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"ABSTRAKAnti-HCV menjadi marker serologi utama yang digunakan untuk uji saring hepatitis C pada donor darah di Indonesia. Selain serologi anti-HCV, untuk lebih meningkatkan kemananan darah, Unit Transfusi Darah UTD DKI Jakarta juga menerapkan pemeriksaan Nucleic Acid Test NAT . Pemeriksaan anti-HCV tidak dapat membedakan antara infeksi aktif dan infeksi yang telah sembuh. Darah akan dianggap terifeksi HCV apabila salah satu dari pemeriksaan serologi atau molekuler positif, begitupula dengan darah donor dengan hasil pemeriksaan anti-HCV grayzone dan NAT negatif. Diperlukan kepastian atas berisiko tidaknya darah tersebut dalam menularkan infeksi HCV, mengingat kebutuhan darah di sebagian besar provinsi di Indonesia masih belum memenuhi target. Sehingga dibutuhkan uji molekuler lain untuk dijadikan pembanding dengan hasil NAT. Interpretasi hasil anti-HCV dilakukan berdasarkan rasio S/CO, yang dapat dijadikan prediksi status viremia donor, sehingga perlu dilakukan analisis hubungan antara S/CO dengan hasil pengujian molekuler dan HCV Ag-Ab. Nilai prediksi viremia diharapkan dapat menjadi alternatif bagi UTD yang belum mampu menerapkan NAT. Kemudian dipilih 93 sampel dengan kriteria anti-HCV positif dan NAT positif; anti-HCV positif dan NAT negatif serta anti-HCV grayzone dan NAT negatif untuk diuji dengan nested PCR kualitatif dan HCV Ag-Ab. Berdasarkan perbandingan hasil pengujian NAT dan nested PCR diperoleh nilai sensitivitas NAT sebesar 90, 63 , dengan Spesifisitasnya 96,71 . Dari hasil analisis chi-square diperoleh hubungan yang bermakna antara nilai S/CO anti-HCV dengan hasil pengujian NAT, nested PCR kualitatif dan HCV Ag-Ab P5 dapat dijadikan prediksi adanya infeksi aktif pada donor.

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ABSTRACTAnti HCV is the main serological marker for hepatitis C screening in blood donors in Indonesia. Besides anti HCV, UTD DKI Jakarta also implementing Nucleic Acid Test NAT to improve blood transfusion safety. Anti HCV assay can not distinguish between active infection and cured infection. Blood will be considered HCV infected if either from a positive serologic or molecular test, including blood with anti HCV grayzone and NAT negative. There is a requirement to ensure the risk status of blood with anti HCV grayzone and NAT negative, because the supply of blood in most provinces in Indonesia still insufficient. So, it takes another molecular test to compare with NAT result. Interpretation of anti HCV results was calculating by S CO ratio, which could be a predictor of viremia status. It is necessary to analyze the correlation between S CO with molecular test and HCV Ag Ab results.Viremia prediction value is expected to be an alternative for UTDs who have not been able to apply NAT. There are 93 samples collected then tested with NAT and anti HCV. Sample with concondantly positive anti HCV and NAT anti HCV positive and NAT negative and anti HCV grayzone and NAT negative. These samples then tested with nested PCR and HCV Ag Ab. Based on comparison of NAT and nested PCR, obtained NAT sensitivity value of 90, 63 , with Specificity 96.71 . The result of chi square analysis shows a significant correlation between S CO anti HCV with NAT, qualitative nested PCR and HCV Ag Ab P 5 can be used as predictors of active infection in donors. "

"Latar belakang: Pasien dengan hemofilia dan Von Willebrand (VWD) memiliki risiko infeksi terkait transfusi, salah satunya adalah infeksi hepatitis C (HCV). Skrining darah donor terbaru adalah nucleic acid testing (NAT) dengan window period 3 hari. Berdasarkan rekapitulasi pasien hemofilia dewasa di RS Cipto Mangunkusumo tahun 2012, ditemukan 38% mengalami infeksi HCV dan dua diantaranya sudah didiagnosis dengan sirosis hati. Pengobatan infeksi HCV secara dini dapat menurunkan risiko sirosis hati. Namun saat ini belum ada data mengenai proporsi infeksi HCV pada hemofilia dan VWD anak yang menggunakan NAT dan tidak menggunakan NAT untuk skrining darah donor.Tujuan: Mengetahui proporsi infeksi HCV pada pasien hemofilia dan VWD anak yang tidak menggunakan skrining NAT dan yang menggunakan skrining NAT.Metode: Penelitian ini menggunakan desain kohort retrospektif yang dilakukan terhadap pasien hemofilia dan Von Willebrand (VWD) anak dengan riwayat transfusi komponen darah. Subyek penelitian dieksklusi bila memiliki riwayat penggunaan jarum suntik bergantian dan ibu dengan riwayat infeksi HCV C. Subyek penelitian dibagi menjadi kelompok tidak menggunakan skrining NAT dan menggunakan skrining NAT. Kemudian dilakukan pemeriksaan anti HCV pada tiap kelompok. Subyek dengan hasil anti HCV reaktif menjalani pemeriksaan HCV RNA. Kemudian dilakukan analisa risiko relatif (RR) antara penggunaan skrining NAT terhadap proporsi infeksi HCV.Hasil: Studi dilakukan terhadap 108 subyek penelitian mendapatkan proporsi anti HCV reaktif pada kelompok yang tidak menggunakan skrining NAT sebesar 3,3% (3/91) dan pada kelompok yang mengguanakan skrining NAT sebesar 0% (0/17). Analisis hubungan antara penggunaan skrining NAT dan anti HCV reaktif ditemukan hasil RR = 1,034 (IK95% 0,996-1,074) dengan nilai P 0,448 dan kekuatan penelitian 8,3%. Hasil pemeriksaan HCV RNA tidak ditemukan virus pada kedua subyek dengan anti HCV reaktif.Simpulan: Proporsi anti HCV reaktif pada kelompok dengan riwayat transfusi komponen darah yang tidak menggunakan skrining NAT lebih besar dibandingkan dengan kelompok yang menggunakan skrining NAT. Namun hasil pemeriksaan HCV RNA tidak ditemukan virus pada seluruh subyek dengan anti HCV reaktif.Title of the article : Hepatitis C Infection Related to Blood Transfusion in Children with Hemofilia and Von Willebrand Before and After the Implementation of Nucleic Acid Testing as the Method of Blood Donor Screening.

