um, this is kinda about hep B really ... whilst being infected with hep B, a further invitation can be made to your body ... "and would you like a side of hep D with that"? ... this article just highlights the importance of good early immunization/protection from hep B (as with no B there is no D). It reminds us that even without IV drug use or engaging in hi risk behaviours, one can still contract hep B (and with it hep D).
Published in Gastroenterology
Journal Scan / Research· March 28, 2019
Global Prevalence of Hepatitis D Virus Infection
Gut
TAKE-HOME MESSAGE
This systematic review and meta-analysis highlights the global burden of hepatitis D in the chronically infected hepatitis B population. Approximately 10.6% of patients with hepatitis B surface antigen positivity are co-infected with hepatitis D. Intravenous drug use and high-risk sexual behavior seem to be risk factors for co-infection.
The authors suggest that routine hepatitis D screening and implementation of robust hepatitis B vaccination programs are important.
- Natasha VonRoenn, MD
Abstract
OBJECTIVE
Hepatitis D virus (HDV) is a defective virus that completes its life cycle only with hepatitis B virus (HBV). The HBV with HDV super-infection has been considered as one of the most severe forms of the chronic viral hepatitis. However, there is a scarcity of data on the global burden of HDV infection.
DESIGN
We searched PubMed, Embase, Cochrane Library and China Knowledge Resource Integrated databases from 1 January 1977 to 31 December 2016. We included studies with a minimum sample size of 50 patients. Our study analysed data from a total of 40 million individuals to estimate the prevalence of HDV by using Der-Simonian Laird random-effects model. The data were further categorised according to risk factors.
RESULTS
From a total of 2717 initially identified studies, only 182 articles from 61 countries and regions met the final inclusion criteria. The overall prevalence of HDV was 0.98% (95% CI 0.61 to 1.42). In HBsAg-positive population, HDV pooled prevalence was 14.57% (95% CI 12.93 to 16.27): Seroprevalence was 10.58% (95% CI 9.14 to 12.11) in mixed population without risk factors of intravenous drug use (IVDU) and high-risk sexual behaviour (HRSB). It was 37.57% (95% CI 29.30 to 46.20) in the IVDU population and 17.01% (95% CI 10.69 to 24.34) in HRSB population.
CONCLUSION
We found that approximately 10.58% HBsAg carriers (without IVDU and HRSB) were coinfected with HDV, which is twofold of what has been estimated before. We also noted a substantially higher HDV prevalence in the IVDU and HRSB population. Our study highlights the need for increased focus on the routine HDV screening and rigorous implementation of HBV vaccine programme.
Observer said
Oct 7, 2018
Cheddy said
Oct 6, 2018
There's a lot to be said for the good old days. I'm so glad you survived them!
Tig said
Oct 6, 2018
Ha, ha! Yep, more than one during the time I was there. Probably ate a few other critters I'm unaware of, too. All cut up and on a stick, you don't know what it's made of. Smelled good and after a dozen San Miguel's, I didn't care. Never gave it much thought. Until you read articles like this and begin to wonder what else I picked up at the time. The ice in some of those bars came from water right out of local rivers that were full of nasties. I guess that's why they put us through the A to Z inoculation program.
Shemp said
Oct 6, 2018
Hey Tig,
You really ate a boiled duck embryo from the shell? WOW!!!
Tig said
Oct 6, 2018
Rats can be terribly infective, able to spread disease like crazy. Often the fleas they carry are the vector. They were responsible for the plagues throughout the middle ages and beyond.
I remember eating at several of the roadside vendors when I lived overseas. I was in my 20’s and lived on beer and barbecue. I shudder to think of some of the things I consumed. Look up Balut, it was considered a delicacy. If you looked at it, you were doomed, just close your eyes and eat. Ewwww!
Cheddy said
Oct 6, 2018
I'm not even going to try. You two are a combo of scientist and funny bunnies.
Canuck said
Oct 5, 2018
Ya Tig, it was limited info contained in this article, and there was only a tiny tad more in the original news article link in red at the bottom ... rats, rat feces, trash-alleys/squalor and such, seems to be the vector of origin (but other conditions would apply) ie. guy had also had a recent transplant/immunosuppressants. In the case they document here, the guy may have been in a disadvantaged state (by perhaps both his locale and because of his immune state) enabling him to contract this rat-type hep E. It would be good if further theory was offered by these Hong Kong scholars and infection control people as to how (exactly) the organism can enter a human body - by the 2 limited stories here, I can only assume it was human oral ingestion of the organism via rat feces, given the presence of rats.
Tig said
Oct 5, 2018
I have lived in Southeast Asia and like people everywhere, your diet is determined by many variables. He may have been bitten or consumed undercooked food. I’m curious how this form of Hep E is spread. I‘m not sure how this gentleman was exposed, but it reminds me of that old warning, be sure you thoroughly cook your meat...
Canuck said
Oct 5, 2018
Hm, so, now ... it might be an idea to be screening for rat hep E when screening for human hep E? Brother! 2 strains we should be screening for. Food for thought - how we best protect the whole of populations from disease, exposure and widening vectors.
Published in Gastroenterology
News· October 03, 2018
First Human Case of Rat Strain of Hepatitis E Seen in Hong Kong
Infection identified in 56-year-old man who had received a liver transplant in May 2017
HealthDay
MONDAY, Oct. 1, 2018 (HealthDay News) -- The first human case of a strain of hepatitis E previously found only in rats was diagnosed in a Hong Kong man who received a liver transplant in May 2017.
University of Hong Kong researchers said the 56-year-old man was cured of the liver disease in March, The New York Times reported. The case is "a wake-up call," according to Yuen Kwok-yung, M.D., chairman of the infectious diseases section of the microbiology department at the university.
The researchers said the man's infection was not related to his liver transplant, but rather to factors such as rat droppings and open piles of garbage near his home, The Times reported. Routine hepatitis E testing would not have detected the man's infection, because the rat strain is much different than the one that typically infects humans. Only after finding similarities with infected rats in Vietnam did the researchers detect the source of the patient's infection in this case.
The rat strain of hepatitis E was discovered in 2010 in Germany and has been found in rats across the world, including in the United States, according to the university researchers.
heehee, you button pusher you! Yup, i am positive i have recognized some distant reli.
Look who's talkin ... old as dirt, dinosaur bait.
um, you only want to hear current news? What ever happened to.... if we dont know where we came from, how will we ever know when we have arrived. (huh?) C.
PS - gloves are off BTW.
Tig said
May 18, 2018
Hey Canuck, did you know that individual? Bwahaha! Sorry, couldn't resist... xxoo
Canuck said
May 18, 2018
Helio - IN THE JOURNALS PLUS
Oldest evidence of HBV found in 4,500-year-old human remains
SHOW CITATION
Mühlemann B, et al. Nature. 2018;doi:10.1038/s41586-018-0097-z.
May 12, 2018
Researchers at the University of Cambridge and the University of Copenhagen have identified hepatitis B viruses, including a genome that is now extinct, in human remains that date as far back as the Bronze Age, the oldest being around 4,500 years old.
Their study, published recently in Nature, reveals a complex evolution of HBV, which could have implications for future research.
"People have tried to unravel the history of HBV for decades - this study transforms our understanding of the virus and proves it affected people as far back as the Bronze Age," Barbara Mühlemann, PhD student at the University of Cambridge, said in a press release. "We have also shown that it is possible to recover viral sequences from samples of this age, which will have much wider scientific implications.
According to WHO, approximately 257 million people are infected with HBV worldwide. In 2015, an estimated 887,000 people died from HBV-related complications, including cirrhosis and hepatocellular carcinoma. However, despite the impact of HBV on public health, little is known about its origin.
"Scientists mostly study modern virus strains, and we have mainly been in the dark regarding ancient sequences - until now," Terry Jones, PhD, of the University of Cambridge's zoology department, said in the release. "It was like trying to study evolution without fossils. If we only studied the animals living today, it would give us a very inaccurate picture of their evolution. It is the same with viruses."
Mühlemann, Jones and colleagues used a shotgun sequencing method to analyze human remains from the Bronze Age to the Medieval period that were exhumed in Europe and Asia. Samples from 25 skeletons tested positive for HBV. Of these, 12 had enough viral material for detailed analyses.
During their investigation, the researchers identified "important spatiotemporal reference points in the evolutionary history of HBV." A geographical analysis showed that the location of several ancient genotypes do not match the locations of modern-day genotypes. Some genotypes typically found today in Africa and Asia, as well as a subgenotype found in India, had mixed European and Asian origins. Data also provided "strong evidence" that an ancient strain known as HBV-DA51 and an unknown parent recombined to form genotype A sequences, suggesting the abundance of HBV genotypes circulating today are just "a subset of the diversity that has ever existed," the researchers wrote.
