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4th European Congress of Chemotherapy and Infection

47 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 raf@antibiotic.ru

The PDF format poster (331 kb)




ABBREVIATIONS

ALT - alanine aminotransferase

Anti-HBe - antibody to hepatiti antigen

CBH - chronic hepatitis

HBV - hepatitis virus

HBsAg - hepatitis surface antigen

HBeAg - hepatiti antigen

PCR - polymerase chain reaction


INTRODUCTION

The diagnosis of chronic HBV infection is based on the persistence of HBsAg > 6 months. Earlier the diagnosis of chronic hepatitis  () was thought to require the presence of hepatitis   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.


AIMS

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 among HBsAg carriers.


METHODS

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.

criteria from AASLD Practice Guidelines, 2001 was used [1]. All patients were HCV, HDV and HIV negative.


RESULTS

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).


Level of HBV DNA among HBsAg carries

Figure 1. Level of HBV DNA among HBsAg carries


The average HBV DNA level was 1.210*9 copies/ml in the HBeAg(+) patients and 1.410*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 (HBsAg-carrier > 6 months, HBV DNA >10*5 copies/ml, ALT >x1.5 ULN).


Patients features depending on HBeAg presence

Figure 2. Patients features depending on HBeAg presence



CONCLUSIONS

  1. 51.5% of HBsAg-carriers had viral replication confirmed by PCR.
  2. 14,1% of them had biochemical, serological and virology signs of active chronic hepatitis B.
  3. Not only HBeAg(+) but also 12.6% of HBeAg(-)/anti-HBeAg(+) patients had characteristic typical for active and requred an antiviral therapy.

REFERENCES

  1. Lok A.S., McMahon B.J. Chronic hepatitis B. Hepatology, 2001 Dec; Vol. 34 (6), pp. 1225-41.

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