Global elimination of hepatitis C virus infection:Progresses and the remaining challenges

Today, with the introduction of interferon-free direct-acting antivirals and outstanding progresses in the prevention, diagnosis and treatment of hepatitis C virus(HCV) infection, the elimination of HCV infection seems more achievable. A further challenge is continued transmission of HCV infection in high-risk population specially injecting drug users(IDUs) as the major reservoir of HCV infection. Considering the fact that most of these infections remain undiagnosed, unidentified HCVinfected IDUs are potential sources for the rapid spread of HCV in the community. The continuous increase in the number of IDUs along with the rising prevalence of HCV infection among young IDUs is harbinger of a forthcoming public health dilemma, presenting a serious challenge to control transmission of HCV infection. Even the changes in HCV genotype distribution attributed to injecting drug use confirm this issue. These circumstances create a strong demand for timely diagnosis and proper treatment of HCV-infected patients through risk-based screening to mitigate the risk of HCV transmission in the IDUs community and, consequently, in the society. Meanwhile, raising general awareness of HCV infection, diagnosis and treatment through public education should be the core activity of any harm reduction intervention, as the root cause of failure in control of HCV infection has been lack of awareness among young drug takers. In addition, effective prevention, comprehensive screening programs with a specific focus on high-risk population, accessibility to the new anti-HCV treatment regimens and public education should be considered as the top priorities of any health policy decision to eliminate HCV infection.

Hepatitis C virus core protein modulates several signaling pathways involved in hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the fifth most common cancer, and hepatitis C virus(HCV) infection plays a major role in HCC development. The molecular mechanisms by which HCV infection leads to HCC are varied. HCV core protein is an important risk factor in HCV-associated liver pathogenesis and can modulate several signaling pathways involved in cell cycle regulation, cell growth promotion, cell proliferation, apoptosis, oxidative stress and lipid metabolism. The dysregulation of signaling pathways such as transforming growth factor β(TGF-β), vascular endothelial growth factor(VEGF), Wnt/β-catenin(WNT), cyclooxygenase-2(COX-2) and peroxisome proliferator-activated receptor α(PPARα) by HCV core protein is implicated in the development of HCC. Therefore, it has been suggested that this protein be considered a favorable target for further studies in the development of HCC. In addition, considering the axial role of these signaling pathways in HCC, they are considered druggable targets for cancer therapy. Therefore, using strategies to limit the dysregulation effects of core protein on these signaling pathways seems necessary to prevent HCV-related HCC.

Lurking epidemic of hepatitis C virus infection in Iran: A call to action

Despite having a relatively low prevalence in the Iranian general population, the burden of hepatitis C virus(HCV) infection is on the rise, and hepatitis C is predicted to be the most important leading cause of viral hepatitis-related mortality in the near future in Iran. The recent population-based epidemiological studies have revealed the predominant role of injecting drug use in increasing prevalence of HCV infection. Undoubtedly, new management paradigm is required to drive down the rising wave of hepatitis C in Iran. Priority should be given to young injecting drug users as the cornerstone of the lurking epidemic of HCV infection in Iran.

Epidemiology of hepatitis E virus in Iran

Iran is known as an endemic country for hepatitis E virus(HEV) infection, while there are variations in the epidemiology of HEV infection throughout the country. The available epidemiological studies in different regions of Iran show HEV seroprevalence of 1.1%-14.2% among general population, 4.5%-14.3% among blood donors, 6.1%-22.8% among injecting drug users, 6.3%-28.3% among hemodialysis patients, 1.6%-11.3% among patients infected with other hepatitis viruses, 27.5% among patients with chronic liver disease, 30.8% among kidney transplant recipient patients, and 10%-16.4% among human immunodeficiency virus-infected patients. These variations reflect differences in the status of public health and hygiene, risk factors, and routes of transmission in different regions and groups. Therefore, it is necessary to review the epidemiology of HEV infection to determine the most prevalent risk factors and routes of transmission, and to evaluate the effectiveness of preventive strategies employed in the public health services of the country. Moreover, the other epidemiological aspects of HEV, including the genotypic pattern, extra hepatic manifestations, and incidence of chronic infection need to be investigated among Iranian population to expand the current knowledge on the epidemiology of HEV and to clarify the real burden of HEV infection. Therefore, this review was performed to provide a general overview regarding the epidemiology of HEV in Iran.

Dynamics of host immune responses to SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),the most recent global health threat,is spreading throughout the world with worrisome speed,and the current wave of coronavirus disease 2019(COVID-19)seems to have no mercy.While this mysterious virus challenges our ability to control viral infections,our opportunities to control the COVID-19 pandemic are gradually fading.Currently,pandemic management relies on preventive interventions.Although prevention is a good strategy to mitigate SARS-CoV-2 transmission,it still cannot be considered an absolute solution to eliminate this pandemic.Currently,developing a potent immunity against this viral infection seems to be the most promising strategy to drive down this ongoing global tragedy.However,with the emergence of new challenges in the context of immune responses to COVID-19,the road to control this devastating pandemic seems bumpier;thus,it is pivotal to characterize the dynamics of host immune responses to COVID-19,in order to develop efficient prophylactic and therapeutic tools.This begs the question of whether the effector mechanisms of the immune system are indeed potent or a possible contributing factor to developing more severe and lethal forms of COVID-19.In this review,the possible role of the immunopathologic phenomena including antibody-dependent enhancement,cytokine storm,and original antigenic sin in severity and mortality of COVID-19 will be discussed.

Pediatric case with vaccine-related poliovirus infection: A case report

BACKGROUND As long as oral poliovirus vaccine(OPV)is used,the potential risk for the emergence of vaccine-related polioviruses remains.CASE SUMMARY We report a case of Sabin-like type 1 poliovirus infection in an immunocompetent 17-mo-old child after receiving four scheduled doses of OPV.Somehow,the four doses did not confer full protection,possibly because of interference created by other enteroviruses.CONCLUSION The surveillance of vaccine-related polioviruses has important implications for improving health policies and vaccination strategies.Missed cases of vaccinerelated poliovirus infection might pose a potential risk to global poliovirus eradication.Therefore,the global withdrawal of OPV and a shift to the inclusion of only inactivated poliovirus vaccine in the vaccination schedule is the main objective of the polio eradication program.

Epidemiology of Hepatitis E in Pregnant Women and Children in Iran: A General Overview

From an epidemiological point of view,hepatitis E is an old infection in Iran,but only recently has its importance as a public health concern been considered from research and public health standpoints.As such,there is still a long road ahead to clarify the real burden of hepatitis E virus (HEV) infection in Iran.According to the available epidemiological studies,the seroprevalence of HEV infection among pregnant women is between 3.6% and 7.4%,and among Iranian children is between 0.9% to 8.5%,varying by geographic regions within the country and directly dependent upon the sanitary status of each.In addition to evaluating the sanitation level of a society,community-based seroprevalence studies of HEV infection demonstrate the most prevalent risk factors,the major routes of transmission,and the epidemiological patterns of HEV among that country's population.In this review,the current knowledge about the pathogenesis and epidemiology of HEV infection in pregnant women and children in Iran,as well as the recent advances in diagnosis,prevention and treatment of HEV infection have been summarized.