HBV epidemiology

Background: Human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV and HCV), and dual or triple infections are serious public health issues. While most medications have significantly improved the management of mono-infections, triple co-infection may be a greater challenge in the future. The aim is to determine triple Co-infection of hepatitis B, C and HIV at the Tertiary care centre of Northern India. Material and Methods: The present study was conducted at the Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences, North India. A total of 30,000 serum samples of Hepatitis B (11, 500), Hepatitis C (12000) and HIV (6500) confirmed patients were tested for co-infection with other viruses. Results: Out of the total pool of 30,000 patients, triple co-infection was seen only in 46 patients (0.15%), and except for one, all were male, the majority in the younger age group, sexually active and were intravenous drug abusers. Of the total pool of 30,000 patients, only 46 (0.15%) had triple co-infection. Of these 46 patients, 45 were male (97.77%), and 1 was female (2.23%). The largest number of patients were young males in the 20-30 years age group, i.e., 35 (76.08%), followed by the 30-40 years age group, with 6 patients (13.04%). There was predominance of patients belonging to rural background, i.e., 33 patients (71.73%), and only 13 patients (28.27%) resided in urban areas. In the marital analysis, 32 patients (69.56%) were unmarried, and 14 patients (31.44%) were married. Out of the total 46 patients, 35 (72.5%) gave a history of intravenous drug abuse, alcohol intake and were smokers. In the total study group of 46 patients, 28 (60.86%) had a history of previous surgery and tattooing. In the total pool of 46 patients, only 6 (13.04%) were admitted for having multiple sexual partners. Of 46 patients, 44 (95.65%) were non-cirrhotic, 1 (2.17%) had significant fibrosis (fibroscan score>7 kPa), and 1 (2.17%) was cirrhotic. All 46 patients were on the HARRT with TLE regimen, containing tenofovir & lamivudine, which have antiviral activity against HBV. All of them were treated with oral directly acting antivirals (DAA's) for HCV. Of 46 patients, 43 (93.47%) achieved sustained virological response, similar to what is seen in mono-infected HCV patients. Conclusion: The HBV, HCV and HIV triple co-infection was extremely low, that too in the hotspot of HBV & HCV mono and dual infections and is a positive sign. It can be attributed to mandatory HBV vaccination of every HIV and HCV patient, along with a multi-pronged strategy of reducing high-risk behaviour. Moreover, early detection and treatment of mono-infections reduced the risk of developing dual or triple co-infections in the future.

Background: Chronic hepatitis B virus (HBV) infection is a leading cause of hepatocellular carcinoma (HCC) worldwide, accounting for over 50% of cases globally. It triggers liver cancer through chronic inflammation (cirrhosis) and direct DNA integration into host cells. Antiviral therapy and vaccination significantly reduce this risk. Reducing liver-related problems, such as HCC, requires effective HBV infection prevention and control techniques. HBV contributes significantly to the development of liver cancer, and our understanding of the variables influencing its carcinogenic potential is expanding. Treatment of HBV infection in individuals with HBV-induced HCC requires special attention due to advances in HCC care. The survival rates vary significantly based on treatment and disease stage, with 5-year overall survival (OS) after radical resection ranging from 20.5% to 64%. Patients receiving curative resection often achieve 1-year survival rates over 90%, while long-term antiviral therapy (NA) is crucial to reducing mortality and recurrence. Material and Methods: The Medical Gastroenterology Department at PGIMS, Rohtak conducted this prospective and retrospective study over a ten-year period, from March 1, 2016, to February 28, 2026. Patients with HBV-related HCC were enrolled in the study after providing written consent. Fifty-four HBV-related HCC patients' data were examined. Data was recovered over the phone if a patient was lost to follow-up. Results: Males and older adults are more likely to have HBV-related H.C.C. Just 4 (7.41%) of the 54 patients were female, while 50 (92.59%) were male. On geographical distribution, there was clear cut predominance of rural background i.e. 51 patients (94.45%) resided in rural area and only 3 patients (5.55%) belonged to urban area. The number of H.C.C. patients in our study group increased with age, with 51 patients (94.45%) being older than 40. The three patients in the third and fourth decades were not cirrhotic; two had a family history of H.C.C. and both had low HBV viral loads; the third patient had chronic hepatitis B with a high viral load and developed multifocal H.C.C. without progressing to the cirrhotic stage. The remaining 51 HBV patients had cirrhosis. Out of total pool of 54 patients of H.C.C, a significant percentage of patients i.e. 25 (46.29%) had low viral load of below 40,000 I.U. or two lakhs copies/ml. The rest 29 patients (53.71%) had high HBV viral load. There was strong association with alcohol and smoking in our study group. Out of total 54 patients, 23 patients (42.59%) consumed both alcohol and smoke, 8 patients (14.81%) were only smoker and 2 patient (3.70%) were only alcoholic. Thus, in total, 33 patients (61.11%) had association with alcohol intake or smoking. Out of total pool of 54 patients, 36 (66.66%) were already diagnosed patients of HBV and were on antiviral treatment and 18 (33.33%) were diagnosed first time as HCC and on aetiological evaluation, were found to be suffering from HBV. Out of these 18 patients, 15 (83.33%) died within six months and only 3 (16.66%) are surviving till date, and all of them have been diagnosed in last one year only. In total 54 patients, 41 (75.92%) have died and only 13 (24.07%) are surviving. Out of these 13 patients who are surviving, 10 (76.92) have been diagnosed in last one year only and only 3 (23.07%) have been diagnosed in last 4-6 years. In these 13 surviving patients, 3 (23.07%) are non-cirrhotic (2 had family history, 1 had advanced fibrosis with high viral load), 6 (46.15%) had compensated cirrhosis and fibroscan improved with antiviral treatment and 4 (30.76%) had decompensated cirrhosis and out of them 2 received TACE (trans-arterial chemo immobilization) therapy. Out of 41 patients who died, only 3 survived for more than five years. Moreover, in 13 patients who are surviving, only 4 patients have been diagnosed for greater than five years and rest 8 have been diagnosed in last one year only. Thus, total five-year survival rate till date is very low i.e. 7 patients out of 54 (12.96%). Conclusion: HBV related HCC can be decreased by effective preventive strategies which includes safe needle practices and hepatitis B vaccination, along with judicious and regular use of antiviral drugs wherever indicated. Patients must take their medications as prescribed, and they should be forbidden from smoking and drinking alcohol, both of which raise the risk of HCC. The HCC patients with metastasis have very short survival of 3-6 months only. The availability of advanced interventional facilities at government set up is must because majority of these patients belong to poor socioeconomic status and cannot bear financial expenses of big corporate hospitals.

mellitus is directly proportional to advancement of HBV disease from inactive carrier stage to chronic hepatitis with F2 fibrosis to cirrhotic from compensated to decompensated stage. Hence, all efforts should be done to prevent HBV patient to progress to advanced stage which can be achieved by abstinence from alcohol & smoking, maintaining normal BMI and regular treatment with antiviral wherever indicated.

