diagnostic reliability and therefore these panels and indices are investigated quite intensively in recent years in order to decrease the number of liver biopsies without completely replace it, which is still regarded as the reference method.

The aim of this study was to identify the risk factors of mother-to-child transmission of HBV in positive Ag Hbs pregnant women in Cote d’Ivoire. Methods: This was a transversal prospective study that took place over a period of 7 months (from February 2016 to August 2016) in 2 university hospital and 2 private clinics. We consecutively recruited 91 pregnant women who were positive for HBs Ag in prenatal consultations. For each pregnant woman record included in the study, we provided Socio-demographic (Age, marital status, education level, social rank, gravidity, parity) and biological data (HBs Ag, Anti-HBc Total Ac, Hbe Ag, Ac anti-Hbe Ac, DNA-VHB, Ac anti-HCV Ac, retroviral serology, transaminases). All of these data were collected using a survey sheet developed for the study. Results: The age of our pregnant women HBs positive ranged from 18 years to 44 years with a mean age of 30.10 years. The age group from 20 to 39 years was the most represented with a frequency of 92.31%. Almost of all positive HBs Ag pregnant women was HBe Ag negative, only 3.3% was HBe Ag positive. The viral load above 2000 IU/ml was found in 21 (23.03%) patients. There were 4 co-infected patients, which 3 HBV-HIV and 1 HBV-HCV. Only 19 (20.88%) pregnant HBs Ag positive women were able to bring back the supplementary virological assessment within a period less than one month. Conclusion: According to our work the virologic profile of positive HBs Ag in pregnant women in Cote d’Ivoire is characterized by an important viral replication objectified by a high viral load in about 23% pregnant women, a negativity of HBe antigen in 96.6% of them.

The article presents data on assessing the state of the humoral immunity in patients with chronic viral hepatitis B, combined with chronic non-calculous cholecystitis, as chronic liver viral lesions are immune-mediated condition, depending on the replicative activity of the virus and the immune system’s responses to this virus. At the same time, there is an increase in the overall level of CIC in serum and an imbalance in the molecular composition of immune complexes, as well as a decrease in the immunological reactivity in such patients.

Objectives: To discuss the value of applying magnetic resonance diffusion-weighted imaging (DWI) to evaluate inflammatory activity from chronic viral hepatitis B. Methods: One hundred forty-two patients with chronic viral hepatitis B who received treatment at The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2015 and 20 healthy persons in the control group who were scheduled to undergo nuclear magnetic resonance scanning and DWI examinations (b value = 0, 800 s/mm2), and the apparent diffusion coefficients (ADCs) were measured and compared with the biopsy results of hepatic tissue. Results: The ADC value of the group with hepatitis B was lower than that of the healthy group (P

Изучены особенности клинического течения алкогольной болезни печени в различных этнических группах в сравнении с хроническим алкогольно-вирусным и вирусным гепатитом В. Всем больным проведено клиническое и лабораторное обследование. Установлено, что у коренных больных хронические алкогольные гепатиты формировались в более короткие сроки, о чем свидетельствует высокая частота их выявления в возрастных группах до 20 и от 20 до 29 лет, и характеризовались более выраженными клиническими проявлениями. Основными отличительными признаками алкогольных поражений печени, независимо от наличия или отсутствия HBV-инфекции, являются гепатомегалия, превалирование выраженных внепеченочных проявлений, повышение активности АлАТ в сочетании с ГГТП, а также иммунологические сдвиги., The features of the clinical course of alcoholic liver disease in various ethnic groups were studied in comparison with chronic alcohol-viral and viral hepatitis B. All patients underwent clinical and laboratory examination. It was revealed that in indigenous patients chronic alcoholic hepatitis was formed in a shorter time, as evidenced by the high frequency of their detection in the age groups up to 20 and from 20 to 29 years and was characterized by more pronounced clinical manifestations. The main distinguishing features of alcoholic liver damage, regardless of the presence or absence of HBV infection, are hepatomegaly, the prevalence of pronounced extrahepatic manifestations, increased activity of AlAT in combination with GGT, and immunological changes., №4(64) (2019)

Aim of the studyThe aim of this study was to assess the thyroid dysfunction (TD) and evaluate the value of antithyroglobulin (anti-TG) and antithyroperoxidase (anti-TPO) antibodies (Abs) in the early diagnosis of subclinical hypothyroidism in Egyptian patients with chronic viral hepatitis B and C.Pa

