India: A=90+%, B=69%, C=2%, D=9%, E=10%, G=4%, HIV=0.82%, 4.1 mill, AIDS=1 mill

February 16, 2000

INDIA

--------

2nd most populated Nation on the Planet

1.018 billion people live in India

% of India's population with a virus

-----------------------------------------------

% Rate Number of People Infected

----------- --------------------------------------

HAV = 90% 900 million cases

HBV = 69% [past] 702 million "

HCV = 2% 10 million "

HDV = 9% 93 million "

HEV = 10% 102 million "

HGV = 4% 20 million "

TTV = NL N/A

------

Total = 184%

HIV = 0.82%

HIV = 4.1 million cases

AIDS = 1 million cases by 1998

Blood bank screening for HCV was not yet mandatory - Fall 99

HAV

------

Indian J Med Res 1999 Jan;109:11-5

Exposure of Indian children to hepatitis A virus & vaccination age.

Chadha MS, Chitambar SD, Shaikh NJ, Arankalle VA

National Institute of Virology (ICMR), Pune.

It is known that

90 per cent of children in India are exposed to (HAV) by the age of six

years.

The aim of the study was to determine when in early childhood maximum HAV

infections take place and to deduce an appropriate age for vaccination

against HAV. Blood samples of 499 children between the ages of three days

and six years were collected and tested for the presence of antibodies

against hepatitis A. A statistically significant negative correlation

between IgG anti-HAV and age was observed (P < 0.01) up to 11.67 months when

IgG anti-HAV positivity was found to be minimum (9.25%). Subsequently a

significant positive correlation was noted (P < 0.01). Exposure to HAV was

28.9 per cent soon after the waning of maternal antibodies in the 13-15

month age group which increased to 52.5 per cent by two years of age and

90.9 per cent by 6 yr.

It is concluded that in addition to other preventive measures, if children

in India are to be vaccinated against hepatitis A they should be immunised

against HAV by 9-10 months of age when the maternal antibodies disappear.

PMID: 10489736, UI: 99419582

HBV

------

Bull World Health Organ 1998;76(1):93-8

Outbreak of viral hepatitis B in a rural community in India linked to

inadequately sterilized needles and syringes.

Singh J, Bhatia R, Gandhi JC, Kaswekar AP, Khare S, Patel SB, Oza VB, Jain

DC, Sokhey J

National Institute of Communicable Diseases (NICD), Delhi, India.

In India, virtually all outbreaks of viral hepatitis are considered to be

due to faeco-orally transmitted hepatitis E virus. Recently, a cluster of 15

cases of viral hepatitis B was found in three villages in Gujarat State. The

cases were epidemiologically

linked to the use of inadequately sterilized needles and syringes

by a local unqualified medical practitioner. The outbreak evolved slowly

over a period of 3 months and was marked by a high case

fatality rate (46.7%),

probably because of concurrent infection with hepatitis D virus (HDV) or

sexually transmitted infections. But for the many fatalities within 2-3

weeks of the onset of illness, the outbreak would have gone unnoticed. The

findings emphasize the importance of inadequately sterilized needles and

syringes in the transmission of viral hepatitis B in India, the need to

strengthen the routine surveillance system, and to organize an education

campaign targeting all health care workers including private practitioners,

especially those working in rural areas, as well as the public at large, to

take all possible measures to prevent this often fatal infection.

Comments:

Comment in: Bull World Health Organ 1998 ;76(1):99-100

PMID: 9615501, UI: 98277735

Gut 1996;38 Suppl 2:S56-9

Epidemiology of hepatitis B virus infection in India.

Tandon BN, Acharya SK, Tandon A

Pushpawati Singhania Research Institute for Liver and Digestive Diseases,

New Delhi, India.

The average estimated

carrier rate of hepatitis B virus (HBV) in India is

4%, with a total pool of approximately 36 million carriers.