"The most interesting difference we see [between ancient and modern HBV] is that three of the sequences older than 3,700 years are closer genetically to viruses present in nonhuman primates than human viruses," Mühlemanntold Infectious Disease News. "Furthermore, we see three different sequences that lack two amino acids relative to the modern sequences. We don't yet know what the functional implications of those changes are."
Before this discovery, the earliest strain of HBV was sequenced from 450-year-old mummified remains of a small childin Naples, Italy. The newly identified sequences represent the oldest evidence of any virus recovered from human DNA, according to the researchers. Other ancient viruses that have been previously identified include a strain of influenza from approximately 100 years ago and a strain of variola virus from approximately 350 years ago.
Mühlemann said she hopes to investigate the origin and evolution of other viruses. However, the shotgun sequencing method that was used in this study is unable to detect RNA, limiting their efforts. Further, she added, it will be difficult to locate remains with virus titers that are high enough to be detected.
"The lack of ancient sequences limits our understanding of the evolution of HBV and very probably of other viruses," the researchers concluded. "Discovery of additional ancient viral sequences may provide a clearer picture of the true origin and early diversification of HBV, enable us to address questions of paleo-epidemiology, and broaden our understanding of the contributions of natural and cultural changes (including migrations and medical practices) to human disease burden and mortality." - by Stephanie Viguers
Tig said
Apr 14, 2018
Oh great, another hepatitis virus being transmitted through blood products? What else is in blood and blood products that we don’t know about? I guess if the virus hasn‘t been isolated yet, it’s difficult to pin down where it’s being harbored and how it contaminates the host. BUT STILL... I think we should have a modicum of trust in the blood supply, not the hit or miss situation this presents. Geez
Canuck said
Apr 14, 2018
um, why would blood screening (being a problem) be ringing bells for me?
'nother article coming out of the Paris "Liver Meeting" that is going on right now.
Helio - Meeting news
One-third of chronic hepatitis E cases transmitted through blood products
April 13, 2018
PARIS - Blood products were linked to 36% of chronic hepatitis E cases among a group of immunosuppressed patients, according to a study presented at the International Liver Congress 2018.
"We are propagating screening of blood donations because an infected blood product given to an immunocompromised patient has serious consequences," Ansgar Lohse, MD, from the University of Medical Center Hamburg-Eppendorf, Germany, told Healio Gastroenterology and Liver Disease. "Just testing blood products given to immunocompromised patients is almost impossible because you don't know ahead which product will go to which patients."
According to Dirk Westhölter, MS, from the University Hospital Hamburg-Eppendorf, Germany, in his presentation on the study, routine HEV testing of blood products has recently been implemented in Great Britain and the Netherlands, but the relevance of bloodborne HEV-transmission remains controversially discussed in numerous countries.
The researchers retrospectively analyzed data from all 37 immunosuppressed patients seen at their center between 2011 and 2017 and all blood products given to patients with chronic HEV.
Eleven of the immunosuppressed patients developed chronic HEV. The researchers confirmed that HEV-infected blood products were the source of transmission in four of the 11 patients, including two patients who received heart transplants.
As part of their research into HEV incidence and risk factors, the researchers also conducted a questionnaire among the HEV-infected donors and found that those with HEV were significantlymore likely to consume raw pork meatoften compared with a set of control participants (63% vs. 35%; P < .01).
"The number of notified transfusion-transmitted HEV infections has so far been relatively low, probably due to under-reporting and under-recognition,"Westhölter, said in a press release. "This study confirms that blood products are an important source of HEV infection for immunosuppressed individuals and it has led us to recommend HEV RNA screening of all blood products destined for transplant or immunosuppressed patients."
"Both inacute hepatitis of unknown etiologyand in raised liver enzymes in immunosuppressed patients, being repeatedly positive, hepatitis E is a differential diagnosis and needs testing," Lohse said. "People who think they're healthy may carry the virus. Physicians need to think about it." - by Talitha Bennett
For more information:
Westhölter D, et al. PS-063. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.
Disclosure: Westhölter and Lohse report no relevant financial relationships.
Canuck said
Apr 6, 2018
Helio
IN THE JOURNALS
EASL releases clinical practice guideline for hepatitis E
Dalton HR, et al.J Hepatol. 2018;doi:10.1016/j.jhep.2018.03.005.
April 5, 2018
The European Association for the Study of the Liver released a new clinical practice guideline for hepatitis E, specifically focused on genotype 3 and 4, which EASL recently published in Journal of Hepatology.
"Infection with hepatitis E virus (HEV) is a significant cause of morbidity and mortality, representing an important global health problem," Harry R. Dalton, MD,from the University of Exeter, United Kingdom, and colleagues wrote. "Our understanding of HEV has changed completely over the past decade.Previously, HEV was thought to be limited to certain developing countries. We now know that HEV is endemic in most high-income countries and is largely a zoonotic infection."
According to Dalton and colleagues, expert estimated that the global burden of HEV was at 20 million infections in 2005, but this estimate only included infections in a limited number of developing counties in which genotypes 1 and 2 are predominate and the seroprevalence data collected demonstrated poor sensitivity.
Recent studies have shown 'hot-spots' of HEV throughout Europe, including locations in France, the Netherlands, Scotland, Germany, Czech Republic, Poland and Italy.
"Our current estimate of global burden of HEV is of limited value, and requires updating urgently," the researchers wrote.
Regarding HEV genotypes 1 and 2, the researchers recommend that travelers with hepatitis returning from endemic areas receive testing,and that pregnant women with HEV genotype 1 or 2 should receive care in a high-dependency setting and transferred to a liver transplant unit if liver failure occurs.
General recommendations from the guideline include testing for HEV in all patients with symptoms of acute hepatitis, patients with unexplained flares of chronic liver disease, and patients with immunosuppression with unexplained abnormal liver function tests.
The researchers recommend combination serology and nucleic acid amplification technique (NAT) testing to diagnose HEV and NAT testing for chronic HEV. The researchers also recommend antiviral treatment for patients with HEV and associated glomerular disease. Ribavirin may be considered in cases of severe acute HEV or acute-on-chronic liver failure; however, the researchers noted that very few case reports are available on ribavirin for severe acute HEV. Acute HEV, on the other hand, does not usually require antiviral therapy.
Patients who present with HEV should receive testing for proteinuria. Those who develop new onset proteinuria may require a renal biopsy.
Regarding prevention, the researchers advise that consumption of undercooked meat from pigs, wild boar and deer have been identified as risk factors for HEV infection in Europe. Patient-to-patient transmission is poorly defined and requires further study.
A vaccine licensed in China in 2011 showed an efficacy of 97% in preventing episodes of symptomatic acute hepatitis and proved long-term efficacy during follow-up. The vaccine is not currently licensed outside of China, but efforts are currently underway to obtain WHO prequalification for emergency settings.
"Our understanding of HEV infection has completely changed in the last decade," the researchers wrote. "There are still many knowledge gaps, and it is likely that as answers to these questions become available, these [guidelines] will require amendment in a few years' time." - by Talitha Bennett
Disclosure: Dalton reports grant support from the British Medical Association; consultant or advisory roles with Roche, Gilead, Wantai, Merck; delivery of sponsored lectures for the Gates Foundation; and is the co-holder of patent Kernow CIPG with the National Institutes of Health and others. Please see the full study for the other authors' relevant financial disclosures.
-- Edited by Tig on Friday 6th of April 2018 02:14:25 PM
Canuck said
Apr 6, 2018
Helio
Evidence supports link between hepatitis E, nerve disorder
Dalton HR, et al.J Hepatol. 2017;doi:10.1016/j.jhep.2017.07.010.
October 20, 2017
Certain European patients who presented with nontraumatic neurologic injury had evidence of hepatitis E. These patients showed similarities to other HEV-associated cases of neuralgic amyotrophy, suggesting a causal relationship, according to the researchers.
"My colleagues and I have noticed, we find some patients presenting primarily with a neurological illness who don't have much in the way of abnormality in the liver blood test," Harry R. Dalton, MD, from the University of Exeter, United Kingdom, told Healio.com/Hepatology. "This study was exploring the notion of hepatitis E virus being misnamed, because these patients have a profound neurological injury, but not much of a hepatitis - it was a preliminary study looking at whether this virus might be neurotropic or not. And there is some laboratory evidence to support that it might be."
The cohort comprised 464 patients enrolled from England, France, and the Netherlands. Mean patient age was 63 years (range, 17-99 years). Eleven patients had evidence of current or recent HEV infection, all genotype 3, and seven had HEV RNA recovered from serum.
"This was just a pilot study," Dalton said. "Basically, we called it 'operation blunderbuss' because it was a bit of a blunt instrument; we decided to test all-comers presenting with non-traumatic acute neurology to secondary care and test for hepatitis E."
