1. Influence of age and gender in hepatitis B and hepatitis C viruses induced liver cirrhosis
Vrushali Patwardhan, Dinesh Kumar, Varun Goel, Sarman Singh
Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine
All India Institute of Medical Sciences, New Delhi
Introduction
Magnitude of HBV and HCV infection: HBsAg was positive in 52.73% males and in only 39.1% females (p= ). Whereas anti HCV antibody was positive in 32% females while only in 17.4% males (p= ). HBV and HCV co-infection was detected in 2.8% males and 2.2% females (p=0.223).
Cirrhosis is an end stage chronic liver disease which is usually irreversible & is emerging as an important cause of global health burden .
Almost one fifth (18.3%) of global liver cirrhosis deaths in 2010 occurred in India alone.
Around 10-30% of patients with HBV infection develop chronic hepatitis, of which 20-50% may end up with cirrhosis.
Whereas % of patients with HCV infection develop cirrhosis.
More than half of cirrhosis burden is attributed to HBV & HCV infection in India.
It has been estimated that over the next 20 years, the proportion of HBV/HCV infected patients with cirrhosis will increase from 16% to 32% and that other complications will also increase dramatically.
In India, the prevalence of HBV and HCV co-infection among patients has been reported to range from 3% to 56%.
Graph 3. Distribution of HBV & HCV in male and female cirrhotic patients
Aim
HBsAg seropositivity was highest (57.6%) in >25-≤45 years age group
HBsAg positivity was least in paediatric patients <12 years of age.
Anti HCV antibody was detected in 9%, 9.6%, 20.2%, 28.5% and 11.1% of patients of <12,>12-≤25, >25-≤45, >45-≤65 and >65 years respectively.
HBV –HCV co-infection was maximum (4.1%) in patients between years age.
HBsAg prevalence was statistically higher in males than in females in 2 age groups i.e. >25-≤45 years and >45-≤65 years.
HCV prevalence was much higher and statistically significant in female patients of all age groups except >12 -≤25 years.
To investigate the seroprevalence of HBV & or HCV infections in patients with clinically diagnosed liver cirrhosis over a 5 years period.
Materials and Methods
Study design: This is a retrospective observational study conducted over 5 years in the division of clinical Microbiology and Molecular Medicine of a tertiary care hospital in India from January December 2015.
Study Population:
Inclusion criteria: All the patients (age 2-80 years) clinically and radiologically diagnosed to have liver cirrhosis were included in the study.
The patients were further categorized into 5 different groups according to patient’s age i.e. <12 years,>12 -≤25 years,>25-≤45years, >45-≤65 years and >65 years for further analysis.
Serological method: Blood samples for serological tests were consecutively obtained from the patients and the sera were separated and stored at -80oC till analyzed further. Each serum was tested for presence of hepatitis B surface antigen (HBsAg) and anti HCV antibody using commercially available electrochemiluminescence immunoassay (ECLIA) kits-from Roche diagnostics, Mannheim, Germany for the in vitro qualitative determination of these serological markers in fully automated Cobas® 6000 modular analyzer as per manufacturer’s instructions.
Statistical data analysis: It was done using the Statistical Package for Social Science software (SPSS version 20.0, IBM Corp., Armonk, NY) and Microsoft Office Excel 2010.The Chi-square test was used for categorical variables. A p value <0.05 was considered statistically significant.
Graph 4 Serological results of HBsAg and anti HCV antibody in various age groups.
Table-1. Age and gender wise distribution of cirrhotic patients
Age group
Gender
Total 
HBsAg positive (%)
P value
Anti HCV positive (%)
Both positive
(%)
Both negative
<12 years
(N= 64)
Males 50
21 (42%)
0.3
3 (6%)
0.04 NA
26 (52%)
Females 14
5 (35.7%)
3 (21.4%)
6 (42.8%)
>12 -≤25 years
(N=198)
163
94 (57.7%)
0.4
15 (9.2%)
0.14
4 (2.5%)
50 (30.6%) 35
20 (57.1%)
4 (11.4%)
1 (2.8%)
10 (28.6%)
>25-≤45
years (N=530)
430
234 (54.4%)
0.019
79 (18.4%)
0.015
18 (4.2%)
99 (23%)
100
43 (43%)
28 (28%)
4 (4%)
25 (25%)
>45-≤65 years (N=386)
314
154 (49%)
0.0001
75 (24%)
7 (2.2%)
0.1
78 (24.8%) 72
18 (25%)
35 (48.6%)
19 (26.4%)
>65 years (N=54)
28 (56%)
4 (8%)
0.001
18 (36%) 4
2 (50%)
Results
Study Subjects: A total of 1232 patients were included in this study. Mean age of the patients was ± 1.84 and range being 2 years to 80 years. Of these 1007 (81.73%) were males and 225 (18.26%) were females. Mean age for males was and was not different than that of female patients years.
Conclusions
Although majority of cirrhosis of the liver is associated with HBV infection in men; HCV is more commonly found to be associated with liver cirrhosis in women.
HBV or HCV associated cirrhosis was found to be more among years of age.
HBV-HCV coinfection is not associated with age or gender of the cirrhotic patients
These age and gender based differences present new challenges for prevention.
Thus age and gender based risk factors need to be evaluated thoroughly which will further help us in decreasing the burden of HBV and or HCV associated liver cirrhosis. Furthermore the study strongly suggests that a widespread application of such measures in national health policies is required to address this growing and largely unappreciated global health problem.
References
Kumar V, Abbas AK, Fausto N, Crawford JM. The liver and the biliary tract. In: Robbins and CotranPathologicbasis of disease. (eds) ElsevierSaunders, Philadelphia.7thedition 2005; 892.
Davis GL, Albright JE, Cook SF, Rosenberg DM. Projecting future complications of chronic hepatitis C in the United States. Liver Transpl Apr;9(4):331-8. 
Chakravarti A, Verma V, Jain M, et al. Characteristics of dual infection of hepatitis B and C viruses among patients with chronic liver disease: a study from tertiary care hospital. Trop Gastroenterol2005;26(4):183-7.
Graph 1. Gender based distribution of cirrhotic patients
Graph 2. Distribution of cirrhotic patients according to age