ntroduction: Hepatitis B and HIV coinfection means simultaneous infection with
both the viruses and is due to sharing common transmission routes like intravenous
drug use. It increases the risk of severe liver disease, including cirrhosis and
hepatocellular carcinoma (HCC), compared to mono-infection. Majority of HIV
patients are already on highly active anti-retroviral treatment which is usually TLE
regimen which contains tenofovir and lamivudine and both are active against HBV
also.
Aim of Study: The aim of present study was to determine the HBV and HIV Co-
infection at Tertiary care centre of Northern India.
Material and Methods: The present study was conducted to determine HBV-HIV
co-infection in patients reporting at Medical Gastroenterology department of Post
Graduate Institute of Medical Sciences in North India. A total of 11,500 serum
samples of Hepatitis B and 6500 of HIV confirmed patients were tested for co-
infection.
Observations: A total of 11,5000 confirmed patients of HBV and 6500 of HIV were
screened for co-infections. Out of this total pool of 18,000 patients, 151 patients
(0.83 %) were found to be having co-infection. Out of these 151 co-infected
patients, 130 (86.09 %) were males and 21 (13.91%) were females. On analysing
geographical distribution of patients, majority belonged to rural area. In male group,
98 (75.38 %) patients resided in rural area whereas in females, 15 (71.42%)
belonged to rural area. Age distribution characteristically showed predominance in
younger age group of 20-50 yrs in both the groups. In males, 110 (84.61%) of
patients were in 20-50 yrs of age group and in females 18 (85.71%) belonged to 20-
50 yrs of age. On analysis of risk factors, there were strong differences noted in both
the groups. In males, out of 130 patients, 68 patients (52.30%) were alcoholic, 77
patients (59.23%) were smokers, 32 patients (24.61%) had past history of surgery,
22 patients (16.92%) were intravenous drug abusers, 15 (11.53%) had got tattooing,
3 (2.30%) had previous history of blood transfusion, 2 patients (1.53%) gave history
of multiple sexual partners, 4 (3.07%) had undergone dental procedures, 3 (2.30 %)
had acute hepatitis B, 76 patients (58.46%) had F0-F1 fibrosis, 42 (32.30%) had F2-
F3 fibrosis, 12 (9.23%) had F4 or cirrhosis and none patient developed HCC. Only
one male patient had both parents positive for HIV. In comparison in females, none
was alcoholic, smoker or intravenous drug abuser, 9 patients (42.85 %) had past
history of surgery, 5 patients (23.80 %) had got tattooing, 1 (4.76 %) had previous
history of blood transfusion, none gave history of multiple sexual partners, 3
(14.28%) had undergone dental procedures, 1 (4.76 %) had acute hepatitis B, 15
patients (71.42 %) had F0-F1 fibrosis, 5 (23.80%) had F2-F3 fibrosis, 1 (4.76 %)
had F4 or cirrhosis and none developed HCC.
Conclusion: Surveillance for co-infections in every patient of HBV, HCV and HIV
is mandatory. Timely diagnosis and institution of antiviral therapy can lead to
decreased incidence of end stage liver disease, development of HCC and need of
liver transplant as definitive cure. It also helps in identification and modification of risk factors.

Introduction-.HCV-related hepatocellular carcinoma (HCC) is a major cause of cancer mortality, often arising 20–40
years after infection, almost always in the presence of cirrhosis. While direct-acting antivirals (DAAs) offer a high cure
rate (sustained virological response, SVR), reducing HCC risk, it is not completely eliminated. HCV induces chronic inammation, oxidative
stress, and cirrhosis, which drive carcinogenesis. The risk factors are increased risks include male gender, older age at infection, alcohol abuse,
metabolic syndrome (diabetes, steatosis), and genotype 1b or 3. Patients with HCV-associated cirrhosis require regular monitoring (typically 6-
month ultrasound). We report a sixty-six-year-old female, a known case chronic hepatitis C related chronic liver disease and wasCase Report-
treated nine years back with oral antiviral for 24 weeks with sofosbuvir 400 mg and velpatasvir 100 mg. She achieved sustained virological
response after 12 weeks of treatment. Her ultrasonogram abdomen showed altered echotexture with moderate ascites and upper gastro-intestinal
endoscopy revealed grade two oesophageal varices for which she was started on tablet carvedilol 3.125 mg twice daily with diuretics and other
supportive therapy. Her baseline alphafeto protein level was in normal range. She was advised for every six monthly ultrasonogram (USG)
abdomen with serum alphafeto protein level, as a part of HCC surveillance which was done regularly. She remained well for next nine years on
regular medications. For last three months, she developed anorexia, generalized fatigue, increased decompensation as evidenced by increased
abdominal distension due to ascites and development of bilateral edema. There was no history of fever, weight loss, haematemesis, melena,
altered sleep pattern or behaviour, bladder or bowel symptoms, breathlessness on exertion or rest. On biochemical evaluation complete
hemogram revealed pancytopenia, liver function test was deranged i.e. there was mild hyper bilirubinaemia, transaminitis, hypoproteinaemia
and hypoalbunemia. The complete lipid prole was in below normal range but renal function test, serum electrolytes and blood sugar level were
in normal range. The patient was referred for medical and surgical oncological consultation but later on lost to follow-up. HCVConclusion-
patients who have signicant brosis or cirrhosis, even after achieving SVR have to be mandatory on surveillance for HCC by six monthly
ultrasonogram abdomen and alphafeto protein level or earlier, if development of any new symptoms or on occurrence of deterioration. The
achievement of SVR does not guarantee against development of HCC; hence lifelong vigil is required for the same.
ABSTRACT
INDIAN JOURNAL OF APPLIED RESEARCH 1
Volume - 16 | Issue - 05 | May - 2026 | .PRINT ISSN No 2249 - 555X | DOI : 10.36106/ijar
KEYWORDS : Hepatocellular Carcinoma, Chronic Liver Disease, Hepatitis C Virus, Triple Phase Ct Scan, Alpha Fetoprotein
Level

Introduction: Hepatitis B and C coinfection means simultaneous infection with
both the viruses and is due to sharing common transmission routes like intravenous
drug use. It increases the risk of severe liver disease, including cirrhosis and
hepatocellular carcinoma (HCC), compared to mono-infection. Direct-acting
antivirals (DAAs) are used to treat HCV, and oral antivirals for HBV and
monitoring for HBV reactivation is crucial.
Aim of Study: The aim of present study was to determine the HBV and HCV Co-
infection at Tertiary care centre of Northern India.
Material and Methods: The present study was conducted to determine HBV-HCV
co-infection in patients reporting at Medical Gastroenterology department of Post
Graduate Institute of Medical Sciences in North India. A total of 11,500 serum
samples of Hepatitis B and 12,000 of Hepatitis C confirmed patients were tested for
co-infection.
Observations: A total of 11,500 confirmed patients of HBV and 12,000 of HCV
were screened for co-infections. Out of this total pool of 23,500 patients, 448
patients (1.90 %) were found to be having co-infection. Out of these 448 co-
infected patients, 331 (73.88 %) were males and 117 (26.12%) were females. On
analysing geographical distribution of patients, majority belonged to rural area. In
male group, 269 (81.26%) patients resided in rural area whereas in females, 101
(86.32%) belonged to rural area. Age distribution was characteristically different in
both the groups. In males 60.41% of patients were in 20-50 yrs of age group
whereas in comparison females had older representation i.e. 72.54% belonged to 40-
70 yrs of age. On analysis of risk factors, there were strong differences noted in both
the groups. In males, 149 patients (45.01%) were alcoholic, 188 patients (56.79%)
were smokers, 105 patients (31.72%) had past history of surgery, 40 patients
(12.08%) were intravenous drug abusers, 30 (9.06%) had got tattooing, 21 (6.34%)
had previous history of blood transfusion, 5 patients (1.51%) gave history of
multiple sexual partners, 3 (0.90%) had undergone dental procedures, 5 (1.51%) had
acute hepatitis B and only 1 patient (0.30%) developed HCC. In comparison in
females, 0 patients (0%) were alcoholic, 2 patients (1.70 %) were smokers, 52
patients (52.99 %) had past history of surgery, 0 patient (0 %) were intravenous
drug abusers, 9 (7.69 %) had got tattooing, 14 (11.96 %) had previous history of
blood transfusion, 1 patient (0.85 %) gave history of multiple sexual partners, 4
(3.41%) had undergone dental procedures, 1 (0.85 %) had acute hepatitis B and
none developed HCC.
Conclusion: Surveillance for co-infections in every patient of HBV, HCV and HIV
is mandatory. Timely diagnosis and institution of antiviral therapy can lead to
decreased incidence of end stage liver disease, development of HCC and need of
liver transplant as definitive cure. The age distribution and risk factors are different
in male and female.

