Background: Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) co-infection in South Africa is estimated between 5-17%; however research determining this prevalence is lacking. With co-infection there is increased risk of liver cirrhosis, end stage liver disease, death as well as higher rates of chronic Hepatitis B infection. Chronic HBV develops in 20% of HIV positive individuals when compared to less than 5% in HIV negative individuals. This also further complicates Highly Active AntiRetroviral Treatment (HAART). Methods: A retrospective observational quantitative, cross-sectional, analytical study was done at the TC Newman Antiretroviral (ARV) centre in Paarl. All adult HIV positive patients that were started on antiretroviral therapy for the time period the new protocol was implemented were analyzed according to their Hepatitis B Antigen (HBsAg) result as well as for any association with gender, CD4 and age. The new protocol stated that all patients who were to start ARV’s had to be tested for Hepatitis B by testing their HBsAg. Results: A total of 498 participants were identified of which 40% were male and 60% were female. The HBsAg positivity rate was established at 7.6%. A higher prevalence was found among men as well as in the age group 50-59 years and those with a CD4 of 50/μL and less. Conclusions: With a prevalence of almost 8% there should definitely be a recommendation towards routine testing of HIV positive patients for Hepatitis B. If not before commencing ART then at least when switching from a regimen containing Lamivudine (3TC) or Tenofovir (TDF) to a regimen not containing these drugs in order to prevent acute flare ups of hepatitis.

Made available in DSpace on 2014-06-11T19:24:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2004Bitstream added on 2014-06-13T20:12:22Z : No. of bitstreams: 1 osti_c_me_botfm.pdf: 1023236 bytes, checksum: d3e13040396339c91197610a262b7a79 (MD5) / Universidade Estadual Paulista (UNESP) / A hepatite viral do tipo B constitui um dos mais importantes problemas de saúde pública em todos os continentes. Estima-se que 300 milhões de indivíduos, em todo o mundo, sejam portadores crônicos do vírus e que 2 milhões morram anualmente dessa doença. O VHB se transmite por via parenteral e sobretudo por via sexual. O risco de infecção, que é de 5% na população geral, e pode ser de 15% a 20% em trabalhadores da área da saúde. Entre esses últimos, os que mantêm contato freqüente com sangue de pacientes apresentam risco duas a quatro vezes maior de adquirir o VHB. Sendo assim, atualmente, a hepatite B é considerada uma das mais prevalentes infecções ocupacionais contraídas no ambiente hospitalar. A medida mais eficaz no combate à infecção é a imunização ativa dos indivíduos suscetíveis, por meio de vacinas atualmente disponíveis, altamente eficientes e seguras. A soroconversão ocorre em proporção inversa à idade do imunizado, podendo a chegar a 90% nos adultos jovens. Os objetivos deste estudo foram: 1. avaliar a presença de infecção natural pelo VHB, anterior à vacinação, medida pelo anticorpo contra o AgHBc (anti-HBc) e sua relação com as condições epidemiológicas gerais, de vida pessoal e profissional e de risco de infecção pelo VHB; 2. os níveis de anticorpo contra o AgHBs (anti-HBs) e sua relação com as condições epidemiológicas gerais, de vida pessoal e profissional e de exposição ao risco de infecção pelo VHB. Foram estudados 113 funcionários, sendo 98 do sexo feminino entre 21 e 60... . / Hepatitis B Virus (HBV) infection is a major worldwide health problem. It is estimated that 300 million people are chronic carriers with 2 million deaths annually. HBV is transmitted by both parental and sexual routes. Infection risk, which is 5% in the general population, can be 15 – 20% in healthcare workers as they are in frequent contact with patient blood. Today Hepatitis B is considered one of the major occupational infections in hospitals. The most effective measure against infection is active immunization of susceptible individuals with available vaccines that are highly efficient and safe. Seroconversion occurs at an inverse proportion to immunized persons age, reaching up to 90% in young adults. The objectives of this study were to evaluate: 1. Natural HBV infection prior to vaccination determined by anti-HBc antibodies and its relation to general epidemiological conditions of personal and professional life and the risk of HBV infection; and 2. anti-HBs antibody levels and its relation to general epidemiological conditions of personal and professional life and exposure to risk of HBV infection. We studied 113 healthcare workers; 98 females between 21 and 60 years old, and 15 males between 21 and 53 years old... (Complete abstract, click electronic address below).

