Hepatitis viruses are most important cause of acute and chronic hepatitis. In past, hepatitis B virus was one of the major causes of acute hepatitis. Recently, around 60-70% of acute hepatitis is attributed to hepatitis A virus infection. In this article, we will discuss the route of hepatitis virus infection, how to prevent transmission of viral hepatitis and who should be immunized to each hepatitis viruses.
Hepacivirus ; Hepatitis ; Hepatitis A virus ; Hepatitis B virus ; Hepatitis Delta Virus ; Hepatitis E virus ; Hepatitis Viruses ; Hepatitis, Chronic ; Vaccination

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region.

In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth).

The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children.

The consensus statements will be amended accordingly as new therapies become available.

Hepatitis B ; Consensus ; Hepatitis B, Chronic ; Hepatitis B Virus ; Fibrosis ; Drug Therapy ; Carcinoma, Hepatocellular ; Liver Cirrhosis ; Hepatitis Delta Virus ; Hiv

Hepatitis D virus (HDV) infection causes the most severe form of viral hepatitis with rapid progression to cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Although discovered > 40 years ago, little attention has been paid to this pathogen from both scientific and public communities. However, effectively combating hepatitis D requires advanced scientific knowledge and joint efforts from multi-stakeholders. In this review, we emphasized the recent advances in HDV virology, epidemiology, clinical feature, treatment, and prevention. We not only highlighted the remaining challenges but also the opportunities that can move the field forward.
Carcinoma, Hepatocellular/complications* ; Hepatitis B virus ; Hepatitis D/epidemiology* ; Hepatitis Delta Virus/genetics* ; Humans ; Liver Cirrhosis/etiology* ; Liver Neoplasms/complications*

OBJECTIVEHepatitis Delt a Virus (HDV) antigen is widely used as a capture antigen in ELISAs for the identification of HDV infection; large amounts of recombinant HDV antigen with active antigenicity are required for this purpose.

METHODSReconstruct the gene of HDV antigen based on the bias code of Escherichia coli, the recombinant protein expresses by high-density fermentation with fed-batch feeding strategy, and purify by immobilized metal chromatography. The sensitivity and specificity of this antigen detect by ELISA method.

RESULTSThe expression of HDV antigen can reach 20% of the total cell mass in the soluble form. The recombinant HDV antigen can be conveniently purified (98%) by immobilized metal ion affinity chromatography (IMAC) using the interaction between a His-tag and nickel ions. Production of recombinant HDV antigen can reach 0.5 g/L under conditions of high-density cell fermentation. Applied to the diagnostic ELISA method, the recombinant HDV antigen shows excellent sensitivity (97% for IgM and 100% for IgG) and specificity (100% for IgG and IgM) for the detection of anti-HDV antibodies.

CONCLUSIONExpression and purification the recombinant HDV antigen as a candidate protein for application in a diagnostic ELISA for HDV infection. Large-scale production of the protein can be achieved using the high-density fermentation strategy.

Enzyme-Linked Immunosorbent Assay ; Escherichia coli ; genetics ; metabolism ; Fermentation ; Hepatitis D ; diagnosis ; immunology ; virology ; Hepatitis Delta Virus ; immunology ; Hepatitis delta Antigens ; immunology ; Recombinant Proteins ; genetics ; metabolism

Hepatitis B virus ; isolation & purification ; Hepatitis Delta Virus ; isolation & purification ; Humans ; Oligonucleotide Array Sequence Analysis ; Polymerase Chain Reaction

BACKGROUNDTo construct the pRSETB-HDAg recombinant expression plasmid and to obtain soluble hepatitis D virus antigen with high biological and antigenic activity.

METHODSHDAg gene fragment was inserted into fusion expression pRSET B vector that includes T7 promoter and a polyhistidine tag. The recombinant plasmid was transformed into host bacterium BL21 after induction with IPTG. The expression supernatant was purified by chelating affinity chromatography and the recombinant HDAg antigenic activity was detected by EIA.

RESULTSEIA detection using the recombinant HDAg showed strong positive reaction with hepatitis D patients sera. The positive rates of the EIA, compared with HDAg from USA and Hua Mei EIA kit in detecting 26 cases of anti-HDV positive reference sera, were 100%, 96.15% and 100%, respectively.

CONCLUSIONRecombinant plasmid for HDAg with good antigenicity was successfully constructed and could be used as hepatitis D antibody detection reagent.

Electrophoresis, Polyacrylamide Gel ; Escherichia coli ; genetics ; Gene Expression ; Hepatitis Delta Virus ; genetics ; immunology ; metabolism ; Hepatitis delta Antigens ; genetics ; immunology ; metabolism ; Immunoenzyme Techniques ; Recombinant Proteins ; immunology ; metabolism

BACKGROUND/AIMS: Mongolia has one of the highest hepatitis A, C, B and D infection incidences worldwide. We sought to investigate changes in the proportion of acute viral hepatitis types in Mongolia over the last decade. METHODS: The cohort comprised 546 consecutive patients clinically diagnosed with acute viral hepatitis from January 2012 to December 2014 in Ulaanbaatar Hospital, Mongolia. A time trend analysis investigating the change in proportion of acute hepatitis A virus, hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection among the cohort with respect to a previous published study was undertaken. RESULTS: Acute hepatitis A, B and C was diagnosed in 50.9%, 26.2% and 6.0% of the cohort. Notably, 16.8% of the cohort had a dual infection. The etiologies of acute viral hepatitis were varied by age groups. The most common cause of acute viral hepatitis among 2-19 year olds was hepatitis A, HBV and superinfection with HDV among 20-40 year olds, and HCV among 40-49 year olds. Patients with more than one hepatitis virus infection were significantly older, more likely to be male and had a higher prevalence of all risk factors for disease acquisition. These patients also had more severe liver disease at presentation compared to those with mono-infection. CONCLUSIONS: Acute viral hepatitis is still prevalent in Mongolia. Thus, the need for proper infection control is increasing in this country.
Cohort Studies ; Hepacivirus ; Hepatitis A virus ; Hepatitis A* ; Hepatitis B ; Hepatitis B virus ; Hepatitis C ; Hepatitis D ; Hepatitis Delta Virus ; Hepatitis Viruses ; Hepatitis* ; Humans ; Incidence ; Infection Control ; Liver Diseases ; Male ; Mongolia* ; Prevalence ; Risk Factors ; Superinfection