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Background: Patient with hemophilia and Von Willebrand (VWD) have an increased risk of acquiring transfusion transmitted infection (TTI). The latest technology of blood donor screening method were using nucleic acid testing (NAT). In 2012, there were 38% of adult with hemophilia acquiring hepatitis C infection in Cipto Mangunkusumo hospital and two of them had developed liver cirrhosis. Early initiation of therapy may prevent the progression of hepatitis C (HCV) infection into liver cirrhosis. Currently, there is no data regarding the incidence of HCV infection in children with hemophilia and VWD before and after the implementation of NAT for blood donor screening.

Aim: To determine the incidence of HCV infection in children with hemophilia and VWD who were not using NAT compares to the one who were using NAT as their blood screening method.

Method: It is a cohort retrospective study of children with hemophilia and VWD with history of blood transfusion. The exclusion criteria were personal history of sharing needle and having mother with history of HCV infection. Subjects were divided into the group of subjects who were using NAT and not using NAT for blood donor screening method. Anti HCV examination were performed on each group. HCV RNA examination were carried out only on subjects with reactive anti HCV result. Relative risk (RR) of using NAT related to the incidence of HCV infection were then calculated.

Results: Study in 108 subjects reported the incidence of reactive anti HCV in a group who were not using NAT around 2% (2/91) compared to other group who were using NAT around 0% (0/17). The association between NAT implementation and the incidence of HCV infection showed RR = 1.022 (CI95% 0.991-1.054) with P value of 0.54 and power of 8.4%. HCV RNA examination showed no virus were found on both subjects with reactive anti HCV.

Conclusion: The incidence of reactive anti HCV was higher in the group who were not using NAT compared to the other group who were using NAT as their blood screening method. However, HCV RNA showed no virus were found on all subjects with reactive anti HCV. It is recommended to consider NAT as screening method due to 3 subjects were found to have history of hepatitis C infection in current study."

"[ABSTRAKLatar belakang. Hepatitis B merupakan salah satu masalah kesehatan yang serius, diperkirakan lebih dari 2 milyar orang didunia telah terinfeksi virus hepatitis B (VHB). Dari jumlah ini kira-kira 360 juta orang mengalami infeksi khronis. Kematian terutama disebabkan karena sirosis hepatis dan karsinoma hepatoseluler. Salah satu upaya pencegahan penularan infeksi VHB adalah uji saring darah donor terhadap hepatitis B surface antigen (HBsAg) yang merupakan pemeriksaan skrinning yang dilakukan oleh Unit Transfusi Darah (UTD) di negara berkembang seperti Indonesia. Banyak peneliti membuktikan bahwa darah HBsAg negatif masih berpotensi menularkan infeksi VHB. Untuk itu meningkatkan keamanan darah, beberapa negara menambahkan parameter pemeriksaan antibodi terhadap hepatits B core (anti-HBc) sebagai petanda paparan terhadap infeksi VHB dan pemeriksaan antibodi terhadap hepatitis B surface (anti-HBs) sebagai tanda respon imun terhadap infeksi VHB. Dengan berkembangnya teknologi biologi molekuler, masa jendela infeksi VHB dengan seronegatif dapat di ketahui lebih cepat melalui deteksi DNA VHB dengan metode Nucleic Acid Test (NAT) multipleks yang dilanjutkan dengan NAT discriminatory. Beberapa penelitian terdahulu menunjukkan, didapatnya DNA VHB pada spesimen darah donor yang seronegatif dengan metoda NAT. Darah dengan HBsAg negatif, DNA VHB positif dengan atau tanpa anti-HBc dan atau anti-HBs merupakan darah asal donor dengan Hepatitis B Occult (HBO). Prevalensi donor dengan HBO di Indonesia berkisar antara 8- 10%.Metodologi. Penelitian ini menggunakan desain potong lintang (cross sectional) yang dilakukan di UTDP dan Lembaga Biologi Molekul Eijkman, dengan jumlah sampel 4.973 asal subyek donor darah dari 4 UTD daerah DKI, Kota Tanggerang,kota Depok dan Kabupaten Tanggerang. Terhadap sampel penelitian dilakukan pemeriksaan serologis HBsAg,anti-HBc,anti-HBs, NAT, dan PCR kuantitatif dan kualitatif, selanjutnya pada sampel yang HBsAg negatif, NAT positif dan didapatkan hasil PCR kuantitatif positif dilakukan pemeriksaan lanjutan sequencing asam amino untuk mengetahui ada tidaknya mutan HBsAg penyebab lolosnya deteksi serologi HBsAg oleh reagensia HBsAg yang digunakan untuk uji saring darah donor.Hasil. Didapatkan hanya 20 subjek (0,40%) mempunyai hasil HBsAg negatif dan NAT positif multipleks, dan hanya 16 subyek (80%) HBsAg negatif dan NAT discrimenatory positif. Lebih lanjut hasil pemeriksaan anti-HBc negatif dan anti- HBs positif/negatif didapatkan hanya1 subyek (6,25%), anti-HBc positif dan anti- Hbs negatif didapatkan 9 subyek (56,25%), hasil pemerksaan anti-Hbc dan anti- HBs positif 5 subyek (31,25%). Lebih lanjut dilakukan pemeriksaan PCR kualitatif dan didapatkan 3 subyek (18,75%) tidak terdeteksi, , 6 (37,5%) subyek menunjukkan hasil viral load yang low detection (dibawah sensitivitas alat), dan 7 subyek (43,75%) menunjukkan hasil viral load dapat di ketahui. Pada pemeriksaan PCR kualitatif dan sequencing didapatkan 2 subyek (28,57%) ditemukan mutasi pada gen S pada posisi 143 dimana terjadi subsitusi asam amino T143M.

