Furthermore, whether liver disease can indeed result from these occult HBV infections is controversial. At present, there are no convincing studies in support of a causal relationship. Therefore, these occult HBV infections, other than the special situations described above, may not be clinically important. How does HBV establish productive infection in vivo and what is the host response early during the infection?
Despite well-described information on the clinical manifestations and natural history of acute HBV infection, detailed knowledge of the virus-host interaction during this stage remains poorly defined. Advances in this area would offer a better understanding of the pathogenesis of HBV infection and its associated disease. What is the immunologic basis of chronic infection and hepatocellular injury?
There have been great strides in understanding the virology and immune response of HBV infection, but the molecular mechanisms whereby the host fails to clear the virus and develops chronic infection remain largely unknown. In addition, the adaptive evolution of virus under host immune pressure remains to be elucidated.
Finally, the pathogenesis of various extra-hepatic manifestations associated with HBV infection is poorly understood. Further research in these areas is crucial not only in better understanding the natural history and disease progression but also in improving treatment for chronic hepatitis B. What is the genetic basis of the diverse clinical manifestations and disease outcomes of HBV infection?
With the recent advances in genetic and genomic medicine, there are increasing opportunities to elucidate the genetic basis for variations in expression and susceptibility to HBV-associated diseases.
Genome-wide association studies and other genomic technological advances would provide crucial information to identify useful genetic markers for disease outcome, clinical manifestations, and treatment response of HBV-associated disease.
Potential conflict of interest: Nothing to report. National Center for Biotechnology Information , U. Author manuscript; available in PMC Jan Jake Liang. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Hepatology.
See other articles in PMC that cite the published article. Abstract Hepatitis B virus HBV infects more than million people worldwide and is a common cause of liver disease and liver cancer. Open in a separate window.
Diagnosis and Serology HBV infection leads to a wide spectrum of liver disease ranging from acute hepatitis including fulminant hepatic failure to chronic hepatitis, cirrhosis, and hepatocellular carcinoma HCC. The clinical course and serologic profiles of A acute and B chronic hepatitis B. Acute Hepatitis B About two-thirds of patients with acute HBV infection have a mild, asymptomatic and subclinical illness that usually goes undetected.
Chronic Hepatitis B Chronic hepatitis B has a variable and dynamic course. Important Questions and Needs for Future Research How does HBV establish productive infection in vivo and what is the host response early during the infection?
Footnotes Potential conflict of interest: Nothing to report. References 1. Ganem D, Schneider RJ. Hepadnaviridae and their replication. Fields Virology. Hepatitis B virus. Structure of hepatitis B surface antigen: characterization of the lipid components and their association with the viral proteins.
J Biol Chem. Gerlich W, Robinson WS. J Virol. Milich D, Liang TJ. Exploring the biological basis of hepatitis B e antigen in hepatitis B virus infection. X-deficient woodchuck hepatitis virus mutants behave like attenuated viruses and induce protective immunity in vivo.
J Clin Invest. Altered proteolysis and global gene expression in hepatitis B virus X transgenic mouse liver. The enigmatic X gene of hepatitis B virus. Genetic and biochemical evidence for the hepatitis B virus replication strategy. Yee J. A liver-specific enhancer in the core promoter region of human hepatitis B virus. Hepatitis B virus DNA contains a glucocortcoid response element. Huang J, Liang TJ. Mol Cell Biol.
Klingmuller U, Schaller H. Hepadnavirus infection requires interaction between the viral pre-S domain and a specific hepatocellular receptor.
Carboxypeptidase D gp , a Golgi-resident protein, functions in the attachment and entry of avian hepatitis B viruses. Phosphorylation of hepatitis B virus Cp at Ser87 facilitates core assembly.
Biochem J. Kock J, Schilicht H-J. Analysis of the earliest steps of hepadnavirus replication genome repair after infectious entry into hepatocytes does not depend on viral polymerase activity.
Internal entry of ribosomes and ribosomal scanning involved in hepatitis B virus P gene expression. The preS1 protein of hepatitis B virus is acylated at its amino terminus with myristic acid.
Pollack J, Ganem D. Replication strategy of human hepatitis B virus. Viral hepatitis, type B. Studies on natural history and prevention re-examined. N Engl J Med. Liang TJ, Ghany M. Hepatitis B e antigen—the dangerous endgame of hepatitis B. Antibody to hepatitis B core antigen in blood donors with a history of hepatitis. Anti-hepatitis B core immunoglobulin M in the serologic evaluation of hepatitis B virus infection and simultaneous infection with type B, delta agent, and non-A, non-B viruses.
Virologic monitoring of hepatitis B virus therapy in clinical trials and practice: recommendations for a standardized approach. The unique features of the HBV replication cycle confer a distinct ability of the virus to persist in infected cells. Virological and serological assays have been developed for diagnosis of various forms of HBV-associated disease and for treatment of chronic hepatitis B infection. HBV infection leads to a wide spectrum of liver disease ranging from acute including fulminant hepatic failure to chronic hepatitis, cirrhosis, and hepatocellular carcinoma.