The researchers observed several neurological events among those with evidence of HEV, including cerebrovascular accident (n = 4), neuralgic amyotrophy (n = 3), seizure (n = 3), encephalitis (n = 1) and cranial nerve palsies (n = 1).
Lasting neurological outcomes included minor sensory deficit, residual visual field defect, residual functional deficits, residual tinnitus, residual right-sided weakness, residual left-sided weakness and minimal deficits at 6 months, among seven patients, respectively. Regarding the other four patients, one recovered, one recovered completely, one returned to work after 6 months, and one recovered with recurrence at 6 months.
According to the researchers, the prevalence of HEV viremia in the cohort was 1.5%, which was at least 10 times higher than the prevalence recently documented in blood donors in England (0.035%), France (0.045%) and the Netherlands (0.17%).
The three patients with neuralgic amyotrophy and HEV had detectable HEV viremia at presentation. All three patients had bilateral asymmetrical involvement in the brachial plexus, which was previously associated with neuralgic amyotrophy in patients with HEV.
"In all patients with neuralgic amyotrophy, all patients with Guillain-Barré syndrome,and all patients with encephalitis, they should have their hepatitis E status checked, irrespective of their liver blood test abnormalities," Dalton concluded. "In other patients with neurology, I think it would be wise to consider it because we have not completely pinned it down what conditions might be associated to an all-cause. I think in the first three conditions I mentioned, there is very good evidence for causality. Hepatitis E is not just a hepatotropic virus, it can cause neurologic injury, so beware." - by Talitha Bennett
Disclosure: Dalton reports he has received travel and accommodation costs and consultancy fees from GlaxoSmithKline, Wantai and Roche; travel, accommodation and lecture fees from Merck, Gilead and GFE Blut GmBh; travel and accommodation fees from the Gates Foundation and Médecins Sans Frontières; and a grant from BMA. Please see the full study for the other authors' relevant financial disclosures.
Canuck said
Apr 6, 2018
Helio - IN THE JOURNALS
High hepatitis E incidence in Germany linked to raw pork intake
Westhölter D, et al.J Hepatol. 2018;doi:10.1016/j.jhep.2018.02.031.
March 26, 2018
Researchers found a relatively high prevalence of hepatitis E viremia (0.12%) among blood donors in Germany. Further, consumption of raw pork tartare by this group represented a significant relevant risk for infection, according to a recently published study.
"Consumption of pork meat has been considered to be the major source of HEV genotype 3 infections in Europe. In addition to zoonotic transmission, blood products were shown to be a potential source of acute and chronic HEV-infectionin industrialized countries," Dirk Westhölter, MS, from the University Medical Center Hamburg-Eppendorf, Germany, and colleagues wrote. "The aim of the present study was to determine the prevalence of bloodborne HEV-infections at our academic tertiary care center in Northern Germany and to evaluate whether routine HEV testing of blood products should be performed."
Between October 2016 and May 2017, the researchers prospectively tested 18,737 blood donations received within Westhölter's institution for HEV and detected 23 asymptomatic donors.
Retrospective analysis showed that four of the asymptomatic donors tested positive in stored samples from previous blood donations. These products were transfused into a total of 14 patients, most of whom died prior to confirming HEV viremia; however, the researchers did confirm two recipients who became infected after transfusion with the infected blood products.
Eighteen of the asymptomatic donors participated in a standardized questionnaire to assess exposure to possible sources of HEV. Sixteen reported regular consumption of pork and 12 reportedconsumption of raw pork tartarewithin two months prior to donation. Additionally, two donors ate undercooked pork liver 4 weeks prior to donation. Residual meat stored at the donors' home tested positive for HEV-RNA at 6,200 IU/mL.
"In this study eating raw pork tartare (a traditional German dish) represented a relevant risk
for acquisition of HEV infection in blood donors in Northern Germany," the researchers wrote. "Domestic pigs are evidentially a major reservoir of HEV."
The researchers conducted a control cohort including 256 previously unselected blood donors who filled out the same questionnaire. In the control cohort, 87% regularly consumed pork and 35% had consumed pork tartare in the prior two months.
"While immunosuppressed patients should be regularly reminded to avoid consumption of raw and undercooked meat to lower the risk of foodborne infections, blood component therapy may be necessary and unpreventable in certain situations," the researchers concluded. "Our data suggest thatroutine HEV screening of blood productsshould be implemented at least at European tertiary care centers and at centers with a high proportion of immunosuppressed patients." - by Talitha Bennett
Disclosure: Westhölter reports no relevant financial disclosures. Please see the full study for the other authors relevant financial disclosures.
-- Edited by Tig on Friday 6th of April 2018 02:14:09 PM
Canuck said
Dec 22, 2017
Another article, just a smidchen more about Hep E. I wouldn't mind knowing more about these "possible" Hep E immunizations (in China), and or who are doing routine screenings for Hep E (and all other Heps) in all "industrialized" countries!
(hm, wish I hadn't put another lone post, about Hep E, over in About Hep E , I should have kept them all togther here!)
Published in Gastroenterology - Journal Scan / Review · December 20, 2017
Advances and Challenges in Hepatitis E Virus
Nature Reviews. Gastroenterology & Hepatology
TAKE-HOME MESSAGE
·The authors review the life cycle and statistics of hepatitis E virus infection, which was previously thought to only be a concern in developing nations but has now been increasingly reported in industrialized nations.
·They discuss animal and cell culture models of the disease and other platforms that are useful in studying viral hepatotropic pathogens.
Abstract
At least 20 million hepatitis E virus (HEV) infections occur annually, with >3 million symptomatic cases and ~60,000 fatalities. Hepatitis E is generally self-limiting, with a case fatality rate of 0.5-3% in young adults. However, it can cause up to 30% mortality in pregnant women in the third trimester and can become chronic in immunocompromised individuals, such as those receiving organ transplants or chemotherapy and individuals with HIV infection. HEV is transmitted primarily via the faecal-oral route and was previously thought to be a public health concern only in developing countries. It is now also being frequently reported in industrialized countries, where it is transmitted zoonotically or through organ transplantation or blood transfusions. Although a vaccine for HEV has been developed, it is only licensed in China. Additionally, no effective, non-teratogenic and specific treatments against HEV infections are currently available. Although progress has been made in characterizing HEV biology, the scarcity of adequate experimental platforms has hampered further research. In this Review, we focus on providing an update on the HEV life cycle. We will further discuss existing cell culture and animal models and highlight platforms that have proven to be useful and/or are emerging for studying other hepatotropic (viral) pathogens.
Nature Reviews. Gastroenterology & Hepatology - Hepatitis E Virus: Advances and Challenges
Nat Rev Gastroenterol Hepatol 2017 Nov 22;[EPub Ahead of Print], I Nimgaonkar, Q Ding, RE Schwartz, A Ploss
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Canuck said
Oct 24, 2017
Helio - From the Liver Meeting
Sarasar with Norvir effectively delays HDV progression, may clear virus
October 22, 2017
WASHINGTON -Combination therapy with Sarasar and Norvir in patients with hepatitis D effectively blocked hepatitis D virus production, regardless of Sarasar dose, according to a presentation at The Liver Meeting 2017. Longer treatment duration may clear the virus.
"Up to 20 million people worldwide are infected with hepatitis delta and the majority of them will develop cirrhosis within 5 to 10 years," Harel Dahari, PhD, from the division of hepatology at the Loyola University Medical Center, Illinois, said in his presentation. "And compared to HBV mono-infected patients, HDV-infected patients will have a higher risk for hepatic decompensation and the development of liver disease."
To confirm the efficacy of Sarasar (lonafarnib, Eiger BioPharmaceuticals) combined with Norvir (ritonavir, AbbVie) for HDV, the researchers conducted a study with a mathematical model that included data from the phase 2 LOWR HDV-3 study. The model also included hepatocyte proliferation to estimate HDV kinetic parameters and treatment efficacy in blocking viral production.
The researchers randomized 21 patients into six groups that received 50, 75, or 100 mg of Sarasar with 100 mg of Norvir daily for 24 weeks (n = 12) or 12 weeks of placebo followed by 12 weeks of treatment with Sarasar and Norvir (n = 9). Additionally, all patients received hepatitis B nucleos(t)ide analogue therapy.
Median patient age was 40, 60% of patients were men, and most patients were Caucasian and Asian, had elevated alanine aminotransferase levels, and had mild fibrosis.
The researchers observed the following viral kinetic patterns among the groups:
·a rapid virus load decline that was followed by a phase in which the virus load decayed slowly or remained constant and a third phase of renewed viral decay;
·a flat partial response that consisted of rapid virus load decline followed by a lower set point of viral load;
·a pattern of virus rebound, in which the flat partial response or the three-point phase were followed by a rebound in viral load due to a varying effectiveness of the drug; and
·non-response (patients were excluded from modeling).