originating from these agents cause serious morbidity and mortality both in general population and healthcare professionals. Transmission risk of viral hepatitis and HIV for healthcare professionals is higher due to occupational reasons. In this study, we aimed to investigate the seropositivity rate of Hepatitis B, Hepatitis A, Hepatitis C and HIV infection among intern nurses and intern emergency medical technicians in a public hospital. Methods: Medical histories of 326 students who worked in our hospital between August 2015 and November 2015 and admitted to the infectious disease outpatient clinic for screening were recorded. Their data were retrospectively reviewed. HBsAg, anti-HBs, anti- HCV, anti-HAV and anti-HIV were analyzed by ELISA method in serum samples. Results: Mean age of 326 students included in the study was 16.4 years, and 245 (75.1%) students were female. HBsAg was found positive in 4 (1.3%), anti-HBc and anti-HBs in 1 (0.4%), isolated anti-HBs in 294 (90.1%), anti-HAV IgG in 52 (15.9%) and anti-HCV in one (0.4%) student. No student was found positive for anti-HIV. Conclusion: Young healthcare professionals are at risk for transmission of viral hepatitis and HIV due to their professional inexperience. In our study, it has been determined that in our country pediatric vaccination program ensured high levels of immunity against Hepatitis B infection. Besides very low incidence of Hepatit C, and lack of HIV have been other pleasing findings of our study. Lower levels of Hepatitis A immunity may lead to serious problems in the years to come. It has been thought that informing the healthcare professionals and applying screening and vaccination programs for them may potentially reduce the transmission of viruses such as viral hepatitis and HIV

Introduction-Hepatitis B surface Antigen (HbsAg) positivity in the general population ranges from 1.1% to 12.2%, with an average prevalence of 3-4%. Based on some regional level studies, it is estimated that in India, approximately 40 million people are chronically infected with Hepatitis B. Chronic Hepatitis B (CHB) is highly associated with sexual dysfunction (SD), with a prevalence rate significantly higher than the general population. Men commonly experience erectile dysfunction (ED), premature ejaculation, and low libido, while women may experience reduced desire and arousal issues. SD often worsens with advanced liver fibrosis, cirrhosis, and related depression. Studies indicate 67.2% or higher of chronic hepatitis B patients experience erectile dysfunction (ED). Liver damage can reduce testosterone levels and impair blood circulation required for erections. Anxiety, depression, and stigma associated with a chronic, sexually transmissible illness are significant contributors to sexual dysfunction. Chronic liver disease can increase sex hormone-binding globulin (SHBG), which binds to testosterone, resulting in lower levels of free, biologically active testosterone. The risk of ED increases to over 70% in cases of cirrhosis. Treatment with phosphodiesterase type 5 inhibitors (e.g., Viagra) can be effective, though these are often underused. Managing liver health through proper treatment, avoiding alcohol, and regular checkups can improve overall health and, in some cases, sexual function. Aim of study-To estimate prevalence of sexual dysfunction in Hepatitis B patients at tertiary care center of Northern India. Material and Methods-This study was conducted at Medical Gastroenterology Department at PGIMS, Rohtak. It was a prospective study done over one year, from 01.04.2025 to 31.03.2026, during which 400 confirmed hepatitis B patients were enquired for any kind of sexual dysfunction. For better understanding 100 patients each of inactive carrier, chronic hepatitis on antiviral treatment, cirrhotic patient on antiviral treatment and acute hepatitis B patients were enrolled. All 400 HBV patients were males, in 20-50 yrs age group and were sexually active. Patient with past history of sexual dysfunction, anxiety, depression, diabetes mellitus, hypertension, hypothyroidism which can cause sexual dysfunction were not included in the study. Except for acute hepatitis B, rest all patients who were having HBV infection for at least three years were included in the study. All hepatitis B patients were confirmed on HbsAg on Enzyme linked immunosorbent assay (ELISA) test and HBV DNA Quantitative on Polymerase chain reaction test (PCR). The written informed consent was taken before enrollment in the study. Observation and Results-Our department is Model treatment Center (MTC) under National Viral Hepatitis Control Program (NVHCP) and is one of the high flow centers in India. On daily basis, 8-10 new and 40 follow up patients of HBV come for consultation and till date 12,000 HBV patients have been enrolled in last twelve years in this program. On prospective analysis of 400 confirmed hepatitis B patients, all were males. Out of total pool of 400 HBV patients, 100 patients each of acute hepatitis B, inactive carrier, chronic hepatitis on antiviral treatment, cirrhotic

The World Health Organization, WHO, estimates that 296 million people were living with chronic hepatitis B infection in 2019, which resulted in 1.5 million new infections each year, and resulted in an estimated 820,000 deaths. Healthcare workers are a high-risk group in terms of exposure to HBV; thus, the observance of the universal safety precautions and vaccination of people at risk is vital. The main objective of this study is to determine the risk perception of healthcare workers on Hepatitis 'B' and their attitudes towards the uptake of its vaccine in selected hospitals in Ibadan, Oyo State, Nigeria. The research design for this study is a descriptive survey, and the study population comprises health workers

Introduction: Healthcare workers (HCWs) are crucial for voluntary blood donation (VBD) due to their medical knowledge, often higher altruistic attitudes, and proximity to facilities but studies show a gap between positive knowledge/attitudes and actual practice, highlighting the need for better motivation through education, incentives (like paid leave/recognition), and accessible donation drives to leverage their potential for a safer, more stable blood supply. VBD is key for blood safety globally, reducing transfusion-transmitted infections, with WHO encouraging 100% voluntary systems, and HCWs as a prime recruitment pool. The challenges in HCWs voluntary donation is despite knowing that donation is good but don't donate regularly. Sometimes, busy work schedules act as a barrier and some lack detailed knowledge on donation frequency or minimum requirements. The World Health Organization (WHO) promotes 100% voluntary, non-remunerated donation as the safest model. Aim of Study: To study habit of blood donation in health care workers at tertiary care center. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of one year from 1st December, 2024 to 30th November, 2025 during which every health care worker, including doctors MBBS, Dental, Physiotherapy, Pharmacy students, nursing officers, operating technicians, bearers, data operators who reported in Medical Gastroenterology OPD as patient or as attendant were interviewed regarding their number of blood donations, if not done, then reasons for the same, any apprehensions associated with blood donation. Everyone was explained about benefits of blood donation for them as well as recipients and were motivated for blood donation in future. In total 1000 health care workers belonging to different streams were interviewed. Observation & Results: Out of total 1000 health care workers who were interviewed, 250 (25%) had donated blood at least once in life. The number blood donation varied from 0-6 times. In a study pool of 1000 HCW, 300 (30%) were doctors belonging to different streams like Medical & Dental and included MBBS, Dental students, Junior & Senior residents, Interns and Consultants. The nursing officers including nursing students constituted 20% (200) of study pool. Physiotherapy students which included both Bachelor and Master course had significant representation i.e. 230 (23%). Pharmacy students, O.T. technicians, Bearers, Clerical staff constituted 100 (10%), 70 (7%), 50 (5%) and 50 (5%), respectively. Out of total 250 HCW who were blood donors, maximum were doctors i.e. 112 (44.8%). Conclusion: There is strong need of increasing awareness among health care workers about voluntary blood donations, as there are many myths associated with blood donation, despite being part of health care system.

