Introduction: The recent use of new direct-acting drugs (DAAs) in the treatment of chronic HEPATITIS C needs to be evaluated in HBV/HCV coinfected patients. Case Presentation: Here, we report the case of a 47-year-old female patient with HBV/HCV coinfection who experienced HBV reactivation during treatment with daclatasvir (DCV) and sofosbuvir (SOF). In addition to the DAAs, Entecavir (ETV) was added to the combined regimen with improvement in ALT levels. Conclusions: Both HBV and HCV treatment could be implemented effectively in case of reactivation of HBV during anti-HCV treatment with DAAs. Close monitoring of HBV DNA and ALT levels are highly recommended during DAAs drug therapy for HCV in patients with HBV/HCV dual infection.

To the Editor The incidence of HEPATITIS C VIRUS (HCV) and Human Immunodeficiency VIRUS (HIV) coinfection in People Who Inject Drugs (PWIDs) is a public health issue; it presents various contentions to the healthcare providers. Although antiretroviral therapy improved the life expectancy of HIV-infected people, HCV-related mortality turned into a greater concern among these individuals. According to Yen et al. 0. 4% of PWIDs were positive for HIV, 78% for HCV, and 13. 1% for HIV/ HCV coinfections. Furthermore, they mentioned, “ injecting drug users in the Taipei methadone maintenance treatment program had a very high prevalence of HIV/ HBV coinfection and HCV mono-infection” . Besides, a systematic review and meta-analysis results suggested a high frequency of HIV/HBV coinfection (>80%) in Intravenous (IV) drug users. Although the incidence of HIV among IV drug users has been decreased, HCV is still endemic in this population...

Objective(s): This study was designed to investigate whether HBx-induced podocyte injury is related to the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and the specific mechanism of the oxidative stress pathway in HEPATITIS B VIRUS-associated glomerulonephritis (HBV-GN). Materials and Methods: The HBx gene was overexpressed in renal podocytes to mimic HBV-GN. Podocyte morphology was observed under a scanning electron microscope. Reactive oxygen species (ROS) generation was detected by dichlorodihydrofluorescein diacetate (DCFH-DA) assay. The podocytes in each group were treated with Hoechst 33342 and subjected to immunofluorescence staining. Caspase-1 activity and LDH levels were assessed with a Caspase-1 Activity Assay Kit and an LDH ELISA Kit, respectively. The expression of all pyroptosis-related proteins was examined by Western blot analysis. Results: Pyroptosis-related proteins, including NLRP3, apoptosis-associated speck-like protein containing card (ASC), caspase-1, IL-1β , and IL-18 (P<0. 05), were up-regulated upon HBx overexpression, and caspase-1 enzyme activity and LDH and Desmin expression were also enhanced (P<0. 05). NLRP3 knockdown attenuated the increased expression of pyroptosis-related proteins upon HBx overexpression (P<0. 05), which was also achieved by the addition of an ROS inhibitor (P<0. 05). Conclusion: HBx regulates podocyte pyroptosis in HBV-GN by targeting the NLRP3 inflammasome, and mitochondrial oxidative stress plays an important role in this process.

Background: HEPATITIS B VIRUS (HBV), HEPATITIS C VIRUS (HCV), and human immunodeficiency VIRUS (HIV) are the three prevalent viral and bloodborne infections worldwide. Considering the similar route of transmission in these infections, their co-infections would be more challenging for health care professionals. Therefore, we investigated the rate of HIV/HBV/HCV co-infection among injection drug users (IDUs) referred to Drop in centers (DICs).Materials and Methods: In this cross-sectional study (2008-2009), IDUs referred to DICs in Isfahan province were evaluated. Venous blood samples were obtained and HBsAg, HBcAb, HCVAb, and HIVAb measured by using enzyme linked immunosorbent assay method. Demographic data and risk factors in patients with HBV/HCV, HIV/HCV, and HIV/HBV co-infections were obtained by a trained social worker using a structured checklist. Data were analyzed using Chi-square test, t-test, and multiple logistic regressions.Results: Totally, 539 IDUs with mean (standard deviation [SD]) age of 35.3 (7.9) were studied. HBV/HCV, HCV/HIV, and HBV/HIV co-infections were presented in 65 (12.1%), 6 (1.1%), and 0 (0%) of IDUs, respectively. All HIV infected IDUs were infected with HCV as well. There was a significant association between HBV/HCV co-infection and behaviors related to sharing needle (odds ratio [OR]=2.06, 95% confi dence interval [CI]; 1.23-3.45) and imprisonment (OR=1.01, 95% CI; 1.04-1.06).Conclusion: According to the results of this study, history of imprisonment and needle sharing were the only adjusted risk factors for HCV/HBV co-infection in IDUs. This might be a warning for national health system and needs to urgent paying attention. It seems that expanded harm reduction strategies can be useful to reduce this co-infection and its mortality and morbidity rate among IDUs.

Background: Detection of HEPATITIS B VIRUS (HBV) genomes without detectable HEPATITIS B surface antigen (HBs-Ag) is termed occult HBV infection (OHBV) that may be transmitted by blood transfusion or organ transplantation and has acute reactivation when an immunosuppressive status like human immunodeficiency VIRUS (HIV) infection occurs. We aimed to evaluate OHBV in HIV-infected patients with isolated antibodies to HEPATITIS B core antigen (anti-HBc) in Isfahan, Iran.Materials and Methods: In a cross-sectional study during August-September 2011, serum samples from HIV-infected patients who attended Isfahan Consultation Center for Behavioral Diseases were tested for HBs-Ag and anti-HBc using ELISA method. HBV-deoxyribonucleic acid (DNA) was detected and quantified in plasma of HBs-Ag negative/anti-HBc positive subjects by real-time polymerase chain reaction.Results: From 64 HIV-positive individuals, 12 (18%) patients were HBs-Ag negative/anti-HBc positive, and from those 3 (25%) had detectable HBV-DNA in their plasma.Conclusion: It seems that occult HBV might be assessed and be treated in HIV-infected patients.

HEPATITIS C VIRUS infection is an emerging disease and a public health problem in the world. There are accumulating data regarding extra hepatic manifestation of HCV, such as rheumatologic manifestations, endocrine, hematologic, dermatologic, renal, neurologic, and systemic manifestations. The therapy of them needs more attention to some exacerbations of extra hepatic manifestation and in some situation it needs different approaches. In this review we tried to provide latest evidence for extra hepatic manifestation and management of them.