Vaccine nonresponse and its management

Among individuals who do not respond to the initial series of hepatitis B vaccine, half may convert after an additional one to three doses 60,85 . Hypo-responders are more likely to seroconvert than nonresponders 86 . The use of investigational mix-particle vaccines containing pre-Sl, pre-S2, and S subunits does not enhance the seroconversion rate achieved by a standard S-unit vaccine of equivalent dosage 87 . Likewise, doubling administered doses for revaccination does not confer any...

Serologic diagnosis of hepatitis B virus

Serologic diagnosis of HBV can be accomplished by identifying virally encoded antigens and their corresponding antibodies HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc. (HBcAg does not circulate freely in the serum Table 1 .) HBsAg, a product of the S gene, is part of the surface envelope of HBV and also circulates in excess ( 1013 particles mL) in the serum as non-virion associated spheres and tubules 7 . HBsAg is the first marker of acute HBV infection and appears as early as 1 week after...

Nonstructural NS

The 9.6-kb (+) strand RNA genome is translated beginning from an IRES into a single polyprotein (indicated by a box), 5' and 3' non-coding regions contain RNA elements required for genome replication. Individual proteins are liberated by a combination of host signal peptidase (N-terminal cleavages) and viral protease activity (indicated by arrows above polyprotein). Known activities of selected proteins are indicated below them. a lipid envelope in which the two...

Prevention

Primary prevention of hepatitis C and B virus infection through control of high-risk behavior (eg, intravenous drug use), adequate screening of blood products, and vaccination are likely to be highly effective if such programs and policies were to be widely implemented. The annual incidence of hepatitis C infection has fallen in the United States since the 1970s, when intravenous drug use was more widespread and screening tests for hepatitis C were unavailable. The AIDS epidemic seems to have...

Predictors of nonresponse

An anti-HBs level of > 10 mlU mL is regarded as a protective serum titer. Patients with certain clinical characteristics may have a lesser chance to sero-convert than others. In a retrospective multicenter cohort study of nearly 600 health care workers who underwent postvaccination testing for anti-HBs within 6 months after completion of vaccine series, five independent variables were identified by multivariate analysis as adverse prognostic factors for sero-conversion 45 , These predictors...

T3

Data from Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. J Hepatol 2001 35 421-30. Data from Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL Conference. J Hepatol 2001 35 421-30. accrued waiting time were ranked higher. As waiting times lengthened through the late 1990s, intention-to-treat survival for HCC patients listed for...

Antiviral Therapy for Treatment Naive Patients with Hepatitis C Virus

Afdhal, MDab* aDepartment of Medicine, Harvard Medical School, 25 Shattack Street, Boston, MA 02115, USA hThe Liver Center, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 8E, Boston, MA 02215, USA Chronic hepatitis C virus (HCV) infection is recognized as a global health problem, with 170 to 200 million people estimated to be infected worldwide. In the United States, chronic HCV is the most common cause of end-stage liver disease, hepatocellular...

Info

Abbreviations AR, acute rejection D C, discontinuation F U, follow-up time HAI, hepatic activity index IFN, interferon LDLT, living donor liver transplant recipient MU, million units PEGIFN, pegylated interferon RBV, ribavirin RCT, randomized controlled trial Rx, treatment SVR, sustained virologic response UN, uncontrolled trial. cytopenias and maintain optimal doses of antiviral treatment are likely to be important in maximizing responses to therapy. Preclinical and retrospective cohort data...

References

Clinical and histopathological variation in hepatocellular carcinoma. Am J Gastroenterol 1995 90 15-23. 2 Di Bisceglie AM. Epidemiology and clinical presentation of hepatocellular carcinoma. J Vasc Interv Radiol 2002 13 S169-71. 3 Kato Y, Tanaka N, Kobayashi K, Ikeda T, Hattori N, Nonomura A. Growth of hepatocellular carcinoma into the right atrium. Report of five cases. Ann Intern Med 1983 99 472-4. 4 Gebo KA, Chander G, Jenckes MW, Ghanem KG, Herlong HF, Torbenson MS,...

Box 2 Risk factors associated with poor antiHBs response to hepatitis B vaccine

Immunocompromised from chronic disease nonresponders mounted an appreciable anti-HBs titer. When nine of the 12 refractory nonresponders were sampled, six of them carried at least one of two extended major histocompatibility complex (MHC) HLA haplotypes B44-DR7-FC31 or B8-DR3-SC01. In contrast, only two of the 11 revaccinees sampled who responded to the second vaccine series carried these haplotypes, suggesting a genetic contribution to immuno-genicity 52 . In a large series of nearly 600...

Approach to the Management of Patients with Chronic Hepatitis C Who Failed to Achieve Sustained Virologie Response

Shiffman, MD* Hepatology Section, Virginia Commonwealth University Medical Center, Box 980341, Richmond, VA 23298. USA Therapy for chronic hepatitis C virus (HCV) infection has improved dramatically since interferon (IFN) was first introduced for treatment of non-A, non-B hepatitis over 15 years ago 1-3 . Historically, standard IFN monotherapy yielded a sustained virologic response (SVR) in less than 15 of patients. The addition of ribavirin (RBV) 4,5 , and later...

Routes of vaccine administration

Hepatitis B vaccine is traditionally administered intramuscularly, using a needle of 1.0 to 1.5 inches in length and 20- to 25-gauge in caliber. The preferred injection site is the deltoid muscle in adults and anterolateral thigh muscle in infants. Among 194 health care workers who received intramuscular buttock injections of hepatitis B vaccination, only 58 subsequently developed detectable anti-HBs titers 36 . This finding was verified by a prospective randomized trial where health care...

Prevaccination screening and isolated antibody to hepatitis B core antigen

Prevaccination screening may be cost effective when the expected prevalence of prior HBV infection exceeds 30 10 , such as in the high-risk adult populations for whom hepatitis B vaccine is indicated. Occasionally potential recipients of hepatitis B vaccine test positive for antibody to hepatitis B core antigen anti-HBc but negative for both HBsAg and anti-HBs. Isolated anti-HBc may be found due to suppression of HBV replication by hepatitis C virus in co-infected patients 21,22 , or in the...

Na

Abbreviations AR, acute rejection CR, chronic rejection CT, controlled trail F U, follow-up time IFN, interferon MU, million units N, number NA, not available PEGIFN, pegylated interferon RBV, ribavirin RCT, randomized controlled trail UC, uncontrolled trail. a Limited to studies with gt 20 patients. b Only randomized study with untreated control group. c 0 in untreated group. for retransplantation for HCV and non-HCV etiologies include outcome measures, such as predicted survival after...

Molecular diagnosis of hepatitis B virus

Molecular Diagnosis Viral Hepatitis

Clinical applications of hepatitis B virus DNA assays The diagnosis of acute and chronic HBV infection can be made using the serologic tests described previously. However, the ability to perform quantitative tests in serum for HBV DNA is useful in several settings 1 to diagnose some cases of acute HBV infection 2 to distinguish replicative from non-replicative chronic HBV infection and 3 to monitor a patient's response to antiviral therapy. Determination of the HBV genotype will likely be used...

Marc G Ghany MDa Edward C Doo MDb

ALiver Diseases Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building 10, Room 9B-06, 10 Center Drive, MSC 1800, Bethesda, MD 29892-1800, USA bLiver Disease Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 6707 Democracy Boulevard, MSC 5450, Bethesda, MD 20892-5450, USA Infection with the hepatitis B virus HBV is a significant global public health problem. Over one third...