We report a fourty two-year-old male, not a known case of any chronic illness, was totally asymptomatic and his brother recently died due to hepatitis B related chronic liver disease and hepatocellular carcinoma. Thus, family screening was advised. They were total six brother & sister who were living, along with their mother and father. Out of these eight all six brother and sisters & mother were found to be hepatitis

Males who have sex with males, including those with HIV infection, sexually active persons with multiple partners, health care workers, employees in medical facilities, patients and staff of live-in facilities and daycare programs for the developmentally disabled, morticians and embalmers, police and fire department personnel, and military personnel

1. Abstract
1.1. Introduction
It is well said and proven in literature that important causes of
cirrhosis of liver include alcohol intake, metabolic associated fatty
liver disease and chronic hepatitis B & C. Less important causes in-
clude autoimmune & congenital liver disease, Wilson’s and alpha1
antitrypsin deficiency disease. There can occur gradual progression
from chronic hepatitis to cirrhosis and in certain cases can further
reach stage of hepatocellular carcinoma. Hepatic encephalopathy
is common complication of cirrhosis or end stage liver disease but
there can be many other reasons of altered behaviour in these pa-
tients which have to be evaluated very carefully.
1.2. Case Report
We report a eighty-two-year-old female, a known case of hyper-
tension and diabetes mellitus for last ten years and was controlled
on oral hypoglycaemic and anti-hypertensive drugs. She presented
with short duration fever which was associated with rigor & chills,
along with anorexia, pain abdomen and diarrhoea. She gave his-
tory of fall fifteen days back and was on bed for last one week
after development of fever episode. She was seen by some private
practitioner who advised for ultrasonogram abdomen which re-
vealed altered liver echotexture with abscess in right lobe. She was
admitted in private hospital where complete hemogram revealed
leucocytosis, thrombocytopenia and iron deficiency anemia. She
developed hypotension and anuria, despite replenishment of intra-
venous fluids. Hence, she was referred to our center with proba-
ble diagnosis of hepatic encephalopathy or septic shock. She was
started on low dose inotropic support, broad spectrum antibiotics,
insulin for control of raised blood sugar and intravenous albumin
for severe hypoalbuminemia. At this point of time, her ultrasono-
gram again showed slight altered echotexture of liver with abscess
in right lobe, leucocytosis, thrombocytopenia, anemia, deranged
renal function test, raised transaminases, hyperbilirubinemia, hy-
poproteinaemia and hypoalbunemia. She responded to treatment
and inotropic support was removed within 36 hours and urinary
output improved. Her sensorium still remained deranged and she
had excessive sleepiness and even used to doze off while talking
and taking food. She was even started on rifaximin thinking it to
be hepatic encephalopathy. The detailed neurological examination,
revealed right sided hemiparesis with right plantar being equivocal.
Hence, in view of deranged renal function tests, she was subjected
to MRI brain and abdomen which showed hepatomegaly with right
lobe liver abscess in segment V1 and V11 with mild ascites and bi-
lateral pleural effusion. The MRI brain showed subacute lacunar
infarcts in bilateral semiovale, cortical aspect of bilateral frontopa-
rietal and temporo-occipital lobes and posterior aspect of bilater-
al cerebellar hemispheres-likely in watershed territory of bilateral
middle carotid and internal carotid artery, most likely embolic in
nature. A chronic infarct was seen in left cerebellar hemisphere
on posterior-inferior aspect. Age related mild diffuse cerebral cor-
tical atrophy with chronic small vessel ischemia changes (Fazeka
grade 11/111). Chronic microhaemorrhages in thalamoganglionic
region of external capsule, right pons, cortical aspect of right fron-
tal, bilateral parietal lobes- parasagittal aspect and right cerebellar
hemisphere-likely hypertensive aetiology. She was shown to neu-
rologist, who started her on low dose single antiplatelet ecosprin
75 mg, in view of thrombocytopenia. She partially responded to
treatment and her sensorium improved within three days, accepted
orally well, became haemodynamically stable with normal urinary
output. Hence, she was discharged on OHA, insulin, antiplatelets
and iron & multivitamins.
1.3. Conclusion
Cirrhosis diagnosis should not be made just on basis of ultraso-
nogram abdomen, as it is operator dependent. Moreover, every
altered behaviour, even in cirrhotic patient should not be always
labelled as hepatic encephalopathy and other causes, especially
neurological, must be considered and ruled out.

Background: Male infertility accounts for nearly half of all infertility cases and is influenced by multiple biological and environmental factors. Conventional semen analysis provides limited information on sperm function. The sperm DNA fragmentation index (DFI) has emerged as a key biomarker reflecting sperm chromatin integrity and fertilizing potential. Evidence from Indian men remains scarce and inconsistent. Aim: To evaluate the association of semen quality, lifestyle habits and systemic conditions with sperm DNA fragmentation among infertile men. Study Design and Place: A retrospective cross-sectional study conducted at birthright fertility by rainbow hospitals, Hyderabad, India. Materials and Methods: Records of 326 men evaluated between January 2023 and May 2025 were reviewed. Clinical details including age, body mass index (BMI), infertility type and duration,

Chronic hepatitis B virus (HBV) infection is one of the most common
diseases in humans and affects human lives worldwide. Human leukocyte
antigen (HLA) plays a vital role in the immunological reaction to HBV.
In this study, we aimed to examine whether HLA class I and II alleles are associated with the outcome of HBV infection in the Saudi population. The current study examined the relationship between human leukocyte antigen (HLA) alleles and the outcome of hepatitis B (HBV) infection. HLA-A, B, BW, CW, and DRB, DQB alleles in peripheral blood were detected, HLA class I typing(serological method) was performed, and for detecting alleles as in addition HLA, class II genes sequence-specific primers- polymerase chain reaction technique (SSP-PCR) was used. The samples were collected from 57 persons who were positive for the hepatitis B surface antigen (HBsAg). Thirty persons who tested for (HBeAg) were negative and positive for (anti-HBe), which is considered a chronic carrier group. Twenty-seven persons tested were positive for (HBeAg) and negative for (anti-HBe) and considered as a chronic active group. In addition, all persons who tested negative for serological markers of HBV infection were in the control group. The two studied groups were statistically different in age and
gender; the age 20-40 was associated with a chronic active
infection(p=0.042124), while age >40 was associated with the chronic
carrier(p=0.008903) and the male was significantly higher in the chronic active group (p=0.0019). The (ALT, AST, ALP ) enzymes were evaluated to see if there is a relation between them and any of the subjects during infection. There was a high frequency of an average ALT level in the chronic carrier group (6%), whereas an abnormal ALT level was higher in the chronic active group (66.67%). Results revealed a gender-specific association with specific HLA class I alleles. The difference between male and HLA-A24 alleles in the chronic carrier group was significant (p=0.0306513), whereas HLA-A68 was higher in females but only marginally significant in the same group (p=0.05900). On the other hand, class II alleles didn’t show any remarkable expression related to the genders. The A25, A34, B42, and CW5 alleles were absent in the subjects studied. The frequency of the DRBI*13 allele in the control group was markedly higher than that in the chronic carrier group (23.33% vs. 3.33% p=0.0261574). The DQB1*03(7) allele was also found to be significantly higher in the standard control group than in the chronic active group (23.33% vs. 3.70%, p=0.0368065). The frequency of allele DQB1*06 in the control group was notably higher (43.33%) than that in both chronic carrier and chronic active groups (13.33% & 14.81%). They had significant frequencies (p=0.02190 and p=0.0393994), respectively. By contrast, DQB1*03 was significantly higher in the chronic carrier and chronic active groups than in the regular control group (26.67% & 37.04% vs. 0% p=0.00228753& p=0.00019536). The chronic carrier patients who had elevated AST revealed ahigh frequency of B51(60%vs.0% p=0.034965) and BW5(80% vs. 12.5% p=0.031857) compared to those with average AST level. It could also be concluded that class I alleles were more frequently expressed in the studied group of chronic carriers, with four marker alleles having frequencies up to 80% for the BW4 allele. In contrast, class II was highly expressed with only one marker allele for chronicity, DQB1*03, in both study groups compared with normal individuals. These had marker alleles of DRB1*13, DRB1*06, DQB1*03(7). Furthermore, our study indicates that further investigations could be conducted to explore genetic susceptibility to HBV infection across different populations. Our study was the first to provide insight into the basis of HLA associations with chronic HBV infection in the Saudi cohort.

