Prevalence and genotype distribution of hepatitis C virus among apparently healthy individuals in Mongolia: a population-based nationwide study

Baatarkhuu, Oidov,Kim, Do Young,Ahn, Sang Hoon,Nymadawa, Pagvajav,Dahgwahdorj, Yagaanbuyant,Shagdarsuren, Manaljav,Park, Jun Yong,Choi, Jong Won,Oyunbileg, Janchiv,Oyunsuren, Tsendsuren,Han, Kwang Hyu Blackwell Publishing Ltd 2008 Liver International Vol.28 No.10

<P>Abstract</P><P>Background and Aims</P><P>Hepatitis C virus (HCV) is one of the major causes of liver cirrhosis and hepatocellular carcinoma (HCC) in Mongolia. However, there are no data concerning nationwide prevalence of HCV infection in Mongolia. We intended to investigate the population-based prevalence of HCV infection and genotype distribution among 1512 apparently healthy individuals in this country.</P><P>Methods</P><P>Between April 2003 and December 2005, sera from 1512 residents of Ulaanbaatar and 12 provinces were collected by two-stage cluster random sampling, and anti-HCV was tested. Anti-HCV-positive samples were tested for HCV RNA by reverse transcription polymerase chain reaction, and HCV genotype was determined.</P><P>Results</P><P>The mean age of the subjects was 46.2±17.8 years, and 812 (53.7%) were male. Overall, the prevalence of anti-HCV was 15.6% (236/1512) and HCV RNA was detected in 167 subjects (11.0%), with the most common genotype being 1b (165/167, 98.8%). When the HCV RNA-positive subjects were categorized by decade of age, the prevalence in each age group was as follows: 2.5% in subjects ≤10 years of age, 4.5% in teens, 10.1% in 20's, 12.5% in 30's, 24.2% in 40's, 29.0% in 50's and 32.6% in subjects ≥61 years of age. The seroprevalence of anti-HCV in a risk group, nurses, was not significantly different from the general population in each decade of age (<I>P</I>>0.05).</P><P>Conclusions</P><P>Approximately 11.0% of apparently healthy population had detectable HCV RNA in Mongolia, and the predominant genotype of HCV was 1b. Preventive and therapeutic strategies for chronic hepatitis C are urgently warranted in this HCV-endemic area.</P>

T-접합선로의 등가회로를 고려한 저역통과 여파기 설계

Baatarkhuu Dorjsuren,최흥택(Choi, Heung-Taek),안달(Ahn Dal) 한국산학기술학회 2009 한국산학기술학회논문지 Vol.10 No.6

본 논문에서는 T-접합선로의 집중소자 등가회로를 고려한 저역통과 여파기를 제안하였다. 일반적인 저역통과 여파기 설계 시 발생하는 T-접합선로의 특성에 따른 주파수 변이 특성을 해결하기 위해 T-접합선로 등가회로의 소자 값을 구하는 수식을 유도 하였다. 또한, 전자장 시뮬레이터(HFSS)를 이용하여 T-접합선로를 디임베딩하였다. 이로써 선로의 임피던스 허수값들이 일치되게 하여 T-접합선로 등가회로에서 집중소자의 정확한 값을 구하였다. 그리고 이 값들을 이용하여 저역통과 여파기를 설계한 결과, 집중소자 여파기의 주파수 특성과 분포소자 여파기의 주파수 특성이 매우 잘 일치함을 확인할 수 있었다. In this paper, the Low Pass Filter (LPF) using the equivalent circuit of T-junction microstrip line is proposed. And we derived the formulas for lumped-elements of the equivalent circuit of T-junction microstrip line to solve the frequency shift characteristic. T-junction microstrip line is de-embedded by Electromagnetic simulation tool and exact lumped element value of T-junction microstrip line is calculated by the equation of Z-parameter. We can get excellent agreement between lumped-element LPF frequency response and transmission line LPF frequency response.

