Dr Iyat Abdul Sattar A study on the clinical & serolological markers of HBV among patients with chronic HBV infection in Babylon Dr Monem Makki Alshok

Worldwide Hepatitis B statistics: > 2 billion people (1/3 of the world’s population) have been exposed ,800 million infected persons , 350 million chronic carriers ,50 million new cases/year Accounts for 60-80 percent of liver cancer cases (the leading cause of liver cancer) Accounts for 500,000 to 1.2 million deaths per year (10th leading cause of death worldwide)

CHB infection Chronic infection is an even greater problem globally, affecting approximately 350 million persons. An estimated 620,000 persons worldwide die from HBV-related liver disease each year.

Factors Associated With Increased Risks of Progression to Cirrhosis Host Factors Virus Factors Environmental Factors Older age* High levels of Concurrent infection (longer duration) HBV replication* (HCV*, HDV, HIV) Male* Genotype (C B)* Alcohol consumption* Immune status HBV variant Diabetes mellitus† (core promoter) Obesity

WHO ;HBV; DCS,CRS,2002 Chronic HBV infection: 45% live in area of high endemicity( > 8% of population are +ve for HBsAg ) 43% live in moderate area ( 2 – 7 % of population are +ve for HBsAg ) 12% live in low areas ( < 2% )

Aims This study seeks to the prevalence of HBe Antigen in patients with chronic HBV infection and to correlate its presence to clinical severity of the disease , infectivity & relation to virus load

In this study Plasma were collected from 70 patients with positive HBs Antigen detected by ELIZA technique and in these patients we test HBe Ag , HBe Ab and HBc Ab by the same technique inaddition we do PCR test to measure the degree of viral load in these patients . All the patients had thorough clinical assessment , U\S examination , blood picture and liver function tests( BR, ALT , PT,and albumin ) .

Results 70 patients with HBsAg +ve , Symptomatic ( 37 ) , Asymptomatics ( 33 ) Demographic Characteristics : Age ( 12 – 70 )with mean of 40 years±8.8SD, <40 80% +ve , 27% - ve Gender M\F , HBeAg +ve 2:3, HBeAg - ve 4:1 Urban: HBeAg +ve 3\15, HBeAg – ve 15\55 Rural : HBeAg +ve 12\15, HBeAg – ve 40\55 HBeAg – Status : Negative 55 Positive 15

Results ( cont.) Low S. Albumin 33% +ve e , 30% -ve e PT prolonged in 40% +ve e , 23% -ve e ALT elevation higher in e +ve 80%\27% U\S changes in 25% e +ve ,while e –ve 17%

Results Viral Load of > 10copies \ml in 86% of HBeAg +ve & in 50% of e –ve ( P value < 0.05 ) Only 15 patients ( 32% ) of patients with AntiHBe Ab , have high viral load & viral DNA , whereas 55 patients , 68% of patients who donot have AntiHBe Ab have high viral load by PCR ( P < 0.05 ) The higher virus load FH +ve 34.1%. In Low virus load 17.9% had +ve FH

Results Summary From a total of 70 patients diagnosed as CLD according to the American Association of liver disease 15 found to have positive e antigen and about 85% of these patients are rural and 80% are symptomatic with abnormal LFTs and findings on liver U\S compared with e negative patients . Viral load of > 105copies \ ml .were reported in 87% of e antigen positive CHB in comparism to 50% in e antigen negative CHBV ( P value < 0.05 )

In conclusion 1 . The prevelance of e antigen positivity is 21 % among patients with CHBV infection in Babylon 2 . HBe Ag is a marker of severity & infectivity , but its absence does not exclude the infectivity rate as a good percentage of these patients had detectable levels of viral DNA .

In conclusion 3 . Persons older than 50 years of age are more HBeAg-negative & more likely to spontaneously clear HBsAg than any other group.

Recommendations Future studies should concentrate on determining the exact time infected persons contract chronic hepatitis B . Hepatitis B vaccination is the most efficient method of preventing HBV and HBV-related illnesses (1st anti-cancer vaccine). Future policy should also focus on improving medical services, detection, liver biopsy and treatment for chronic HBV carriers, especially in Asian populations where precore mutant HBeAg –ve is prevalent

Thank You Alsalam Alaikum