Introduction: Chronic Hepatitis B viral infection is associated with significant health and financial challenges. An estimated 15-40% of the Chronic Hepatitis B infected patients would develop liver Cirrhosis and a quarter of which may result in Hepatocellular cancer. In Africa, about 65 million people are said to be chronically infected with HBV. Thus, Africa with 12% of the world’s population carries approximately 18% of the global burden of HBV infection. An elevated level of ALT is an important component in the consideration for treatment of CHB, however, the presence of normal level ALT levels with discordantly elevated HBV DNA levels may requires further evaluation with Liver histology. Method: All patients who were newly diagnosed with CHB infection and above 18 years of age were consecutively recruited from December 2019 to October 2020, into the study. Blood samples were taken for the Liver Function Test, HBV immunologic panel and HBV DNA levels. Liver biopsy was performed for 84 patients with variance elevated serum HBV DNA (>2000 IU/mls) and normal serum ALT defined as level <40 Unit/mls. The Data collected was entered and analyzed using the SPSS version 20. The clinical profiles and HBV DNA level of the respondents were presented using mean and standard deviation while frequencies, percentages and charts was used to summarize qualitative variables. Chi-square test and Fisher’s exact test were used to analyze factors associated with respondent’s HBeAg status and liver histology. Result: The Liver biopsy histology shows, mild inflammation (A1) was observed in 50 (60%), and moderate inflammation (A2) in 12% while the remaining 10 patients (28%) showed no inflammatory. Similarly, 20 patients (24%) had no fibrosis (F0), 8% had portal fibrosis without septa (F1), 24% had portal fibrosis with rare septa (F2) while the remaining majority (44%) had numerous septa (F3). Conclusion: Chronic HBV infection is Endemic in our region and studies had shown the importance of adequate evaluation and early treatment to avert the associated high morbidity and mortality. Also, significant number of patients with normal ALT levels had fibrosis on liver histology. Liver histology remains an important parameter in the evaluation of patients with CHB, as 57 patients would have missed the opportunity of early treatment. These findings are expected to provide a basis for an informed planning of national and International CHBV treatment guidelines.
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Chronic HBV infection is a major health challenge particularly in the Tropics. The estimated world prevalence is about 2 billion and 240 million people with evidence chronic carriers of HBV
[1]
Schweitzer A, Horn J, Mikolajczk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systemic review of data published between 1965 and 2013. Lancet 2015; 386: 1546–1555.
[1]
. The South-east Asia, China, Sub-Sahara Africa and Amazon basin accounted for 75% of chronic carrier state
[2]
Pyrsopoulos ANT, Katz J. Hepatitis B clinical presentation. Curr Gastroenterol Rep. 2013; 7: 2; 1–9.
[2]
. About 15-40% of the CHB infected patients would develop liver Cirrhosis and a quarter of which may result in Hepatocellular cancer
[3]
Shimakawa Y, Yan H, Tsuchiya N, Bottomley C, Hall AJ. Association of Early Age at Establishment of Chronic Hepatitis B Infection with Persistent Viral Replication, Liver Cirrhosis and hepatocellular Carcinoma: A systemic Review. PloS One 2013; 8: 7.
[3]
.
In Africa, an estimated 65 million people are said to be chronically infected with HBV. Hence, Africa with about 12% of the world’s population carries approximately 18% of the global burden of HBV infection
[4]
Kiire CF. The epidemiology and prophylaxis of Hepatitis B in sub Saharan Africa: a view from tropical and sub-tropical Africa. Gut 1996; 38(suppl 2): S5-S12.
[4]
. The pooled prevalence estimate for Nigeria was 13.6%
[5]
Musa BM, Bussell S, Borodo MM, Samaila AA, Femi OL. Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: a systematic review and meta-analysis. Niger J Clin Pract 2015; 18: 163–72.
[5]
, and the higher prevalence rates were in older children which further supports the established fact that most HBV transmission in Africa occur in early childhood via contact rather than vertically.
It is therefore pertinent to have an early evaluation of patients with CHB infection and consider treatment where necessary, to significantly reduce the diseases burden and associated morbidity and mortality. The thorough evaluation to determine those who might benefited from the treatment based on the guidelines, factors including the level of ALT, HBV DNA, presence or absence of HBeAg and/or Liver histology need to be considered.
The common pathway in the development of CLD is fibro-genesis which is initially a physiological response, and beneficial to the host but subsequently becomes pathological if viral infection and chronic hepatocellular injury persist. After considering viral HBV DNA levels, precise definition of liver fibrosis stage, as well as inflammation, are essential for management of the patients with chronic viral hepatitis in clinical practice
[6]
Sebastiani G. Non-invasive assessment of liver fibrosis in chronic liver disease : Implementation in clinical practice and decisional algorithms. World J Gastroenterol 2009; 15: 2190–203.
[6]
.In order to achieve liver tissue diagnosis, liver biopsy must be resorted to; therefore liver biopsy remains probably the most important diagnostic tool in CLD therapeutic decision
[7]
Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology. 2000 Sep; 32(3): 477-81.
