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)

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.

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.

Prevalence of Hepatitis B and C Virus Infection among Apparently Healthy Population of Ulaanbaatar City

( Oidov Baatarkhuu ),( Baasankhuu Amartuvshin ),( D. Tungalag ),( G. Tsagaantsooj ),( A. Jazag ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Hepatitis B (HBV) and C virus (HCV) are one of the major causes of liver cirrhosis and hepatocellular carcinoma (HCC) in Mongolia. More than 77% of the Mongolian population is estimated to have been infected with hepatitis B virus (HBV) at some time during their life, and between 10 and 22% of the general population is chronically infected with either hepatitis B or C. We intended to investigate the population-based prevalence of HBV and HCV infection prevalence among apparently healthy population in Ulaanbaatar city. Methods: This study was conducted from June 2015 to December 2016. Two thousand six hundred sixty-seven people who lives in Ulaanbaatar city were included in this study. The rapid immunochromatographic test was applied for detection of HCV antibodies and HBV combo rapid test. Results: The mean age of the subjects was 38 ± 12 years, and 1064 (51%) were male. The anti-HCV prevalence was 9% (n = 185), HBsAg positive was 8% (n = 166) and HBsAb positive was 32% (n = 666). The median age for positive and negative anti-HCV test was 46 ± 14 and 38 ± 12. When the anti-HCV positive subjects were categorized by decade of age, the prevalence in each age group was as follows: 7.7% in teens, 3.8% in 20’s, 7.6% in 30’s, 10.7% in 40’s, 14.1% in 50’s and 27.8% in subjects[/=61 years of age. For HBV, the median age for positive and negative HBsAg test were same 39 ±12. The prevalence in each age group was: 8.5% in 20’s, 7.8% in 30’s, 7.5% in 40’s, 9.2% in 50’s and 5.6% in subjects[/=61 years of age. Conclusions: In 2008, the prevalence of anti-HCV in Mongolia was 15.6% and in these findings, the prevalence decreased to 9%. Although it is a high prevalence of HBV and HCV in Ulaanbaatar, Mongolia. Approximately 8% of apparently healthy population had a HBsAg positive and 32% had aHBsAb positive. By age group HCV is higher among under 60’s, HBV is higher among 50’s.

HBV : Prevalence and Genotype Distribution of Hepatitis B, C and D Viruses among Patients with Chronic Liver Diseases of Mongolia

( Oidov Baatarkhuu ),( N Tuvshinjargal ),( T Alimaa ),( B Tsatsralt Od ),( J Amarsanaa ),( H Okamoto ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background/aims: Mongolia is known for its high endemicity for HBV, HCV, and HDV infections among apparently healthy populations. However there are little or no data on the prevalence and genotype distribution of HBV, HCV and HDV among patients with chronic liver diseases in Mongolia. Materials and methods: Serum samples obtained in 2009 from 207 patients (51.0±1.9 years) including those chronic hepatitis (n=90), liver cirrhosis (n=41), and HCC (n=76) were tested for serological and molecular markers of HBV, HCV, and HDV infections. Results: Of the 207 patients, 144 (69.6%), 106 (51.2%), and 117 (56.5%) tested positive for HBsAg and HBV DNA , HCV RNA, and HDV RNA, respectively. Collectively, 172 patients (83.1%) were viremic for one or more of these viruses, including dual viremia of HBV/HDV (26.6%) or HBV/HCV (7.7%) and triple HBV/HCV/HDV viremia (30.0%). Of note, triple ongoing infection was significantly more frequent among patients with HCC than among those with chronic hepatitis (63.2%) vs. 14.4%, P≤0.0001). The distribution of HBV genotypes among the 116 HBV-viremic patients was: A (0.9%), B (0.9%), C (6.0%), D (88.8%), and C plus D(3.4%). All 117 HDV isolates were classified into genotype 1. The 106 HCV RNA positive samples were typed as genotype 1b (92.5%). Conclusions: The present study revealed that ongoing dual or triple infection of HBV, HCV and HDV is highly prevalent among patients with chronic liver diseases of Mongolia.

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>

Acute hepatitis A, B and C but not D is still prevalent in Mongolia: a time trend analysis

( Oidov Baatarkhuu ),( Hye Won Lee ),( Jacob George ),( Dashchirev Munkh-orshikh ),( Baasankhuu Enkhtuvshin ),( Sosorbaram Ariunaa ),( Mohammed Eslam ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Do Young 대한간학회 2017 Clinical and Molecular Hepatology(대한간학회지) Vol.23 No.2

Background/Aims: Mongolia has one of the highest hepatitis A, C, B and D infection incidences worldwide. We sought to investigate changes in the proportion of acute viral hepatitis types in Mongolia over the last decade. Methods: The cohort comprised 546 consecutive patients clinically diagnosed with acute viral hepatitis from January 2012 to December 2014 in Ulaanbaatar Hospital, Mongolia. A time trend analysis investigating the change in proportion of acute hepatitis A virus, hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis delta virus (HDV) infection among the cohort with respect to a previous published study was undertaken. Results: Acute hepatitis A, B and C was diagnosed in 50.9%, 26.2% and 6.0% of the cohort. Notably, 16.8% of the cohort had a dual infection. The etiologies of acute viral hepatitis were varied by age groups. The most common cause of acute viral hepatitis among 2-19 year olds was hepatitis A, HBV and superinfection with HDV among 20-40 year olds, and HCV among 40-49 year olds. Patients with more than one hepatitis virus infection were significantly older, more likely to be male and had a higher prevalence of all risk factors for disease acquisition. These patients also had more severe liver disease at presentation compared to those with mono-infection. Conclusions: Acute viral hepatitis is still prevalent in Mongolia. Thus, the need for proper infection control is increasing in this country. (Clin Mol Hepatol 2017;23:147-153)

