Search Results (104)

Background: Despite the widespread implementation of childhood vaccination programmes, hepatitis B virus (HBV) infection remains an ongoing occupational risk for healthcare students. In multi-ethnic and international university settings, differences in vaccination programmes and immune responses must be considered. This retrospective study aimed to assess the prevalence of protective levels of anti-HBs among medical students at an international university in Rome, exploring associations with demographic and vaccination-related factors. Methods: Data were collected from routine occupational health surveillance conducted in 2023. Anti-HB titres were measured in 507 students, and information on age, sex, country of birth, age at vaccination, and time since the last dose was analysed. Results: Overall, 55.0% of students had antibody levels of at least 10 mIU/mL, indicating serological protection. Higher seroprotection rates were observed among students vaccinated in the first year of life compared to those vaccinated later. A significant decline in antibody titres was also associated with longer intervals since vaccination. Students born outside Europe tended to show lower levels of protection. Conclusions: These results emphasise the importance of screening future healthcare professionals and continuously monitoring antibody titres to help reduce HBV infections. Full article

Background/Objectives: Sustained drug exposure is a key factor in the treatment of patients infected with human immunodeficiency virus (HIV) or hepatitis B virus (HBV) in order to achieve the intended virological response. Although influenced also by other parameters, adherence to the treatment scheme is the most important for adequate drug exposure. This can be assessed by therapeutic drug monitoring (TDM). Tenofovir (TFV) is a nucleotide analogue used in the treatment of both HIV and HBV. Although various analytical methods for the quantification of tenofovir prodrugs have been published, there is limited literature on methods for simultaneous TFV and its active metabolite, tenofovir diphosphate (TFVDP) direct determination. Methods: In this study, we describe a novel micro-liquid-chromatography-mass spectrometry (micro-LC-MS/MS) method for TDM of TFV and TFVDP in biological matrices (whole blood, plasma). The challenging separation of the high-polarity analytes was resolved on an amino stationary phase, eluted in HILIC (hydrophilic interaction liquid chromatography) mode. The sample preparation included a clean-up step with hexane for the removal of lipophilic compounds and then protein precipitation with organic solvent. Results: The achieved low limits of quantification in blood were 0.25 ng/mL for TFV, and 0.5 ng/mL for TFVDP. Linearity, accuracy (91.63–109.18%), precision (2.48–14.08), and stability were validated for whole blood matrix, meeting the guidelines performance criteria. Samples collected from treated patients were analyzed, with results being in accordance with the reported pharmacokinetics. Conclusions: The new method is adequate for analyzing samples in a clinical set-up. The measurement of both TFV and TFVDP improves clinical decision by an in-depth evaluation of long-term adherence, and together with viral load and resistance data helps guiding the treatment towards the intended virological suppression. Full article

Background: Hepatitis B virus (HBV) infection remains a significant occupational health concern for healthcare workers (HCWs), including trainees exposed to biological risks. Although vaccination is the most effective preventive measure, the persistence of immunity over time and the need for booster doses remain subjects of debate. Objective: The present study aims to assess the prevalence of protective anti-HB antibody titers among healthcare trainees at the “SS Annunziata” Hospital in Chieti, comparing those vaccinated in infancy with those vaccinated during adolescence. Methods: A retrospective observational study was conducted on 2028 healthcare trainees from 2021 to 2024. Participants were divided into two groups based on vaccination timing: infancy (PED group) and adolescence (ADO group). Serological tests were performed to measure anti-HB titers, with a protective threshold set at ≥10 IU/L. Statistical analyses were conducted to evaluate differences in immunity persistence between the two groups. The results showed that the overall prevalence of protective anti-HB titers was 50.7%, with significant differences between the PED and ADO groups. Protective immunity was observed in 79.2% of individuals vaccinated during adolescence, compared to 44.6% of those vaccinated in infancy (p < 0.001). No significant differences in antibody persistence were found between males and females. Notably, 92.4% of participants with non-protective titers received a booster dose within two months of testing. Conclusions: The study confirms a significant decline in anti-HB titers over time among individuals vaccinated in infancy, suggesting a potential need for booster doses later in adulthood. The high adherence to vaccination recommendations among healthcare trainees is a promising finding, reinforcing the importance of continuous education and immunization programmes in healthcare settings. Further research, including longitudinal studies and additional HBV biomarkers, is necessary to optimize vaccination strategies and long-term immunity monitoring in HCWs. Full article