The sero-prevalence of hepatitis B infection among pregnant women found by this study is higher than study findings of four studies from Ethiopia. The reasons stated here above for the difference in prevalence of the infection among pregnant women in developing countries are cited by some studies as reasons for the difference of the prevalence in their studies. Among many possible factors affecting prevalence of hepatitis B infection among pregnant women tested for the association in this study, history of abortion and history of tattooing were statistically significant both under bivariate and multivariate logistic regression analysis.
This indicates having history of tattooing and abortion makes the women most susceptible for the infection. However, this finding contradicts a study from the northwestern part of Ethiopia.
Further, according to the findings of this study women having history of tattooing and abortion were more likely to be infected by hepatitis B among the pregnant women participating in the study. Additionally, they may use unclean materials for the procedure.
Further, in regard to the history of abortion, this finding is in line with a study from the southern part of Ethiopia. However, the findings of that study contradicts our findings with the history of tattooing. According to the findings of this study, para-gravid women in respect to their pregnancy number were more likely to be infected by hepatitis B compared to the primi-gravid pregnant women. This may be due to the higher number of visits to the hospital making them susceptible for hospital-acquired infection, lowering of immunity as compared to the younger pregnant women.
The findings of this study with regard to the infection level among para-gravid pregnant women contradicts those of a study from the southern part of Ethiopia. This may be due to the difference in awareness level of the infection among the study participants, difference in sample size of the study, season of the study, method used to investigate the sero-prevalence of the study.
This may be due to the employed study participants having good awareness about the transmission and prevention route of the disease compared to the unemployed pregnant women participating in the study. The most probable reason for good awareness of the transmission and prevention method of the disease among employed pregnant women participating in the study was their higher educational level compared to unemployed pregnant women participating in the study.
This finding is in line with the study from the southern part of Ethiopia. Therefore, it is important to regularly monitor the infection level among pregnant women and employ influencing factors that help prevent and control the infection among these most vulnerable populations.
Although the study was conducted in a single institution, the study contributes significant information for policy makers, government officers, researchers and nongovernmental stakeholders participating in the control and prevention of the disease.
This cross-sectional study cannot determine cause and effect. Timing of the study period is also a limitation of the study as results are limited by the cross-sectional time period. The information obtained from mothers could be subject to recall bias, social acceptability bias, interviewer bias, and responder bias.
Maternal health is a basic concern for the global community. Therefore, the global community including the World Health Organization is striving to consistently maintain health for women; however, it still needs strong attention. This study concluded that the prevalence of hepatitis B infection among pregnant women participating in this study is at the cut-off point of higher-level hepatitis endemicity. The authors thank Addis Ababa University for their financial support and Addis Ababa Health Bureau for providing permission to conduct the study.
We would also like to thank all study participants, data collectors and supervisors. The study was funded by the Addis Ababa University postgraduate office. However, the funding organization had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. The datasets for the study are available from the corresponding author on reasonable request.
Permission to conduct the study was obtained from the concerned office. Participants of the study were informed about the objective of the study and asked to provide informed voluntary written consent. Further, assent was taken from her husband for those whose age was less than 18 years.
To keep the confidentiality of any information provided by study subjects, the data collection procedure was anonymous.
The authors declare that they do not have any conflicts of interest in this work. National Center for Biotechnology Information , U. Int J Womens Health.
Published online Jan Hailay Kinfe 1 St. Author information Article notes Copyright and License information Disclaimer. Petros Hospital, Addis Ababa, Ethiopia.
Received Sep 7; Accepted Dec This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms.
Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4. This article has been cited by other articles in PMC. Abstract Background Hepatitis B infection is among the most common public health concerns globally, particularly in low- and middle-income countries.
Methods nstitution-based cross-sectional study design and a structured face-to-face interview were used to collect data from the study participants. Results The overall prevalence of hepatitis B virus infection among the study participants was 9. Conclusion A significant number of pregnant women participating in the study were infected by the hepatitis B virus which needs efficient intervention to reduce the infection rate. Keywords: pregnancy, hepatitis B infection, hepatitis B virus, Ethiopia.
Background Hepatitis B infection is among the leading public health problems globally. Methods Study Setting and Period The study was conducted at Adigrat general hospital, which is found in Tigray regional state in the northern part of Ethiopia.
Study Design and Sample Size Determination Institutional-based cross-sectional study design was used to examine the prevalence and factors associated with hepatitis B infection among pregnant women attending the ANC clinic at Adigrat General Hospital. Study Subjects and Sampling Procedure In the normal maternal care procedure of the hospital, pregnant women were triaged and assigned to the clinic as a routine service delivery procedure in the antenatal care clinic of the hospital.
Data Collection Procedure and Quality Control Socio-demographic and other pertinent data were collected by trained data collectors using a pre-tested standard questionnaire adapted from study conducted in Ethiopia. Ethical Considerations The study was conducted based on the human research ethics declaration of Helsinki Data Analysis After checking for completeness and consistency of the collected information, the data were entered into EpiData version 3.
Results Socio-Demographic Characteristics of the Study Participants The majority of the study participants were in the age category of 15—34 years. Open in a separate window. Figure 1. Factors Associated with Hepatitis B Virus Infection In order to measure association of variables with dependent variable prevalence of hepatitis B virus infection, we used both bivariable and multivariable logistic regression analysis with significance level of less than 0.
Discussion Indisputably, infection secondary to hepatitis B virus is the major public health problem globally, and is a leading cause of chronic hepatitis in low- and middle-income countries.
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