Poster Exhibition : Prevalence and Genotype Distribution with Hepatitis A, B, C, and Delta Viruses Among Patients with Acute Viral Hepatitis in Mongolia (초)

Oidov Baatarkhuu,Tsatsralt Od Bira 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4(S)

Results of Lutasan Treatment in Mongolia

( O. Baatarkhuu ),( B. Amartuvshin ),( D. Munkh-orshikh ),( D. Badamsuren ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Chronic liver diseases are very common among the Mongolians. Study suggests that alcohol induced pathologies composed of cirrhosis 39%, fatty liver disease 27%, and 11% chronic hepatitis respectively. “Lutasan” (reduced glutathione) injection is known as hepatoprotector, antioxidant, immune modulator and detoxifying functions. As chronic disease progresses, glutathione insufficiency leads to poor cognitive outcomes and tremor in upper limbs. Therefore, we aimed to study treatment efficacy of “Lutasan” injection for chronic liver diseases and the complications. Methods: Total of ten subjects were recruited randomly from GI Department of Third General Hospital. Liver functions were evaluated by serum total bilirubin, total protein, albumin, AST, ALT, GGT, and alkaline phosphatase measures and hepatic neurocognitive deterioration was evaluated by Reitan neurophysiological test. Results: 10% of the patients were alcohol induced, and 60% had combination of viral and alcoholic reasons, and remaining 20% had biliary tract disorders. Compare to the first day’s results, on the 10th day of hospitalization, serum indicators were much improved within the treatment period (^*-P<0.05) including AST 3.02 times, ALT 2.21 times, ALP 2.56 times and GGT 1.78 times were decreased respectively (Table 1). Also neuro-cognitive improvements were significantly observed, by 1.74 times on Reitan neurophysiological test when comparing before and after treatment scores, 58.6±4.61 and 33.7±1.34, respectively. Conclusions: These findings suggest that Lutasan, a glutathione supplement has effects of minimizing hepatic cytolysis, cholestasis in the biliary tract, reducing destruction of hepatocytes, and aiding regeneration of liver cells. Moreover, it reduces symptoms of hepatic neurocognitive disorders significantly.

Peculirity of Cell Immunity and Immunogenetics of Patients with Hepatitis C and Ways for Elimination of Virus and Immunocorrection

( Oidov Baatarkhuu ),( Baasankhuu Enkhtuvshin ),( G. Sarangoo ),( S. Tsogtsaikhan ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Hepatitis C is one of actual health problem of the country. So we have rised the aim to establish peculirity of cell immunity and immunogenetics of patients with hepatitis C and to search ways for elimination of virus and immunocorrection. Methods: There were enrolled total 85 patients (47 males and 38 females) and 64 of them were with chronic and 21 patients with acute hepatitis C. Count of CD3+,CD4+,CD8+ cells (cell/mm3) and CD4/CD8 ratio in 64 patients with chronic hepatitis C were determined by flowcytometry using “BD-FACS count” machine. Lymphocyte blasttransformation reaction with T cell mytogen-phetohemoagglutinin (PHA) were performed in 25 patients with chronic hepatitis C and 15 healthy individuals (rational design sertificate No 1798 from Intellectual Property Autority of Mongolia). For purpose of elimination of virus and immunocorrection aIFN 2b and ribavirin therapy were used in 52 patients with hepatitis C and calculated portion of patients with sustainable viral response (SVR). Results: Count of lymphocytes (BТL2-BТL1) went under blasttransformation by stimulation of PHA was lower (p<0.05) in patients with chronic HC compared to control individuals. There were no side factors excluding PHA (placebo: BТL1=26.11; BТL2=26.00; BТ L2-BTL1=-0.11). It was found lower blastransformation activity (BТL2-BТL1) in patients with CD4+ cell count less than 800 cell/мм3 compared to patients with CD4+ cell count more than 800 cell/мм3 (p<0.05). Number of blasttransformed T cells had direct correlation with count of CD4+T cells (r=0.424) but had indirect correlation with count of CD8+T cells (r= - 0.77). There were more clear manifestation of clilnical signs and elevated serum ALAT level in patients with decreased CD4/CD8 ratio compared to patients with normal ratio. Decrease of CD4/CD8 ratio were caused by increased count of CD8 T cells (CD8 count: 1030±117.3 in patients with clear clinical manifestation and 573.4±98.3 in patients with inclear clinical manifestation, t=3.45, p<0.01). 71.4% of 21 patients (15 males, 6 females, aged 19-44, mean age 27.2±3.4) with acute HC developed SVR after 6 month single IFN therapy. 12 month combined IFN and ribavirin therapy were used in 31 patient patients (15 males, 16 females, mean age 45.4±4.5) with chronic HC. 45.1% of them developed SVR, 42% - PR and 12.9% had not demonstrate no response-NR. Conclusions: There were found disregulation of cell immune response in chronic HCV patients which demonstrated with decreased CD4 count and CD4/CD8 ratio, increased CD8 count and decreaed blasttransformation activity of T cells. Increased CD8+Т cell count was correlated with clear clinical manifestation, low blasttransformation activity of peripheral T cells and elevated level of serum ALAT. Interferon therapy is effective in patients with HC infection for elimi nation of virus and immunocorrection. Sustainable virus response was observed in 71.4% of patients with acute HC and in 45.1% of patients with chronic hepatitis C.