Our aim was to investigate the association of liver fibrosis and necroinflammation with HS in untreated young patients with chronic hepatitis B (CHB).A retrospective study was conducted in a military hospital in Turkey. A total of 254 subjects with CHB were included in this study. These subjects were divided into two groups: group 1 consisted of patients with hepatic steatosis (HS) according to ultrasonography (USG) and group 2 consisted of non-HS subjects. Sociodemographic, biochemical, histopathological, virological and USG results were recorded for both groups retrospectively. Statistical analysis was performed using SPSS 22.0.The prevalence of HS was found to be 11.4%. A significant statistical difference was found between group 1 and group 2 regarding the fibrosis degree (p = 0.045). No statistically significant difference was noted between two groups for age, levels of ALT, AST, HBeAg, HBV-DNA levels, HAI scores, diagnosis age and duration of CHB. No difference was noted between the grade of HS and variables. A positive correlation was found between fibrosis groups and the grade of HS (p = 0.012, r = 0.158) and between HAI groups and the grade of HS (p = 0.029, r = 0.137).The prevalence of steatosis was not higher in patients with CHB. HS is associated with advanced hepatic fibrosis, but not viral liver disease.

Amoxicillin-clavulanic acid (ACA) related hepatotoxicity is among the most common causes of drug-related hepatotoxicity. Cholestatic liver injury is the most common type. Symptoms usually begin 1-4 weeks after ingestion and heal within 8 weeks. Rarely develop fulminant hepatitis and death. In this study, we present a case of a 62-year-old woman who had chronic viral hepatitis B and developed toxic hepatitis after receiving ACA treatment. When ACA was discontinued, the patient’s symptomps improved and her liver enzyme levels reduced to near to the normal range.

Purpose. To study the features of liver fibrosis in children with chronic hepatitis B (CHB) depending on the variant of the gene polymorphism of IL-28B. Materials and methods.The study involved 66 children aged 3–18 years with chronic hepatitis B. All patients were involved in clinical, laboratory and instrumental examination. The stage of fibrosis was assessed morphologicallyon a scale METAVIR, by the calculation method — Fibro Test, on APRI index, and by the concentration of hyaluronic acid (HA), transforming growth factor TGF-β1 in serum usingIFA. The SNP genotypes of rs8099917 and rs12979860 lociin IL-28B were determinedby the method of the polymer chain reaction (PCR). A statistical analysis of the datawas conducted. Results. Most of the patients had genotype CC at rs12979860 locus of the gene IL-28B (31.5%) and the TT genotype at rs8099917 locus (41.6%).It was found that fibrogenesis in the liver of patients with chronic hepatitis B depends on the polymorphism of the gene IL-28B. The worst scenario for the development of liver fibrosis and the formation of HBeAg negative hepatitis B in children is a CT genotype (rs12979860). Variants CC (rs12979860) and TT (rs8099917) have a beneficial effect on fibrogenesis in the liver in this group of patients. Conclusions.The polymorphism variants CC (rs12979860) and TT (rs8099917)of the gene IL-28B are more favorable (lower severity of fibrosis) in the progression of chronic hepatitis B in children. HBeAg negative hepatitis B in children often occurs in patients with a CT polymorphism (rs12979860) and is characterized by a significant fibrotic changes in the liver.

Objectives. Chronic viral hepatitis B and C represent an important health burden all over the world. Reduced bone mineral density is an extrahepatic complication which has been found in patients with chronic liver disease. The aim of our study was to identify bone mineral impairment (osteopenia/osteoporosis) and the risk factors that are correlated with its severity, in patients with chronic viral hepatitis B (CHB) and C (CHC). Material and methods. Anthropometric, biological parameters and bone mineral density (BMD) were measured in 60 patients with CHB (n = 30) and CHC (n = 30). BMD was assessed using Dual Energy X-ray Absorptiometry (DEXA) in the hip and lumbar spine regions, inclusively a whole scan (total body). Results. Sixty patients (mean age 44.93 years, range: 20-70) were enrolled, including 30 CHB patients (mean age 46.43 years, range: 20-70) and 30 CHC patients (mean age 43.43 years, range: 28-64). Forty of patients were men (66.66 %). Active smokers were 16 patients (26.66 %). Meanbody mass index (BMI) was 25.38 kg/m2 (range: 16.70-38.40). At baseline, 21 of 60 (35%) of the patients had evidence of osteopenia and 4 of 60 (6.66%) of patients, respectively presented osteoporosis at LS. At total hip, 22 of 60 of the patients (36.66%) recorded osteopenia; osteoporosis was found at 7 patients (11.66%) at total hip assessment. Low BMD values at different regions correlated significantly with low BMI, smoking and liver fibrosis grade. Conclusions. Our results suggest that bone mineral metabolism disorders exist in patients with chronic viral hepatitis B and C who are active smokers, presenting low BMI and advanced liver fibrosis, even without liver cirrhosis.

