Serum Hepatitis B Virus (HBV)DNA Levels at Different Stages of Clinical Course in Patients with Chronic HBV Infection in an Endemic Area

Abstract

The aims of this study were to investigate serum hepatitis B virus (HBV) DNA levels at different clinical stages in patients with chronic HBV infection, and to determine the serum HBV DNA level that discriminated HBeAg-negative chronic hepatitis B (CHB) cases from inactive HBsAg carriers. In all, 222 patients, encompassing 68 HBeAg-positive CHB patients (HBeAg-positive, ALT-elevation), 89 HBeAg-negative CHB patients (HBeAg-negative, ALT-elevation), and 65 inactive HBsAg carriers (HBeAg-negative, ALT-normal), were tested. The ALT levels had been tested more than twice during the previous six months, and the serum HBV DNA levels were quantified by a polymerase chain reaction-based assay. The serum HBV DNA levels of the HBeAg-negative patients were significantly lower than those of the HBeAgpositive patients (median 2.7×10 4 vs. 1.6×10 8 copies/mL; p=0.000). In addition, the HBV DNA levels of the HBeAg-negative CHB patients were significantly higher than those of the inactive HBsAg carriers (median 2.2×10 5 vs. 3.2×10 3 copies/ mL; p=0.000). The optimal HBV DNA level for discriminating HBeAg-negative CHB cases from inactive HBsAg carriers was 2.0×10 4 copies/mL. The serum HBV DNA levels were lower than the cutoff value in 72.3% (47/65) of the inactive HBsAg carriers, and in 31.5% (28/89) of the HBeAg-negative CHB patients. The serum HBV DNA levels differed significantly between these two groups. However, the levels in the two groups overlapped extensively, preventing the definition of a differentiation cut-off value.

Diagnosing different stages of hepatitis B infection using a competitive polymerase chain reaction assay

“…[6][7][8][9] However, the median HBV DNA level for the HBeAg-positive patients was statistically higher than the HBeAg-negative ones and similar trend was observed between the HBeAg-negative CHB patients and the inactive carriers (Table). Various studies on different populations of the world suggest that a lower cut-off value appears to be a better marker for differentiating HBeAg-negative CHB patients from the inactive carriers 6-9 as compared to NIH recommended value of 10 5 copies/mL.…”

“…However, according to a study by Chu et al, 6 NIH recommended value excluded 45.0% of HBeAg-negative CHB patients in their population. Similarly, Hoe et al, 7 observed while studying Korean population, that NIH value exclude 40.4% HBeAg-negative CHB patients and additionally, 20.0% of the inactive carriers were above this value. Evidently, HBV DNA levels in Indian HBsAgpositive population are lower in both the cases.…”

“…Following this, various investigators have attempted to validate the proposed cut-off limits for differentiating these two groups of carriers and found that a lower threshold value might be more relevant in their populations. [6][7][8][9] Such a study turns out to be imperative in a country like India where no such data exists and the burden of this virus is second highest in the world. 10 The present study attempts to Þ ll this void.…”

Low Viral Load Does Not Exclude Significant Liver Damage in Patients with Chronic HBV Infection in Bangladesh

“…From Bangladesh also, our group as well as our colleagues have reported similar experience in the recent past [9][10] . Two more recent studies have rather reported that high HBV DNA load is associated with less severe histologic liver disease [11][12] .…”

“…HBV DNA load in CHB patients may be influenced by host factors like immune response and alcohol consumption and viral factors like genotype and pre-core/ core promoter mutations 12 . CHB patients may have fluctuating HBV DNA level, which may also explain such observation.…”