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ABSTRACTBackground. Hepatitis B is one of the most serious health problem. It is estimated that more than 2 bilion people have been infected by this virus, of which 360 milion are chronically infected with severe and fatal risk especially of cirrosis and hepatocellular carcinoma. One of the main ways to prevent transfusion transmitted HBV infection is blood screening for HBsAg. However, many studies have proven that HBsAg negative blood can still be infection. Therefore to enhance blood safety same countries have added antibody parameters in blood screening of donors – antibody for hepatitis B core antigen (anti-HBc) as marker for HBV infection and antibody for hepatitis B surface antigen (anti-HBs) as marker for immunological response to HBV infection.And with the development of molecular biology technology, HBV infection can be knowing faster in seronegative windows period with HBV DNA examination inspection by methods Nucleic Acid Test (NAT) multiplex and discrimenatory. In fact the results of seronegative blood is still there HBV virus with NAT, and this result we can called with the Occult hepatitis B (HBO). Prevalence of donors with HBO ranges 8- 10% in Indonesia. This study aims to determine the efectivity analized by NAT method blood donor with HBO to see continuity with the examination of anti-HBc, anti-HBs, viral load, and the cause of the HBO that mutations in the gene encoding HBsAg.Methodology. This study used a cross-sectional design (cross-sectional) conducted in UTDP and Eijkman Institute for Molecular Biology, with a sample of 4,973 sampless blood bloods donor from 4 units of blood transfusion area of Jakarta, Tangerang City, Depok and Bekasi district. Against sample serological examination HBsAg, anti-HBc, anti-HBs, NAT, quantitative and qualitative PCR, then samples were HBsAg negative, positive NAT and quantitative PCR positive results obtained further investigation amino acid sequencing to determine whether there is a mutant HBsAg cause serological detection of HBsAg escape by HBsAg reagents used for screening of blood donorsResult. There was 20 samples (0.40%) had results of HBsAg negative and positive NAT multiplex, and only 16 samples (80%) HBsAg negative and positive discrimenatory NAT. Furthermore, the results of the examination of anti-HBc and anti-HBs negative positive / negative obtained only 1 samples (6.25%), anti-HBc positive and negative anti-Hbs obtained 9 samples (56.25%), and anti-HBc , anti- HBs positive are 5 samples (31.25%). and then , qualitative PCR examination and had 3 samples (18.75%), is not detected, 6 (37.5%) samples, and some samples showed a low viral load results detection (sensitivity under tools value), and 6 samples (43.75%) shows viral load is positive. In qualitative PCR and sequencing obtained 2 samples (28.57%) found a mutation in the S gene at position 143 where there T143M amino acid substitution.;Background. Hepatitis B is one of the most serious health problem. It is estimated that more than 2 bilion people have been infected by this virus, of which 360 milion are chronically infected with severe and fatal risk especially of cirrosis and hepatocellular carcinoma. One of the main ways to prevent transfusion transmitted HBV infection is blood screening for HBsAg. However, many studies have proven that HBsAg negative blood can still be infection. Therefore to enhance blood safety same countries have added antibody parameters in blood screening of donors – antibody for hepatitis B core antigen (anti-HBc) as marker for HBV infection and antibody for hepatitis B surface antigen (anti-HBs) as marker for immunological response to HBV infection.And with the development of molecular biology technology, HBV infection can be knowing faster in seronegative windows period with HBV DNA examination inspection by methods Nucleic Acid Test (NAT) multiplex and discrimenatory. In fact the results of seronegative blood is still there HBV virus with NAT, and this result we can called with the Occult hepatitis B (HBO). Prevalence of donors with HBO ranges 8- 10% in Indonesia. This study aims to determine the efectivity analized by NAT method blood donor with HBO to see continuity with the examination of anti-HBc, anti-HBs, viral load, and the cause of the HBO that mutations in the gene encoding HBsAg.Methodology. This study used a cross-sectional design (cross-sectional) conducted in UTDP and Eijkman Institute for Molecular Biology, with a sample of 4,973 sampless blood bloods donor from 4 units of blood transfusion area of Jakarta, Tangerang City, Depok and Bekasi district. Against sample serological examination HBsAg, anti-HBc, anti-HBs, NAT, quantitative and qualitative PCR, then samples were HBsAg negative, positive NAT and quantitative PCR positive results obtained further investigation amino acid sequencing to determine whether there is a mutant HBsAg cause serological detection of HBsAg escape by HBsAg reagents used for screening of blood donorsResult. There was 20 samples (0.40%) had results of HBsAg negative and positive NAT multiplex, and only 16 samples (80%) HBsAg negative and positive discrimenatory NAT. Furthermore, the results of the examination of anti-HBc and anti-HBs negative positive / negative obtained only 1 samples (6.25%), anti-HBc positive and negative anti-Hbs obtained 9 samples (56.25%), and anti-HBc , anti- HBs positive are 5 samples (31.25%). and then , qualitative PCR examination and had 3 samples (18.75%), is not detected, 6 (37.5%) samples, and some samples showed a low viral load results detection (sensitivity under tools value), and 6 samples (43.75%) shows viral load is positive. In qualitative PCR and sequencing obtained 2 samples (28.57%) found a mutation in the S gene at position 143 where there T143M amino acid substitution.;Background. Hepatitis B is one of the most serious health problem. It is estimated that more than 2 bilion people have been infected by this virus, of which 360 milion are chronically infected with severe and fatal risk especially of cirrosis and hepatocellular carcinoma. One of the main ways to prevent transfusion transmitted HBV infection is blood screening for HBsAg. However, many studies have proven that HBsAg negative blood can still be infection. Therefore to enhance blood safety same countries have added antibody parameters in blood screening of donors – antibody for hepatitis B core antigen (anti-HBc) as marker for HBV infection and antibody for hepatitis B surface antigen (anti-HBs) as marker for immunological response to HBV infection.And with the development of molecular biology technology, HBV infection can be knowing faster in seronegative windows period with HBV DNA examination inspection by methods Nucleic Acid Test (NAT) multiplex and discrimenatory. In fact the results of seronegative blood is still there HBV virus with NAT, and this result we can called with the Occult hepatitis B (HBO). Prevalence of donors with HBO ranges 8- 10% in Indonesia. This study aims to determine the efectivity analized by NAT method blood donor with HBO to see continuity with the examination of anti-HBc, anti-HBs, viral load, and the cause of the HBO that mutations in the gene encoding HBsAg.Methodology. This study used a cross-sectional design (cross-sectional) conducted in UTDP and Eijkman Institute for Molecular Biology, with a sample of 4,973 sampless blood bloods donor from 4 units of blood transfusion area of Jakarta, Tangerang City, Depok and Bekasi district. Against sample serological examination HBsAg, anti-HBc, anti-HBs, NAT, quantitative and qualitative PCR, then samples were HBsAg negative, positive NAT and quantitative PCR positive results obtained further investigation amino acid sequencing to determine whether there is a mutant HBsAg cause serological detection of HBsAg escape by HBsAg reagents used for screening of blood donorsResult. There was 20 samples (0.40%) had results of HBsAg negative and positive NAT multiplex, and only 16 samples (80%) HBsAg negative and positive discrimenatory NAT. Furthermore, the results of the examination of anti-HBc and anti-HBs negative positive / negative obtained only 1 samples (6.25%), anti-HBc positive and negative anti-Hbs obtained 9 samples (56.25%), and anti-HBc , anti- HBs positive are 5 samples (31.25%). and then , qualitative PCR examination and had 3 samples (18.75%), is not detected, 6 (37.5%) samples, and some samples showed a low viral load results detection (sensitivity under tools value), and 6 samples (43.75%) shows viral load is positive. In qualitative PCR and sequencing obtained 2 samples (28.57%) found a mutation in the S gene at position 143 where there