Wide variations in social, economic, and health factors in different regions

may explain variations in carrier rates from one part of the country to

another. Professional blood donors constitute the major high risk group for

HBV infection in India, with a hepatitis B surface antigen positivity rate

of 14%. Blood transfusions represent the most important route of HBV

transmission among adults. However, most of India's carrier pool is

established in early childhood, predominantly by horizontal spread due to

crowded living conditions and poor hygiene. Acute and subacute liver failure

are common complications of viral hepatitis in India and HBV is reckoned to

be the aetiological agent in 42% and 45% of adult cases, respectively. HBV

is reported to be responsible for 70% of cases of chronic hepatitis and 80%

of cases of cirrhosis of the liver. About 60% of patients with

hepatocellular carcinoma are HBV marker positive. Small numbers of patients

have been reported to be infected with the pre-core mutant virus but none

with the S mutant. Coinfection with hepatitis C virus or hepatitis delta

virus is comparatively uncommon. In conclusion, hepatitis

B is a major public health problem in India

and will continue to be until appropriate nationwide vaccination programmes

and other control measures are established. Publication Types: Review

Review, tutorial PMID: 8786056, UI: 96273435

Am J Gastroenterol 1996 Jul;91(7):1312-7

Frequency and clinical profile of precore and surface

hepatitis B mutants in Asian-Indian patients

with chronic liver disease.

Guptan RC, Thakur V, Sarin SK, Banerjee K, Khandekar P

Department of Gastroenterology, GB Pant Hospital, New Delhi, India.

BACKGROUND. Infection due to hepatitis B virus (HBV) could be due to wild or

mutant (precore or surface) viruses. The prevalence and clinical profile of

different viral forms in patients with chronic liver disease has not been

established. METHODS. One hundred and twenty patients with histologically

proven HBV-related chronic liver disease were studied. Patients with dual

infection with HCV/HDV/HIV, past history of interferon therapy, or

autoimmune hepatitis were excluded. Eighteen (15.5%) patients had the

precore mutation (HBsAg +ve, HBeAg -ve/anti-HBe +ve, HBV DNA +ve), and 13

(10.8%) had the surface gene mutations (HBsAg -ve, HBeAg -ve, IgG anti-HBc,

and HBV DNA +ve). The remaining 89 (74.2%) patients were infected with wild

type HBV. The course of all patients with mutant forms and 41 of those with

the wild type form was followed for a mean (+/- SD) of 4.4 +/- 2.4 yr.

RESULTS. Compared with wild-type-infected patients, those with surface

mutation were younger (39.9 +/- 14 vs. 30.1 +/- 12.4 yr, p < 0.05). Patients

with precore mutations had a shorter illness than those with surface mutant

(p < 0.01) and wild forms (p < 0.05). Histologically, patients with precore

type had more active liver disease than wild type (39% vs. 15%, p < 0.05).

Patients with precore mutations were always symptomatic, often presenting

with ascites (67%) and jaundice (55%). Patients with surface mutant forms

often presented with quiescent cirrhosis (77%) or cirrhosis with hepatoma

(15%). CONCLUSIONS.

One-fourth [25%] of HBV-related chronic liver disease in Asian Indians

is attributable to mutant HBV forms.

The presence of variant viruses alters the natural history of the disease,

with the precore variance having a more aggressive course and the surface

mutant, a more quiescent but unfavorable course, compared with the wild

type. Comments: Comment in: Am J Gastroenterol 1996 Jul;91(7):1297-8 PMID:

8677985, UI: 96280495

Vox Sang 1994;67(2):183-6

High prevalence of HBV infectivity in blood donors detected by the dot blot

hybridisation assay.

Nagaraju K, Misra S, Saraswat S, Choudhary N, Masih B, Ramesh V, Naik S

Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical

Sciences, Lucknow, India.

