Spectrum of Hepatitis B infection in a Tertiary Care Centre A cross sectional analysis

Background Hepatitis B virus related liver disease is not an uncommon problem in India. There are very few reports on pattern of chronic hepatitis B virus infection in a tertiary care centre from South India.The aim of the present study was to determine the spectrum of chronic Hepatitis B virus infection amongst patients attending the liver clinic in a tertiary referral centre. Methods Hepatitis B surface antigen positive patients registered in the liver clinic between July 2010 and Mar 2011 were included in the study. Totally 189 patients were included in the study. Based on the viral profile, transaminase levels and ultrasound findings, patients were categorized as immunotolerant, inactive carriers, immune clearance and reactivation phase, chronic liver disease (chronic hepatitis, cirrhosis) and hepatocellular carcinoma.Results Among the 189 patients, 64 of them were asymptomatic and incidentally detected to be positive for HBsAg. One patient was positive for both HBV and retrovirus, and 3 were positive for HBV and HCV. In the immune tolerant phase (13.2), women were a decade younger than their male counterparts. The mean HBV DNA values were significantly high in HBeAg positive patients. 35.9 of patients were in the immune inactive phase . ALT levels were in the normal range and HBV DNA values were either low or not detectable in this phase.Amongst patients with elevated ALT and HBV DNA levels (50.8) in immune clearanceimmune reactive phase, HBV DNA levels were high in HBeAg positive patients (either sex). In all the 3 groups, there was no correlation between HBsAg quantitative and HBV DNA levels. Nine patients (4.8) had HBV related HCC. The mean age was 55 years. Five of the 9 patients had very low HBV DNA levels, 3 were HBeAg positive and remaining negative. Conclusion In this study, 50.8 of patients were in immune clearance and reactive phases required treatment with antiviral drugs. Rest of the patients (49.2) were in immune tolerant and inactive carrier phases and they require meticulous follow up.