AIM To build a regional database of chronic patients to define the clinical epidemiology of hepatitis B virus (HBV)-infected patients in the Tuscan public health care system. METHODS This study used a cross-sectional cohort design. We evaluated chronic viral hepatitis patients with HBV referred to the outpatient services of 16 hospital units. Information in the case report forms included main demographic data, blood chemistry data, viral hepatitis markers, instrumental evaluations, and eligibility for treatment or ongoing therapy and liver transplantation. RESULTS Of 4015 chronic viral hepatitis patients, 1096 (27.3%) were HBV infected. The case report form was correctly completed for only 833 patients (64% males, 36% females; mean age 50.1 ± 15.4). Of these HBV-infected patients, 73% were Caucasian, 21% Asian, 4% Central African, 1% North African and 1% American. Stratifying patients by age and nationality, we found that 21.7% of HBV-infected patients were aged < 34 years (only 2.8% were Italian). The most represented routes of transmission were nosocomial/dental procedures (23%), mother-to-child (17%) and sexual transmission (12%). The most represented HBV genotypes were D (72%) and A (14%). Of the patients, 24.7% of patients were HBeAg positive, and 75.3% were HBeAg negative. Of the HBV patients 7% were anti-HDV positive. In the whole cohort, 26.9% were cirrhotic (35.8% aged < 45 years), and 47% were eligible for or currently undergoing treatment, of whom 41.9 % were cirrhotic. CONCLUSION Only 27.3% of chronic viral hepatitis patients were HBV infected. Our results provide evidence of HBV infection in people aged < 34 years, especially in the foreign population not protected by vaccination. In our cohort of patients, liver cirrhosis was also found in young adults.

В статье приведен клинический пример, который демонстрирует неблагоприятное течение беременности у женщины с острым гепатитом D, развившимся на фоне хронического гепатита В (ХГВ). C учетом эндемичности Якутии по HBV- и НDV-инфекции необходимо обследовать всех беременных с гепатитом В на антитела к вирусу гепатита D. Также следует проявлять у женщин с ХГВ настороженность в родах на угрозу кровотечения и усилить мероприятия по перинатальной профилактике., The article presents a clinical example of unfavorable course of pregnancy in a woman with acute hepatitis D, developed against a background of chronic hepatitis B (CHB). Taking into account the endemicity of Yakutia for HBV and HDV infection, all pregnant women with hepatitis B should be examined for antibodies to the hepatitis D virus. Also, it is necessary to be alert towards women with CHB to the threat of bleeding during childbirth and strengthen measures for perinatal prevention., №4(60) (2018)

Since the introduction of Transient Elastography (TE) into Australia in 2008, non-invasive liver fibrosis assessments have integrated themselves into clinical hepatology. The Australian Liver Association (ALA) recognizes these technologies perform an important role in the assessment of chronic viral hepatitis B and C. However, in the setting of viral hepatitis and many other chronic liver diseases, there remains no consensus or guidelines regarding the performance, utility or reporting of TE. Accordingly, the ALA sought to produce an expert consensus statement for the use of TE in chronic viral hepatitis. The recommendations incorporated in this document are based upon a thorough literature review and draw on extensive clinical experience using TE. The initial draft was presented at Australian Gastroenterology Week (AGW) 2013. Through a collaborative process and expert external review a finalized document was presented at AGW 2014.