Hepatitis B virus (HBV) continues to be a significant cause for

post-transfusion hepatitis in India, in spite of the introduction of

compulsory hepatitis B surface antigen (HBsAg) screening. To understand the

true HBV-infective pool in the blood donor population, HBV DNA was detected

by a 32P-labelled dot blot hybridisation assay in 605 donor units that were

negative for HBsAg by a third-generation . Serum alanine

aminotransferase (ALT) was estimated in all these samples and correlated

with DNA positivity. The frequency of HBV DNA positivity in

HBsAg-negative units was very high (

9.91%

) and correlated well with the elevation in ALT (p < 0.00005). However, the

frequency of elevated ALT was high (11.9%), using the locally determined

upper limit of normal, and half of the DNA-positive samples had a normal

ALT. Thus, ALT is a poor surrogate marker for HBV infectivity and efforts

should be made to apply DNA detection systems in blood banks.

Publication Types:

Clinical trial

Randomized controlled trial

PMID: 7801609, UI: 95099843

Trop Anim Health Prod 1993 Nov;25(4):229-33

Duck hepatitis B virus (DHBV) infection in Indian domestic ducks: a pilot

study.

Sridhar G, Valliammai T, Varalakshmi CS, Udayasankar K, Panchanadam M,

Ramakrishna J, Gopal KV, Jayaraman K, Thyagarajan SP

Department of Microbiology, Dr A. L. M. Post Graduate Instute of Basic

Medical Sciences, Taramani, India.

One hundred and two apparently healthy Indian domestic ducks from the

Poultry Research Station, Madras were screened for duck hepatitis B virus

(DHBV) infection by; 1. screening for the duck hepatitis B virus surface

antigen (DHBsAg) in their sera using hepatitis B virus (HBV) reagents, 2.

screening for DHBsAg using specific duck hepatitis B virus (DHBV) reagents

and 3. demonstration of DHBV DNA using DHBV DNA probe by dot blot

hybridisation. While 5

ducks (4.9%) were consistently positive with HBV reagents,

use of DHBV reagents showed a total of 4 ducks (including 3 of the above 5)

to be positive for DHBsAg. DNA hybridisation showed 6 ducks to be positive

for DHBV DNA. On clinical examination, 5 out of these 6 ducks did not reveal

abnormalities, the other one showed hepatomegaly and ascites. Post-mortem

studies showed the presence of nodules on the surface of the liver in all 5

which were positive with HBV reagents including the one with hepatomegaly.

On histopathological evaluation, they were found to be hepatocellular

carcinoma with or without bile duct carcinoma. The present study is a pilot

report on the occurrence of DHBV infection in Indian domestic ducks and the

possibility of

antigenic cross reactivity between human HBV and duck hepatitis B virus

antigens.

PMID: 8109057, UI: 94152037

Indian J Med Res 1991 Nov;93:337-9

Prevalence of HBsAg & anti-HBs in children & strategy suggested for

immunisation in India.

Tandon BN, Irshad M, Raju M, Mathur GP, Rao MN

Department of Gastroenterology & Human Nutrition, All India Institute of

Medical Sciences, New Delhi.

The prevalence of HBsAg and anti-HBs was studied in sera from 982 children

of different age groups below 5 yr. HBsAg was detected in 0.9, 2.3, 4.1, 2.3

and 1.6 per cent children of 0-1, 2-6, 7-12, 13-36 and 37-60 months age

groups respectively.

Anti-HBs in these five groups was noted in

17.0, 12.9, 18.4, 14.2 and 13.7 per cent children, respectively.

The findings suggest that the carrier pool is built up in the preschool age

group, particularly, below the age of 6 months. Perinatal transmission and

the relative role of transplacental need re-evaluation. Cost analysis does

not permit inclusion of HBV in the Expanded Programme of Immunisation.

PMID: 1797638, UI: 92184286

Indian J Med Res 1991 May;93:143-6

Hepatitis B infection among dental personnel in Pune & Bombay (India).

Chobe LP, Chadha MS, Arankalle VA, Gogate SS, Banerjee K

National Institute of Virology, Pune.

To assess the risk of hepatitis B infection among dental personnel, serum

samples were collected from dentists of Pune and students, staff, auxiliary

staff and class D staff of a dental college in Bombay.