Background: Hepatitis B (HBV) and C (HCV) virus coinfections remain major contributors to liver-related morbidity and mortality among people living with HIV (PLWH). This study aimed to assess the prevalence of HBV and/or HCV coinfections in a Romanian HIV cohort and to evaluate their impact on immunological, virological, and liver function parameters under antiretroviral therapy (ART). Methods: We retrospectively analyzed 462 HIV-infected patients (2018–2021) from the National Institute of Infectious Diseases, Bucharest, stratified into four groups: HIV mono-infection (n = 176), HIV/HBV (n = 114), HIV/HCV (n = 97), and HIV/HBV/HCV (n = 75) coinfections. Immunological (CD4 count, CD8 count, and CD4/CD8 ratio), virological (HIV-1 RNA), and hepatic parameters (ALT, AST, GGT, bilirubin, amylase, and lipase) were compared. Results: No significant differences were observed between groups regarding the immune recovery (mean CD4 count p = 0.89, HIV-RNA suppression p = 0.78). However, liver and pancreatic parameters showed statistically significant deterioration in the coinfected groups. ALT (p < 0.001), GGT (p = 0.009), total bilirubin (p = 0.011), amylase (p = 0.010), and lipase (p < 0.001) were significantly higher in the triple-infection (HIV/HBV/HCV) group compared to HIV mono-infected patients. Coinfection was also associated with a longer duration of illness (p = 0.002) and therapy (p = 0.021) and with a higher number of ART regimens used (p = 0.013). Conclusions: While HIV suppression and immune recovery were not significantly impaired by HBV/HCV coinfections, liver and pancreatic injuries were significantly more prevalent and severe in coinfected patients. Regular monitoring of hepatic function and integrated management strategies are recommended to minimize liver-related complications in this population. Full article

Chronic viral hepatitis B and C remain major global health challenges, contributing significantly to liver-related morbidity and mortality. Despite antiviral therapies and vaccines for HBV, progression to cirrhosis and hepatocellular carcinoma remains common. For HCV, the lack of a vaccine and high chronicity rates further complicate outcomes. Recent evidence highlights gut–liver axis dysfunction and microbiota dysbiosis in disease progression, immune dysregulation, and fibrosis. Notably, alterations in microbiota composition, including reduced commensal bacteria such as Bifidobacteria and Lactobacilli and an increase in putatively harmful Enterobacteriaceae and Veillonellaceae, have been observed in HBV/HCV infections and cirrhosis. While antiviral therapies do not directly target the gut microbiota, they can contribute to partial restoration of microbial balance by reducing hepatic inflammation and improving gut–liver axis integrity. Nonetheless, post-treatment patients remain at elevated risk of HCC due to persistent epigenetic and immune-mediated changes. Emerging interventions, including probiotic strains, prebiotics, and symbiotics, demonstrate potential in enhancing gut health, alleviating inflammation, and enhancing the quality of life for liver disease patients. Moreover, the gut microbiota is gaining increasing recognition as a potential non-invasive biomarker for early disease detection and monitoring. Ultimately, modulating the gut microbiota could become an integral component of future strategies for managing chronic liver diseases and preventing their complications. Full article

This study aimed to assess the prevalence of HDV (hepatitis delta virus), HCV (hepatitis C virus), and HIV (human immunodeficiency virus) coinfections among HBsAg-positive patients and to determine the severity of liver fibrosis and biochemical markers. Furthermore, the study sought to evaluate the noninvasive fibrosis scores (APRI and FIB4) in predicting the severity of liver disease in patients with hepatitis B. A retrospective analysis of 1434 patients with chronic HBV admitted between January 2020 and December 2024 was conducted at Sincan Tertiary Hospital. The positivity rates of the following antibodies were the focus of the study: anti-HDV, anti-HCV, and anti-HIV. In addition to these, the levels of HIV-RNA, HCV-RNA and HBV-DNA, as well as several biochemical markers (ALT, AST, INR, albumin, bilirubin and platelet count) were also evaluated. The APRI and FIB-4 scores were calculated. Of the 1434 patients, 49 (3.4%) tested positive for anti-HDV, 784 were screened for anti-HCV, and 749 were screened for anti-HIV. The positivity rates were 3.4% (27/784) and 3.4% (26/749), respectively. According to ROC analysis, the FIB-4 score had a statistically significant effect on predicting anti-HDV negativity (AUC = 0.59, p = 0.031). However, the APRI score was not a significant predictor for anti-HDV positivity (AUC = 0.53, p > 0.05). APRI and FIB-4 scores did not have a statistically significant discriminatory power in predicting anti-HCV and anti-HIV positivity (p > 0.05). The cut-off value for the FIB-4 score in predicting anti-HDV positivity was 1.72, with a sensitivity of 61.4% and a specificity of 42.9% (p = 0.031). Among the HCV/RNA-positive patients (n = 5), all were male, and two also had positive anti-HBe results with undetectable HBV/DNA levels. One HIV/RNA-positive patient, a foreign national, was confirmed to have HIV/HBV/HDV infection. All HBsAg-positive patients should undergo routine anti-HDV testing. Vaccination programmes are vital in preventing the spread of HDV. Dual screening strategies are essential for identifying infected individuals and developing prevention and treatment programmes. Anti-HDV positivity indicates advanced liver fibrosis, emphasising the importance of screening and monitoring. However, the limited accuracy of the APRI and FIB-4 scores for detecting coinfections highlights the need to integrate noninvasive methods with molecular diagnostics for precise management. Full article

