Characteristics of patients with HBeAg negative chronic hepatitis B virus infection in Duhok, Kurdistan region
DOI:
https://doi.org/10.18203/2320-6012.ijrms20183242Keywords:
Characteristics, Chronic hepatitis, Duhok, HBeAg negativeAbstract
Background: The objective of this study was to characterize patients with HBeAg-negative chronic hepatitis B in Duhok province.
Methods: We recruited all patients with HBeAg negative chronic hepatitis B virus infections who visited viral hepatitis clinic in Azadi Teaching Hospital between September 2015-December 2017. The main evaluation parameters were: serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, serum albumin, total serum bilirubin (TSB), viral load. Few patients were subjected to Fibro-test, Fibroscan, or liver biopsy.
Results: There were 251 patients. The mean age of the patients was 35.75±14.40 years. One hundred fifty-seven cases were male and 94 cases were female. The baseline mean of ALT, AST and viral load was 42.09±2.71U/L, 30.26±19.65U/L, and 1421197.08±14436692.04IU/ml, respectively. Compared with women, men have significantly higher values of ALT and AST, serum albumin, and TSB. There were 217 chronic inactive carrier (IC) patients and 34 chronic active hepatitis (AH) patients. ALT, AST, and viral load levels were significantly higher among AH patients.
Conclusions: The majority of patients showed nil to mild liver injury. The higher level of ALT in males is a supporting guide to follow the American Association for the Study of Liver Diseases (AASLD) considering 30U/L and 19U/L levels for males and females, respectively. There was preponderance of males in AH, which indicates greater frequency of advanced fibrosis in such patients. There was a greater probability of AH in old aged people. Serum albumin and TSB were not good markers for differentiation between AH and IC state. Twenty-four patients had ALT above twice upper limit of normal level, but 34 patients showed AH based on liver biopsy, firboscan or fibrotest.
References
World Health Organization (WHO). Global hepatitis report 2017. 2017. Available at: http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/.
Lok AS. Chronic hepatitis B. N Engl J Med. 2002;346(22):1682-83.
Liaw YF, Chu CM. Hepatitis B virus infection. Lancet. 2009;373(9663):582-92.
Kennedy PT, Lee HC, Jeyalingam L, Malik R, Karayiannis P, Muir D, et al. NICE guidelines and a treatment algorithm for the management of chronic hepatitis B: a review of 12 years experience in west London. Antivir Ther .2008;13(8):1067-76.
Brunetto MR, Oliveri F, Coco B, Leandro G, Colombatto P, Gorin JM, et al. Outcome of anti-HBe positive chronic hepatitis B in alpha-interferon treated and untreated patients: A long term cohort study. Hepatol. 2002;36(2):263-70.
Martinot-Peignoux M, Lapalus M, Asselah T, Marcellin P. HBsAg quantification: Useful for monitoring natural history and treatment outcome. Liver Int. 2014;34 Suppl 1:97-107.
Merza MA, Hassan WM, Muhammad AS. Frequency of HBV and HCV among patients undergoing elective surgery in a tertiary care referral hospital in Duhok, Iraqi Kurdistan. J Med Sci Clin Res. 2014; 2(7):1810-5.
Merza MA. Characteristics of chronic hepatitis b virus. patients related liver cirrhosis in a tertiary. care referral hospital, Duhok, Iraqi Kurdistan. J Gastroenterol Pancreatol Liver Disord. 2017;4(5):1-5.
Fateen AA, Shahin RY, Farres MN, Eldeeb MA, Amer HA. Assess¬ment of hepatic fibrosis and necroinflammation among inac¬tive HBsAg carriers in Egypt. Ann Hepatol. 2012;11(11):464-70.
Bedossa P, Poynard T. METAVIR Cooperative Study Group. An algorithm for grading activity in chronic hepatitis C. Hepatology. 1994;24(2):289-93.
Kumar M, Sarin SK, Hissar S, Pande C, Sakhuja P, Sharma BC, et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT. Gastroenterol. 2008;134(5)1376-84.
Lok A, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50(3):661-2.
Tarky AM, Akram W, Al-Naaimi AS, Omer AR. Epidemiology of viral hepatitis B and C in Iraq: a national survey 2005-2006. Zanco J Med Sci. 2013;17(1)370-80.
Sharma SK, Chwla NSY. Hepatitis B virus: inactive carriers. J Virol. 2005;2:82.
Tian Y, Kuo CF, Chen WL, Ou JH. Enhancement of hepatitis B virus replication by androgen and its receptor in mice. J Virol. 2012;86(4):1904-10.
Mukherjee R, Reddy PB, Arava J, Rao P, Mitnala S, Gupta R, et al. Relationship between serum HBsAg level, HBV DNA level, and peripheral immune cells in patients with chronic hepatitis B virus infection. Hepat Med. 2010;2:157-62.
Pincus MR, Schaffer JA. Assessment of liver function. In: John Bernard Henry, ed. clinical diagnosis and management by laboratory methods. 20th ed., W.B. Saunders Company;2001:253-67.
Sorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi JM, et al. National institutes of health consensus development conference statement: management of hepatitis B. Hepatology. 2009:49(5 Suppl):S4-S12.
Perveen I, Saha M, Dhar KK, Islam MS. Hepatitis B virus, hepatitis C virus markers and serum alanine amino-transferase (ALT) levels, in a young adult population of Sylhet district. J Bang Coll Physic Surg. 2016;34(4):199-205.
Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH. American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63(1):261-83.
Fattovich G. Natural history of hepatitis B. J Hepatology. 2003;39:S50-S58.
Victoria Fda S, Oliveira CM, Victoria MB, Victoria CB, Ferreira LC. Characterization of HBeAg-negative chronic hepatitis B in western Brazilian Amazonia. Braz J Infect Dis. 2008:12(1):27-37.
European Association for Study of Liver (EASL). clinical practice guidelines: management of hepatitis C virus infection. J Hepatol. 2014;60(2):392-420.
Esmaeelzadeh A, Saadatnia H, Memar B, Mokhtari AE, Ganji A, Goshayeshi L, et al. Evaluation of serum HBV viral load, transaminases and histological features in chronic HBeAg-negative hepatitis B patients. Gastroenterol Hepatol Bed Bench. 2017;10(1):39-43.
Hadziyannis SJ, Papatheodoridis GV. Hepatitis B e antigen negative chronic hepatitis B: natural history and treatment. Seminars in liver disease. 2006;26(2):130-41.
Abulude OA, Ahmed I, Sadisu FU. Assessment of hepatitis B viral infection as a predictor of hepatic enzymes and compounds alteration among antenatal patients. Med Sci (Basel). 2017:5(4):1-9.
Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med. 2000:342(17):1266-71.
Chan HL, Tsang SW, Liew CT, Tse CH, Wong ML, Ching JY. Viral genotype and hepatitis B virus DNA levels are correlated with histological liver damage in HBeAg-negative chronic hepatitis B virus infection. Am J Gastroenterol. 2002;97(2):406-12.
Lindh M, Hora P, Dhillon AP, Norkrans G. Hepatitis B virus DNA levels, precore mutations, genotypes and histological activity in chronic hepatitis B. J Viral Hepat. 2000:7(4):258-67.