Current Status New Direct Acting Anti-Viral Treatment of Hepatitis C in Mongolia

( O. Baatarkhuu ),( Z. Bat-erdene ),( D. Munkh-orshikh ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: During last several years, internationally available diagnostics, treatments and medicines of HCV have changed dramatically. Interferon-based therapy for HCV has comparatively low result of treatment effect, more side effects, long treatment duration, high cost of single dose and limited option of treatment. Since introduction of direct antiviral agents including in 2011 Boceprevir, Telaprevir, in 2013 Simeprevir, Sofosbuvir, in 2014 Harvoni (ledipasvir/sofosbuvir), Daklinza (daclatasvir), Vikera Pack (ombitasvir/paritaprevir/dasabuvir), the new era HCV treatment came up. thanks to those new drugs HCV infection became one of the curable diseases, and entire world is targeting free from HCV /WHO/. Therefore, there is need of to access milestones of diagnostic and treatment development of HCV in our country. Our study aims to determine implementation of global trend for HCV diagnostic and treatment in Mongolia. Methods: This study is qualitative one and we analyzed policy and strategic documents and statistics issued by Mongolian Government, Ministry of Health, National Center for Communicable Disease, Mongolian National University of Medical Sciences and other organizations. Results: Ministry of Health played very large role in introduction of new management of HCV into the country. It provided all the legal ground and support to service providers at all levels of care. New guideline was approved which includes all new schemes of the treatment, diagnostic methods, new drugs were registered, specialist doctors were trained and access of the new drug were widened thanks to joining the Access program from Gilead Sciences. It can be said that the tentative result of DAA treatment is successful, compare few years ago interferon treatment effect was fewer than 20 percent to the 99 percent effective of current new treatment. Conclusions: All those achievements show that Mongolia has been able to introduce a comprehensive and efficient shortterm treatment for HCV and free the population of that disease which may increase the mortality level due to liver cancer.

Ledipasvir and Sofosbuvir Fixed-Dose Combination without Ribavirin for 12 Weeks in Treatment-Naive Mongolian Patients with Hepatitis C: A Multi-Center Study

