Diagnostic incidence of the presence of positive HBsAg: epidemiologic, clinical, and virological characteristics

Abstract

Objective: to analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepatitis B surface antigen (HBsAg) in the digestive diseases department of a district hospital.Patients and methods: we performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patients who required liver biopsy.Results: we diagnosed 213 patients (18.8/10,000 inhabitants/year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D, followed by A. Resistance was detected at baseline in only 2 cases: to adefovir in one case and to entecavir in another. Among the 36 biopsies performed, 32.4% showed inflammatory activity ≥ 2, and 23.5% had fibrosis ≥ 2 according to the METAVIR scoring system. According to clinical practice, specific treatment for HBV infection was necessary (any reason) in 17.4% of those diagnosed (3 patients per 100,000 inhabitants/year).Conclusions: despite prevention and vaccination, HBV infection is a health problem that most commonly affects the immigrant population and men. Serum transaminase levels are normal in 62.2% of patients. The most frequent genotype is D, followed by A, and baseline resistance is scarce.

Characterization and evaluation of liver fibrosis grade in patients with chronic hepatitis B virus infection and normal transaminases

“…The majority of the patients in our study (96%) had normal transaminase levels at diagnosis and during follow-up, and only a small percentage showed minimal elevations above normal values, findings which are in agreement with those of other current publications in our setting [32,36]. There are studies reporting that patients with normal transaminases at diagnosis have an up to 15-20% increased risk of showing alteration in these values during the first year of follow-up [3,37,38], with the risk decreasing after 3 years of follow-up [2,38,39].…”

“…This study allowed assessment of the different demographic and virological characteristics in a total of 214 patients with chronic HBV infection and normal transaminases. This analysis yielded similar data to those published in other series carried out in a similar setting to ours; predominance of male sex [2,13] and a mean patient age of 47 years [30-32]. More than half of our patients had a BMI≥25 kg/m 2 and 21% had obesity.…”

Virological and serological features of acute hepatitis B in adults

“…In Western countries, the major routes of transmission are sexual contact and intravenous drug abuse. [ 13 ] Our results showed patients aged 26 to 65 years (especially male patients) had a high risk for AHB. Thus, screening for serologic markers for HBV infection is recommended in this population, and vaccination may be administered if necessary.…”

Hepatitis crónicas virales B y C en población inmigrante en España

“…Sin embargo, las hepatitis virales crónicas merecen una especial consideración tanto por la carga de enfermedad que supone en años de vida perdidos por discapacidad y muerte prematura como por su coste para el sistema sanitario 1,6,[31][32][33] . En este sentido, debe considerarse el impacto que la población inmigrante pueda tener en el aumento de estas enfermedades en nuestro medio, como refleja un reciente estudio donde el 53% de los nuevos casos diagnosticados de hepatitis crónica B correspondían a personas inmigrantes 34 .…”