Liver fibrosis is a relatively common consequence of chronic liver diseases, especially chronic viral hepatitis B and C. Biopsy still remains the gold standard in the assessment of liver fibrosis. However, due to its invasiveness and possible complications, less or even non-invasive methods are being developed, e.g. using biochemical parameters (Fibrotest) or elastography. Elastography is a new diagnostic tool that aims to evaluate stiffness of the tissues. Elastography techniques that are used in the assessment of liver fibrosis are transient elastography (TE), acoustic radiation force impulse (ARFI) and shear-wave elastography (SWE). SWE is a novel real-time two-dimensional elastography technique, which allows one to estimate stiffness quantitatively in kilopascals (kPa). Moreover, lapping elastography over regular B-mode allows precise choice of the region of interest. Therefore SWE creates the opportunity for accurate assessment of liver fibrosis. In this paper we describe processes leading to liver fibrosis as well as methods of liver fibrosis assessment, e.g. liver biopsy, biochemical tests or elastography. The main goal of this paper is to present the SWE technique, its role in liver fibrosis assessment and a short review of the most important clinical studies on SWE. We also present several examples of SWE examinations performed on patients with different stages of liver fibrosis – F0 to F4 on the METAVIR scale.

Chronic viral hepatitis B (CHB) still represents a significant world health problem despite obligatory and worldwide immunization against infections of viral hepatitis B. In some patients with chronic viral hepatitis B infections, in the natural course of the disease, progression towards cirhossis and hepatocellular carcinoma is primarily targeted by antiviral CHB therapy stopping further progression of the disease. Today on the market there exist two classes of pharmnaceutical drugs for treatment of CHB: a) immunomodulatory therapy with conventional interferon alpha (INF) and PEGylated interferon alpha-2a, b) and oral antiviral therapy with nucleos( t)ide analogues. Lamivudine was for quite a period the only medicament available on our market for the treatment of HVB and in most of our patients led to the development of resistance. As of two years ago, a new oral analogue from the group of nucleotides is being registered in Serbia for market use: tenofovir disoproxil (TDF). In our work we have analysed 69 patients with chronic viral hepatitis B treated in the Clinic for Infectious and Tropical Diseases KCS Belgrade in the period between years 2012 and 2014. All patients involved in this reasearch were previously treated with LAM, and on subsequent development of resistance to LAM, TDF was used. TDF showed an excellent efficacy, a high resistance barrier and very few unwanted side effects over several years of treatment. Our experience with the use of this drug does not pertain to and acount for its long term use, in view of its brief availability on our market.

Aim. To assess the trends for the epidemiological situation of chronic hepatitis B monoinfection and chronic hepatitis B+D co-infection in the Kyrgyz Republic for the period of 2010-2012 for the development of anti-epidemic measures depending on the intensity of the process. Methods. The analysis of a database of national reporting forms on the treated cases of chronic viral hepatitis B monoinfection and chronic hepatitis B+D co-infection in primary health care units, cumulated by Republican Medical Information Center of the Ministry of Healthcare of the Kyrgyz Republic for the period of 2010-2012 was performed. Results. The incidence of chronic viral hepatitis D is identical to that of chronic viral hepatitis B (23 and 21 per 100 000 of population respectively) in the Kyrgyz Republic. Over the period of 2010-2012 the high level of total chronic hepatitis B incidence was reported in the northern part of the country (the Issyk-Kul region, 71 per 100 000, and chronic hepatitis D - in the southern part of the country (Osh, 62 per 100 000 of population). Statistically significant increase in the incidence of chronic hepatitis B in almost all regions of the country was recorded whereas only an upward trend was revealed in chronic hepatitis D incidence. Conclusion. Separate registration of patients with chronic viral hepatitis B and D in the Kyrgyz Republic starting from 2010 allowed evaluating the trends for the epidemiological situation of these diseases in different areas and developing preventive and anti-epidemic measures in regions of Kyrgyz Republic.

The features of the electrical and viscoelastic parameters of red blood cells obtained by dielectrophoresis in patients with chronic hepatitis B in depending on the level of viral load were investigated. It has been found that the summerized rigidity, viscosity, conductivity, index of aggregation and destruction, the relative polarizability significantly increased and polarizability at all frequencies, the velocity of cells to the electrodes, electric capacitance of membranes — decreased as ascending viremia. A marked change in the parameters of red blood cells in patients with high viral load, likely, reflects the expressed degree of disadaptation of erythrocytes. Correlation of electrical and viscoelastic parameters erythrocytes with the biochemical indices reflecting the level of dysproteinemia, cytolysis, immune-inflammatory syndrome have been installed. The data obtained allow us to supplement understanding of the pathogenesis of systemic manifestations of virus hepatitis B and association of high viral load with a significant change in the viscoelastic and electrical properties of red blood cells.