Introduction: Chronic hepatitis B virus (HBV) and C Virus (HCV) infection are important cause of cirrhosis of liver and Hepatocellular carcinoma (H.C.C). Majority of patients are asymptomatic and are detected incidentally before surgery, pregnancy, blood donation, dialysis and thalassemia treatment. Aims and Objectives: To determine prevalence of HBV & HCV among blood donors and dialysis patients. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of one year from 1st April, 2024 to 31st March, 2025 during which 40266 blood donors and 17474 dialysis patients were screened for HBV and HCV infections by HbsAg and anti HCV antibody test who were further confirmed by HBV DNA Quantitative and HCV RNA Quantitative test and treated as per scientific protocol. Results: Out of the 40266 blood donors, 354 (0.88%) were HBV positive and 476 (1.18%) were HCV positive. On analysis of 17,474 dialysis patients, 130 (0.88%) were HBV positive and 476 (1.18%) were HCV positive. Conclusion: In view of asymptomatic nature in majority of HBV and HCV patients, manoeuvres to detect at early stage should be taken on broader front. The awareness regarding blood donation is one of them, as it is beneficial for both donor and recipient. The patients on dialysis are also at risk of getting these infections, hence are screened regularly for the same, so that extra care regarding strict infection control practices can be taken to reduce transmission to other patients.

Introduction: Chronic hepatitis B virus (HBV) and C Virus (HCV) infection are important cause of cirrhosis of liver and Hepatocellular carcinoma (H.C.C). Majority of patients are asymptomatic and are detected incidentally before surgery, pregnancy, blood donation, dialysis and thalassemia treatment. Aims and Objectives: To determine the causes of detection of HBV & HCV in patients reporting for treatment at Model treatment center. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of three years from 1 st August, 2022 to 31 st July, 2025 during which 2595 HBV patients and 1691 HCV patients reported for treatment at Model treatment centre, PGIMS, Rohtak. They were confirmed by both ELISA and PCR quantitative test for viral load i.e. HbsAg, anti HCV antibody, HBV DNA Quantitative and HCV RNA Quantitative test before enrolling in the study, that too after proper written consent. Results: In total 1691 HCV patients' data was analyzed and out of them maximum i.e. 672 (39.73%) were detected before surgery during pre-an aesthetic checkup , followed by evaluation of liver disease (23.29%), during blood donation (20.34%), antenatal checkup during pregnancy (12%), during dialysis (3.72%) and evaluation of intravenous drug abuse (0.88%). In total 2595 HBV patients' data was analyzed and out of them maximum i.e. 974 (37.53%) were detected before surgery during pre-anesthetic checkup , followed by during blood donation (26.93%), antenatal checkup during pregnancy (26.93%), evaluation of liver disease (6.85%), during dialysis (1.61%) and evaluation of intravenous drug abuse (0.11%). Conclusion: In view of asymptomatic nature in majority of HBV and HCV patients, manoeuvres to detect at early stage should be taken on broader front. The awareness regarding blood donation is one of them, as it is beneficial for both donor and recipient. The patients on dialysis are also at risk of getting these infections, hence are screened regularly for the same, so that extra care regarding strict infection control practices can be taken to reduce transmission to other patients.

ARTICLE DETAILS Background: Diabetes mellitus is a chronic disease characterized by an imbalance in glucose homeostasis. The hepatitis B virus is a liver-attacking virus that can cause viral hepatitis, cirrhosis, and liver cancer. A cytotoxic T-lymphocyte antigen-4 called CTLA-4 is an immune checkpoint protein that is necessary for T cells to control immune responses and stop the HBV infection from spreading. It does this by acting as an inhibitory receptor, limiting liver damage during an acute infection, and making it easier for the infection to stay in the body during a chronic case. Objective: The study aims to assess CTLA-4 levels in relation to HBV infection in diabetes mellitus patients. Subjects and methods: A cross-sectional study was conducted from July to October 2023. The serum was obtained from 200 diabetic patients who were Iraqis. All of the patients were tested using an ELISA technique for CTLA-4 and HBc IgG. They were tested using a five-panel kit for HBsAb, HBsAg, HBcAb, HBeAg, and HBeAb and measured blood sugar levels. The statistical analysis approach was conducted using SPSS version 26. Results: Serum CTLA-4 levels were correlated with serum HBc IgG positivity (P = 0.000), total HBc Ab positivity (P = 0.000), and HBs Ab positivity (P = 0.000), and CTLA-4 level was correlated with diabetes mellitus (P = 0.034). Conclusions: The study concluded that elevated serum CTLA-4 levels in diabetic patients with HBV infection and type I diabetes compared to type II diabetes. This suggests that diabetes affects the immune system's response to HBV.

Background: Hepatitis B Virus (HBV) is a partly double-stranded, hepatotropic, non-cytotoxic Hepadnaviridae virus. HBV is linked to many autoimmune diseases, including Rheumatoid Arthritis(RA), Cryoglobulinemia, and Antiphospholipid Syndrome(APS). Anticardiolipin antibodies (ACL) are a type of anti-phospholipid antibodies(APA) that target cardiolipin molecules. They're more common in systemic lupus erythematosus (SLE) and APS. APA may be caused by viral infections such as HBV. Aim of the study: Determination of Anticardiolipin antibody positivity among hepatitis B virus-infected patients in Najaf governorate. material, and methods: a cross-sectional study was conducted between September 2022 to March 2023 in Najaf,
a non-random sampling was depended, the sera of 113 HBV-infected patients were collected from the main health facilities in Najaf, and all had no other possible disease that is associated with APA, then it was tested for HBS antigen, total HBc antibodies, IgM HBc antibodies, ACL
antibodies by ELISA technique. SPSS version 26 was used to perform the statistical analysis processes. Results: anti-cardiolipin antibodies(ACL) prevalence was 10.6%, The type of HBV infection and ACL production were significantly correlated (p<0.05), males had a higher percentage of ACL autoantibodies and middle age patients presented with the highest rate of ACL antibodies, however, there was no statistically significant relationship between ACL and age or gender.  In Conclusion: hepatitis B virus (HBV) is one of the main viruses that lead to the production of ACL especially in middle-aged people males, the chronic type is more prevalent for ACL than the acute type.
Keywords: HBV, ACL, Najaf, Cross-Sectional, ELISA

