Pattern of hepatitis B infection in two tertiary care hospitals of Peshawar

Abstract

Objective: To determine the Clinico-Pathological pattern of Hepatitis B (HBV) infection in patients reporting to Combined Military Hospital (CMH) Peshawar and Hayatabad Medical Complex (HMC) Peshawar.

Study design: Observational Study.

Place and durtion: CMH Peshawar (Departments of Medicine, Pathology and Radiology) in collaboration with Hayatabad Medical Complex Peshawar from July 2006 to Jun 2009.

Patients and Methods: One hundred and forty nine patients with Hepatitis B Surface Antigen (HBsAg) positive results for the last six months were studied. Various investigations related to their disease were carried out e.g. Serum ALT, Hepatitis B e Antigen (HBeAg), Hepatitis B e Antibody (HBeAb), PCR for HBV DNA (PCR-HBV). Histopathological classification on the basis of liver biopsy was carried out by Knodal Scoring System (KS). Ultrasonography (USG) of liver was also carried out in some subjects.

Results:  The frequency of Chronic Hepatitis B (e + CHB) as defined by HBsAg positive, HBeAg positive and DNA PCR positive and HbeAg negative Chronic Hepatitis B (e –CHB) as defined by HbeAg negative and raised ALT (>40 U/L) was 38% and 25% respectively. Another 15% subjects with HBsAg positive, HBeAg negative and DNA PCR positive were having normal serum ALT levels. In 22% subjects HBeAg as well as PCR-HBV were negative (inactive carriers). In patients with active disease (PCR HBV positive), no significant difference was found between mean serum ALT level in e –CHB and e + CHB. More than 50% of young (<20 years) subjects of e + CHB had normal ALT levels (immune tolerance phase). 

Conclusion: In CMH and HMC Peshawar HBeAg negative hepatitis constituted an important proportion of HBV infected population.

Keywords: Hepatitis B, Hepatitis B e Antigen, Alanine Transaminase.