4th European Congress of Chemotherapy and Infection
4–7 May, 2002, Paris, France
Prevalence of active chronic hepatitis B among the HBsAg-carriers in Smolensk, Russia
V. Rafalski, N. Sudilovskaya, E. Karakina
Institute of Antimicrobial Chemotherapy, State Medical Academy, Smolensk, Russia
Correspondence to: V. Rafalski firstname.lastname@example.org
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ALT - alanine aminotransferase
Anti-HBe - antibody to hepatiti Â å antigen
CBH - chronic hepatitis Â
HBV - hepatitis Â virus
HBsAg - hepatitis Â surface antigen
HBeAg - hepatiti Â å antigen
PCR - polymerase chain reaction
The diagnosis of chronic HBV infection is based on the persistence of HBsAg > 6 months. Earlier the diagnosis of chronic hepatitis Â (ÑÍÂ) was thought to require the presence of hepatitis Â å antigen (HBeAg) and HBsAg+/HBeAg- individuals were considered to have nonreplicative HBV infection. Now serum HBVDNA assays should be performed to determine if the patient should be considered for antiviral therapy.
To evaluate the incidence of HBV DNA+ ampng HBsAg+ patients and estimate the level of viraemia both in HBeAg(+)/HBsAg(+) and HBeAg(-)/anti-HBeAg(+)/HBsAg(+) patients. To study the ratio of patients who have criteria of active ÑÍÂ among HBsAg carriers.
In this observational study were included 170 patients > 18 years of age with documented HBsAg-carrier > 6 months (average age - 40.0 years, male - 56%, female - 44%). HBV DNA in serum was tested by qualitative and quantitative PCR (commercial test-system Ampli-Sens HBV), sensitivity 500 copies/ml. HBeAg, HBeAb, HBsAg, anti-HCV, anti-HDV, anti-HIV were detected by ELISA (Hoffmann La Roche). Clinical chemistry (ALT, AST level) was assessed by automatic analyser HUMALYZER 2000.
ÑÍÂ criteria from AASLD Practice Guidelines, 2001 was used . All patients were HCV, HDV and HIV negative.
51.5% of HBsAg carriages were HBV DNA positive by qualitative PCR. HBeAg was detected in 7.5% patients. HBV DNA in the concentration >10*5 copies/ml assessed by quantitative PCR was detected in 22.2% patients (fig. 1). The HBV DNA level >10*5 copies/ml was detected in 100% HBeAg(+) and in 28.6% HBeAg(-) patients (fig. 2).
Figure 1. Level of HBV DNA among HBsAg carries
The average HBV DNA level was 1.2õ10*9 copies/ml in the HBeAg(+) patients and 1.4õ10*7 copies/ml in HBeAg(-) patients (p-Wilcox < 0.001). Elevated ALT level (> x1.5 the upper limit of normal - ULN) was determined in 5.4% of the HBV DNA- and 30.1% of the HBV DNA+ HBsAg carriages. 66.7% of HBVDNA+/HBeAg+ and 16.7% HBVDNA+/HBeAg-HBsAg carriers have 1.5 ULN or higher increase of the ALT level (fig. 2).
14.1% of all and 12.6% of HBeAg-/anti-HBeAg+ HBsAg carriers had the combination of the biochemical, serological and virology criteria, which are typical for active ÑÍÂ (HBsAg-carrier > 6 months, HBV DNA >10*5 copies/ml, ALT >x1.5 ULN).
Figure 2. Patients features depending on HBeAg presence