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...