Results of the model showed a delay of HDV production (median, 8.5 days), in which viral load remained at pre-treatment levels, and that Sarasar with Norvir had a 95% efficacy in blocking HDV production, regardless of Sarasar dose. Viral rebound was due to a decline in treatment efficacy from approximately 95% to approximately 50% after 28 to 137 days after treatment started.
According to Dahari, the model suggests treatment for 51 weeks in those with the three-phase response, treatment for 52 weeks in those with the flat partial response, and treatment for 94 weeks in those with a pattern of virus rebound.
"Lonafarnib and rotanovir were safe and generally well-tolerated," Dahari said. "The model was able to reproduce the observed viral HBS antigen and ALT kinetics in each patient and provide an insight into viral response to the drug." - by Talitha Bennett
Reference:
Dahari H, et al. Abstract 38. Presented at: The Liver Meeting; Oct. 20-24, 2017;
Tig said
Oct 22, 2017
Starting to resemble Alphabet Soup! That Michael Jackson song is now rattling in my head! ABC it's easy as 1, 2, 3 , Do Ra Me or something like that.... Thanks for that, lol!
-- Edited by Tig on Friday 6th of April 2018 02:10:28 PM
Canuck said
Oct 22, 2017
See also "About Hep D".
As "rare" as these "other" types of hepatitis's are (like the incidence of Hep E say being found in North Americians), we will continue to find articles and studies attesting to the need for better/further study/consideration of various hepatitis's that exist in the world and their risks to us, in a global light.
Never say never, especially if people are not screened or fully screened for ALL types of hepatitis's.
Even within this article on Hep E, the study data shown of those found with having, or of having had Hep E, is very small.
Evidence supports link between hepatitis E, nerve disorder
Certain European patients who presented with nontraumatic neurologic injury had evidence of hepatitis E. These patients showed similarities to other HEV-associated cases of neuralgic amyotrophy, suggesting a causal relationship, according to the researchers.
"My colleagues and I have noticed, we find some patients presenting primarily with a neurological illness who don't have much in the way of abnormality in the liver blood test," Harry R. Dalton, MD, from the University of Exeter, United Kingdom, told Healio.com/Hepatology. "This study was exploring the notion of hepatitis E virus being misnamed, because these patients have a profound neurological injury, but not much of a hepatitis - it was a preliminary study looking at whether this virus might be neurotropic or not. And there is some laboratory evidence to support that it might be."
The cohort comprised 464 patients enrolled from England, France, and the Netherlands. Mean patient age was 63 years (range, 17-99 years). Eleven patients had evidence of current or recent HEV infection, all genotype 3, and seven had HEV RNA recovered from serum.
"This was just a pilot study," Dalton said. "Basically, we called it 'operation blunderbuss' because it was a bit of a blunt instrument; we decided to test all-comers presentingwith non-traumatic acute neurology to secondary care and test for hepatitis E."
The researchers observed several neurological events among those with evidence of HEV, including cerebrovascular accident (n = 4), neuralgic amyotrophy (n = 3), seizure (n = 3), encephalitis (n = 1) and cranial nerve palsies (n = 1).
Lasting neurological outcomes included minor sensory deficit, residual visual field defect, residual functional deficits, residual tinnitus, residual right-sided weakness, residual left-sided weakness and minimal deficits at 6 months, among seven patients, respectively. Regarding the other four patients, one recovered, one recovered completely, one returned to work after 6 months, and one recovered with recurrence at 6 months.
According to the researchers, the prevalence of HEV viremia in the cohort was 1.5%, which was at least 10 times higher than the prevalence recently documented in blood donors in England (0.035%), France (0.045%) and the Netherlands (0.17%).
The three patients with neuralgic amyotrophy and HEV had detectable HEV viremia at presentation. All three patients had bilateral asymmetrical involvement in the brachial plexus, which was previously associated with neuralgic amyotrophy in patients with HEV.
"In all patients with neuralgic amyotrophy, all patients with Guillain-Barré syndrome,and all patients with encephalitis, they should have their hepatitis E status checked, irrespective of their liver blood test abnormalities," Dalton concluded. "In other patients with neurology, I think it would be wise to consider it because we have not completely pinned it down what conditions might be associated to an all-cause. I think in the first three conditions I mentioned, there is very good evidence for causality. Hepatitis E is not just a hepatotropic virus, it can cause neurologic injury, so beware." - by Talitha Bennett
Further info on Hep E - http://www.journal-of-hepatology.eu/article/S0168-8278(16)30692-4/fulltext
Canuck said
Sep 17, 2017
About Hep D
Being that we are mostly concerned with Hep C on this site, it is not to say that we don't also need to be aware every other kind if potential insult/infection/another kind of hepatitis that we could possibly get or be exposed to, no matter how slim that event may be.
Around the world many types of hepatitis(s) are found, and the world is getting smaller every day with more of us in it and moving about on it! Hep E, for instance, may be more of a risk to North Americans than it used to be. Outbreaks of Hep A can happen just about anywhere! Hep E, spread mostly much like Hep A, is not seen a lot in North America as it is in other countries. Some countries still remain to boast a high prevelance of Hep B (and with it can come D). this side of the ocean maybe only something like 5% of B's may also have D, but other countries it is up to 40% of the B's who can also be having D.
In North America, when we are being routinely tested for Hep C, we are quite used to being additionally screened for HIV, Hep A and B. We DO find Hep C people co-infected with HIV, and/or Hep C people co-infected with various other tyes of hepatitis, mostly Hep B. HIV people can be found co-infected with Hep C and Hep B. Just a disaster to add a Hep A to any infection you are currently owning or battling! It should be said, that it is withing the realm of possibility to also have any of the other assorted types of hepatitis that are out there!
Feeling "safe" in a first world country, or, it being considered "unlikely" we may be harbouring another types of hepatitis (that are not so common), docs do not even test for some of the less commonly found Heps!
We have lots to choose from - 5 main types of Hep exist - A,B,C,D and E, but, there is also F and G, G being investigated as to what true type of hep it is.
By now, most of us who are familiar with having Hep C, understand well, the importance of not having a co-infection to complicate things. If you have Hep C, be checked and immunized (or re-immunized if required) against A and B. Such a simply thing to do, to try to protect yourself from having a secondary liver infection on top of what you have going on!
If you, or your family, in the past, have lived in other countries, let your doc know.
Get tested, get diagnosed, be immunized - important to know/treat, and/or prevent other infections if we can possibly decrease the risk of any other harms to befall us, our health and livers.
If you have Hep B, be sure you are tested (for everything) including Hep D - Hep B and D can go hand in hand.
Just a disaster waiting to happen, for an unimmunized (or under-immunized) person (who has Hep C) to be wandering around this glorious bad ole world, bumping Hep A or B, and aquiring one of those as well. One disease at a time is quite enough.
FDA grants orphan drug designation to Lambda for HDV - September 11, 2017 - Helio
FDA granted orphan drug designation to Eiger BioPharmaceuticals for its pegylated interferon lambda 1a, known as Lambda, to treat chronic hepatitis delta virus infection, according to a press release.
Lambda, a top, late-stage type III interferon, stimulates immune responses that help develop host protection during viral infections by targeting specific receptors, according to the press release. These specific type III interferon receptors are expressed on hepatocytes with limited expression on hematopoietic and central nervous system cells, which can decrease off-target effects and increase tolerability of Lambda, per the release. Further, Lambda does not use the IFN alfa receptor, which targets type 1 interferon receptors, but signaling through either the IFN Lambda or IFN alfa receptor complexes causes the activation of the same Jak-STAT signal transduction cascade.
Researchers have administered this potential HDV treatment in hepatitis B virus/HCV clinical trials involving more than 3,000 patients, but it has not received approval for any indication, per the press release.
The designation of this potential HDV therapy correlates with the FDA Office of Orphan Products Development's mission to advance the development of products and therapies that show promise for diagnosing and treating rare diseases, per the release.
Reference: www.eigerbio.com
Canuck said
Aug 1, 2017
About Hep E - (excerpts fromGastroenterology- Journal Scan / Review-July 26, 2017)
Comprehensive Review of the Hepatitis E Virus
TAKE-HOME MESSAGE
·Hepatitis E virus is a growing problem that is not just limited to the developing world but is increasingly being locally acquired in developed countries. This review discusses the current understanding of hepatitis E virus, from molecular biology to diagnostic and therapeutic interventions. The authors also propose future directions for basic and clinical research.
BACKGROUND
Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure.
RESULTS
There has been increasing recognition of autochthonous HEV infection in Western countries, mainly associated with genotype 3. Chronic HEV infection has been recognised since 2008, and in transplant recipients this may lead to cirrhosis and organ failure. Modes of transmission include food-borne transmission, transfusion of blood products and solid organ transplantation. Ribavirin therapy is used to treat patients with chronic HEV infection, but new therapies are required as there have been reports of treatment failure with ribavirin.