Dentists (32.02%),

dental auxiliary staff (35.89%),

clinical assistants and post-graduate students (19.56%)

were found to have significantly higher prevalence of HBV infection as

compared to undergraduate dental students (3.94%). The prevalence of HBV

infection was high among the dentists as compared to voluntary donors. A

positive linear association was observed in the positivity of HBV

seromarkers with increasing age and number of years spent by the workers in

the dental environment. The rate of increase in HBV seropositivity with age

was higher (P less than 0.05) among dental personnel when compared to

voluntary donors. Vaccination against hepatitis B is recommended for all the

dental students before they start their clinical phase and for susceptible

dentists and dental auxillary staff.

PMID: 1937590, UI: 92039828

J Commun Dis 1990 Jun;22(2):129-33

Incidence of different types of viral hepatitis in Delhi, Uttar Pradesh and

Rajasthan areas.

Sebastian M, Ichhpujani RL, Kumari S

National Institute of Communicable Diseases, Shamnath Marg, Delhi.

A total of 428 sera samples from patients of acute sporadic viral hepatitis

collected from Delhi (172), Uttar Pradesh (192) and Rajasthan (64) were

tested for Hepatitis A Virus (HAV) and Hepatitis B Virus (HBV) markers. Non

A non B was diagnosed by exclusion. The prevalence of HAV, HBV and non A non

B in such cases was almost comparable at three places. The prevalence of HAV

ranged between 15.7 and 20.3 per cent,

HBV between 41.3 and 51.6 per cent

while non A non B ranged between 28.1 and 43 per cent. The study signifies

the role of non A non B in non-epidemic situations.

PMID: 2129122, UI: 91277378

J Hepatol 1988 Oct;7(2):151-6

An epidemic of hepatitis D in the foothills of the Himalayas in south

Kashmir.

Khuroo MS, Zargar SA, Mahajan R, Javid G, Lal R

Department of Gastroenterology, Sher-i-Kashmir Institute of Medical

Sciences, India.

We have identified hepatitis D as an etiologic cause of an outbreak of

'hepatitis' in an endemic area for hepatitis B in South Kashmir, India.

Thirty-five of the 51 patients

[69%] with jaundice were hepatitis B virus carriers.

Twenty-two of the 24 such patients tested had hepatitis D (hepatitis D virus

superinfection). Two of the 3 patients with acute hepatitis B were

coinfected with hepatitis D virus (HDV). Thirty-six asymptomatic household

contacts of hepatitis D patients were assessed. Six were hepatitis B virus

carriers, 3 of whom had HDV superinfection. Two contacts had acute hepatitis

B, one with HDV coinfection. The disease occurred in adults with a mean age

of 28.2 +/- 10.5 years (range 10-56 years) and was equally distributed

between the sexes. Three patients with HDV superinfection presented with

fulminant hepatic failure with a fatal outcome. All the patients with

non-fulminant hepatitis D showed apparent clinical recovery. However, in the

subsequent follow-up at 4 years, 7 patients with HDV superinfection had

evidence of chronic hepatitis. One of these 7 patients died due to

progressive chronic liver disease.

PMID: 3057061, UI: 89054764

Increasing HBV reservoir by post-transfusion HBV infection in India.

Indian J Med Res. 1986 Aug;84:227-9. No abstract available.

PMID: 3759179; UI: 87006951.

N Z Med J 1985 Jul 10;98(782):529-32

Prevalence of hepatitis B infections in a multiracial New Zealand community.

Milne A, Allwood GK, Moyes CD, Pearce NE, Lucas CR

Plans to control hepatitis B virus (HBV) infections in a high risk mixed

race community, included the need for prevalence studies of HBV markers.

Accordingly 7901 subjects, 93% of the population of Kawerau, where European

and non-European children are present in almost equal numbers, were tested

for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs).

Positive HBsAg sera were titred and tested for hepatitis B e antigen

(HBeAg). Highest rates for HBsAg and anti-HBs combined, were found in the

15-19 year old age groups; 61.6% in Europeans and

74.5% in non-Europeans. [indians]

HBsAg prevalence was 4.2% and 18.2% respectively in the same groups.

