Hepatitis: Verma V

Verma V, Shen D, Sieving PC, Chan CC. · Immunopathology Section, Laboratory of Immunology, National Eye Institute, Bethesda, Maryland 20892-1857, USA. · Surv Ophthalmol. · Pubmed #18572051 links to  free full text

Abstract: Given the fact that infectious agents contribute to around 18% of human cancers worldwide, it would seem prudent to explore their role in neoplasms of the ocular adnexa: primary malignancies of the conjunctiva, lacrimal glands, eyelids, and orbit. By elucidating the mechanisms by which infectious agents contribute to oncogenesis, the management, treatment, and prevention of these neoplasms may one day parallel what is already in place for cancers such as cervical cancer, hepatocellular carcinoma, gastric mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. Antibiotic treatment and vaccines against infectious agents may herald a future with a curtailed role for traditional therapies of surgery, radiation, and chemotherapy. Unlike other malignancies for which large epidemiological studies are available, analyzing ocular adnexal neoplasms is challenging as they are relatively rare. Additionally, putative infectious agents seemingly display an immense geographic variation that has led to much debate regarding the relative importance of one organism versus another. This review discusses the pathogenetic role of several microorganisms in different ocular adnexal malignancies, including human papilloma virus in conjunctival papilloma and squamous cell carcinoma, human immunodeficiency virus in conjunctival squamous carcinoma, Kaposi sarcoma-associated herpes virus or human herpes simplex virus-8 (KSHV/HHV-8) in conjunctival Kaposi sarcoma, Helicobacter pylori (H. pylori,), Chlamydia, and hepatitis C virus in ocular adnexal mucosa-associated lymphoid tissue lymphomas. Unlike cervical cancer where a single infectious agent, human papilloma virus, is found in greater than 99% of lesions, multiple organisms may play a role in the etiology of certain ocular adnexal neoplasms by acting through similar mechanisms of oncogenesis, including chronic antigenic stimulation and the action of infectious oncogenes. However, similar to other human malignancies, ultimately the role of infectious agents in ocular adnexal neoplasms is most likely as a cofactor to genetic and environmental risk factors.

Jain M, Chakravarti A, Verma V, Bhalla P. · Department of Microbiology, Maulana Azad Medical College, New Delhi 110 019, India. · Indian J Pathol Microbiol. · Pubmed #19136772 links to  free full text

Abstract: OBJECTIVE: The co-infection of Hepatitis B and C viruses with HIV accelerates disease progression and also has an effect on the management of patients infected with HIV. The prevalence of HIV co-infection with hepatitis viruses varies widely. This study is planned to evaluate the prevalence of HIV co-infection with Hepatitis B and C viruses in North India. MATERIALS AND METHODS: A total of 1178 patients enrolled in the ART center were retrospectively analyzed for the presence of HBV and HCV on the basis of the presence of HBsAg and anti-HCV markers. RESULTS: In patients infected with HIV, the prevalence of co-infection with HBV was 9.9% (117/1178), the prevalence of co-infection with HCV was 6.3% (74/1178) and the prevalence co-infection with both HBV and HCV was ~1% (12/1178). DISCUSSION: The prevalence rate of HBV and HCV are increasing in patients infected with HIV. Having acquired the knowledge about the importance of such a co-infection, it is essential that all the patients infected with HIV be screened for HBV and HCV co-infection.

Verma V, Chakravarti A, Kar P. · Department of Microbiology, Maulana Azad Medical College and Associated Lok Nayak Hospitals, Bahadur Shah Zafar Marg, New Delhi 110002, India. · Diagn Microbiol Infect Dis. · Pubmed #18455899 No free full text.

Abstract: The characterization of hepatitis C virus (HCV) strains has important prognostic, therapeutic, and epidemiologic implications. The present study was intended to determine the HCV genotypes from Northern India in chronic liver disease (CLD) patients. The response to therapy in various subtypes was also evaluated in patients with chronic hepatitis. Furthermore, the genotypes were correlated with the biochemical and histopathologic parameters to assess the severity of liver disease. Five milliliter of blood sample was collected aseptically from 98 patients with CLD due to hepatitis C. Genotyping was performed by restriction fragment length polymorphism and type-specific polymerase chain reaction, followed by direct sequencing. The HCV genotypes depicted were 1a (6.12%), 1b (8.16%), 1c (8.16%), 3a (17.34%), 3b (6.12%), 3a + 3b (40.81%), 3a + 1b (7.14%), and an unclassified type of 6.12%. The present study revealed that HCV genotype 3 is the predominant one, with 40.81% (40/98) being a mixed type of 3a with 3b and identification of newer subtype 1c. HCV subtypes 1a, 3a, and 3b are responding to therapy, whereas 1b (40%, 2/5), 1c (66.67%, 2/3), 3g (33.3%, 1/3), 3a + 3b (41.6%, 5/12), and mixed type 3a + 1b (66.67%, 4/6) are poor responders to therapy. The biochemical profiles were higher in mixed type followed by types 3 and 1, whereas the histologic parameters revealed that the severity of liver disease was more in mixed type followed by types 1 and 3, which also showed poor response to therapy.

