IMMUNOLOGICAL AND BIOCHEMICAL PARAMETERS OF CHRONIC HEPATITIS B INFECTION AMONG PATIENTS IN DUHOK CITY – KURDISTAN REGION / IRAQ
Background: Hepatitis B virus infection (HBV) is regarded as serious public health problem and approximately two billion people are infected with the virus. The presence of HBsAg with the clinical and biochemical features of hepatitis B infection reflects onset of the infection. It is sometimes very difficult to distinguish between inactive HBV carrier and patients with active HBeAg negative chronic hepatitis B. The current study aimed to measure the immunological and biochemical markers other than HBsAg in patients with chronic hepatitis B virus (HBV) attended the infectious diseases unit at Azadi Teaching Hospital in Duhok.
Subjects and Methods: Eighty nine chronic hepatitis B patients were included in this study from June 2015 through December 2015. Serum samples were collected from each patient and measured for HBsAg, anti HBs Ab, HBeAg, anti HBe Ab, and total Anti HB core Ab by using a rapid test (PLASMATEC One Step Multi –HBV Test Device). The HBsAg level was further tested by ELISA (HBsAg ELISA Test Kit, PLASMATEC Laboratory Products). The HBeAg & HBeAb were confirmed by immune-chemilumencense assay. Levels of Alanine Aminotransferase (ALT), Aspartate Transaminase (AST), and Alkaline Phosphatase (ALP) in each serum sample were also measured.
Results: Out of the 89 HBs Ag positive patients 51(57.3%) were males and 38 (42.7%) were females by using ELISA test, 21(23.6%) were positive for HBeAg, and 76 (85.4%) were positive for anti-HBe antibodies by using Chemiluminescent Immunoassay (CLIA) techniques. There were 68 cases of HBe Ag negative and anti HBe Ab positive, 13 patients were HBe Ag positive and anti HBeAb negative and only 8 cases were both HBe Ag and anti HBeAb positive. Among the male patients, 10(47.61%) and 44(57.9%) were positive for HBeAg and anti-HBe antibodies respectively, whereas for the females, 11(52.40%) and 32(42.10%) patients were positive for HBeAg and anti-HBeAb respectively. Regarding the ALT, 11(12.35%) were upper than normal range in which 7 (7.9%) were elevated (40-80 IU/mL) and 4 (4.5%) were twice upper than normal limit (>80). For AST, 12 (13.48%) patients were upper than normal range in which 11(12.35%) were elevated and only 1 (1.12%) was twice upper than normal range. In ALP, only 7(7.9%) of the patients were upper than reference range.
Conclusion: From the current study, it has been concluded that HBeAg and anti Hbe Ab are dependable indicators for the active stage of HBV replication in carrier patients when both of these variables are linked with elevated levels of serum ALT. Furthermore, most increased levels of HBsAg quantitatively were found among the early and young adults who were in the age range of (24- 44) years.