Hepatitis B virus-persistent infection and innate immunity defect: Cell-related or virus-related?

The outcomes of hepatitis B virus(HBV) infection are closely related to the age at which infection was acquired. Infection acquired in adult life tends to be selflimited, in contrast to perinatal acquirement, for which chronic persistence of the HBV is a general outcome. Innate immunity plays an indispensable role in early virus infection, facilitating virus clearance. However, it has been reported that HBV is under-recognized and poorly eliminated by the innate immune system in the early stages of infection, possibly explaining the long-lasting persistence of viremia afterwards. Furthermore, due to the existence of covalently closed circular DNA, chronic HBV clearance is very difficult, even when patients are given interferon-α and nucleotide/nucleoside analogs for antiviral therapy. The mechanism by which HBV evades innate immune recognition and establishes persistent infection remains a subject of debate. Besides, some researchers are becoming more interested in how to eradicate chronic HBV infection by restoring or boosting innate immunity. This review aimed to summarize the current knowledge on how intrahepatocyte signaling pathways and innate immune cells act after the onset of HBV infection and how these actions are related to the persistence of HBV. We anticipate the insights presented herein to be helpful for future development of novel immune therapeutic strategies to fight HBV infection.

Epidemiological and clinical characteristics of COVID-19 patients in Hengyang,Hunan Province,China

BACKGROUND In December 2019,an ongoing outbreak of coronavirus disease 2019(COVID-19)was first identified in Wuhan,China.The characteristics of COVID-19 patients treated in local hospitals in Wuhan are not fully representative of patients outside Wuhan.Therefore,it is highly essential to analyze the epidemiological and clinical characteristics of COVID-19 in areas outside Wuhan or Hubei Province.To date,a limited number of studies have concentrated on the epidemiological and clinical characteristics of COVID-19 patients with different genders,clinical classification,and with or without basic diseases.AIM To study the epidemiological and clinical characteristics of COVID-19 patients in Hengyang(China)and provide a reliable reference for the prevention and control of COVID-19.METHODS From January 16 to March 2,2020,a total of 48 confirmed cases of COVID-19 were reported in Hengyang,and those cases were included in this study.The diagnostic criteria,clinical classification,and discharge standard related to COVID-19 were in line with the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 7)released by National Health Commission and National Administration of Traditional Chinese Medicine.The presence of SARS-CoV-2 in pharyngeal swab specimens was detected by quantitative reverse transcription polymerase chain reaction.All the data were imported into the excel worksheet and statistically analyzed by using SPSS 25.0 software.RESULTS A total of 48 cases of COVID-19 were collected,of which 1 was mild,38 were moderate,and 9 were severe.It was unveiled that there were 31(64.6%)male patients and 17(35.4%)female patients,with a female-to-male ratio of 1.82:1.The range of age of patients with COVID-19 was dominantly 30-49 years old[25(52.1%)of 48],followed by those aged over 60 years old[11(22.9%)].Besides,29.2%(14 of 48)of patients had basic diseases,and 57.2%(8 of 14)of patients with basic diseases were aged over 60 years old.The occupations of 48 COVID-19 patients were mainly farmers working in agricultural production[15(31.5%)of 48],rural migrant workers from Hengyang to Wuhan[15(31.5%)],and service workers operating in the service sector[8(16.7%)].The mean latent period was 6.86±3.57 d,and the median was 7[interquartile range(IQR):4-9]d.The mean time from onset of symptoms to the first physician visit was 3.38±2.98(95%CI:2.58-9.18)d,with a median of 2(IQR:1-5)d,and the mean time from hospital admission to confirmed diagnosis was 2.29±2.11(95%CI:1.18-6.42)d,with a median of 2(IQR:1-3)d.The main symptoms were fever[43(89.6%)of 48],cough and expectoration[41(85.4%)],fatigue[22(45.8%)],and chills[22(45.8%)].Other symptoms included poor appetite[13(27.1%)],sore throat[9(18.8%)],dyspnea[9(18.8%)],diarrhea[7(14.6%)],dizziness[5(10.4%)],headache[5(10.4%)],muscle pain[5(10.4%)],nausea and vomiting[4(8.3%)],hemoptysis[4(8.3%)],and runny nose[1(2.1%)].The numbers of peripheral blood leukocytes,lymphocytes,and eosinophils were significantly reduced in the majority of the patients.The levels of C-reactive protein,fibrinogen,blood glucose,lactate dehydrogenase,Ddimer,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(γ-GT),myoglobin(MB),and creatine kinase(CK)were increased in 64.6%,44.7%,43.2%,37.0%,29.5%,22.9%,20.8%,21.6%,13.6%,and 12.8%of patients,respectively.The incidence of ALT elevation in male patients was remarkably higher than that in females(P<0.01),while the incidences of AST,CK,and blood glucose elevations in severe patients were remarkably higher than those in moderate patients(P<0.05,respectively).Except for the mild patients,chest computed tomography showed characteristic pulmonary lesions.All the patients received antiviral drugs,38(79.2%)accepted traditional Chinese medicine,and 2(4.2%)received treatment of human umbilical-cord mesenchymal stem cells.On March 2,2020,48 patients with COVID-19 were all cured and discharged.CONCLUSION Based on our results,patients with COVID-19 often have multiple organ dysfunction or damage.The incidences of ALT elevation in males,and AST,CK,and blood glucose elevations in severe patients are remarkably higher.