( O. Baatarkhuu ),( B. Davaakhuu ),( N. Naranzul ),( Ch. Gantuul ),( Ch. Bolormaa ),( P. Delgermaa ),( S. Ariunaa ),( G. Sarangua ),( G. Khishigjargal ),( D. Javzmaa ),( D. Ouyntuya ),( S. Nyamaa ),( 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: In Mongolia, previous studies shown HCV prevalence is over 10% and 97-98% of people with HCV infection have infected with genotype 1b. In addition, Mongolia is on first place of HCC mortality rate per 100.000 population and this is eighth times higher than globally average rate. HCV prevalence among primary hepatic carcinoma patients is 35%-45%. Therefore activities on reducing chronic infection prevalence of hepatitis viruses and preventing complications of hepatitis viral infections have been conducted in the country. One of them is availability of Harvoni treatment for HCV patients since December 2015. To evaluate data on the antiviral efficacy and safety of direct acting antiviral (DAA) treatment with respect to sustained virological response (SVR) 12 weeks after completion of treatment. Methods: We retrospectively analyzed patient monitoring records and patient registration forms for HCV patients who received Harvoni treatment at NCCD, MNUMS, provinces and districts hospitals. Quantitative methods were applied in that retrospective study. Six hundred and forty-seven patients diagnosed as HCV and treated by Harvoni(ledipasvir/sofosbuvir) were attended the study. Results: There were totally 647 patients received Harvoni for HCV infection by September 2016. People who received treatment for less than 3 months there 31% and for longer than 3 months were 8%. Among them 91.9% have chronic hepatitis and first stage of liver cirrhosis and 8% have liver cirrhosis and carcinoma. After 1 month of treatment, HCV RNA tests result was negative for 98.8% of all Harvoni patients and for the rest 1.1% resulted in decrease of HCV RNA.After 3 month of trerapy, blood test result showed 100% recovery on transaminase level. 453/465, 10/465 and 2/465 of them were respectively genotype 1b, 2 and 1a. APRI score were pre-treatment 1.3±0.58 and post treatment 0.443±0.148. FIB4 score were pre-treatment 3.8±1.2 and post treatment 1.65±0.59. Occurrences of side effects were mild. 1.2%, 5.8% and 4.6% of them were respectively with CTP C, CTP B and CTP A scores. 88.2% of the participants were chronic hepatitis C and 1.7% of them were pre-treated by interferon. Conclusions: After treatment by Harvoni tablets, excellent SVR12 results were shown among the study participants’ and the favorable side-effect profile were observed for the Mongolian context.

Cause of Cirrhosis in Mongolia Evaluated by Non-Invasive Methods Including Fibroscan, FIB4 and APRI

( Oidov Baatarkhuu ),( Munkhchuluun Batzaya ),( D. Enkhutya ),( S. Munkhdemberel ),( S. Ariunaa ),( B. Davaakhuu ),( B. Erkhem ),( G. Egelmaral ),( J. Amarsanaa ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Liver cirrhosis is the one of the most deadly diseases in Mongolia and in rest of the world. To determine the main cause of liver cirrhosis through using methods as AST-to-Platelet Ratio Index (APRI), Fibrosis 4 score (FIB4), and Fibroscan. Methods: We collected 2758 patients who had Fibroscan, then divided them in three groups, HBV positive, HCV positive, and virus negative. Depending on the result of the Fibro scan ,we made a cut-off point of 12kPa to separate patients with F4 stage from F0, F1, F2, and F3 patients. To compare the result of the Fibroscan with other techniques we collected other laboratory results including AST, ALT level, thrombocyte number, viral markers, and viral load. Results: Among 2758 subjects 57.7% (1591) of patients were anti-HCV positive, 35.7% (984) of patients were HBV positive and 6.6% (182) of patients were virus negative. Amongst 1590 patients who were anti-HCV positive, 62.4%(992) of patients diagnosed with F4 stage of fibrosis by Fibroscan. On the other hand, 34.7%(551) of patients with HBV positive has developed cirrhosis and 2.9% (47) of patients had cirrhosis without any evidence of virus. We randomly selected 100 patients from both HBV and HCV positive groups to determine the correlation between Fibroscan, FIB4 and APRI. The correlation between Fibroscan and other non-invasive method including APRI and FIB4 was not strong. In our further study, among 2.9% patients with cirrhosis caused by non-viral etiology, 70% were frequent alcohol consumers and only 15%t admitted that they were addicted to alcohol, and rest of the patients developed liver cirrhosis caused by other factors. Conclusions: The most common cause of liver cirrhosis is HCV, followed by HBV in Mongolia.