Reliable rainfall data are critical for managing hydrometeorological hazards in West Africa, yet they are often sparse and temporally inconsistent. The current study assessed the accuracy of four near real-time satellite-based rainfall data, namely IMERGv7 Late, IMERGv6 Early, GSMAP-NRT and PERSIANN-DIR Now, for rainfall estimation and hydrological modeling in the Ouémé basin. These datasets were compared with ground-based rainfall data, bias-corrected and used to calibrate and validate the hydrological model HBV light. While they demonstrated qualitative accuracy, their quantitative estimation shows obvious discrepancies on a daily scale, varying across subdomains. The original IMERGv7 product outperforms others in capturing the rainfall pattern and amount (KGE > 0.6), while GSMAP performs moderately (KGE ≈ 0.51) and IMERGv6 and PERSIANN show lower reliability with KGE < 0.5. Quantile mapping emerges as the most effective bias-correction method, improving the performance of all satellite products, with RMSE reductions ≤ 15%. The results of hydrological simulations demonstrate the potential of satellite-based rainfall, particularly IMERGv7 and corrected IMERGv6 (NSE > 0.75), for near real-time flood monitoring and water management in the study area. This study underscores their suitability as valuable alternatives to ground-based data for flood management decision making in the Ouémé basin. Full article

Occult hepatitis B infection (OBI) is a serious public health issue. Although a number of effective hepatitis B vaccines are available, hepatitis B still poses a threat to global public health. Patients with OBI are usually asymptomatic, but there may be active HBV DNA present in their blood, leading to the risk of virus transmission during blood transfusions or organ transplantation, constituting a hazard to the health of recipients and increasing the risk of liver cirrhosis and liver cancer. Although China has progressed in the development of blood-screening technology, OBI is still a significant hidden danger to blood transfusion safety. Therefore, in blood screening and blood transfusion, strengthening the monitoring and management of OBI is crucial to ensure blood safety and protect public health. Full article

People with HIV (PWH) receiving antiretroviral therapy (ART), despite a similar life expectancy, have a higher incidence of comorbidities than the general population. This study assessed the influence of proinflammatory biomarkers and clinical factors on mortality of PWH. We included PWH hospitalized from 2009 to 2014 who continued ART until 2023. The baseline lipid profile, CD4+ cell count, platelets, CRP, PCT, TNF-α, VCAM-1, and HCV and HBV coinfection were evaluated. Multivariable logistic regression was used to evaluate factors associated with mortality. Among 72 PWH, 19 were lost to a follow-up and 13 died before 2023. The mean follow-up was 12.07 years, while the mean time to death was 4.32 years. The main causes of death were cancer (n = 7) and drug-related death (n = 4). In the multivariate analysis, HCV coinfection, CRP ≥ 5 mg/L, PCT ≥ 0.05 ng/mL, and VCAM-1 ≥ 922 ng/mL were associated with higher odds of death. Although people who died had lower total cholesterol and triglyceride concentrations, these parameters were not associated with mortality. Determining HCV coinfections and CRP, PCT, and VCAM-1 levels may help identify PWH at increased risk of death for intensified monitoring. Care should also be taken of PWH with normal lipid parameters. Full article