Verma V, Chakravarti A, Kar P. · Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospitals, New Delhi, India. · Dig Dis Sci. · Pubmed #18080762 No free full text.

Abstract: Cytokines play a key role in regulation of immunity and inflammation. The aim of the study was to detect serum levels of TGF-beta, IL-10, and sTNFalphaRII in patients with type C chronic liver disease (CLD) and to correlate these with biochemical and histopathological parameters used to assess the severity of the disease. Blood samples were aseptically collected from 90 CLD patients. Cytokine levels were also followed up in 39 chronic hepatitis cases. Levels of the cytokines in 90 CLD patients were significantly higher than in controls. In the follow up patients, 12 were non-responders and the serum levels of cytokines were still elevated after therapy whereas in 27 responders cytokine levels were significantly reduced after therapy and correlated well with biochemical and histopathological parameters. It is inferred that cytokine levels reflect the level of inflammation in chronic hepatitis C virus (HCV) infection and can be used as indirect markers to assess the severity of liver disease.

Chakravarti A, Verma V. · Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospitals, New Delhi, India. · Transfus Med. · Pubmed #17163874 No free full text.

Abstract: Multitransfused beta-thalassaemic patients constitute a population having a higher prevalence of hepatitis C virus (HCV) infection because of its transmission from infected blood collected during seronegative window period. HCV genotyping in thalassaemic patients is mainly useful for the clinical management of the patients and for facilitating decisions on therapy. Thus, the aim of the present study was to identify the genotypes that are prevalent in thalassaemic patients and to correlate these with gender, age, number of blood transfusions and the liver function test profiles. Reverse transcription-polymerase chain reaction (RT-PCR) was carried out in 80 beta-thalassaemic patients (58 men and 22 women) for detection of HCV RNA who were seronegative for hepatitis B virus or human immunodeficiency virus antibodies. HCV genotyping was carried out by restriction fragment length polymorphism (RFLP) method of Chinchai et al. Type-specific PCR followed by direct sequencing was also used to confirm the mixed-genotype infection. Among the 80 thalassaemic patients, 20 and eight patients were infected with genotypes 3 and 1, respectively, whereas two cases had infection with HCV genotype1c/5a. The serum levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were found to be significantly altered between the two groups of HCV-infected and noninfected thalassaemic patients. No significant correlation was observed between genotypes when compared with gender, age and number of blood transfusions, except significantly higher level of ALP in genotype 1 than in genotype 3. Genotype 3 alone was the predominant type in beta-thalassaemic patients, with approximately 45% being infected with mixed type. Hence, detection of HCV RNA would help in decreasing the transmission of HCV-infected blood collected during the seronegative window period, whereas determination of genotypes would provide help in adoption of different treatment policies for better management of thalassaemic patients.

Arankalle VA, Sarada Devi KL, Lole KS, Shenoy KT, Verma V, Haneephabi M. · National Institute of Virology, Pune, India. · Indian J Med Res. · Pubmed #16885597 links to  free full text

Abstract: BACKGROUND & OBJECTIVES: Hepatitis A is highly prevalent in India and mainly presents as a sporadic disease. This study investigated an outbreak of viral hepatitis at Medical College Hospital area, Kottayam, Kerala state, India during January 2005. METHODS: Blood (133), faecal (1), sewage (4), and water samples (13) were collected. Sera were tested for IgG- and IgM-anti-HAV and IgM antibodies against hepatitis E (IgM-anti-HEV). Sewage, faeces and water samples were tested for HAV RNA in nested RT-PCR and HAV RNA positive samples were further processed for RNA quantitation using Real Time PCR. RESULTS: Of the 1180 total cases, 540 were reported from Medical college area. Two deaths were reported among doctors. Patients from the community gave a previous history of visit to medical college hospital area. The sewage treatment plant at the campus was non-functional since 1990 and the untreated sewage was constantly overflowing and getting mixed with a canal. At the time of the study, all the water sources were superchlorinated. HAV RNA was present in the faeces of hepatitis A patient (1.36 x 10(7) copies/ml), sewage tank (2.57 x 10(3) copies/ml and the canal (<100 copies/ml). None of the 13 water samples concentrated 10,000-fold and the soil sample showed presence of HAV RNA. Phylogenetic analysis based on 5'-non-coding and P2 regions showed HAV-genotype IIIA in all samples. INTERPRETATION & CONCLUSION: The aetiological agent of the present outbreak was found to be HAV. Epidemic hepatitis A (genotype-IIIA) is emerging in Indian adults, emphasizing the need for definite policy for control.