CONCLUSIONS
Autochthonous HEV infection is a clinical issue with increasing burden. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.
I was reading a few other articles about hep E, and treatment of, and of some of the riba based treatments that were done to cure the person's Hep E, and the riba therapy, surprizingly, had quite short time frames to effect a cure and eradicate the E from the body!
Hep B and Viread administration during pregnancy. Studies are indicating good progress in keeping HBV under control, while safe for the fetus.
FDA revises Viread Safety Data
um, this is kinda about hep B really ... whilst being infected with hep B, a further invitation can be made to your body ... "and would you like a side of hep D with that"? ... this article just highlights the importance of good early immunization/protection from hep B (as with no B there is no D). It reminds us that even without IV drug use or engaging in hi risk behaviours, one can still contract hep B (and with it hep D).
Journal Scan / Research · March 28, 2019
Global Prevalence of Hepatitis D Virus Infection
TAKE-HOME MESSAGE
- Natasha VonRoenn, MD
Abstract
OBJECTIVE
Hepatitis D virus (HDV) is a defective virus that completes its life cycle only with hepatitis B virus (HBV). The HBV with HDV super-infection has been considered as one of the most severe forms of the chronic viral hepatitis. However, there is a scarcity of data on the global burden of HDV infection.
DESIGN
We searched PubMed, Embase, Cochrane Library and China Knowledge Resource Integrated databases from 1 January 1977 to 31 December 2016. We included studies with a minimum sample size of 50 patients. Our study analysed data from a total of 40 million individuals to estimate the prevalence of HDV by using Der-Simonian Laird random-effects model. The data were further categorised according to risk factors.
RESULTS
From a total of 2717 initially identified studies, only 182 articles from 61 countries and regions met the final inclusion criteria. The overall prevalence of HDV was 0.98% (95% CI 0.61 to 1.42). In HBsAg-positive population, HDV pooled prevalence was 14.57% (95% CI 12.93 to 16.27): Seroprevalence was 10.58% (95% CI 9.14 to 12.11) in mixed population without risk factors of intravenous drug use (IVDU) and high-risk sexual behaviour (HRSB). It was 37.57% (95% CI 29.30 to 46.20) in the IVDU population and 17.01% (95% CI 10.69 to 24.34) in HRSB population.
CONCLUSION
We found that approximately 10.58% HBsAg carriers (without IVDU and HRSB) were coinfected with HDV, which is twofold of what has been estimated before. We also noted a substantially higher HDV prevalence in the IVDU and HRSB population. Our study highlights the need for increased focus on the routine HDV screening and rigorous implementation of HBV vaccine programme.
There's a lot to be said for the good old days. I'm so glad you survived them!
Ha, ha! Yep, more than one during the time I was there. Probably ate a few other critters I'm unaware of, too. All cut up and on a stick, you don't know what it's made of. Smelled good and after a dozen San Miguel's, I didn't care.
Never gave it much thought. Until you read articles like this and begin to wonder what else I picked up at the time. The ice in some of those bars came from water right out of local rivers that were full of nasties. I guess that's why they put us through the A to Z inoculation program.
Hey Tig,
You really ate a boiled duck embryo from the shell? WOW!!!
Rats can be terribly infective, able to spread disease like crazy. Often the fleas they carry are the vector. They were responsible for the plagues throughout the middle ages and beyond.
I remember eating at several of the roadside vendors when I lived overseas. I was in my 20’s and lived on beer and barbecue. I shudder to think of some of the things I consumed. Look up Balut, it was considered a delicacy. If you looked at it, you were doomed, just close your eyes and eat. Ewwww!
I'm not even going to try. You two are a combo of scientist and funny bunnies.
Ya Tig, it was limited info contained in this article, and there was only a tiny tad more in the original news article link in red at the bottom ... rats, rat feces, trash-alleys/squalor and such, seems to be the vector of origin (but other conditions would apply) ie. guy had also had a recent transplant/immunosuppressants. In the case they document here, the guy may have been in a disadvantaged state (by perhaps both his locale and because of his immune state) enabling him to contract this rat-type hep E. It would be good if further theory was offered by these Hong Kong scholars and infection control people as to how (exactly) the organism can enter a human body - by the 2 limited stories here, I can only assume it was human oral ingestion of the organism via rat feces, given the presence of rats.
I have lived in Southeast Asia and like people everywhere, your diet is determined by many variables. He may have been bitten or consumed undercooked food. I’m curious how this form of Hep E is spread. I‘m not sure how this gentleman was exposed, but it reminds me of that old warning, be sure you thoroughly cook your meat...
Hm, so, now ... it might be an idea to be screening for rat hep E when screening for human hep E? Brother! 2 strains we should be screening for. Food for thought - how we best protect the whole of populations from disease, exposure and widening vectors.
News · October 03, 2018
First Human Case of Rat Strain of Hepatitis E Seen in Hong Kong
Infection identified in 56-year-old man who had received a liver transplant in May 2017
MONDAY, Oct. 1, 2018 (HealthDay News) -- The first human case of a strain of hepatitis E previously found only in rats was diagnosed in a Hong Kong man who received a liver transplant in May 2017.
University of Hong Kong researchers said the 56-year-old man was cured of the liver disease in March, The New York Times reported. The case is "a wake-up call," according to Yuen Kwok-yung, M.D., chairman of the infectious diseases section of the microbiology department at the university.
The researchers said the man's infection was not related to his liver transplant, but rather to factors such as rat droppings and open piles of garbage near his home, The Times reported. Routine hepatitis E testing would not have detected the man's infection, because the rat strain is much different than the one that typically infects humans. Only after finding similarities with infected rats in Vietnam did the researchers detect the source of the patient's infection in this case.
The rat strain of hepatitis E was discovered in 2010 in Germany and has been found in rats across the world, including in the United States, according to the university researchers.
The New York Times Article
Formalizing a Hep D treatment regiment ...
Eiger Biopharmaceuticals receives notice of allowance for hepatitis D treatment
hahaha, and the dinosaur convo continues .hahaha
heehee, you button pusher you! Yup, i am positive i have recognized some distant reli.
Look who's talkin ... old as dirt, dinosaur bait.
um, you only want to hear current news? What ever happened to.... if we dont know where we came from, how will we ever know when we have arrived. (huh?)
C.
PS - gloves are off BTW.
Hey Canuck, did you know that individual? Bwahaha! Sorry, couldn't resist... xxoo
Helio - IN THE JOURNALS PLUS
Oldest evidence of HBV found in 4,500-year-old human remains
SHOW CITATION
Mühlemann B, et al. Nature. 2018;doi:10.1038/s41586-018-0097-z.
May 12, 2018
Researchers at the University of Cambridge and the University of Copenhagen have identified hepatitis B viruses, including a genome that is now extinct, in human remains that date as far back as the Bronze Age, the oldest being around 4,500 years old.
Their study, published recently in Nature, reveals a complex evolution of HBV, which could have implications for future research.
"People have tried to unravel the history of HBV for decades - this study transforms our understanding of the virus and proves it affected people as far back as the Bronze Age," Barbara Mühlemann, PhD student at the University of Cambridge, said in a press release. "We have also shown that it is possible to recover viral sequences from samples of this age, which will have much wider scientific implications.
According to WHO, approximately 257 million people are infected with HBV worldwide. In 2015, an estimated 887,000 people died from HBV-related complications, including cirrhosis and hepatocellular carcinoma. However, despite the impact of HBV on public health, little is known about its origin.
"Scientists mostly study modern virus strains, and we have mainly been in the dark regarding ancient sequences - until now," Terry Jones, PhD, of the University of Cambridge's zoology department, said in the release. "It was like trying to study evolution without fossils. If we only studied the animals living today, it would give us a very inaccurate picture of their evolution. It is the same with viruses."
Mühlemann, Jones and colleagues used a shotgun sequencing method to analyze human remains from the Bronze Age to the Medieval period that were exhumed in Europe and Asia. Samples from 25 skeletons tested positive for HBV. Of these, 12 had enough viral material for detailed analyses.
During their investigation, the researchers identified "important spatiotemporal reference points in the evolutionary history of HBV." A geographical analysis showed that the location of several ancient genotypes do not match the locations of modern-day genotypes. Some genotypes typically found today in Africa and Asia, as well as a subgenotype found in India, had mixed European and Asian origins. Data also provided "strong evidence" that an ancient strain known as HBV-DA51 and an unknown parent recombined to form genotype A sequences, suggesting the abundance of HBV genotypes circulating today are just "a subset of the diversity that has ever existed," the researchers wrote.