T143M amino acid substitution.;Background. Hepatitis B is one of the most serious health problem. It is estimated that more than 2 bilion people have been infected by this virus, of which 360 milion are chronically infected with severe and fatal risk especially of cirrosis and hepatocellular carcinoma. One of the main ways to prevent transfusion transmitted HBV infection is blood screening for HBsAg. However, many studies have proven that HBsAg negative blood can still be infection. Therefore to enhance blood safety same countries have added antibody parameters in blood screening of donors – antibody for hepatitis B core antigen (anti-HBc) as marker for HBV infection and antibody for hepatitis B surface antigen (anti-HBs) as marker for immunological response to HBV infection.And with the development of molecular biology technology, HBV infection can be knowing faster in seronegative windows period with HBV DNA examination inspection by methods Nucleic Acid Test (NAT) multiplex and discrimenatory. In fact the results of seronegative blood is still there HBV virus with NAT, and this result we can called with the Occult hepatitis B (HBO). Prevalence of donors with HBO ranges 8- 10% in Indonesia. This study aims to determine the efectivity analized by NAT method blood donor with HBO to see continuity with the examination of anti-HBc, anti-HBs, viral load, and the cause of the HBO that mutations in the gene encoding HBsAg.Methodology. This study used a cross-sectional design (cross-sectional) conducted in UTDP and Eijkman Institute for Molecular Biology, with a sample of 4,973 sampless blood bloods donor from 4 units of blood transfusion area of Jakarta, Tangerang City, Depok and Bekasi district. Against sample serological examination HBsAg, anti-HBc, anti-HBs, NAT, quantitative and qualitative PCR, then samples were HBsAg negative, positive NAT and quantitative PCR positive results obtained further investigation amino acid sequencing to determine whether there is a mutant HBsAg cause serological detection of HBsAg escape by HBsAg reagents used for screening of blood donorsResult. There was 20 samples (0.40%) had results of HBsAg negative and positive NAT multiplex, and only 16 samples (80%) HBsAg negative and positive discrimenatory NAT. Furthermore, the results of the examination of anti-HBc and anti-HBs negative positive / negative obtained only 1 samples (6.25%), anti-HBc positive and negative anti-Hbs obtained 9 samples (56.25%), and anti-HBc , anti- HBs positive are 5 samples (31.25%). and then , qualitative PCR examination and had 3 samples (18.75%), is not detected, 6 (37.5%) samples, and some samples showed a low viral load results detection (sensitivity under tools value), and 6 samples (43.75%) shows viral load is positive. In qualitative PCR and sequencing obtained 2 samples (28.57%) found a mutation in the S gene at position 143 where there T143M amino acid substitution.;Background. Hepatitis B is one of the most serious health problem. It is estimated that more than 2 bilion people have been infected by this virus, of which 360 milion are chronically infected with severe and fatal risk especially of cirrosis and hepatocellular carcinoma. One of the main ways to prevent transfusion transmitted HBV infection is blood screening for HBsAg. However, many studies have proven that HBsAg negative blood can still be infection. Therefore to enhance blood safety same countries have added antibody parameters in blood screening of donors – antibody for hepatitis B core antigen (anti-HBc) as marker for HBV infection and antibody for hepatitis B surface antigen (anti-HBs) as marker for immunological response to HBV infection.And with the development of molecular biology technology, HBV infection can be knowing faster in seronegative windows period with HBV DNA examination inspection by methods Nucleic Acid Test (NAT) multiplex and discrimenatory. In fact the results of seronegative blood is still there HBV virus with NAT, and this result we can called with the Occult hepatitis B (HBO). Prevalence of donors with HBO ranges 8- 10% in Indonesia. This study aims to determine the efectivity analized by NAT method blood donor with HBO to see continuity with the examination of anti-HBc, anti-HBs, viral load, and the cause of the HBO that mutations in the gene encoding HBsAg.Methodology. This study used a cross-sectional design (cross-sectional) conducted in UTDP and Eijkman Institute for Molecular Biology, with a sample of 4,973 sampless blood bloods donor from 4 units of blood transfusion area of Jakarta, Tangerang City, Depok and Bekasi district. Against sample serological examination HBsAg, anti-HBc, anti-HBs, NAT, quantitative and qualitative PCR, then samples were HBsAg negative, positive NAT and quantitative PCR positive results obtained further investigation amino acid sequencing to determine whether there is a mutant HBsAg cause serological detection of HBsAg escape by HBsAg reagents used for screening of blood donorsResult. There was 20 samples (0.40%) had results of HBsAg negative and positive NAT multiplex, and only 16 samples (80%) HBsAg negative and positive discrimenatory NAT. Furthermore, the results of the examination of anti-HBc and anti-HBs negative positive / negative obtained only 1 samples (6.25%), anti-HBc positive and negative anti-Hbs obtained 9 samples (56.25%), and anti-HBc , anti- HBs positive are 5 samples (31.25%). and then , qualitative PCR examination and had 3 samples (18.75%), is not detected, 6 (37.5%) samples, and some samples showed a low viral load results detection (sensitivity under tools value), and 6 samples (43.75%) shows viral load is positive. In qualitative PCR and sequencing obtained 2 samples (28.57%) found a mutation in the S gene at position 143 where there T143M amino acid substitution., Background. Hepatitis B is one of the most serious health problem. It is estimated that more than 2 bilion people have been infected by this virus, of which 360 milion are chronically infected with severe and fatal risk especially of cirrosis and hepatocellular carcinoma. One of the main ways to prevent transfusion transmitted HBV infection is blood screening for HBsAg. However, many studies have proven that HBsAg negative blood can still be infection. Therefore to enhance blood safety same countries have added antibody parameters in blood screening of donors – antibody for hepatitis B core antigen (anti-HBc) as marker for HBV infection and antibody for hepatitis B surface antigen (anti-HBs) as marker for immunological response to HBV infection.And with the development of molecular biology technology, HBV infection can be knowing faster in seronegative windows period with HBV DNA examination inspection by methods Nucleic Acid Test (NAT) multiplex and discrimenatory. In fact the results of seronegative blood is still there HBV virus with NAT, and this result we can called with the Occult hepatitis B (HBO). Prevalence of donors with HBO ranges 8- 10% in Indonesia. This study aims to determine the efectivity analized by NAT method blood donor with HBO to see continuity with the examination of anti-HBc, anti-HBs, viral load, and the cause of the HBO that mutations in the gene encoding HBsAg.Methodology. This study used a cross-sectional design (cross-sectional) conducted in UTDP and Eijkman Institute for Molecular Biology, with a sample of 4,973 sampless blood bloods donor from 4 units of blood transfusion area of Jakarta, Tangerang City, Depok and Bekasi district. Against sample serological examination HBsAg, anti-HBc, anti-HBs, NAT, quantitative and qualitative PCR, then samples were HBsAg negative, positive NAT and quantitative PCR positive results obtained further investigation amino acid sequencing to determine whether there is a mutant HBsAg cause serological detection of HBsAg escape by HBsAg reagents used for screening of blood donorsResult. There was 20 samples (0.40%) had results of HBsAg negative and positive NAT multiplex, and only 16 samples (80%) HBsAg negative and positive discrimenatory NAT. Furthermore, the results of the examination of anti-HBc and anti-HBs negative positive / negative obtained only 1 samples (6.25%), anti-HBc positive and negative anti-Hbs obtained 9 samples (56.25%), and anti-HBc , anti- HBs positive are 5 samples (31.25%). and then , qualitative PCR examination and had 3 samples (18.75%), is not detected, 6 (37.5%) samples, and some samples showed a low viral load results detection (sensitivity under tools value), and 6 samples (43.75%) shows viral load is positive. In qualitative PCR and sequencing obtained 2 samples (28.57%) found a mutation in the S gene at position 143 where there T143M amino acid substitution.]"

