Hepatitis B virus (HBV) infection is the main cause ofControversial data were recently published concerning the fulminant hepatitis (FH) in several geographic areas, includassociation of hepatitis B virus (HBV) variants with fulminant ing the Mediterranean basin. 1 Traditionally the fulminant hepatitis (FH). In this study, we first analyzed the complete course of an HBV infection has been ascribed to an enhanced nucleotide sequences of HBV genomes isolated from serum host immune response against viral antigens. 2 There is some samples from a surgeon and his mother, who was accidentally evidence, however, indicating that viral factors may also be infected by the son; both died of FH. The infecting viruses involved in the pathogenesis of this disease. 3,4 A number of were genetically almost identical in both patients; all the papers have recently reported a significant association of FH clones examined carried a double nucleotide mutation in the with infection by HBV variants unable to produce HBe prostart codon of the pre-S2 region that prevented the synthesis tein (HBeAg) because of a translational stop codon in the of the corresponding protein. Analyses of different serum samprecore region of the viral genome 5-9 or because of point ples from the son revealed only wild-type precore sequences mutations at the level of the core promoter located in the X in a high viremic serum, whereas hepatitis B e antigen region (nucleotides 1,742-1,849). 10 Nevertheless, the possi-(HBeAg)-defective strains were prevalent when the viremia ble role of HBeAg-defective variants in the development of had decreased. Subsequently, we extended the analysis to the FH is controversial, since an association between these viral viral genomes isolated from 18 additional patients with acute mutants and the acute liver failure was not found in all HBV infection and different clinical behaviors: 3 of 5 patients the studies, 11-14 evaluation of HBV genomic heterogeneity in with FH and without previous liver disease had pre-S2 start cases of FH was generally limited to examination of part of codon mutations preventing pre-S2 protein synthesis, the viral genome, 5-14 and HBV molecular analysis was perwhereas none of the 13 control cases had similar genomic formed on serum samples collected when the viremia had rearrangements. Analysis of the precore region showed that already decreased to levels detectable only by the polymerase viral populations normally producing HBeAg were the only chain reaction (PCR) amplification technique. 5-14or the prevalent viral strains in all of these cases. In summary, In this study, we have had the opportunity to analyze the our results support the hypothesis that the pre-S2 protein is entire nucleotide sequence of HBV genomes isolated from not essential for HBV infectivity. They also show that infection two members of a family who both died from FH type B. In by pre-S2-defective virus is frequently associated with FH, addition, serum samples collected during both high and low indicating that this variant might pla...

We conducted a study on injecting drug users attending one of 3 drug treatment centres in Naples, to estimate HIV and hepatitis C virus (HCV) incidence rates and to identify risk factors for seroconversion. Incidence rates were estimated using as denominator the person-time of follow-up of participants who were negative for both HIV and HCV at enrollment and who were retested within 6-12 months. Information on risk factors was collected using a standardized questionnaire. A nested case-control analysis was performed comparing seroconverters with persistently HCV-negative individuals. None of the initially non-infected participants seroconverted for HIV, while the incidence rate for HCV infection was approximately 29 per 100 person-years. Analysis of risk factors showed that age > 28 years and injecting use of cocaine were associated with HCV seroconversion. The protective role of methadone treatment was also marginally significant. Our findings suggest that HCV infection may represent an important public health problem in areas with low HIV circulation. The identification of specific risk factors for HCV infection is needed to plan effective prevention strategies.

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