"The most interesting difference we see [between ancient and modern HBV] is that three of the sequences older than 3,700 years are closer genetically to viruses present in nonhuman primates than human viruses," Mühlemann told Infectious Disease News. "Furthermore, we see three different sequences that lack two amino acids relative to the modern sequences. We don't yet know what the functional implications of those changes are."
Before this discovery, the earliest strain of HBV was sequenced from 450-year-old mummified remains of a small child in Naples, Italy. The newly identified sequences represent the oldest evidence of any virus recovered from human DNA, according to the researchers. Other ancient viruses that have been previously identified include a strain of influenza from approximately 100 years ago and a strain of variola virus from approximately 350 years ago.
Mühlemann said she hopes to investigate the origin and evolution of other viruses. However, the shotgun sequencing method that was used in this study is unable to detect RNA, limiting their efforts. Further, she added, it will be difficult to locate remains with virus titers that are high enough to be detected.
"The lack of ancient sequences limits our understanding of the evolution of HBV and very probably of other viruses," the researchers concluded. "Discovery of additional ancient viral sequences may provide a clearer picture of the true origin and early diversification of HBV, enable us to address questions of paleo-epidemiology, and broaden our understanding of the contributions of natural and cultural changes (including migrations and medical practices) to human disease burden and mortality." - by Stephanie Viguers
Oh great, another hepatitis virus being transmitted through blood products? What else is in blood and blood products that we don’t know about? I guess if the virus hasn‘t been isolated yet, it’s difficult to pin down where it’s being harbored and how it contaminates the host. BUT STILL... I think we should have a modicum of trust in the blood supply, not the hit or miss situation this presents. Geez
um, why would blood screening (being a problem) be ringing bells for me?
'nother article coming out of the Paris "Liver Meeting" that is going on right now.
Helio - Meeting news
One-third of chronic hepatitis E cases transmitted through blood products
April 13, 2018
PARIS - Blood products were linked to 36% of chronic hepatitis E cases among a group of immunosuppressed patients, according to a study presented at the International Liver Congress 2018.
"We are propagating screening of blood donations because an infected blood product given to an immunocompromised patient has serious consequences," Ansgar Lohse, MD, from the University of Medical Center Hamburg-Eppendorf, Germany, told Healio Gastroenterology and Liver Disease. "Just testing blood products given to immunocompromised patients is almost impossible because you don't know ahead which product will go to which patients."
According to Dirk Westhölter, MS, from the University Hospital Hamburg-Eppendorf, Germany, in his presentation on the study, routine HEV testing of blood products has recently been implemented in Great Britain and the Netherlands, but the relevance of bloodborne HEV-transmission remains controversially discussed in numerous countries.
The researchers retrospectively analyzed data from all 37 immunosuppressed patients seen at their center between 2011 and 2017 and all blood products given to patients with chronic HEV.
Eleven of the immunosuppressed patients developed chronic HEV. The researchers confirmed that HEV-infected blood products were the source of transmission in four of the 11 patients, including two patients who received heart transplants.
As part of their research into HEV incidence and risk factors, the researchers also conducted a questionnaire among the HEV-infected donors and found that those with HEV were significantly more likely to consume raw pork meat often compared with a set of control participants (63% vs. 35%; P < .01).
"The number of notified transfusion-transmitted HEV infections has so far been relatively low, probably due to under-reporting and under-recognition," Westhölter, said in a press release. "This study confirms that blood products are an important source of HEV infection for immunosuppressed individuals and it has led us to recommend HEV RNA screening of all blood products destined for transplant or immunosuppressed patients."
"Both in acute hepatitis of unknown etiology and in raised liver enzymes in immunosuppressed patients, being repeatedly positive, hepatitis E is a differential diagnosis and needs testing," Lohse said. "People who think they're healthy may carry the virus. Physicians need to think about it." - by Talitha Bennett
For more information:
Westhölter D, et al. PS-063. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.
Disclosure: Westhölter and Lohse report no relevant financial relationships.
Helio
EASL releases clinical practice guideline for hepatitis E
Dalton HR, et al. J Hepatol. 2018;doi:10.1016/j.jhep.2018.03.005.
April 5, 2018
The European Association for the Study of the Liver released a new clinical practice guideline for hepatitis E, specifically focused on genotype 3 and 4, which EASL recently published in Journal of Hepatology.
"Infection with hepatitis E virus (HEV) is a significant cause of morbidity and mortality, representing an important global health problem," Harry R. Dalton, MD,from the University of Exeter, United Kingdom, and colleagues wrote. "Our understanding of HEV has changed completely over the past decade. Previously, HEV was thought to be limited to certain developing countries. We now know that HEV is endemic in most high-income countries and is largely a zoonotic infection."
According to Dalton and colleagues, expert estimated that the global burden of HEV was at 20 million infections in 2005, but this estimate only included infections in a limited number of developing counties in which genotypes 1 and 2 are predominate and the seroprevalence data collected demonstrated poor sensitivity.
Recent studies have shown 'hot-spots' of HEV throughout Europe, including locations in France, the Netherlands, Scotland, Germany, Czech Republic, Poland and Italy.
"Our current estimate of global burden of HEV is of limited value, and requires updating urgently," the researchers wrote.
Regarding HEV genotypes 1 and 2, the researchers recommend that travelers with hepatitis returning from endemic areas receive testing, and that pregnant women with HEV genotype 1 or 2 should receive care in a high-dependency setting and transferred to a liver transplant unit if liver failure occurs.
General recommendations from the guideline include testing for HEV in all patients with symptoms of acute hepatitis, patients with unexplained flares of chronic liver disease, and patients with immunosuppression with unexplained abnormal liver function tests.
The researchers recommend combination serology and nucleic acid amplification technique (NAT) testing to diagnose HEV and NAT testing for chronic HEV. The researchers also recommend antiviral treatment for patients with HEV and associated glomerular disease. Ribavirin may be considered in cases of severe acute HEV or acute-on-chronic liver failure; however, the researchers noted that very few case reports are available on ribavirin for severe acute HEV. Acute HEV, on the other hand, does not usually require antiviral therapy.
Patients who present with HEV should receive testing for proteinuria. Those who develop new onset proteinuria may require a renal biopsy.
Regarding prevention, the researchers advise that consumption of undercooked meat from pigs, wild boar and deer have been identified as risk factors for HEV infection in Europe. Patient-to-patient transmission is poorly defined and requires further study.
A vaccine licensed in China in 2011 showed an efficacy of 97% in preventing episodes of symptomatic acute hepatitis and proved long-term efficacy during follow-up. The vaccine is not currently licensed outside of China, but efforts are currently underway to obtain WHO prequalification for emergency settings.
"Our understanding of HEV infection has completely changed in the last decade," the researchers wrote. "There are still many knowledge gaps, and it is likely that as answers to these questions become available, these [guidelines] will require amendment in a few years' time." - by Talitha Bennett
Disclosure: Dalton reports grant support from the British Medical Association; consultant or advisory roles with Roche, Gilead, Wantai, Merck; delivery of sponsored lectures for the Gates Foundation; and is the co-holder of patent Kernow CIPG with the National Institutes of Health and others. Please see the full study for the other authors' relevant financial disclosures.
-- Edited by Tig on Friday 6th of April 2018 02:14:25 PM
Helio
Evidence supports link between hepatitis E, nerve disorder
Dalton HR, et al. J Hepatol. 2017;doi:10.1016/j.jhep.2017.07.010.
October 20, 2017
Certain European patients who presented with nontraumatic neurologic injury had evidence of hepatitis E. These patients showed similarities to other HEV-associated cases of neuralgic amyotrophy, suggesting a causal relationship, according to the researchers.
"My colleagues and I have noticed, we find some patients presenting primarily with a neurological illness who don't have much in the way of abnormality in the liver blood test," Harry R. Dalton, MD, from the University of Exeter, United Kingdom, told Healio.com/Hepatology. "This study was exploring the notion of hepatitis E virus being misnamed, because these patients have a profound neurological injury, but not much of a hepatitis - it was a preliminary study looking at whether this virus might be neurotropic or not. And there is some laboratory evidence to support that it might be."
The cohort comprised 464 patients enrolled from England, France, and the Netherlands. Mean patient age was 63 years (range, 17-99 years). Eleven patients had evidence of current or recent HEV infection, all genotype 3, and seven had HEV RNA recovered from serum.
"This was just a pilot study," Dalton said. "Basically, we called it 'operation blunderbuss' because it was a bit of a blunt instrument; we decided to test all-comers presenting with non-traumatic acute neurology to secondary care and test for hepatitis E."
The researchers observed several neurological events among those with evidence of HEV, including cerebrovascular accident (n = 4), neuralgic amyotrophy (n = 3), seizure (n = 3), encephalitis (n = 1) and cranial nerve palsies (n = 1).