Phenotypic and functional features of IFNα-induced dendritic cells (DCs) were studied in patients with chronic viral hepatitis B and C (HBV and HCV), and in cases with hepatitis-related liver cirrhosis (LC). It was shown that DCs are characterized by delayed differentiation/maturation which was more pronounced in HCV patients, as well as in all patients with LC, regardless of virus type. DCs from HBV patients were characterized by increased IFNγ secretion. Transformation of HBV-infection to LC is accompanied by a moderate decrease in IFNγ production, combined with a significantly increased IL-10 secretion. Irrespectively of fibrosis severity, the IFNα-induced DCs of HCV patients displayed active IL-10 synthesis. Moreover, ability of DCs to secrete IFNγ was significantly decreased only in cases of fibrosis-complicated HCV-infection. With respect to TNFα and IL-4 production levels, DCs of the patients were compatibe to normal donor cells, independently on the type of virus, or fibrosis severity. DCs from HBV- and HCV-patients were characterized by intact allostimulatory and Th1/Th2-stimulatory activities in MLC. At the same time, IFNα-induced DCs exhibited suppression of allostimulatory and increase in Th2-polarizing activity upon LC development, both in HBV and HCV patients.

To evaluate the association between liver stiffness measured by acoustic radiation force impulse (ARFI) elastometry and the outcome of antiviral treatment in patients with chronic viral hepatitis B and C.Thirty-eight patients with chronic viral hepatitis B (n = 16) or hepatitis C (n = 22) underwent liver biopsy and ARFI elastometry of the right hepatic lobe. A follow-up assessment using ARFI was performed a mean of 2.3 years after the baseline evaluation. The patients with favourable outcome were classified in group S and those receiving no treatment, showing no response to treatment, or experiencing a relapse were classified in group N.The 38 patients had an initial mean ARFI value of 1.56 ± 0.62 m/s as compared with 1.54 ± 0.64 m/s in the follow-up evaluation. Group S showed a significant decline in ARFI values (1.55 ± 0.60 m/s versus 1.34 ± 0.47 m/s; p0.05) and included 16 (64%) patients with lower shear wave velocities at follow-up. In group N, liver stiffness values showed a slight but not significant increase (1.57 ± 0.70 m/s versus 1.93 ± 0.77 m/s).Changes in liver stiffness during antiviral therapy can be assessed by ARFI reflecting response or no response. ARFI elastometry is an additional, useful tool for the follow-up assessment of treatment outcome in patients with chronic viral hepatitis B or C infection.

Aim. To estimate the prevalence of non-acloholic fatty liver disease in patients with chronic hepatitis B, and the association of non-acloholic fatty liver disease with the biochemical, virological and metabolic faсtors. Methods. 53 patients with chronic hepatitis B observed in the regional hospital of infective diseases, Stavropol, at 2008-2012, were included. Patients were distributed to 2 groups according to the results of liver biopsies: group I - patients with hepatosteatosis (5%) and group II - no signs of steatosis (≤5%). Anthropometric, histological, biochemical, virological, and metabolic determinants were compared. Results. Of 53 patients, 18 (34%) liver biopsies had signs of steatosis. Patients with steatosis (group I), compared with group II, were older (43±13 vs 34.5±10.9 years, р=0.015), had higher body mass index (30±5.3 vs 22.9±4.3 kg/m 2, р=0.015), higher level of triglycerides (1.6±0.8 vs 1.06±0.7 mmol/l, р=0.014), higher level of cholesterol (5.6±0.7 vs 4.97±0.9 mmol/l, р=0.012), and higher serum insulin (13±7.9 vs 8.2±3 mkME/l, р=0.002) and leptin levels (16.2±15.6 vs 6.5±5.2 ng/ml, р=0.001). The values of HOMA (Homeostasis Model Assessment) and QUICKI (quantitative insulin sensitivity check index) indices corresponded to insulin resistance (НОМА 2.9±1.8 and 1.9±0.8, р=0.007; QUICKI 0.33±0.02 and 0.35±0.03, р=0.014). There were no differences in histological activity scores by Knodell and fibrosis scores by METAVIR scale between the groups. No reliable differences in virological parameters (viral load and HBeAg status) were obtained. Conclusion. Non-alcoholic fatty liver disease is observed in one-third of patients with hepatitis B and is associated with host metabolic factors, which correspond to the parameters of metabolic syndrome.