Characteristics of treatment naive chronic hepatitis B in Bangladesh: Younger populations are more affected; HBeAg-negatives are more advanced

Abstract

Background/Aim:Bangladesh is a densely populated country with intermediate endemicity for chronic hepatitis B (CHB). The aim of the present study was to evaluate the biochemical, virological and histological character of CHB patients and to examine the relationship between these indices.Materials and Methods:One thousand and twenty-two patients of CHB fulfilled our inclusion criteria. Inclusion criteria were (1) HBsAg positive for at least 6 months, (2) HBeAg-positive or negative and (3) hepatitis B virus (HBV) DNA positive. Patients with detectable antibodies to human immunodeficiency virus (HIV), hepatitis Delta virus (HDV) or hepatitis C virus (HCV), with previous antiviral treatment, overt cirrhosis and hepatocellular carcinoma, were excluded. Of these, 191 patients were randomly selected for liver biopsy and were evaluated for analysis.Results:In the 191 patients, male to female ratio was 4.6:1; age distribution was 26.5 ± 8.5 (mean ± standard deviation) years. One hundred and seventy-eight (93.2%) patients were under 40 years. Sixty-eight (35.6%) patients were HBeAg-negative, had less DNA load, and were significantly older, more fibrotic and cirrhotic (P < 0.001). Correlation was not found between DNA level and histological activity. Histological activity was not correlated with ALT level in HBeAg-positive patients (P < 0.001).Conclusion:CHB affects the younger population in Bangladesh. HBeAg-positive CHB was associated with more fibrosis and cirrhosis. Serum HBV DNA levels do not correlate with the severity of histological lesions in all patients. Evaluation by liver biopsy remains gold standard for taking decision of treatment.

Comparative study of HBV DNA levels in HBeAg positive and negative female patients suffering from chronic hepatitis b in child bearing age.

“…13 Transfer of HBV from mother to off spring is directly correlated with high levels of circulating viral DNA. 14,15 HBeAg negative chronic hepatitis B was once thought to be uncommon in our region but studies from UK, Hong Kong, India and Pakistan shows the prevalence of HBe negative CHB was around (30%-60%) [16][17][18] A study that was conducted on 100 patients showed that 19% of patients with HBsAg positive status had HBeAg negative CHB. Another study conducted in Pakistan showed that 15% if HBeAg negative cases had high levels of HBV DNA due to the presence of pre core mutants.…”

Hepatitis B Virus positive (HBsAg positive) among the blood donors attended at transfusion medicine department, Dhaka Medical College Hospital, Bangladesh: a one year study

“…Bangladesh most HBV infection occurs in childhood and younger populations with a high rate of inter familial HBV Infection and the low rate of history of acute hepatitis. 28 We may conclude that after proper donor selection and donor blood screening for HBsAg will decrease the possibility of posttransfusion hepatitis significantly.…”

High HBcAg Expression in Hepatocytes of Chronic Hepatitis B Patients in Bangladesh

“…The high percentage of HBeAg-negative patients expressing HBcAg in liver could explain the high levels of cirrhosis found in HBeAg-negative patients at very young ages in Bangladesh. [15][16][17] The HBeAg tolerogenic effect, 18,19 is the most rational explanation about the lower FI found among HBeAg positive with grade 3 HBcAg expression.…”