Lasting neurological outcomes included minor sensory deficit, residual visual field defect, residual functional deficits, residual tinnitus, residual right-sided weakness, residual left-sided weakness and minimal deficits at 6 months, among seven patients, respectively. Regarding the other four patients, one recovered, one recovered completely, one returned to work after 6 months, and one recovered with recurrence at 6 months.
According to the researchers, the prevalence of HEV viremia in the cohort was 1.5%, which was at least 10 times higher than the prevalence recently documented in blood donors in England (0.035%), France (0.045%) and the Netherlands (0.17%).
The three patients with neuralgic amyotrophy and HEV had detectable HEV viremia at presentation. All three patients had bilateral asymmetrical involvement in the brachial plexus, which was previously associated with neuralgic amyotrophy in patients with HEV.
"In all patients with neuralgic amyotrophy, all patients with Guillain-Barré syndrome,and all patients with encephalitis, they should have their hepatitis E status checked, irrespective of their liver blood test abnormalities," Dalton concluded. "In other patients with neurology, I think it would be wise to consider it because we have not completely pinned it down what conditions might be associated to an all-cause. I think in the first three conditions I mentioned, there is very good evidence for causality. Hepatitis E is not just a hepatotropic virus, it can cause neurologic injury, so beware." - by Talitha Bennett
Disclosure: Dalton reports he has received travel and accommodation costs and consultancy fees from GlaxoSmithKline, Wantai and Roche; travel, accommodation and lecture fees from Merck, Gilead and GFE Blut GmBh; travel and accommodation fees from the Gates Foundation and Médecins Sans Frontières; and a grant from BMA. Please see the full study for the other authors' relevant financial disclosures.
High hepatitis E incidence in Germany linked to raw pork intake
Westhölter D, et al. J Hepatol. 2018;doi:10.1016/j.jhep.2018.02.031.
March 26, 2018
Researchers found a relatively high prevalence of hepatitis E viremia (0.12%) among blood donors in Germany. Further, consumption of raw pork tartare by this group represented a significant relevant risk for infection, according to a recently published study.
"Consumption of pork meat has been considered to be the major source of HEV genotype 3 infections in Europe. In addition to zoonotic transmission, blood products were shown to be a potential source of acute and chronic HEV-infection in industrialized countries," Dirk Westhölter, MS, from the University Medical Center Hamburg-Eppendorf, Germany, and colleagues wrote. "The aim of the present study was to determine the prevalence of bloodborne HEV-infections at our academic tertiary care center in Northern Germany and to evaluate whether routine HEV testing of blood products should be performed."
Between October 2016 and May 2017, the researchers prospectively tested 18,737 blood donations received within Westhölter's institution for HEV and detected 23 asymptomatic donors.
Retrospective analysis showed that four of the asymptomatic donors tested positive in stored samples from previous blood donations. These products were transfused into a total of 14 patients, most of whom died prior to confirming HEV viremia; however, the researchers did confirm two recipients who became infected after transfusion with the infected blood products.
Eighteen of the asymptomatic donors participated in a standardized questionnaire to assess exposure to possible sources of HEV. Sixteen reported regular consumption of pork and 12 reported consumption of raw pork tartare within two months prior to donation. Additionally, two donors ate undercooked pork liver 4 weeks prior to donation. Residual meat stored at the donors' home tested positive for HEV-RNA at 6,200 IU/mL.
"In this study eating raw pork tartare (a traditional German dish) represented a relevant risk
for acquisition of HEV infection in blood donors in Northern Germany," the researchers wrote. "Domestic pigs are evidentially a major reservoir of HEV."
The researchers conducted a control cohort including 256 previously unselected blood donors who filled out the same questionnaire. In the control cohort, 87% regularly consumed pork and 35% had consumed pork tartare in the prior two months.
"While immunosuppressed patients should be regularly reminded to avoid consumption of raw and undercooked meat to lower the risk of foodborne infections, blood component therapy may be necessary and unpreventable in certain situations," the researchers concluded. "Our data suggest that routine HEV screening of blood products should be implemented at least at European tertiary care centers and at centers with a high proportion of immunosuppressed patients." - by Talitha Bennett
Disclosure: Westhölter reports no relevant financial disclosures. Please see the full study for the other authors relevant financial disclosures.
-- Edited by Tig on Friday 6th of April 2018 02:14:09 PM
Another article, just a smidchen more about Hep E. I wouldn't mind knowing more about these "possible" Hep E immunizations (in China), and or who are doing routine screenings for Hep E (and all other Heps) in all "industrialized" countries!
(hm, wish I hadn't put another lone post, about Hep E, over in About Hep E , I should have kept them all togther here!)
Published in Gastroenterology - Journal Scan / Review · December 20, 2017
Advances and Challenges in Hepatitis E Virus
Nature Reviews. Gastroenterology & Hepatology
TAKE-HOME MESSAGE
· The authors review the life cycle and statistics of hepatitis E virus infection, which was previously thought to only be a concern in developing nations but has now been increasingly reported in industrialized nations.
· They discuss animal and cell culture models of the disease and other platforms that are useful in studying viral hepatotropic pathogens.
Abstract
At least 20 million hepatitis E virus (HEV) infections occur annually, with >3 million symptomatic cases and ~60,000 fatalities. Hepatitis E is generally self-limiting, with a case fatality rate of 0.5-3% in young adults. However, it can cause up to 30% mortality in pregnant women in the third trimester and can become chronic in immunocompromised individuals, such as those receiving organ transplants or chemotherapy and individuals with HIV infection. HEV is transmitted primarily via the faecal-oral route and was previously thought to be a public health concern only in developing countries. It is now also being frequently reported in industrialized countries, where it is transmitted zoonotically or through organ transplantation or blood transfusions. Although a vaccine for HEV has been developed, it is only licensed in China. Additionally, no effective, non-teratogenic and specific treatments against HEV infections are currently available. Although progress has been made in characterizing HEV biology, the scarcity of adequate experimental platforms has hampered further research. In this Review, we focus on providing an update on the HEV life cycle. We will further discuss existing cell culture and animal models and highlight platforms that have proven to be useful and/or are emerging for studying other hepatotropic (viral) pathogens.
Nature Reviews. Gastroenterology & Hepatology - Hepatitis E Virus: Advances and Challenges
Nat Rev Gastroenterol Hepatol 2017 Nov 22;[EPub Ahead of Print], I Nimgaonkar, Q Ding, RE Schwartz, A Ploss
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Helio - From the Liver Meeting
Sarasar with Norvir effectively delays HDV progression, may clear virus
October 22, 2017
WASHINGTON - Combination therapy with Sarasar and Norvir in patients with hepatitis D effectively blocked hepatitis D virus production, regardless of Sarasar dose, according to a presentation at The Liver Meeting 2017. Longer treatment duration may clear the virus.
"Up to 20 million people worldwide are infected with hepatitis delta and the majority of them will develop cirrhosis within 5 to 10 years," Harel Dahari, PhD, from the division of hepatology at the Loyola University Medical Center, Illinois, said in his presentation. "And compared to HBV mono-infected patients, HDV-infected patients will have a higher risk for hepatic decompensation and the development of liver disease."
To confirm the efficacy of Sarasar (lonafarnib, Eiger BioPharmaceuticals) combined with Norvir (ritonavir, AbbVie) for HDV, the researchers conducted a study with a mathematical model that included data from the phase 2 LOWR HDV-3 study. The model also included hepatocyte proliferation to estimate HDV kinetic parameters and treatment efficacy in blocking viral production.
The researchers randomized 21 patients into six groups that received 50, 75, or 100 mg of Sarasar with 100 mg of Norvir daily for 24 weeks (n = 12) or 12 weeks of placebo followed by 12 weeks of treatment with Sarasar and Norvir (n = 9). Additionally, all patients received hepatitis B nucleos(t)ide analogue therapy.
Median patient age was 40, 60% of patients were men, and most patients were Caucasian and Asian, had elevated alanine aminotransferase levels, and had mild fibrosis.
The researchers observed the following viral kinetic patterns among the groups:
· a rapid virus load decline that was followed by a phase in which the virus load decayed slowly or remained constant and a third phase of renewed viral decay;
· a flat partial response that consisted of rapid virus load decline followed by a lower set point of viral load;
· a pattern of virus rebound, in which the flat partial response or the three-point phase were followed by a rebound in viral load due to a varying effectiveness of the drug; and
· non-response (patients were excluded from modeling).
Results of the model showed a delay of HDV production (median, 8.5 days), in which viral load remained at pre-treatment levels, and that Sarasar with Norvir had a 95% efficacy in blocking HDV production, regardless of Sarasar dose. Viral rebound was due to a decline in treatment efficacy from approximately 95% to approximately 50% after 28 to 137 days after treatment started.