Introduction: Hepatocellular Carcinoma (HCC) is one of the most common malignant tumours in the world. The various risk factors include hepatitis B &C viruses, alcohol, metabolic syndrome including diabetes mellitus, chemicals, and inborn and acquired metabolic disease. HCC is closely associated with hepatitis B and C virus because liver injury caused by viral factor affects many cellular processes such as cell signaling, apoptosis, transcription, DNA repair which in turn induce important effects on cell survival, growth, transformation and maintenance. Material and Methods: This was a prospective study done at Medical Gastroenterology Department, PGIMS,Rohtak conducted over a period of five years i.e. 01.08.2020 to 31.07.2025, during which patients diagnosed to be having HCC due to HBV and HCV were enrolled into study, after written consent for the same. The data pertaining to eighty HCC patients, fourty each of HBV and HCV was analyzed. Observations and Results: HBV and HCV related H.C.C is commonly seen in males and older age group. In Hepatitis B group, out of 40 patients, 32 patients (80%) were above 50 yrs of age. The two patients who belonged to third decade were non cirrhotic and were having chronic hepatitis B with high viral load and directly developed multifocal H.C.C without going into cirrhotic stage. Rest all 38 patients of HBV were cirrhotic. In Hepatitis C group, out of 40 patients, 23 patients (90%) were above 50 yrs of age. Out of 40 HCV patients, 39 were cirrhotic but one 19 years old female was non-cirrhotic and this may be the first case of HCV which has developed HCC without going to cirrhotic stage. Conclusion: Good compliance on drugs is mandatory and patients should be strictly prohibited against smoking and alcohol intake which increases the risk of developing HCC. Females with HBV and HCV requires strict vigil, as they may develop HCC with low viral loads in HBV and even non-cirrhotic can develop HCC in background of HCV. Due to efforts under NVHCP, the need of liver transplant is decreasing steadily in HBV and HCV group.

Introduction: Chronic hepatitis C Virus (HCV) has various routes of transmission for HCV like parenteral, vertical, nosocomial and through close contact among family members of HBV patient. Aims and Objectives: To determine prevalence of HCV in family members of HCV patients confirmed on anti HCV antibody and HCV RNA quantitative viral load testing. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, PGIMS, Rohtak, over a period of three years from 1 st June, 2022 to 31 st May, 2025 during which 2000 confirmed patients of HCV reported in department in last three years duration and out of this total pool of 2000 patients, till date 5000 family members of 1600 HCV patients got tested for anti HCV antibody and HCV RNA quantitative viral load testing for ruling out HCV infection. Hence data pertaining to them was used in final analysis. Results: Out of the 1600 HCV patients, whose 5000 family members were checked for HCV infection, 196 (3.92 %) were found to be HCV positive and 4804 (96.08 %) were HCV negative. If we calculate these 1600 patient family as a whole, then out of them 128 (8%) families were having at least one more member, in addition to patient positive for HCV infection, Conclusion: The family members of every Hepatitis C patient should be screened for HCV infection. The positive members should be evaluated in detail for stage of disease and treatment should be started on priority.

Introduction: Chronic hepatitis B Virus (HBV) infection is an important cause of cirrhosis of liver for which effective treatment is available but still significant number of patients require liver transplantation when it reaches end stage liver disease. There are various routes of transmission for HBV like parenteral, vertical, nosocomial and through close contact among family members of HBV patient. Familial prevalence in HBV is an important aspect and merits strict screening of all family members which can prove to be lifesaving for many. Case Report:-We report a thirty-six-year-old male, not a known case of any chronic illness presented with bilateral pedal oedema for last one-month, abdominal distension and breathlessness on exertion for last two weeks. On evaluation he was diagnosed to be suffering from chronic hepatitis B related chronic liver disease (CLD) with decompensation in form of ascites with hepatocellular carcinoma (H.C.C) with portal vein thrombosis. On family evaluation he told that his on elder brother had died of HBV related H.C.C few years back and mother also died of HBV related CLD in past. His five brother and one sister were found to be HBV Positive and only one brother was HBV negative. on regular antiviral treatment for last five years. Conclusion: The family members of every Hepatitis B patient should be screened for HBV infection. The positive members should be evaluated in detail for stage of disease and if needed treatment should be started on priority. In case of family history of HBV related hepatocellular carcinoma (H.C.C), other HBV positive patients with low viral load should also be treated with antiviral therapy. The members who are found to be HbsAg negative should be vaccinated with complete course of three doses of HBV vaccine.

Background Hepatitis B virus (HBV) infection is a major global health issue, affecting millions of individuals worldwide. Chronic HBV infection is associated with various systemic health complications, including liver disease with its impact on reproductive health in male fertility. Methods This study investigated the impact of HBV on sperm quality in a cohort of 1566 male infertile patients undergoing assisted reproductive treatment from 2021 to 2024. Patients aged 23 to 40 years (mean age 34.2 ± 3.62 years) were categorized into HBV-positive (783 cases) and HBV-negative (783 cases) groups based on serological tests for hepatitis B surface antigen (Hbs Ag). Results HBV-positive and HBV-negative groups exhibited significantly lower progressive motility (41.3% vs. 43.0%; P = 0.006), sperm concentration (53.6 vs. 59.8 × 10 6 /mL; P = 0.009), and normal morphology (4.5% vs. 5.0%; P < 0.001), with reduced viability (P = 0.027). No differences were observed in semen volume (P = 0.807) or DNA fragmentation index (P = 0.970). Conclusion HBV infection is associated with impaired sperm motility, concentration, and morphology in infertile men.
Highlights • HBV seropositivity exhibits negative associations with progressive motility, sperm concentration, and normal morphology in infertile men. • The absence of association with DNA fragmentation indicates that HBV may impair spermatogenesis through pathways independent of direct genetic damage. • HBV exhibits associations with poorer sperm quality.

Introduction: Chronic hepatitis B Virus (HBV) infection is an important cause of cirrhosis of liver for which effective treatment is available but still significant number of patients require liver transplantation when it reaches end stage liver disease. There are various routes of transmission for HBV like parenteral, vertical, nosocomial and through close contact among family members of HBV patient. There are limited studies in literature determining familial prevalence in HBV patient. Aims and Objectives: To determine prevalence of HBV in family members of HBV patients confirmed on HbsAg and HBV DNA quantitative viral load testing.

Introduction: Chronic hepatitis B Virus (HBV) infection is a Pandemic disease which not only cause hepatic or extrahepatic manifestations but also has psychological impact, mainly related to phobias associated with this illness, both in patient and their family members. Aims and Objectives: To determine Phobias associate with Hepatitis B infection in confirmed patients of HBV and their family members. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of three years from 1 st June, 2022 to 31 st May, 2025 during which 3000 confirmed patients of Chronic hepatitis B reported in department and various kind of phobias associated with HBV infection were studied in patient themselves and their family members. Hence data pertaining to them was used in final analysis. Results: Out of the 3000 HBV patients, 2100 (70 %) were found to be HBV positive and 900 (30 %) were in chronic active phase or cirrhotic and were taking antiviral treatment. On analysis of 3000 HBV patients, 1980 (66%) were having phobias associated with HBV and 1020 (34%) were free of any fears associated with illness. When family members of these 3000 HBV patients were analysed, then 1770 (59%) were having phobias and 1230 (41%) were free of phobias. Conclusion: There are various kind of phobias associated with HBV infection both in patient themselves and their family members which should be allayed on priority by the treating team for overall better outcome, both physically as well as mentally.