Achieving HBsAg seroclearance is a key goal in treating chronic hepatitis B virus (HBV) infection but remains difficult with nucleos(t)ide analogues (NAs). Tenofovir alafenamide fumarate (TAF), a recommended NA for managing chronic HBV infection (CHB), has uncertain effects on HBsAg levels and potential adverse events when used long-term after switching from entecavir (ETV). We retrospectively evaluated 77 CHB patients, including 47 who switched from ETV to TAF with a median follow-up of 40 months post-switch and a median of 60 months of HBsAg monitoring pre-switch. No significant change in HBsAg levels was observed in the overall cohort post-switch, consistent with the ETV continuation group. However, a significant decrease in HBsAg was noted in patients with HBsAg < 100 IU/mL at the time of switching. HBsAg loss occurred in three patients who switched to TAF. No adverse effects were observed, and TAF was well tolerated. The most significant factor associated with achieving HBsAg < 100 IU/mL was the Fib-4 index, a marker of liver fibrosis, at the time of switching. Switching from ETV to TAF is an effective strategy in CHB management, with hepatic inflammation potentially playing an essential role in achieving HBsAg decrease. Patients with increased Fib-4 index were significantly more likely to show decreased HBsAg. This finding suggests patients with mild to moderate fibrosis may respond better to TAF in terms of HBsAg reduction. Full article

Objective: This study aimed to investigate hepatitis B knowledge and hepatitis B virus (HBV)-related surveillance status among HBsAg-positive patients, as well as to further explore the relevant influencing factors. Methods: A cross-sectional study was conducted on the HBsAg-positive patients from 8 October 2023 to 10 November 2023 in Qidong City. A self-report questionnaire was developed based on a literature review of similar studies. Univariate analysis of variance, multivariate logistic regression, and t-test analysis were conducted to analyze the collected data. Results: Of the 982 respondents who completed the on-site questionnaire, all participants were HBsAg-positive patients. Moreover, 51.32% had “good” knowledge of HBV. Multivariate logistic regression analysis showed that participants with a doctor in the family, those with an average monthly income above CNY 3000, and those with an average monthly income of CNY 1500–3000 were more likely to obtain a “good” cognitive evaluation (p < 0.001). The scores of the populations using HBV-related surveillance methods were low (2.02 ± 0.87); 64.87% (637/982) of the populations monitored had a score of no more than 2. Conclusions: This study suggests that the awareness of HBV prevention and treatment among participants, especially those of low-income classes and individuals lacking physician clinical management, should be promoted to increase the dissemination of HBV knowledge. Full article

Background: Everolimus is approved for treating breast, renal, and pancreatic neuroendocrine cancers but carries the risk of hepatitis B virus (HBV) reactivation (HBVr) and hepatitis. However, data on HBVr in everolimus-treated patients are limited. This study evaluates the risk of hepatitis and HBVr in cancer patients with current or past HBV infection. Methods: This retrospective study analyzed patients prescribed everolimus between 1 January 2011 and 31 May 2022, using a private healthcare system database in Taiwan. Patients with HBsAg positivity or HBsAg negativity and anti-HBs or anti-HBc results were included. The cumulative incidence function and risk of hepatitis from a competing risk model, which estimates Fine-Gray subdistribution hazard (SDH), were analyzed across different HBV serological subgroups. The risk of hepatitis B reactivation was also calculated. Results: Of 377 patients, 45% (36/80) of HBsAg-positive and 0.67% (2/297) of HBsAg-negative patients received nucleos(t)ide analogues (NUCs) prophylaxis. Hepatitis occurred in 28.75% of HBsAg-positive and 17.85% of HBsAg-negative patients. Baseline HBsAg positivity and exemestane use increased hepatitis risk. HBVr occurred in 11.36% (5/44) of HBsAg-positive patients without NUCs and 5.56% (2/36) with prophylaxis. Two HBsAg-negative, anti-HBc-positive patients developed severe HBVr-related hepatitis. Conclusion: Hepatitis occurred in 28.75% of HBsAg-positive and 17.85% of HBsAg-negative patients on everolimus. HBVr was common in HBsAg-positive patients but rare in HBsAg-negative individuals. HBV screening and liver function monitoring are critical for patients with past or current HBV infection receiving everolimus, especially in endemic areas. Full article