Chronic hepatitis B affects 400 million people worldwide and is one of the leading causes of liver-related morbidity and mortality. All clinically available hepatitis B virus (HBV) drugs are nucleoside or nucleotide analogs that inhibit viral reverse transcriptase (RT) activity. Resistance to these HBV drugs has been widely reported, and is due to specific mutations in the viral RT domain. Therefore, the development of new, non-polymerase targeting anti-HBV agents is urgently needed. A potential drug target, the HBV receptor that mediates the viral entry process, has been recently identified using human primary hepatocytes, northern tree shrew (Tupaia belangeri) hepatocytes, and HepaRG cells. A transporter of bile acids, sodium taurocholate cotransporting polypeptide (NTCP), was identified as the receptor for HBV and hepatitis D virus, and the transport function of NTCP was correlated with HBV entry. Therefore, functional inhibitors of NTCP may inhibit HBV infection, and viral entry was blocked by several NTCP receptor-targeting compounds. The HBV receptor is an attractive target for development of entry inhibitors, and serves as a model for the mechanistic study of HBV entry and infection. This review will summarize the characteristics and clinical importance of NTCP, and will discuss the potential therapeutic use of NTCP inhibitors to prevent HBV entry.
Bile Acids and Salts ; Hepatitis B virus ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis Delta Virus ; Hepatocytes ; Humans ; Mortality ; RNA-Directed DNA Polymerase ; Taurocholic Acid ; Tupaiidae

BACKGROUND/AIMS: The prevalence of hepatitis delta virus (HDV) infection has been estimated as being approximately 5% among global HBsAg carriers. The anti-delta positive rate in Koreans had been reported as being 0.85% in 1985. While the prevalence of HBV has been decreased from nearly 10% to 5% during the past twenty years, there have been no more studies on the anti-delta prevalence in Koreans. The aim of this study was to estimate the anti-delta prevalence in Koreans and to study the clinical characteristics of anti-delta positive patients in a single center. METHODS: Serum anti-delta was measured in one hundred ninety four HBsAg-positive patients who were admitted to our hospital from February 2003 to August 2003. We checked the genotypes of the HBV in the anti-delta positive patients. The clinical features of the anti-delta positive patients were compared to those clinical features of the anti-delta negative patients from the aspect of age, gender, mode of transmission, the positivity of HBeAg and serum HBV DNA. RESULTS: Serum anti-delta was positive in seven patients among the 194 subjects, giving a 3.6% positive rate. Among these seven patients, six had hepatocellular carcinoma (HCC) and the other one had cholangiocarcinoma. All of the anti-delta positive patients had the C genotype of HBV. The anti-delta positive patients showed significantly suppressed HBV DNA replication compared to the anti-delta negative patients. CONCLUSIONS: In Koreans, anti-delta was positive mainly in HCC patients with an approximate prevalence of 4%, and this rate has not changed much for the past twenty years. HBV DNA replication was suppressed by HDV infection.
Adult ; Carcinoma, Hepatocellular/virology ; English Abstract ; Female ; Hepatitis Antibodies/analysis ; Hepatitis D/complications/*epidemiology/immunology ; Hepatitis Delta Virus/immunology ; Hepatitis delta Antigens/analysis ; Humans ; Korea/epidemiology ; Liver Neoplasms/virology ; Male ; Middle Aged ; Prevalence

OBJECTIVETo explore the possibility of transacting hepatitis D virus (HDV) ribozyme cleaving in vitro the hepatitis B virus (HBV) mRNA fragments.

METHODSAccording to the established pseudoknot-like structure, its' H1 domain was changed to design the transacting HDV ribozyme Rc1 and Rc2, which targeted the 701-713 site and 776-788 site of HBV C domain. After the chemically synthesised cDNA of the ribozyme was cloned into the vector PGEM-4Z, the transacting HDV ribozyme was transcriped using in vitro transcription technology. The in vitro cleavage characteristics of the ribozyme were studied and the kinetic parameters (Kcat and Km) were determined by Eadie Hofstee plotting.

RESULTSBoth the two ribozymes had the ability to cleave the substrate, the cleavage percentage at 37 degrees for 90 minutes were 50% and 51%. According to the Eadie Hofstee plot, the Km of the Rc1 and Rc2 were 0.61 micromol and 0.58 micromol, the Kcat were 0.64 x min(-1) and 0.60 x min(-1),respectively.

CONCLUSIONSThe cleaving ability of trans-acting HDV ribozyme on non-HDV RNA fragment was tested. The results showed a new potential of the antisense antisense regent for HBV gene therapy.

DNA, Antisense ; genetics ; Genome, Viral ; Hepatitis B virus ; genetics ; Hepatitis Delta Virus ; enzymology ; genetics ; Humans ; RNA, Catalytic ; genetics ; metabolism ; RNA, Messenger ; genetics ; RNA, Viral ; genetics ; Transcription, Genetic