Ninety-six point four percent of 503 HBsAg positives followed up were

confirmed as carriers. Infectivity as shown by HBeAg prevalence and HBsAg

titre was highest in 0-10 year olds and declined with age. Prevalences were

low in children aged less than one year old, suggesting that perinatal

transmission was not a major factor in childhood carriage. Therefore

attempts to control acquisition of carriage by vaccinating only those

children of HBeAg positive mothers are unlikely to be successful.

PMID: 3861964, UI: 85297071

HBV + HCV

----------------

Eur J Gastroenterol Hepatol 1999 Nov;11(11):1231-7

Hepatitis C virus infection in sporadic fulminant viral hepatitis in North

India: cause or co-factor?

Jain A, Kar P, Madan K, Das UP, Budhiraja S, Gopalkrishna V, Sharma JK, Das

BC

Department of Medicine, Maulana Azad Medical College, New Delhi, India.

INTRODUCTION: The role of hepatitis C virus (HCV) infection in fulminant

hepatitis (FH) is poorly understood and the available data are conflicting.

We have examined the aetiological role of HCV in 50 consecutive patients

with sporadic FH by employing serology and reverse transcription-polymerase

chain reaction (RT-PCR). MATERIALS AND METHODS: A total of 50 consecutive

patients with sporadic FH were included. After an initial clinical and

biochemical assessment, tests were performed for detection of HBsAg, IgM

anti-HBc, IgM anti-HAV, IgM anti-HEV and anti-HCV. RT-PCR was carried out

for detection of HCV RNA in sera of all the patients and in post mortem

liver biopsy tissue of 20 subjects, using primers selected from the

conserved 5' non-coding region of the HCV genome. RESULTS: Hepatitis E virus

(HEV) was found to be the most common viral infection (21/50; 42%) followed

by HBV (14/50; 28%), HCV (7/50; 14%) and HAV (2/50; 4%). No viral markers

could be detected in nine patients (18%) and multiple infections were seen

in seven (14%). Of the seven subjects who tested positive for HCV-related

markers, two had both anti-HCV and HCV RNA, three had HCV RNA alone and the

remaining two had anti-HCV alone.

Interestingly, all the HCV-infected subjects were co-infected

with other hepatotropic viruses and the

most common co-infecting agent was found to be HBV (5/7) [71%].

Liver tissue was available in 20 cases and HCV RNA was detected in three of

them. All of these patients were also positive for the viral genome in their

serum samples. Comparison of the biological attributes of HCV-positive and

HCV-negative cases revealed that haemorrhagic symptomatology (haematemesis,

melaena and purpurae) was significantly more common, prothrombin time more

deranged and mortality was much higher in the former group. The overall

mortality was 68% and the

most common cause of death was cerebral oedema (70.6%).

No significant correlation was observed between mortality and the duration

of the icterus-encephalopathy interval. The study included a total of 21

pregnant females; HEV infection was found to be significantly greater in

this group and was associated with a higher mortality rate. CONCLUSIONS: The

results clearly suggest that HCV is not an important aetiological factor for

FH in North India. However, it may act as a co-factor in the development of

FH leading to a higher mortality. HEV appears to contribute substantially to

the causation of sporadic FH in India and advanced stage pregnancy is a

potential risk factor for HEV-induced FH and high rate of mortality. Our

study also suggests that the length of the icterus-encephalopathy period may

not have significant prognostic implications in Indian patients with FH.

PMID: 10563532, UI: 20025056

Indian J Public Health 1998 Apr-Jun;42(2):56-8

Incidence of hepatitis B virus (HBV) infection amongst clinically diagnosed

acute viral hepatitis cases and relative risk of development of HBV

infection in high risk groups in Calcutta.

Hazra BR, Saha SK, Mazumder AK, Deb A, Sinha S

Department of Medicine, Medical College, Calcutta.