Immune checkpoint inhibitors (ICIs) significantly improve survival, while immune-mediated hepatotoxicity (IMH) has been reported. To evaluate the incidence and potential risk factors of IMH among cancer patients treated by ICIs, PubMed/Medline, Web of Science, Cochrane, and Embase were searched before 30 March 2024 for systematic review and meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Quality assessment was completed using the Newcastle–Ottawa scale. Of 1217 articles identified, 24 consisting of 9076 patients were included, with one study being prospective and the rest retrospective. The overall incidence of any grade IMH and grade ≥ 3 secondary to ICIs was 14% and 7%, respectively. The cholestatic pattern was more prevalent than the hepatocellular and mixed patterns. The meta-analysis revealed that ICI treatment was related to reduced risk of IMH in older patients (SMD: −0.18; 95% CI: −0.33 to −0.04), individuals with higher body mass index (WMD: −2.15; 95% CI: −3.92 to −0.38), males (OR: 0.44; 95% CI: 0.27 to 0.72), and patients with lung cancer (OR: 0.58, 95%CI 0.41 to 0.83). On the other hand, patients with liver metastasis (OR: 1.80; 95% CI: 1.47 to 2.20), history of ICI treatment (OR: 3.09; 95% CI: 1.21 to 7.89), diabetes (OR: 2.19; 95% CI: 1.36 to 3.51), chronic HBV (OR: 3.06; 95% CI: 1.11 to 8.46), and concomitant use of ICIs (OR: 8.73; 95% CI: 2.41 to 31.59) increased the risk of developing IMH. This study will provide clinicians with information on potentially high-risk groups for IMH, who need to be cautiously monitored for liver function when receiving immunotherapy. Full article

The GeneXpert HBV Viral Load test is a simplified tool to scale up screening and HBV monitoring in resource-limited settings, where HBV is endemic and where molecular techniques to quantify HBV DNA are expensive and scarce. However, the accuracy of field diagnostics compared to gold standard assays in HBV-endemic African countries has not been well understood. We aim to validate the diagnostic performance of the GeneXpert HBV Viral Load test in freshly collected and stored plasma and dried blood spot (DBS) samples to assess turn-around-time (TAT) for sample processing and treatment initiation, to map GeneXpert machines and to determine limitations to its use in The Gambia. Freshly collected paired plasma and DBS samples (n = 56) were analyzed by the GeneXpert test. Similarly, stored plasma and DBS samples (n = 306, n = 91) were analyzed using the GeneXpert HBV test, in-house qPCR and COBAS TaqMan Roche. The correlation between freshly collected plasma and DBS is r = 0.88 with a mean bias of −1.4. The GeneXpert HBV test had the highest quantifiable HBV DNA viremia of 81.4% (n = 249/306), and the lowest was detected by in-house qPCR at 37.9% (n = 116/306) for stored plasma samples. Bland–Altman plots show strong correlation between GeneXpert and COBAS TaqMan and between GeneXpert and in-house qPCR with a mean bias of +0.316 and −1.173 log₁₀ IU/mL, respectively. However, paired stored plasma and DBS samples had a lower mean bias of 1.831 log₁₀ IU/mL, which is almost significant (95% limits of agreement: 0.66–3.001). Patients (n = 3) were enrolled in the study within a TAT of 6 days. The GeneXpert HBV test displayed excellent diagnostic accuracy by detecting HBV viremia in less than 10 IU/mL. Full article

Background: Pediatric hepatitis B virus (HBV) serostatus remains variably characterized, hardly determined at times, or documented as part of national monitoring of the Extended Programs for Immunization (EPI). Methods: We cross-sectionally characterized the seroprevalence of HBV vaccine and/or infection status among 501 and 288 children <5 and 15–17 years old, respectively, in Kawempe Division, Kampala, Uganda, between May and August 2023. These children received HBV vaccination under the Uganda National Extended Program on Immunizations (UNEPI). Samples were qualitatively screened for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb or anti-HBs), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb or anti-HBe), and for hepatitis B core antibody (HBcAb or anti-HBc) using three different HBV Combo test rapid immunochromatographic diagnostic tests: Nova, Fastep, and Beright. Results: The seroprevalence of HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc was 1.52%, 27.75%, 0.88%, 0.63%, and 0.76%, respectively, for the combined study age groups. The HBsAg seroprevalence of 2.78% was almost 3.5-fold higher among adolescents when compared to the 0.8% observed in the under-5-year-olds. The qualitative seroprevalence of anti-HBs was 33.1% and 18.4% in the under-5 and among the 15–17-year-old study groups, respectively. Conclusions: The proportion of qualitatively detectable anti-HBs in both groups of vaccinated children is low and probably indicates reduced seroprotection. Consequently, a large proportion of children who received the hepatitis B vaccine under UNEPI may be at risk of HBV infection, especially adolescents. A booster dose of the Hepatitis B Vaccine may be required for adolescents. Full article