According to Dahari, the model suggests treatment for 51 weeks in those with the three-phase response, treatment for 52 weeks in those with the flat partial response, and treatment for 94 weeks in those with a pattern of virus rebound.
"Lonafarnib and rotanovir were safe and generally well-tolerated," Dahari said. "The model was able to reproduce the observed viral HBS antigen and ALT kinetics in each patient and provide an insight into viral response to the drug." - by Talitha Bennett
Reference:
Dahari H, et al. Abstract 38. Presented at: The Liver Meeting; Oct. 20-24, 2017;
Starting to resemble Alphabet Soup! That Michael Jackson song is now rattling in my head! ABC it's easy as 1, 2, 3 , Do Ra Me or something like that.... Thanks for that, lol!
-- Edited by Tig on Friday 6th of April 2018 02:10:28 PM
See also "About Hep D".
As "rare" as these "other" types of hepatitis's are (like the incidence of Hep E say being found in North Americians), we will continue to find articles and studies attesting to the need for better/further study/consideration of various hepatitis's that exist in the world and their risks to us, in a global light.
Never say never, especially if people are not screened or fully screened for ALL types of hepatitis's.
Even within this article on Hep E, the study data shown of those found with having, or of having had Hep E, is very small.
Evidence supports link between hepatitis E, nerve disorder
Dalton HR, et al. J Hepatol. 2017;doi:10.1016/j.jhep.2017.07.010. October 20, 2017 - Helio
Certain European patients who presented with nontraumatic neurologic injury had evidence of hepatitis E. These patients showed similarities to other HEV-associated cases of neuralgic amyotrophy, suggesting a causal relationship, according to the researchers.
"My colleagues and I have noticed, we find some patients presenting primarily with a neurological illness who don't have much in the way of abnormality in the liver blood test," Harry R. Dalton, MD, from the University of Exeter, United Kingdom, told Healio.com/Hepatology. "This study was exploring the notion of hepatitis E virus being misnamed, because these patients have a profound neurological injury, but not much of a hepatitis - it was a preliminary study looking at whether this virus might be neurotropic or not. And there is some laboratory evidence to support that it might be."
The cohort comprised 464 patients enrolled from England, France, and the Netherlands. Mean patient age was 63 years (range, 17-99 years). Eleven patients had evidence of current or recent HEV infection, all genotype 3, and seven had HEV RNA recovered from serum.
"This was just a pilot study," Dalton said. "Basically, we called it 'operation blunderbuss' because it was a bit of a blunt instrument; we decided to test all-comers presenting with non-traumatic acute neurology to secondary care and test for hepatitis E."
The researchers observed several neurological events among those with evidence of HEV, including cerebrovascular accident (n = 4), neuralgic amyotrophy (n = 3), seizure (n = 3), encephalitis (n = 1) and cranial nerve palsies (n = 1).
Lasting neurological outcomes included minor sensory deficit, residual visual field defect, residual functional deficits, residual tinnitus, residual right-sided weakness, residual left-sided weakness and minimal deficits at 6 months, among seven patients, respectively. Regarding the other four patients, one recovered, one recovered completely, one returned to work after 6 months, and one recovered with recurrence at 6 months.
According to the researchers, the prevalence of HEV viremia in the cohort was 1.5%, which was at least 10 times higher than the prevalence recently documented in blood donors in England (0.035%), France (0.045%) and the Netherlands (0.17%).
The three patients with neuralgic amyotrophy and HEV had detectable HEV viremia at presentation. All three patients had bilateral asymmetrical involvement in the brachial plexus, which was previously associated with neuralgic amyotrophy in patients with HEV.
"In all patients with neuralgic amyotrophy, all patients with Guillain-Barré syndrome,and all patients with encephalitis, they should have their hepatitis E status checked, irrespective of their liver blood test abnormalities," Dalton concluded. "In other patients with neurology, I think it would be wise to consider it because we have not completely pinned it down what conditions might be associated to an all-cause. I think in the first three conditions I mentioned, there is very good evidence for causality. Hepatitis E is not just a hepatotropic virus, it can cause neurologic injury, so beware." - by Talitha Bennett
Further info on Hep E - http://www.journal-of-hepatology.eu/article/S0168-8278(16)30692-4/fulltext
About Hep D
Being that we are mostly concerned with Hep C on this site, it is not to say that we don't also need to be aware every other kind if potential insult/infection/another kind of hepatitis that we could possibly get or be exposed to, no matter how slim that event may be.
Around the world many types of hepatitis(s) are found, and the world is getting smaller every day with more of us in it and moving about on it! Hep E, for instance, may be more of a risk to North Americans than it used to be. Outbreaks of Hep A can happen just about anywhere! Hep E, spread mostly much like Hep A, is not seen a lot in North America as it is in other countries. Some countries still remain to boast a high prevelance of Hep B (and with it can come D). this side of the ocean maybe only something like 5% of B's may also have D, but other countries it is up to 40% of the B's who can also be having D.
In North America, when we are being routinely tested for Hep C, we are quite used to being additionally screened for HIV, Hep A and B. We DO find Hep C people co-infected with HIV, and/or Hep C people co-infected with various other tyes of hepatitis, mostly Hep B. HIV people can be found co-infected with Hep C and Hep B. Just a disaster to add a Hep A to any infection you are currently owning or battling! It should be said, that it is withing the realm of possibility to also have any of the other assorted types of hepatitis that are out there!
Feeling "safe" in a first world country, or, it being considered "unlikely" we may be harbouring another types of hepatitis (that are not so common), docs do not even test for some of the less commonly found Heps!
We have lots to choose from - 5 main types of Hep exist - A,B,C,D and E, but, there is also F and G, G being investigated as to what true type of hep it is.
By now, most of us who are familiar with having Hep C, understand well, the importance of not having a co-infection to complicate things. If you have Hep C, be checked and immunized (or re-immunized if required) against A and B. Such a simply thing to do, to try to protect yourself from having a secondary liver infection on top of what you have going on!
If you, or your family, in the past, have lived in other countries, let your doc know.
Get tested, get diagnosed, be immunized - important to know/treat, and/or prevent other infections if we can possibly decrease the risk of any other harms to befall us, our health and livers.
If you have Hep B, be sure you are tested (for everything) including Hep D - Hep B and D can go hand in hand.
Just a disaster waiting to happen, for an unimmunized (or under-immunized) person (who has Hep C) to be wandering around this glorious bad ole world, bumping Hep A or B, and aquiring one of those as well. One disease at a time is quite enough.
FDA grants orphan drug designation to Lambda for HDV - September 11, 2017 - Helio
FDA granted orphan drug designation to Eiger BioPharmaceuticals for its pegylated interferon lambda 1a, known as Lambda, to treat chronic hepatitis delta virus infection, according to a press release.
Lambda, a top, late-stage type III interferon, stimulates immune responses that help develop host protection during viral infections by targeting specific receptors, according to the press release. These specific type III interferon receptors are expressed on hepatocytes with limited expression on hematopoietic and central nervous system cells, which can decrease off-target effects and increase tolerability of Lambda, per the release. Further, Lambda does not use the IFN alfa receptor, which targets type 1 interferon receptors, but signaling through either the IFN Lambda or IFN alfa receptor complexes causes the activation of the same Jak-STAT signal transduction cascade.
Researchers have administered this potential HDV treatment in hepatitis B virus/HCV clinical trials involving more than 3,000 patients, but it has not received approval for any indication, per the press release.
The designation of this potential HDV therapy correlates with the FDA Office of Orphan Products Development's mission to advance the development of products and therapies that show promise for diagnosing and treating rare diseases, per the release.
Reference: www.eigerbio.com
About Hep E - (excerpts from Gastroenterology - Journal Scan / Review - July 26, 2017)
Comprehensive Review of the Hepatitis E Virus
TAKE-HOME MESSAGE
· Hepatitis E virus is a growing problem that is not just limited to the developing world but is increasingly being locally acquired in developed countries. This review discusses the current understanding of hepatitis E virus, from molecular biology to diagnostic and therapeutic interventions. The authors also propose future directions for basic and clinical research.
BACKGROUND
Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure.
RESULTS
There has been increasing recognition of autochthonous HEV infection in Western countries, mainly associated with genotype 3. Chronic HEV infection has been recognised since 2008, and in transplant recipients this may lead to cirrhosis and organ failure. Modes of transmission include food-borne transmission, transfusion of blood products and solid organ transplantation. Ribavirin therapy is used to treat patients with chronic HEV infection, but new therapies are required as there have been reports of treatment failure with ribavirin.
CONCLUSIONS
Autochthonous HEV infection is a clinical issue with increasing burden. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.
I was reading a few other articles about hep E, and treatment of, and of some of the riba based treatments that were done to cure the person's Hep E, and the riba therapy, surprizingly, had quite short time frames to effect a cure and eradicate the E from the body!