The present study revealed that 30.5% of acute infective hepatitis were due

to the infection of Hepatitis B virus (HBV) however, 8% controls also showed

HBV positivity. The possible route of infection of HBV in our country were

Parenteral in 51.9%, Sexual in 24% and Unidentified in 24.1% cases.

HBV marker positivity was

45.5% amongst health care workers

33.3% in recipients of multiple blood and blood product transfusion,

25% in sexual partners and their children,

20% in S.T.D. clinic attendants and

10% in patients on haemodialysis.

PMID: 10389512, UI: 99317743

Gastroenterol Jpn 1991 Jul;26 Suppl 3:192-5

Hepatitis C virus infection is the major cause of severe liver disease in

India.

Tandon BN, Irshad M, Acharya SK, Joshi YK

Department of Gastroenterology, All-India Institute of Medical Sciences, New

Delhi.

The present study describes the status of hepatitis C virus infection in 167

patients with severe forms of liver diseases in India. The anti-HCV

positivity rate was recorded as 43%, 47%, and 42% in patients with FHF,

SAHF, and CAH respectively.

HBV and HCV coinfection was recorded in

28% of FHF,

43% of SAHF and

75% of the CAH cases.

Superinfection of HCV in HBsAg carriers was

recorded in the 54% cases of FHF,

60% of SAHF and

42% of the CAH.

None of these 167 patients was positive of HAV-IgM. Further, 27.7% of FHF,

26.4% of SAHF and 15.2% of CAH cases were neither HBV nor HCV markers

positive. These can be labelled as non-A, non-B and non-C infections. PMID:

1909266, UI: 91357381

HCV

-------

Vox Sang 1999;77(1):6-10

Transfusion-associated hepatitis in a tertiary referral hospital in India. A

prospective study.

Saxena R, Thakur V, Sood B, Guptan RC, Gururaja S, Sarin SK

Department of Social and Preventive Medicine, Lady Hardinge Medical College

and Department of Gastroenterology, and Blood Bank, G.B. Pant Hospital, New

Delhi, India.

BACKGROUND AND OBJECTIVES: In

Indian blood banks, screening for hepatitis B virus (HBV) is currently done

by the EIA method, but

no routine screening is

done for hepatitis C virus (HCV).

MATERIALS AND METHODS: To determine the incidence of transfusion-associated

HCV hepatitis, and of any residual transfusion-associated hepatitis (TAH)

after HBsAg screening, we prospectively studied 182 patients who underwent

surgery and received blood transfusion. These recipients had normal alanine

aminotransferase (ALT) and were negative for HBsAg (monoclonal EIA), and

anti-HCV (third-generation EIA) before receiving transfusion. RESULTS: Of

the 818 blood units transfused after routine screening (average 4.49+/-3.3

U/patient, range 1-14), 14 (1.7% of units) were found to be infected. Of the

182 recipients, 14 (7.69%) developed TAH during a follow-up of 6 months, 3

(21.4%) from HBV, 10 (71.5%) from HCV, and 1 (1.7%) from a coinfection of

HBV and HCV. All patients with TAH due to HCV were asymptomatic. One patient

with TAH due to HBV (33%) and 5 with TAH due to HCV (50%) developed chronic

infection with persistently elevated ALT at 6 months. CONCLUSIONS: With the

current screening practices, the incidence of

TAH remains high in India and is mainly due to HCV infection.

Furthermore, the screening methods for HBV also need to be improved.

Publication Types:

Clinical trial

Controlled clinical trial

PMID: 10474084, UI: 99407044

J Med Virol 1997 Mar;51(3):167-74

Magnitude of hepatitis C virus infection in India: prevalence in healthy

blood donors, acute and chronic liver diseases.

Panigrahi AK, Panda SK, Dixit RK, Rao KV, Acharya SK, Dasarathy S, Nanu A

Department of Pathology, All India Institute of Medical Sciences (AIIMS) New

Delhi, India.