Chakravarti A, Verma V, Jain M, Kar P. · Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospitals, New Delhi. · Trop Gastroenterol. · Pubmed #16737047 No free full text.

Abstract: The major causes of chronic liver disease (CLD) are infection with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) either alone or together. The clinical course of the disease varies in cases ofcoinfection with HCV and HBV as compared to single infection. The present study was carried out to determine the occurrence of coinfection of HCV with HBV in CLD patients and to look for the presence of suppressive effect of the two viruses on each other. The severity of liver disease was also assessed and correlated with biochemical profiles. Sera from 150 patients of CLD were tested serologically for the presence of HBsAg, IgG anti HBc and anti-HCV antibodies. HBV DNA and HCV RNA were also detected by amplifying surface region and 5' noncoding-core region respectively by polymerase chain reaction. Forty-seven (31.3%) cases showed the presence of HBsAg or anti IgG-HBc or HBV DNA either alone or together (Group A). Thirty-nine (26%) cases were found to be positive for HCV by detecting either anti-HCV antibodies or HCV RNA (Group B). Coinfection ofHCV with HBV (Group C) could be detected in twenty-four (16%) cases, of these twenty-one cases (87.5%) were positive both for HCV RNA and IgG anti-HBc without the presence of HBV DNA whereas in none of the cases could HBV DNA be detected in the absence of HCV RNA. Forty (26.6%) cases had neither HCV or HBV related CLD. Amongst, the biochemical parameters, the liver function test profiles were altered and found to be statistically significantly in HCV positive cases (Group B) when compared to the negative ones while in case of HBV (Group A) and coinfected (Group C) cases none of the parameters was statistically significant when compared with non-HBV and non-coinfected cases respectively. Thus, coinfection of HCV with HBV is seen in a substantial number of CLD cases. It is also revealed from the present study that HCV infection has a suppressive effect on the replication of HBV as seen by the loss of replicative markers like HBV DNA.

Chakravarti A, Verma V, Kumaria R, Dubey AP. · Department of Microbiology, Maulana Azad Medical College, New Delhi 110002. · J Indian Med Assoc. · Pubmed #16008315 No free full text.

Abstract: Hepatitis C virus is considered to be the main aetiological agent responsible for the occurrence of post-transfusion hepatitis. Patients with thalassaemia acquire hepatitis most often from viruses contracted through blood transfusions. The present study was undertaken to evaluate the prevalence of hepatitis C virus (HCV) in thalassaemic patients with multiple blood transfusions. The association of HCV seropositivity with number of blood transfusions and liver enzyme profile was also analysed. The study group consisted of fifty patients (40 males and 10 females) attending the thalassaemic unit of Lok Nayak Hospital, a tertiary care hospital at Delhi, within the age group of 1-25 years. Thirty patients (60%) were found to be seropositive for HCV antibodies while one patient (2%) was co-infected with HCV antibodies and hepatitis B surface antigen. Study of liver enzyme profile showed aspartate aminotransferase levels to be significantly higher, although the level of serum alanine aminotransferase, alkaline phosphatase, total protein, bilirubin and albumin were not significantly altered in these patients. It is inferred from this study that 60% of the thalassaemics were infected with HCV and this was directly related to the number of blood transfusions received by them. The regularised national blood policy followed by blood banks for providing safe blood along with better screening method of donated blood in blood banks would bring down the incidence of hepatitis C in such high risk group.

Kaur H, John M, Pawar G, Ninan J, Verma V. · Department of Microbiology, Christian Medical College & Hospital, Ludhiana, Punjab 141 008. · Indian J Med Sci. · Pubmed #14514273 links to  free full text

Abstract: This study was carried out to find the etiological spectrum and clinical profile of acute viral hepatitis in Ludhiana. Hepatitis E was encountered most frequently (44.56%) followed by hepatitis B (29.7%), whereas hepatitis D occurred least frequently (0.99%). The age group most commonly affected was 20-30 years(32,67%) followed by 30-40 years (23.76%). Males showed higher incidence as compared to females in the ratio of 62.4:37.6. The most frequent clinical features were anorexia and jaundice. The disease was found to be more common in urban set up(78.2%) than in rural regions (21.8%). Mortality was mainly because of fulminant hepatitic failure. In 1.98% of cases, etiology remained undecided. Total bilirubin and prothrombin time were found to be useful prognostic indicators.

Chakravarti A, Verma V. · No affiliation provided · Indian J Med Microbiol. · Pubmed #16327131 links to  free full text

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