Class of 2016 Abstract / Objectives: To compare the SVR12 rates of newer hepatitis C therapies, approved between November 2013 and December 2014, in patients at Avella Specialty Pharmacy to SVR12 rates from published literature. Insurance coverage rates will be compared to determine a difference among insurances. Methods: Data were collected electronically from patient charts utilizing the existing computer system and manually through chart review. A complete data collection form in excel compiled the collected data and included the SVR12 rates by therapy, and sub-analysis data such as demographic and descriptive variables. Therapies included Harvoni, Olysio + Sovaldi ± Ribavirin (RBV), Viekira Pak ± RBV, or Sovaldi + RBV. Demographic and descriptive variables included gender, medical insurance, hepatitis C genotype, fibrosis score, treatment-experienced, treatment-naïve, and adverse effects. Insurance coverage rates were also collected through a separate electronic report. Results: A total of 578 patients were included in the analysis of SVR12 (mean age = 59, 60% male). There were 50% of patients with genotype 1a, 18% had cirrhosis, and 60% were treatment-naïve. The overall SVR12 rate achieved by patients at Avella was not significantly different from published clinical trials (91% vs 91%, p = 0.75). Data for coverage rates included a total of 6,284 patients and revealed that Medicare had the highest coverage rate (85%) while Medicaid had the lowest (30%). Conclusions: Newer hepatitis C therapies used in a real world setting had similar SVR12 rates to published literature. Medicaid had a lower coverage rate compared to Medicare and commercial insurances while Medicare had the highest coverage rate.

M.Tech. (Homoeopathy) / According to the World Health Organisation (2008), an estimated two billion individuals globally, are infected with Hepatitis B (HBV). South Africa reported 864 notified new cases between 2001 and 2004 (Department Of Health, 2005), with an estimated 3-4 million chronic HBV infected black South Africans (Kew, 2008). Kwa-Zulu Natal and Free State were the most affected provinces; while 20-39 years was the most affected age group as of 2005 (Department Of Health, 2005). Workers in the health industry, intravenous drug users and children of women who have Hepatitis B are at the most risk for contracting this disease from blood products and body fluids (Immunization Action Coalition, 2007; Boon et al., 2006), where contraction of the disease can lead to liver cirrhosis, fibrosis and hepato-cellular carcinoma (Highleyman, 2008). The Expanded Program on Immunization (EPI) of the South African Department of Health (2009) suggests vaccination for Hepatitis B should be administered at six, ten and fourteen weeks, or a dose every month for 3 months. Adverse reactions associated with the vaccine include “Guillain-Barre Syndrome, arthritis, demyelinating nervous system disease” (Pratt, 2008) and anaphylaxis (Danis & Halm, 1997). Alternatives that may assist in avoiding such symptoms include: waiting until adolescence to vaccinate (Slonim et al., 2005); only vaccinating high risk groups (Francois et al., 2002); or researching an alternative (Romm, 2001). Homeoprophylaxis is the use of homeopathy to prevent the contraction or development of disease (Zoltan, 2000) and its successful use has been recorded in various disease types and locations. There have been very few studies to show the effect of individual homeopathic nosodes used as prophylactic treatment in their related diseases, with almost none of these utilising any means of serological testing (Bevan-Jones, 2009; Frost et al., 2003; Sheffield, 2006). The aim of this study was to determine the production of the antibody to the surface antigen of Hepatitis B (anti-Hbs) due to Hepatitis B 12cH nosode administration.   Forty-three participants ranging, in ages 18 to 65 years, who tested negative for the presence of anti-HBs, took part in this four week long, double-blind, placebo controlled study. Participants were randomly placed into either the Verum or Placebo group, each group receiving four lactose powders to be taken weekly for four weeks. The Active group received lactose powders medicated with Hepatitis B 12cH, whereas the Placebo group received lactose powders medicated with 96% alcohol. Participants underwent a repeat of the serum/plasma antibody testing at the conclusion of the study to determine if there were anti-HBs present in their blood. The results were then statistically analysed using nonparametric testing: Chi-squared independent test, Mann-Whitney test and Sign test. These showed that there was no change measurable effect on the surface antigen of hepatitis B (anti-HBs) of either the Verum (active medication) or Placebo group. Primary preventative medicine is becoming increasingly popular (Kuehlein et al., 2010). Both vaccination and homeoprophylaxis are examples of primary preventative medicine, where the aim is to prevent future disease. Vaccinations encourage the production of antibodies via the activation of T-helper cells and B-lymphocytes, thus providing a template for immunity against future infections (Miller, 2000; Janeway et al., 2001). While the mechanisms of vaccination are well understood, those of homeoprophylaxis are still being investigated. One theory is that nosodes enable the body to overcome diseases. Several studies have been conducted on the effects of nosodes (Bracho et al., Prophylactic vaccination against human papilloma virus infection and disease in women: a systemic review of randomized control trial.; Gosavi et al., 2012; Shuller, 2010) and have shown favourable results in the prevention of diseases associated with those homeopathic nosodes. However, only two studies have investigated the effects that nosodes have on the antibodies of the immune system (Hoover, 2006; Neustaedter, 2002) showing the need for further studies conducted in this area. The study showed that homeopathically prepared Hepatitis B 12cH nosode is not capable of eliciting an immune response that would result in the production of the antibody to the surface antigen of Hepatitis B, and thus not able to provide immunity against Hepatitis B.

Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and hepatocellular carcinoma. The degree of fibrosis progression and treatment-related outcomes are critically dependent on the age of the infected individual. Progressive ageing is associated with a decline in the efficacy of adaptive immune system function. T-lymphocytes from aged subjects demonstrate multiple phenotypic and functional changes, including telomere shortening. Short telomeres are associated with poor proliferative capacity, pro-inflammatory responses and increased mortality in clinical studies. This research aimed to study telomere length changes in T-lymphocytes in chronic HCV infection and its relationship to clinical endpoints. Further, the intracellular signalling changes in T-lymphocytes with short telomeres were studied in subjects with chronic HCV. Short CD4+ T-lymphocyte telomeres were associated with the presence of severe hepatic fibrosis independent of other known factors. Telomere length was associated with blood markers of hepatic damage and dysfunction as well as histological markers of inflammation and fibrosis. Further, on prospective follow-up, short CD4+ telomere length at enrolment predicted progression to clinical endpoints of hepatic decompensation, development of hepatocellular carcinoma and death. Short CD4+ telomere length predicted a failure to respond to anti-viral treatment for HCV infection. Unexpectedly, subjects with non-viraemic HCV had short CD8+ telomere length. Liver biopsy tissue from a cohort of subjects with non-viraemic HCV was studied and demonstrated significant inflammation or fibrosis in most. To study the IFN-α signalling pathway in cells with short telomeres, I utilised the phospho-histone γ-H2AX, a downstream signal from short telomeres. CD8+ T-lymphocytes expressing γ-H2AX had the form and function of cells with end-stage differentiation. γ-H2AX+ cells had a pro-inflammatory cytokine secretion profile with high expression of IFN-γ and low IL-2. Further γ-H2AX+ cells were unable to respond to exogenous IFN-α by phosphorylating Stat1. This failure was attributable to a post-receptor defect. T-lymphocyte telomere length changes in HCV may underpin the effect of age on clinical and treatment-related outcome. Short telomeres are associated with intracellular signalling defects which may explain the failure to respond to anti-viral therapy.

The hepatitis G virus and GBV-C are recently discovered variants of the same virus belonging to the family Flavivirus (HGV/GBV-C). Although initially thought to be a hepatitis virus, it has been shown to have no association with liver disease. No work has been performed on the prevalence or molecular characteristics of HGV/GBV-C in southern Africa. In addition, although it is clear that the liver is not the primary site of replication, there is no data on the sites of HGV/GBV-C replication in normal subjects. Thus, this study aimed to assess the prevalence of HGV/GBV-C carriage in the urban and rural adult Black communities of the Western and Eastern Cape Provinces of South Africa, and compare it to the prevalence of serological markers of the hepatitis viruses A-E. In addition, this study aimed to assess the molecular features of South African HGV/GBV-C isolates and demonstrate the organs where viral replication was present. The mean prevalences of antibodies to hepatitis A lgG, hepatitis B surface antigen and antibodies to hepatitis B surface antigen were 98%, 4.3% and 61.1 % respectively. The mean prevalence of antibodies to hepatitis C was 1.8%. No significant differences in prevalence were shown between the urban and rural regions for these viruses. The mean anti-hepatitis E prevalence varied from 5.8% to 19.1 % in the different regions. Those living in mud houses without access to chlorinated tap water had a significantly higher prevalence of antihepatitis E. No anti-hepatitis D positive samples were isolated. The overall prevalence of HGV/GBV-C was 26.9%, with rural communities having a significantly lower prevalence than urban communities. A significant relationship was observed between HGV/GBV-C infection with the use of illicit drugs, female gender, younger age and past blood transfusions. Phylogenetic analysis demonstrated a novel fourth South African HGV/GBV-C genotype, distinct from the previously described genotypes 1-3. In addition, certain isolates showed a major deletion in the highly conserved 5' non-coding region of HGV/GBV-C. Analysis of 23 tissue biopsies from infected cadavers suggested that the spleen and bone marrow were the primary sites of HGV/GBVC replication.