Comparative Study of Persistent Immunity to HBV after Vaccination and Naturally Acquired Immunity Post HBV Infection in Mongolia

( O. Baatarkhuu ),( O. Otgonbayar ),( J. Amarsanaa ),( D. Munkh-orshikh ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: As of 2015 over 260 million people live with chronic hepatitis B in the world. Every year about 1 million people died due to liver cirrhosis, liver cancer caused by Hepatitis B virus. HBV and HCV are high prevalent in Mongolia,, around one fourth Mongolian has HCV or HBV . According to the study, 39.4% of people who had HBV infection got HBV vaccination which leads to viral problem in Mongolian health care system. Since 1991 all newborns have been vaccinated with HBV vaccine. And people who born before that year did not take the HBV vaccination. To determine the generation of persistent immunity from HBV vaccination or after HBV infection. Methods: 492 patients have enrolled who were investigated with quantitative HBsAb using Sysmex HISCL-800 at Happy Veritas Clinic and Diagnostic Center and MNUMS. The vaccination scheme consists of three doses. Vaccination is successful if the antibody titer is higher than 10 mlU/L. Also we have conducted questionnaires about HBV vaccination and risk factor for taking hepatitis infections from patients. Results: In this study 492 patients have participated 313(63%) female and 179 (37%) male, out of which 471(96%) people born before 1991 and remaining 21(4%), people born after 1991. 12 people (57%) who born after 1991 or vaccinated within 24 hours after birth were quantification HBsAb low titer (< 10mlU/L), remaining (43%) were qHBsAb titer ( >10mlU/L), while 297 people (64%) who born before 1991 were qHBsAb titer (<10mlU/L),and remaining 36% of patients had persistent HBV vaccine. The 99 people who born before 1991 have enrolled in HBV vaccination voluntarily while 372 people did not take HBV vaccine at all. Conclusions: Persistent immunity against HBV is generated not only in person who have taken HBV vaccination but also in person who have had slight HBV infection. It was considered that people aged between 50 and 60 years could not get persistent immunity against HBV. We assumed that persistent immunity against HBV depends on age, not other factor and sex.

The Development of DAA Treatment for HCV in Mongolia

( O. Baatarkhuu ),( Sosorbaram Ariunaa ),( N. Naranzul ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: During last several years, internationally available diagnostics, treatments and medicines of HCV have changed dramatically. Interferon-based therapy for HCV has comparatively low result of treatment effect, more side effects, long treatment duration, high cost of single dose and limited option of treatment. Since introduction of direct antiviral agents including in 2011 Boceprevir, Telaprevir, in 2013 Simeprevir, Sofosbuvir, in 2014 Harvoni (ledipasvir/sofosbuvir), Daklinza (daclatasvir), Vikera Pack (ombitasvir/paritaprevir/dasabuvir), the new era HCV treatment came up. thanks to those new drugs HCV infection became one of the curable diseases, and entire world is targeting free from HCV /WHO/. Therefore, there is need of to access milestones of diagnostic and treatment development of HCV in our country. Our study aims to determine implementation of global trend for HCV diagnostic and treatment in Mongolia. Methods: This study is qualitative one and we analyzed policy and strategic documents and statistics issued by Mongolian Government, Ministry of Health, National Center for Communicable Disease, Mongolian National University of Medical Sciences and other organizations. Results: Ministry of Health played very large role in introduction of new management of HCV into the country. It provided all the legal ground and support to service providers at all levels of care. New guideline was approved which includes all new schemes of the treatment, diagnostic methods, new drugs were registered, specialist doctors were trained and access of the new drug were widened thanks to joining the Access programme from Gilead Sciences. It can be said that the tentative result of DAA treatment is successful, compare few years ago interferon treatment effect was fewer than 20 percent to the 99 percent effective of current new treatment. Conclusions: All those achievements show that Mongolia has been able to introduce a comprehensive and efficient short-term treatment for HCV and free the population of that disease which may increase the mortality level due to liver cancer.