Introduction: Chronic hepatitis B (HBV) & C Virus (HCV) infection are important cause of cirrhosis of liver for which effective treatment is available but still significant number of patients require liver transplantation when it reaches end stage liver disease. HBV patients in two-third of cases are in inactive carrier stage whereas in one-third cases they are in chronic phase or in cirrhotic stage but in both cases require lifelong follow-up. In contrast to HBV, HCV patients require 12-24 weeks treatment and who achieve sustained virological response (SVR) do not require follow-up, except in cirrhotic patients who remain on lifelong follow up. There are limited studies in literature determining satisfactory index of HBV &HCV patients with treatment given to them, hardships faced during treatment and remedies for the same. familial prevalence in HCV patient. Aims and Objectives: To determine satisfactory index of HBV & HCV patients with treatment given and hurdles faced by them.to them. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of three years from 1 st June, 2022 to 31 st May, 2025 during which 2000 confirmed patients each of HBV & HCV were enrolled in the study and satisfactory index with treatment and hurdles faced by them were studied. Hence data pertaining to these total 4000 patients was used in final analysis. Results: Out of the 2000 HCV patients, none had any grievances regarding treating team but 600 patients (30%) complained about difficulty in getting OPD registration, blood sampling (15%) and ultrasonogram abdomen (50%). In comparison to HCV, 35% (700) HBV patients complained about difficulty in getting OPD registration, blood sampling 920%) and ultrasonogram abdomen 955%) but on similar lines like HCV none had complaint about treating team. Conclusion: The HBV and HCV patients are already terrified regarding their illness, course & side effects of treatment, familial transmission and social stigma associated with the illness. Hence, all manoeuvres should be done make treatment journey of these patients easy and readily accessible.

Introduction: Chronic hepatitis C Virus (HBV) infection is a Pandemic disease which not only cause hepatic or extrahepatic manifestations but also has psychological impact, mainly related to phobias associated with this illness, both in patient and their family members. Aims and Objectives: To determine Phobias associate with Hepatitis C infection in confirmed patients of HCV and their family members. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of three years from 1 st August, 2022 to 31 st July, 2025 during which 2000 confirmed patients of Chronic hepatitis C reported in department and various kind of phobias associated with HCV infection were studied in patient themselves and their family members. Hence data pertaining to them was used in final analysis. Results: Out of the 2000 HCV patients, 1600 (80 %) were found to be non-cirrhotic and 400 (20 %) had cirrhosis and all of them were given antiviral treatment. On analysis of 2000 HVC patients, 1380 (69%) were having phobias associated with HCV and 620 (31%) were free of any fears associated with illness. When family members of these 2000 HCV patients were analysed, then 1320 (66%) were having phobias and 680 (34%) were free of phobias. Conclusion: There are various kind of phobias associated with HCV infection both in patient themselves and their family members which should be allayed on priority by the treating team for overall better outcome, both physically as well as mentally.

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Hepatitis B virus (HBV) infection is a global public health problem. Sudan is classified among the countries with high hepatitis B virus seroprevalence. The purpose of this study was to study the correlation between the hepatitis B viral load and the liver function test in hepatitis BV patients Descriptive cross-sectional hospital based study conducted at the hepatology clinic Ibn Sinaa teaching hospital, covering all the patients who presented to the clinic from March-April 2018, primary data was collected from the patients and/or their care giver, a specifically designed questionnaire was used, and then the data was re-entered into a predesigned data collection form. A P value of 0.05 or less was considered statistically significant. The Data was analyzed using Social Package Statistical Analysis version (24). A total of 83 patients, 19 (22.9%) have viral load level less than 20 IU\ml, 33(39.8%) have viral ranging between (20-2000IU\ ML), 13 (15.6%)have viral load between (2000-20,000IU\ML) and 18(21.7%)have viral load more than 20,000IU\ML). The study showed a significant correlation between hepatitis B viral load and alanine aminotransferase level (ALT) with a P value of 0.027. The study showed a significant correlation between hepatitis B viral load and aspartate aminotransferase level (AST) with a P value of 0.009 .The study also showed there was a significant relation between hepatitis B viral load and serum albumin level with a P value of 0.007. Hepatitis B viral load was not affected by the age, gender or the duration of the disease. The liver function tests is recommended to be used as an indicator for the hepatitis B viral load and the degree of liver inflammation.

Background: Hepatitis B virus (HBV) is considered one of the most paternally transmissible viruses. Therefore, education about its risk factors and transmission is vital in decreasing the prevalence of the disease burden in Sudan. The aim of the present study was to investigate the relative risk factors of HBV and its impact on the society. Materials And Methods: A facility-based, descriptive, cross-sectional study was conducted among those who were incidentally detected with HBV surface antigen (HbsAg) and their contact family members by ICT and enzyme-linked immunosorbent assay (ELISA) in Tropical Diseases Teaching Hospital, Omdurman locality, Khartoum state, Sudan. Results: The study recruited 112 participants, among whom 63 individuals incidentally attended for screening for HBV and this led to contact tracing of 49 individuals (contact relative group). Among 63 patients of the incidental group, there were 83.9% males and 16.1% females. In the contact tracing group consisting of 49 individuals, there were 83.3% males and 16.7% females (odds ratio [OR] = 1.375, 95% confidence interval [CI] = 0.14-13.6; P = 0.000). All the participants were screened for HBsAg. HBV was found to have a significant association with male gender (

One of the commonest modes of detection of hepatitis-B virus (HBV) infection is incidental detection. Incidentally detected asymptomatic HBsAg (IDAHS) positive patients represent a heterogeneous group with variable serological and clinical profile. The aim is to study the viral activity of IDAHS positive patients.

The aim of this paper is to study the early stage of HBV infection and impact delay in the infection process on the adaptive immune response, which includes cytotoxic T-lymphocytes and antibodies. In this stage, the growth of the healthy hepatocyte cells is logistic while the growth of the infected ones is linear. To investigate the role of the treatment at this stage, we also consider two types of treatment: interferon-α (IFN) and nucleoside analogues (NAs). To find the best strategy to use this treatment, an optimal control approach is developed to find the possibility of having a functional cure to HBV.

Chronic hepatitis C virus (HCV) infection is a pan-global public health problem; our crosssectional study over one year in 100 HCV-Ab positive patients whose mean age was 44.9 years showed predominance between 31 and 40 years. Genotype 3 was the most prevalent but maximum viral load was seen in genotype 1. Genotype 3 is most difficult to treat, hence it will be difficult to achieve a high sustained virological response with treatment.

Hepatitis B and C is prevalent in certain parts of India like Andhra Pradesh, North Eastern states, Punjab, Haryana, Uttarakhand and Uttar Pradesh. There are many challenges in these patients which start from identification of the disease, bringing them on treatment and getting it completed and later on problems faced in life even after successful completion of treatment. Our department is model treatment center under National Viral Hepatitis Control Program (NVHCP) and is high flow center and daily 70-80 patients of hepatitis B & C, including both new and old come for consultation and treatment.We have till date enrolled more than ten thousand patients of hepatitis B and treated 25,000 patients of hepatitis C in last fourteen years. Ashi in English means Smile, laughter, joy or blessing and Angel in English means messenger of God. Hepatitis B & C are transmissible diseases and not only general population but health care workers try to avoid these patients which leads to development of complex in these patients. We as a team were coming to know all this discrimination through patient and their relatives first hand version. Thus, it made us well versed with all kind of hurdles, challenges, myths, social taboos being faced by these patients and their family members.The health care workers should have empathy and not only sympathy towards patients. They should treat and help patients with human angle, thus giving joy & smile on their faces(ASHI) and, thus patients will accept them as messenger of God(ANGEL)which will lead to good compliance and successful outcome of treatment. This is MALHOTRAS ASHI-ANGEL CONCEPT in interest of better patient care and it is already showing its positive results.