Hepatitis B virus (HBV) infection is an important global health concern and chronic carriers of the virus are at high risk of developing hepatocellular carcinoma (HCC) and cirrhosis. Current therapies are only partially effective, which emphasises the need for improved treatment strategies. Harnessing the RNA interference (RNAi) pathway as a treatment strategy against HBV has shown great promise. However, there are obstacles that need to be overcome before RNAi-based treatment of HBV infection is realised. These include problems of liver tissue targeting and dose regulation. This study investigated the use of a liver specific and mifepristone-inducible RNA polymerase (Pol) II promoter system for the specific and precise regulation of anti-HBV sequence expression. The inducible system used consists of two expression cassettes; one containing the regulator/transactivator protein and another containing the transgene. Natural primary microRNA (pri-miR) mimics, pri-miR-31/5 and pri-miR-31/5/8/9, were used as anti-HBV sequences. Firefly luciferase gene expression was used to test modulation by the inducible system and to determine optimal induction conditions. The pri-miR-31/5, pri-miR-31/5/8/9 and luciferase encoding fragments were incorporated into the plasmid vector pRS17 that bears the inducible promoter, creating pRS-31/5, pRS-31/5/8/9 and pRS-Luc respectively. Firefly luciferase expression with this system was shown to be inducible and mifepristone dose-dependent. Effective knockdown of HBV gene expression was achieved with both pRS-31/5 and pRS-31/5/8/9 in vitro and in vivo. However, with high vector amounts, similar efficiency in silencing of HBV gene expression was observed in the presence and absence of the inducer mifepristone suggesting leaky expression of the pri-miRs. To confirm this, knockdown studies were carried out with the pri-miR-31/5/8/9-expressing cassette separated from the transactivator cassette. HBV gene expression knockdown was observed with the pri-miR-31/5/8/9 cassette alone confirming leaky expression from the inducible system. Leakiness appears to be as a result of the E1B promoter driving the expression of the pri-miRs in the absence of mifepristone. However, reducing the vector amounts decreased basal expression and improved the inducibility of the system in cell culture studies. Successful propagation of an inducible and liver-specific RNAi-activating expression system will address the difficulty of achieving dose control of RNAi effectors and contribute to advancing the use of RNAi for HBV treatment.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / A 24-year-old pregnant woman arrived at the emergency service at 34 weeks of gestational age with intermittent right upper abdominal pain. An abdominal ultrasound was performed showing signs of hepatopathy with multiple neo-formative nodules with mild ascites and fetal biometry confirmed at 34 weeks gestation. During her hospitalization, an emergency caesarean was induced with favorable result in the survival of the mother and the baby. / Revisión por pares

No description available.

Background: The liver biopsy technique in dogs that consistently provides samples adequate for accurate histopathologic interpretation and the variability of histopathology among lobes is unknown. Hypothesis:  Liver biopsy specimens obtained via punch, cup biopsy, and 14 gauge needle biopsy would result in similar histopathologic diagnoses to those found on deeply sectioned samples of liver obtained at necropsy and that discordant results would not differ between lobes.   Animals:  Seventy dogs undergoing necropsy. Methods: Liver specimens were obtained from the left lateral liver lobe with an 8 mm punch, a cup, and a 14 gauge needle. Two larger tissue samples were then collected near the center of the left lateral lobe and used as a histologic standard for comparison.  Samples were also obtained from all remaining lobes. Histopathologic features and numbers of portal triads in each sample were compared. Results: The mean number of portal triads were 2.9 in needle biopsies, 3.4 in cup biopsies, 12 in punch biopsies, and 30.7 in the necropsy samples. Sixty-six percent of needle biopsies,  60% of laparoscopic cup samples, and 69% of punch samples were in agreement with the necropsy samples, differences that were not significantly different. The corresponding kappa coefficient were 0.59 for needle biopsies, 0.52 for cup biopsies, and 0.62 for punch biopsies.  Discordant results did not differ between the liver lobes. Conclusions and Clinical Relevance:  A single biopsy using any of the tested techniques is insufficient for reliable diagnosis of liver disease in the dog.  Multiple biopsies from 2 lobes is recommended. / Master of Science