"Karsinoma hepatoseluler (KHS) adalah salah satu kanker dengan laju mortalitas tertinggi di dunia. Kadar serum alfa-fetoprotein (AFP) dapat digunakan sebagai biomarker untuk menegakkan diagnosis dini. Tetapi, perbandingan antara kadar serum AFP dan KHS dengan etiologi infeksi virus dan etiologi non infeksi virus belum diketahui. Mengetahui perbandingan antara kadar serum AFP dan KHS dengan etiologi infeksi virus dan etiologi non infeksi virus. Penelitian potong lintang dilakukan di RSUPN Cipto Mangunkusumo, Jakarta pada Januari-Oktober 2018 dengan melihat data rekam medis dari 287 pasien yang terdiagnosis KHS dalam periode 2013-2017. Nilai median (minimum-maksimum) dari kadar AFP pada pasien KHS dengan etiologi infeksi VHB atau VHC adalah 419 (0.8-400.000). Nilai median (minimum-maksimum) kadar AFP pada pasien KHS dengan etiologi non infeksi VHB-VHC adalah 7.18 (0.6-90.944). Terdapat perbedaan bermakna antara kadar AFP dengan KHS dengan etiologi infeksi VHB atau VHC dan etiologi non infeksi VHB-VHC.

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Hepatocellular carcinoma (HCC) is one of the highest rates of mortality in the world. Serum alpha-fetoprotein (AFP) levels can be used as a biomarker for early diagnosis. However, the comparison between serum AFP and HCC with viral infections etiology and non-viral etiology is unknown. This research aims to determine the comparison between serum AFP and HCC with viral infections etiology and non-viral aetiology. A cross-sectional study conducted in Cipto Mangunkusumo Hospital, Jakarta in January to October 2018 by reviewing 287 medical records of patients diagnosed with HCC from 2013-2017 period of time. The median (minimum-maximum) value of AFP levels in HCC patients with the etiology of HBV or HCV infection is 419 (0.8-400,000). The median value (minimum-maximum) of AFP levels in HCC patients with the etiology of non HBV-HCV infection was 7.18 (0.6-90,944). There were significant differences between AFP levels and KHS with the etiology of HBV or HCV infections and the etiology of non HBV-HCV infections."

