Detection of HBV DNA in ascitic fluid of decompensated cirrhotic patients to assess infectivity: A novel pilot study

Abstract

Background and aims: Body fluids such as saliva, tears and urine from patients with hepatitis B virus (HBV) infection are well known to be infectious. However, the infectivity of internal body fluids like ascitic fluid from patients with HBV infection has not been established. So, we conducted this study to know the infectivity of ascitic fluid for hepatitis B in decompensated cirrhosis by detecting HBV DNA in it.Methods: Patients with HBV related cirrhosis with ascites were enrolled. The levels of HBV DNA in the ascitic fluid from these patients were quantified by real-time PCR, and compared with HBV DNA levels in serum. Clinical and laboratory parameters to predict HBV DNA positivity in ascitic fluid were also assessed.Results : Twenty one patients (mean age 45.43±13 years) with HBV related cirrhosis with ascites were enrolled. HBV DNA in ascitic fluid was detected in 4/21 (19 %) patients. The ascitic fluid HBV DNA levels ranged from 4.8 to 6.4 log copies/mL (mean ± SD = 5.27 ± 0.55). High levels of serum HBV DNA was significantly associated with HBV DNA detectability in ascitic fluid (p=0.001). Patients with HBV DNA detected in ascitic fluid had significantly higher serum protein levels as compared to those having undetectable HBV DNA in ascitic fluid (6.83 ± 0.33 versus 5.70 ± 0.77 g/dl, p=0.011). Conclusions : HBV DNA is detectable in ascitic fluid in about one fifth of HBV related cirrhosis patients with ascites so it may not be considered an important source for HBV transmission. High serum HBV DNA and high serum protein levels were positively associated with HBV DNA detectability in ascitic fluid.