An enzyme immunoassay (EIA) was developed in-house for the detection of

anti-hepatitis C virus (HCV) antibody against the prevailing genotypes in

India.

The specific reactivity of the test was compared with commercial second and

third-generation EIAs and reverse transcription nested polymerase chain

reaction (RT-nested PCR). Fifteen thousand nine hundred twenty-two healthy

blood donors at the All India Institute of Medical Sciences (AIIMS), New

Delhi, India, were screened for anti-HCV antibody. Two hundred ninety-five (

1.85%) of these donors were positive.

The screening was also used to determine how many patients with acute

hepatitis and chronic liver diseases were positive for anti-HCV antibody.

Five hundred sixty-four chronic liver disease patients were screened for

anti-HCV antibody and 78 (13.83%) were found positive. Two hundred

forty-seven sporadic acute viral hepatitis patients were screened for viral

infection markers. Hepatitis B and E viruses (

HBV and HEV) were the major etiologic agents.

HCV was associated with 9% of the acute cases. Anti-HCV

core IgM with HCV RNA detection were found to be helpful for the diagnosis

of acute HCV infection. PMID: 9139079, UI: 97218351

HDV

-------

Trop Gastroenterol 1999 Jan-Mar;20(1):29-32

Prevalence of anti-delta antibodies in central India.

Jaiswal SP, Chitnis DS, Artwani KK, Naik G, Jain AK

Choithram Hospital and Research Centre, Indore, India.

A total of 238 sera samples from cases of hepatitis, renal failure,

thalassaemia, healthy health care workers (HCWs) & asymptomatic HBsAG

carriers coming from central India from July 1992 to June 1998, were

screened for anti-delta antibodies. Among 238 subjects, 206 were reactive

for hepatitis B surface antigen (HBsAg) while 32 were HBsAg non-reactive.

The prevalence of anti-delta antibodies was low (1.9%) among 54 patients of

acute viral hepatitis (AVH) while it was higher (5.7%) among 52 patients of

chronic liver disease (CLD). The anti-delta antibodies positivity among 34

patients with hepatic failure was around 15% and all of them were FHF

patients. Among multitransfused subjects such as chronic renal failure (CRF)

the prevalence of anti-delta antibodies was low (2.3%). None of the

apparently healthy HBsAg reactive HCWs and asymptomatic HBV carriers were

reactive for anti-delta antibodies. Similarly anti-delta antibodies could

not be detected in HBsAg negative viral hepatitis patients. There is a

wide variation in the prevalence of anti-delta antibodies

in different parts of India. However, overall prevalence of anti-delta

antibodies appears to be lower in the Indian population in comparision to

western countries.

PMID: 10464445, UI: 99393697

Eur J Gastroenterol Hepatol 1996 Oct;8(10):995-8

Hepatitis D virus (HDV) infection in severe forms of liver diseases in north

India.

Irshad M, Acharya SK

Department of Laboratory Medicine and Gastroenterology, All India Institute

of Medical Sciences, New Delhi, India.

BACKGROUND: Preliminary reports indicate that hepatitis D virus (HDV)

infection exists in India. However, its prevalence in patients with

different types of liver diseases has not been studied in detail. The aim of

this study was to evaluate the status of HDV infection in severe types of

liver disease in India. METHODS: Using commercial kits for various hepatitis

viral markers, the present study was undertaken to determine the serological

status of hepatitis B virus (HBV) and hepatitis D virus (HDV) markers in 208

patients with severe liver diseases. This total included 110 cases with

fulminant hepatic failure (FHF), 65 cases with subacute hepatic failure

(SHF) and 33 cases with chronic active hepatitis (CAH). RESULTS: The

hepatitis B surface antigen (HBsAg) carrier population, indicated by the

presence of HBsAg without IgM anti-HBc (hepatitis B core) in serum, was

recorded in 23.6%, 24.6% and 60.6% cases of FHF, SHF and CAH groups,

respectively. HBV infection, as indicated by serum positivity of IgM

anti-HBc in the FHF and SHF groups and HBsAg and/or IgM anti-HBc in the CAH

group, was detected in 19.1%, 23.1% and 69.7% of cases from these three

groups, respectively. IgM anti-HDV, demonstrating active/recent HDV

infection, was found in 8.1% cases of FHF and 9.2% cases of SHF patients.