"ABSTRAK<

Karsinoma hepatoseluler (KHS) merupakan karsinoma primer tersering pada sel hati. Sebagian besar KHS disebabkan oleh virus hepatitis B (VHB) dan virus hepatitis C (VHC) yang memiliki patogenesis yang berbeda dalam menyebabkan KHS. Alfa-fetoprotein (AFP) sebagai penanda tumor pada KHS dan dipengaruhi oleh berbagai faktor, salah satunya status infeksi. Berbagai penelitian sudah dilakukan untuk mengetahui pengaruh pengaruh jenis virus penyebab KHS dengan kadar AFP namun hasilnya sangat beragam. Berdasarkan hal tersebut dan ditambah dengan belum adanya penelitian serupa yang menggunakan data pasien di Indonesia maka penelitian ini bertujuan untuk membandingkan kadar AFP pada pasien KHS terkait infeksi VHB terhadap VHC. Penelitian ini dilakukan dengan desain studi potong lintang menggunakan 199 data AFP pasien KHS yang terdiri dari 129 kasus KHS terkait VHB dan 70 kasus KHS terkait VHC. Dari penelitian ini didapatkan sebanyak 97% dan 87.3% pasien KHS terkait VHC dan VHB mengalami peningkatan kadar AFP secara berurutan. Nilai median kadar AFP pada pasien KHS terkait VHB adalah 419 IU/mL sedangkan pada pasien KHS terkait VHC sebesar 400 IU/mL. Perbedaan nilai tersebut memiliki nilai p = 0.97 dalam uji Mann-Whitney U sehingga disimpulan tidak ada perbedaan bermakna pada rerata kadar AFP antara pasien KHS terkait VHB dibanding dengan VHC.