Role of Fibroscan and APRI Score in Detection of Liver Fibrosis in Patients with Hepatitis B

( Oidov Baatarkhuu ),( Dashchirev Munkh-orshikh ),( Baasankhuu Enkhtuvshin ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: The assessment of liver fibrosis is essential for predicting the prognosis and outcome of all forms of chronic liver disease. A liver biopsy is the gold standard for the assessment of liver fibrosis, but it has its limitations which include life-threatening complications. Alternative methods of non-invasive laboratory and radiological testing for the assessment of liver fibrosis in hepatitis have evolved during the past decade and these methods may be able to overcome the limitations of liver biopsy. This study was conducted in order to asses liver fibrosis using Fibroscan and to compare these results to the AST. Platelet ratio index (APRI scores) on HBV patients. Methods: A cross-sectional study was conducted on HBV patients who underwent Fibroscan examinations between March 15, 2015 and February 30, 2017 in Happy Veritas Clinic and Diagnostic Center. Demographic data was collected including sex, age, and nationality, serum alanine aminotransferase levels (ALT 6-24 U/l), serum aspartate aminotransferase levels (13-33U/L) and platelet counts (180-320-10⁹) wre also determined. The stages of fibrosis (F0 0-7.2; F1 7.2-8.2; F2 8.2-11; F3 11-18.3 and F4 >18.3) were in kPa. The result of APRI was compared with the Fibroscan fibrosis scores. Results: The results of 228 patients were analyzed including 126(55%) males with a mean age of 42 years (SD: 9.9, range : 22-67). The males were significantly younger than the females (47 years (SD: 10.5 (range 18-72) (P<0,001). The mean stiffness score was 11:29(SD: 8.7)kPa and most patients exhibited no fibrosis (37%) and mid-moderate level (38%) of fibrosis. Thirty patients (13%) had advanced fibrosis. The mean platelet and serum ALT levels were 1.11 (SD: 1.42; range 0.12-3.7). There was a significant positive correlation between the Fibroscan results and the APRI scores (P<0,001). Similarly, there was a significant positive correlation between age and fibrosis score and a significant negative correlation between platelet count and stiffness score. Conclusions: This study has shown that the combination of Fibroscan and APRI methods providers a valuable approach for assessing liver fibrosis in patients with hepatitis. This can eliminate the need for liver biopsy in patients without clear indication.

Efficacy and safety of ledipasvir/sofosbuvir in 5,028 Mongolian patients infected with genotype 1 hepatitis C virus: A multicenter study

( Oidov Baatarkhuu ),( Jae Seung Lee ),( Jazag Amarsanaa ),( Do Young Kim ),( Sang Hoon Ahn ),( Nyamsuren Naranzul ),( Damba Enkhtuya ),( Nagir Choijamts ),( Purev Batbayar ),( Radnaa Otgonbayar ),( B 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.1

Background/Aims: Ledipasvir/sofosbuvir (LDV/SOF) shows high efficacy and safety in patients with genotype 1-hepatitis C virus (HCV). We aimed to investigate the efficacy and safety of LDV/SOF in real-world Mongolian patients. Methods: Between 2015 to 2019, 23 (0.5%) and 5,005 patients (99.5%) with genotype 1a and 1b HCV, respectively, were treated with a fixed-dose tablet containing 90 mg ledipasvir and 400 mg sofosbuvir for 12 weeks, and 81 patients (1.6%) with previous experience of interferon (IFN)-based treatment received additional 1,000 mg ribavirin. HCV RNA was measured at 4, 12, and 24 weeks after the first dose to determine rapid virologic response, end of treatment response (ETR), and sustained virologic response at 12 weeks after end of treatment (SVR12). Results: Most patients (n=5,008; 99.6%) achieved ETR and SVR12 without virologic relapse. Patients with genotype 1a showed low rates of ETR and SVR12 in only 16 patients (69.6%). There was no significant difference in SVR12 rate between patients regardless of IFN experience (n=81; 1.6%), cirrhosis (n=1,151; 22.9%), HCV RNA >6×10⁶ IU/mL (n=866; 17.2%), or liver stiffness >9.6 kPa (n=1,721; 34.2%) (100.0%, 99.3%, 99.4%, and 99.4%, respectively). No severe adverse events (AEs) were reported, and there was no dose reduction or interruption due to AE. The most common AEs were headache (n=472; 9.4%), fatigue (n=306; 6.2%), abdominal discomfort (n=295; 5.9%), and skin rash (n=141; 2.8%). Conclusions: LDV/SOF showed high efficacy and safety for patients with genotype 1, especially 1b HCV, in Mongolia. The real-world data might be applicable to patients in other Asian-Pacific countries. (Clin Mol Hepatol 2021;27:125-135)

Hepatitis C, LC : Status of HCV and HBV quantification in Mongolia (초)

( Amarsanaa Jazag ),( Baatarkhuu Oidov ),( Dashtseren Luvsan ),( Tsatsralt Od Bira ),( Chinburen Jigjidsuren ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)