HDV as a superinfection in HBsAg carriers was noted in 4.5% and 4.6% cases,

respectively of FHF and SHF groups. Similarly, HDV-HBV coinfection,

diagnosed by simultaneous presence of IgM anti-HBc and IgM anti-HDV in the

FHF and SHF groups, was recorded in 3.6% and 4.6% of cases from these two

groups, respectively. In the CAH group, HDV infection was observed in 9.2%

cases. CONCLUSION: HDV infection, recorded in

less than 10%

of patients with different liver diseases in India, seems to be an

unimportant factor in inducing severe liver diseases in this country. PMID:

8930565, UI: 97084221

Intervirology 1994;37(6):369-72

Status of hepatitis viral markers in patients with acute and chronic liver

diseases in northern India.

Irshad M, Acharya SK

Department of Laboratory Medicine, All India Institute of Medical Sciences,

New Delhi, India.

The present study describes the frequency of hepatitis viral markers in

patients with uncomplicated acute viral hepatitis (AVH; n = 32) and in

patients with severe liver diseases, including those with fulminant hepatic

failure (FHF; n = 110), subacute hepatic failure (SAHF; n = 65), and chronic

active hepatitis (CAH; n = 33). The results indicate that hepatitis A virus

infection is quite rare, whereas hepatitis B virus (HBV) and hepatitis C

virus (HCV) infections are the predominant causes of acute and chronic liver

failure in India. The incidence of HBV infection in AVH, FHF, SAHF, and CAH

groups was recorded in 3.7, 19.1, 23.1, and 69.7% of the cases,

respectively. Similarly, HCV infection in these four groups was noted in

12.5, 45, 44.6, and 48.5% of the cases, respectively. Further analysis of

HCV infection demonstrated that it was as frequent as single infection in

acute cases, but more commonly found in association with HBV infection in

chronic liver failure cases. Hepatitis D virus (HDV) infection, as indicated

by the presence of IgM anti-HDV antibodies, was recorded in 7.3% of the

cases with AVH, in 7.3% of the cases with FHF, in 9.2% of the cases with

SAHF, and in 6.1% of the cases with CAH. HDV was associated with HBV both as

superinfection as well as coinfection. Interestingly, nearly

2-6% of the cases in each group showed the presence of

simultaneous HBV, HCV, and HDV infection.

83.3% of the AVH, 42.1% of the FHF, 37.0% of the SAHF, and 15.1% of the CAH

patients had unknown viral markers.

PMID: 8586538, UI: 96022727

Trans R Soc Trop Med Hyg 1992 Jul-Aug;86(4):424-5

Hepatitis delta virus infection in Bombay.

Banker DD, Desai P, Brawner TA, Decker RH

Sir Hurkisondas Nurrotumdas Medical Research Society, Bombay, India.

From June 1985 to June 1989, sera from 425 cases of acute viral hepatitis

were gathered from 2 hospitals in Bombay; 331 sera were positive for

hepatitis B surface antigen and immunoglobulin M anti-hepatitis B core

antigen, and the donors' disease was diagnosed as hepatitis B.

Anti-hepatitis D virus was found in 124 of these sera, and hepatitis D

antigen was present in 24 more, conclusively proving the presence of

hepatitis delta infection in association with hepatitis B in Bombay. Among

the 425 cases of hepatitis, 39 cases of

fulminant hepatitis

developed, of whom 31 died. Hepatitis B virus (HBV) was the apparent viral

infection in 32 of the fulminant cases, and 20 (

63%) of them also showed evidence of hepatitis D

virus (HDV) infection, suggesting an aggravation of their clinical course

due to concurrent HBV and HDV infections.

PMID: 1440825, UI: 93069458

HEV