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ABSTRACT

Hepatocellular carcinoma (HCC) is the most primary common carcinoma in liver cells. Most HCC are caused by the hepatitis B virus and hepatitis C that have different pathogenesis in causing carcinoma. Alpha-fetoprotein as tumor marker in HCC is influenced by various factors, one of which is infection status. Various studies have been carried out to determine the influence of the types of viruses causing HCC with AFP levels but the results are very diverse. Based on this and coupled with the absence of similar studies using patient data in Indonesia, this study aims to compare AFP levels in HCC patients related to HBV and HCV. Using cross-sectional design, this study included 199 data of AFP in patient with HCC comprises of 129 cases of HCC related to HBV and 70 cases of HCC related to HCV. From this study, it was found that 97% and 87.3% of HCC patients related to HCV and HBV experienced an increase in AFP levels consecutively. The median value of AFP levels in HBV-related HCC patients was 419 IU / mL while in HCV-related HCC patients was 400 IU / mL. The difference in value has a p value = 0.97 in the Mann-Whitney U test thus it is concluded that there is no significant difference in AFP levels between HBV-related HCC patients compared with HCV-related HCC.

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"Latar Belakang: Hepatitic C merupakan penyakit yang disebabkan oleh Virus Hepatitis C (HCV) dan dapat mengakibatkan peradangan hati, biasanya bersifat asimtomatik, bahkan kronik yang ditandai dengan sirosis, kanker hati, kelainan fungsi hati yang dapat menyebabkan kematian. Pengobatan standar dengan PEGinterferon-a dan ribavirin memiliki efek samping yang berat, sehingga diperlukan pengobatan alternatif sebagai anti-HCV. Dimocarpus longan merupakan tanaman yang memiliki khasiat sebagai antijamur, antivirus, antiinflamasi, antioksidan, antibakteri, dan antikanker. Tujuan penelitian ini untuk mengetahui efek dan mekanisme kerja ekstrak metanol daun D. longan terhadap virus Hepatitis C.Metode: Cell line derivate Human hepatocarcinoma (Huh 7it-1) diinfeksikan dengan HCV strain JFH1 dari genotipe 2a yang diinduksikan ekstrak metanol daun D. longan selama dua hari, kemudian diukur virus yang terbentuk ekstraseluler dan intraseluler. Pemeriksaan virus ekstraseluler dengan cara focus forming assay sedangkan intraseluler dengan qRT-PCR, western blot dan relative fluorescence assay. Pengujian sitotoksisitas terhadap Huh 7it-1 dengan metode MTT assay. Ekstrak metanol daun D. longan diuji adanya kandungan saponin, flavonoid, triterpenoid dan steroid, tanin, dan glikosida.Hasil: Konsentrasi hambatan 50% (IC50) ekstrak terhadap HCVsebesar 13,2 ± 0,52 μg/ml dan toksik 50% (CC50) terhadap sel Huh 7it-1 sebesar 681,9 ± 13,2 μg/ml dengan nilai indek selektivitas (SI) sebesar 51,2. Efek virusidal ekstrak metanol daun D. longan secara langsung terhadap HCV berupa pengurangan titer virus sebesar 99%. Analisis RNA dan protein NS3 HCV intraseluler memperlihatkan adanya hambatan sebesar 20%. Kandungan fitokimia yang terdapat pada ekstrak metanol daun D. longan di antaranya saponin, flavonoid, triterpenoid dan steroid, alkaloid, tanin, dan glikosida.Kesimpulan: Mekanisme anti-HCV dari ekstrak metanol daun D. longan diduga melalui adanya hambatan pada entry dan post-entry yang bekerja dengan menghambat pada penempelan virus, membunuh virus dengan interaksi langsung, menghambat ekspresi NS3, dan menghambat replikasi. Kandungan fitokimia yang terkandung seperti saponin, flavonoid, triterpenoid dan steroid, tanin, dan glikosida.