Introduction: cirrhosis which require liver transplantation as the definitive treatment which in developing country like India, is not easily accessible due to limited centres and spe routes of transmission for HCV, many of them are well documented but certain like sexual one requires more in depth researches for determining its exact contribution in transmission Objectives: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of ten years from 1 31 st December, 2024. Out of ten thousand patients of Chronic hepatitis C who reported in department in last ten years duration, 800 patients pre therapy HCV RNA was not detected; hence they were excluded from the study. Out of the remaini checked for HCV infection, hence they were also excluded from the study. The remaining 9000 confirmed patients of Chronic hepatitis C in whom spouses got checked for HCV antibody and RNA test were incl HCV infection,635 (7.05%) were found to be HCV positive and 8365 (92.95%) were HCV negative. Conclusion: other co Copyright©2025, Parveen Malhotra et al. This is an open use, distribution, and reproduction in any medium, provided

Introduction: Chronic Hepatitis B Virus (HBV) infection is responsible for causing cirrhosis in significant number of cases for whom liver transplantation is the only definitive treatment which in developing country like India, is not easily accessible due to limited centres and specialists for the same. There are various routes of transmission for HBV, many of them are well documented but certain like sexual one requires more in depth researches for determining its exact contribution in transmission. Aims and Objectives: To determine the sexual transmission in HBV confirmed patients on HbsAg and HBV DNA quantitative viral load testing. Materials & Methods: It was prospective study conducted at Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, over a period of eleven years from 1st January, 2014 to 31st December, 2024. During which 8000 confirmed patients of Chronic hepatitis B who reported in department in last eleven years duration were enrolled in the study. Out of this total pool of 8000 patients, till date 5000 patient got tested HbsAg and HBV DNA quantitative test in their spouses for ruling out HBV infection. Hence data pertaining to them was used in final analysis. Results: Out of the 5000 patients in whom spouses were checked for HBV infection, 362 (7.24%) were found to be HBV positive and 4638 (92.76%) were HBV negative. Conclusion: The sexual route cannot be missed as an important route, especially in those who have other co-risk factors.

The aim of this paper is to study the early stage of HBV infection and impact delay in the infection process on the adaptive immune response, which includes cytotoxic T-lymphocytes and antibodies. In this stage, the growth of the healthy hepatocyte cells is logistic while the growth of the infected ones is linear. To investigate the role of the treatment at this stage, we also consider two types of treatment: interferon-α (IFN) and nucleoside analogues (NAs). To find the best strategy to use this treatment, an optimal control approach is developed to find the possibility of having a functional cure to HBV.

Human immunodeficiency virus infection destroys the body immune system, increases the risk of certain pathologies, damages body organs such as the brain, kidney, and heart, and causes death. Unfortunately, this infectious disease currently has no cure; however, there are effective retroviral drugs for improving the patients’ health conditions but excessive use of these drugs is not without harmful side effects. This study presents a mathematical model with two control variables, where the uninfected CD4+T cells follow the logistic growth function and the incidence term is saturated with free virions. We use the efficacy of drug therapies to block the infection of new cells and prevent the production of new free virions. Our aim is to apply optimal control approach to maximize the concentration of uninfected CD4+T cells in the body by using minimum drug therapies. We establish the existence of an optimal control pair and use Pontryagin’s principle to characterize the optimal levels o...

Background Hepatitis C is a global public health problem. As many as 12 million people may be chronically infected in India and most are unaware of it. Aims To determine the incidence of hepatitis C in the Ratia block of the Fatehabad district, Haryana, India. Method This cross-sectional study was carried out by house-tohouse visits over 2 weeks. After obtaining written consent, a blood sample was drawn from suspected cases by a laboratory technician maintaining all necessary safety precautions and sterilization. Results Of the samples, 1,630 (22.3 per cent) were found to be positive for hepatitis C by ELISA, 253 (15.5 per cent) patients were previously hepatitis C positive, and adults (21-60 years) were affected maximally (70.0 per cent). Conclusion The study emphasises the need for public awareness campaigns at various levels and prevention of HCV infection. It also suggests the need to develop and strengthen evaluation methodology for the Integrated Disease Surveillance Project (IDSP).

Background: Hemodialysis services in Vietnam are being decentralised outside of tertiary hospitals. To identify the challenges to infection control standards for the prevention of bloodborne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV) we tested the magnitude of HBV and HCV infections in the largest unit in Ho Chi Minh City servicing patients with end stage renal disease. Methods: All 113 patients provided consent HBV surface antigen (HBsAg) and HCV core antigen (HCV-coreAg) testing. Positive patients were tested for viral genotypes. All participants completed a questionnaire on demographic characteristics, risk factors and previous attendance to other hemodialysis units. Results: Seroprevalence of 113 patients enrolled was 7% (8/113, 95% CI 2.3%-11.8%) HBsAg, 6% (7/113, 95% CI 1.7%-10.6%) HCV-coreAg and 1% (1/113, 95% CI 0.8%-2.6%) co-infection. Having a HBV positive sexual partner significantly increased the risk of acquiring HBV (P = 0.016, Odds Ratio (OR) =29, 95% CI 2-365). Risk factors for HCV included blood transfusion (P = 0.049), multiple visits to different hemodialysis units (P = 0.048, OR = 5.7, 95% CI 1.2-27.5), frequency of hemodialysis (P = 0.029) and AST plasma levels >40 IU/L (P = 0.020, OR = 19.8, 95% CI 2.3-171). On multivariate analysis only blood transfusion remained significant risk factor for HCV (P = 0.027, adjusted OR = 1.2). Conclusions: HCV screening for HCV of blood products must improve to meet the infection prevention challenges of decentralizing hemodialysis services. The level of HCV and HBV in our hemodialysis unit is a warning that universal precautions will be the next challenge for decentralised hemodialysis services in Vietnam.

People living with HIV/AIDS in 2010 are around 34 million, already; more than 30 million people around the world have died of AIDS-related diseases. In 2010, 2.7 million people were newly infected with HIV, and 1.8 million men, women and children died of AIDSrelated causes [9].

Background: Hemodialysis services in Vietnam are being decentralised outside of tertiary hospitals. To identify the challenges to infection control standards for the prevention of bloodborne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV) we tested the magnitude of HBV and HCV infections in the largest unit in Ho Chi Minh City servicing patients with end stage renal disease. Methods: All 113 patients provided consent HBV surface antigen (HBsAg) and HCV core antigen (HCV-coreAg) testing. Positive patients were tested for viral genotypes. All participants completed a questionnaire on demographic characteristics, risk factors and previous attendance to other hemodialysis units. Results: Seroprevalence of 113 patients enrolled was 7% (8/113, 95% CI 2.3%-11.8%) HBsAg, 6% (7/113, 95% CI 1.7%-10.6%) HCV-coreAg and 1% (1/113, 95% CI 0.8%-2.6%) co-infection. Having a HBV positive sexual partner significantly increased the risk of acquiring HBV (P = 0.016, Odds Ratio (OR) =29, 95% CI 2-365). Risk factors for HCV included blood transfusion (P = 0.049), multiple visits to different hemodialysis units (P = 0.048, OR = 5.7, 95% CI 1.2-27.5), frequency of hemodialysis (P = 0.029) and AST plasma levels >40 IU/L (P = 0.020, OR = 19.8, 95% CI 2.3-171). On multivariate analysis only blood transfusion remained significant risk factor for HCV (P = 0.027, adjusted OR = 1.2). Conclusions: HCV screening for HCV of blood products must improve to meet the infection prevention challenges of decentralizing hemodialysis services. The level of HCV and HBV in our hemodialysis unit is a warning that universal precautions will be the next challenge for decentralised hemodialysis services in Vietnam.

We propose a delayed SIR model with saturated incidence rate. The delay is incorporated into the model in order to model the latent period. The basic reproductive number R0 is obtained. Furthermore, using time delay as a bifurcation parameter, it is proven that there exists a critical value of delay for the stability of diseases prevalence. When the delay exceeds the critical value, the system loses its stability and a Hopf bifurcation occurs. The model is extended to assess the impact of some control measures, by reformulating the model as an optimal control problem with vaccination and treatment. The existence of the optimal control is also proved. Finally, some numerical simulations are performed to verify the theoretical analysis.