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Background: Hepatitic C is a disease caused by the hepatitis C virus (HCV). HCV infection can lead to inflammation of liver tend to be asymptomatic, and chronic characterized by cirrhosis, liver cancer, abnormal liver function can cause mortality. Standard HCV treatment with PEG-interferon-a and ribavirin have severe side effects, necessitating alternative treatments as anti-HCV. Dimocarpus longan is a plant that previously reported has antifungal, antiviral, anti-inflammatory, antioxidant, antibacterial, and anticancer activity. The purpose of this study is determine the effects and mechanism of action of the methanol extract of leaves of D. longan against hepatitis C virus.Methods: A derivate of Human hepatocarcinoma Cell line (Huh 7it-1) was infected with HCV of genotype 2a JFH1 strain which is inducted with methanol extracts of D. longan for two days and then number of virus produced outside of the cell (extracellular) and inside of the cell (intracellular) were measured by focus forming assay, while intracellular virus was measured by qRT-PCR, western blot and relative fluorescence assay. Cytotoxicity against Huh 7it-1 was tested by MTT assay. Examination of phytochemical content D. longan showed the presence of saponins, flavonoids, triterpenoids and steroids, alkaloids, tannins, and glycosides.Result: D. longan concentration of inhibition 50% (IC50) and Toxic effects of concentration of cytotoxicity 50% (CC50) againts cells Huh 7it-1were obtained 13,2 ± 0.52 ug/ml and 681.9 ± 13.2 ug/ml, respectively and with selectivity index (SI) 51.2. Result of direct virucidal effect was shown inhibition of titer virus 99%. RNA and NS3 protein analysis of HCV were shown inhibition 20%. Phytochemical contains of methanol extracts of Dimocarpus longan Lour. Leaves are saponins, flavonoids, triterpenoids and steroids, tannins, and glycosides.Conclusion: Anti-HCV mechanisms of methanol extracts of Dimocarpus longan Lour. Leaves are inhibition at entry and post-entry with action at attachment, direct killing, inhibition of expression NS3, and replication. Phytochemical content in the methanol extract of leaves of D. longan were saponins, flavonoids, triterpenoids and steroids, tannins, and glycosides."

"Chronic hepatitis C virus : lessons from the past, promise for the future documents the monumental advances that have been made in our understanding of chronic HCV during the past decade. The first section reviews the natural history of chronic HCV, how this virus can affect other organs in addition to the liver, and whether treating chronic HCV alters the natural history of this disease. Section 2 reviews the advances that have been made in the treatment of chronic HCV during the past decade with interferon based therapy. Separate chapters on response guided therapy and how to manage the adverse events associated with these medications provide the physician with the concepts required to more effectively treat chronic HCV now and in the future. As the genetics of virologic response have recently been elucidated, a chapter is devoted to helping the clinician understand how genes that modulate disease processes and their treatment are identified and utilized in clinical care. Section 3 deals with the future of HCV treatment and specific inhibitors of HCV. Specific chapters explain how targets for drugs are identified and how drugs are then developed and tested; how mutations of HCV develop and how anti-viral agents will affect this process; the most up to date data regarding the treatment of chronic HCV with peginterferon, ribavirin and anti-viral agents; and the potential to treat chronic HCV with just oral anti-viral agents and without peginterferon and ribavirin in the future. The final section of this book covers issues related to liver transplantation in patients with chronic HCV. Separate chapters review the natural history of chronic HCV in liver transplant recipients and the impact of utilizing HCV positive donors. The volume concludes with chapters that cover the treatment of chronic HCV both prior to and after liver transplantation with potent anti-viral agents. Chronic hepatitis C virus : lessons from the past, promise for the future is a valuable resource for all physicians caring for patients with chronic HCV."

"Hepatitis C merupakan penyakit infeksi yang dapat ditemukan di seluruh dunia, baik di negara maju maupun di negara berkembang. Sekitar 90-95% dari seluruh hepatitis pasca transfusi disebabkan oleh infeksi virus hepatitis C, sedangkan sebagian besar diantaranya cenderung asimptomatik. sehingga kadang-kadang tidak terdeteksi. Sekitar separuh dari penderita tersebut dalam perjalanan penyakitnya akan menjadi hepatitis kronis, dan 20% di antaranya berlanjut menjadi sirosis bahkan karsinoma hepatoseluler. Timbulnya hepatitis C pada transfusi tentunya akan memperburuk kondisi penderita. Di Indonesia, penggunaan darah dan komponennya dari tahun ke tahun semakin meningkat. Komplikasi utama dari transfusi adalah timbulnya hepatitis pasca transfusi. Pada penderita hemofilia/talasemia seringkali harus berulang kali menerima transfusi darah dan faktor pembekuan, sehingga mempunyai resiko tinggi untuk menderita hepatitis pasca transfusi. Begitu pula para penderita lain yang suatu waktu harus menerima transfusi darah, juga mempunyai resiko yang cukup besar untuk mendapat hepatitis pasca transfusi. Selain melalui transfusi darah, dilaporkan juga adanya berbagai Cara penularan secara parenteral yang juga sering mengakibatkan seseorang terinfeksi virus hepatitis C, antara lain melalui hemodialisa, transplantasi organ, melalui jarum suntik pada pengguna obat bius, dan lain-lain. Penularan hepatitis C pada penderita hemodialisa tentunya akan mempersulit penanganan penderita tersebut. Akhir-akhir ini telah banyak dikembangkan tes serologic untuk mendeteksi adanya antibodi HCV yang merupakan petanda infeksi virus hepatitis C. Diharapkan dengan dilakukan penelitian ini penularan virus hepatitis C baik melalui transfusi darah dan komponennya, ataupun secara tidak langsung melalui proses hemodialisa dapat dikurangi."