HBV infection is a fluctuating process with replicative and non-replicative/low replicative phases. The presence of circulating HBsAg and the HBeAg and high levels of HBV DNA characterize the immune-tolerant phase. Where patients have no symptoms, normal or slightly increased ALT levels, and minimal histological activities, this imply that there is a lack of or a very weak immune response against the infected hepatocytes. The second phase of chronic HBV infection, patients may, is the Immune-active phase, which is associated with a slightly decrease in HBV DNA concentrations but markedly elevated ALT levels and increase histological activity, this is due to immune-mediated lysis of infected hepatocytes. In the low or non-replicative third phase, seroconversion from HBeAg to HBeAb (anti-HBe) occurs. This phase is usually preceded by a marked reduction of HBV DNA to levels that may not be detectable in the serum followed by normalization of ALT levels and resolution of liver necro-inflammation. This phase is also referred to as the Inactive HBV Carrier state. There is a fourth phase of the disease called Immnuo-reactivation stage, it occur when previously inactive carrier patients become active due to either change in host immunity or virulent factors of the infection
[8]
Mansour-Ghanaei F, Rafiei R, Joukar F, Naghipour M, Besharati S, Aminian K, et al. Relationship between serum HBV DNA level and liver histology in HBV carriers with normal ALT in Guilan province, Iran. Med Sci Monit. 2010; 16(3): BR97-BR101.
[8]
. Anti-viral therapy are mostly indicated in Immuno-active and Immuno-reactive phases of the CHB infection.
However, all these recognized Chronic HBV infection phases according the guidelines significantly played down the importance of the liver histology in the evaluation of the HBV infection management by using ALT level as a surrogate. Earlier studies had shown that normal ALT level in patients with CHB diseases is significantly associated with low prevalence of liver injury histologically
[9]
Dragosics B, Ferenci P, Hitchman E, Denk H. Long-term follow-up study of asymptomatic HBsAg-positive voluntary blood donors in Austria: a clinical and histologic evaluation of 242 cases. Hepatology. 1987 Mar-Apr; 7(2): 302-6.
,other studies have however reported significant liver injury in a fair proportion of these patients
[12]
Nguyen MH, Trinh H, Garcia RT, Keefe EG. Significant histologic disease in HBV-infected patients with normal to minimally elevated ALT levels at initial evaluation. Hepatology. 2005: 42; 1; 593.
[13]
Chandra R, Kapoor D, Agarwal SR, Malhotra V, Sakhuja P, Sarin SK. High frequency of biochemical and histological disease in incidentally discovered asymptomatic HBsAg positive carrier: need to change terminology. Hepatology 1999; 30; 10-7.
[12, 13]
.
Therefore, the aim of our study is to determine the relationship between the elevated HBV DNA levels and the liver histology in a patients with normal serum ALT level.
2. Method
The study was conducted at the Gastroenterology out-patient Clinic of Aminu Kano Teaching Hospital (AKTH) Kano, Nigeria. It a cross-sectional descriptive study of patients that was newly diagnosed with HBsAg positive result referred to the Out-patient Clinic. All patients newly diagnosed with CHB infection without co-infection with HCV, HIV and above 18 years of age were consecutively recruited from December 2019 to October 2020, into the study after signing the informed consent form for the study. And 10 mls of blood samples were taken for the Liver Function Test, HBV immunologic panel and HBV DNA level.
The immunologic markers (HBeAg, anti-HBcAb, anti-HBeAb and anti-HBsAg) were done using commercially available enzyme-linked immunosorbent assay (ELISA) kits, while biochemical (LFTs) tests were performed using routine automated analyzers. The serum HBV DNA levels was quantified using ABI 7300 machine with LIFERIVER PCR kit with the lower limit of detection being < 5 IU/ml.
Liver biopsy was done for all patients with discordant elevated serum HBV DNA (>2000 IU/mls) with normal serum ALT defined as level <40 Unit/mls
[14]
Malu AO, Borodo MM, Ndububa DA, Ojo OS, Anomneze EE, Lesi OA et al. Hepatitis B and C treatment guidelines for Nigeria. Nig J Gatroenterol Hepatol 2015; 7; 2; 63-75.
[14]
.All the liver biopsies were done after obtaining of written informed consent and 84 patients were found to have normal ALT level with elevated HBV DNA and were further evaluated for the Liver biopsies. The liver tissues obtained was transferred into a well-labelled formalin container and sent to histopathology laboratory for analysis.
Ethical clearance was obtained from the Ethics and Research committee of AKTH for the study. Ref. No. NHREC/21/08/2008/AKTH/EC/2612 dated 9th September, 2019.
The provision of the Helsinki declaration was duly observed. Data collected from the patients were kept confidential.
Data collected was cleaned, entered and analyzed using the SPSS version 20. The clinical profiles, serum ALT; and HBV DNA levels of the respondents were presented using mean and standard deviation while frequencies, percentages and charts was used to summarize qualitative variables. Chi-square test and Fisher’s exact test were used to analyze factors associated with respondent’s HBeAg status and liver histology. In all tests of significance, P<0.05 was considered statistically significant.
3. Result
Demographic pattern of the study population: Liver biopsy was performed on 84 patients with elevated HBV DNA but normal ALT of which 71 were males, and 13 females with M:F 5.5:1 and the mean age was 29.5 6.4 years as shown in Table 1.
Table 1. HBV DNA vs Gender and Age distribution.
Variables
HBV-DNA (IU/mL) n (%)
2000-19,999
≥ 20,000
p-value
All
26 (31.0)
58 (69.0)
Sex
0.03
Male
19 (22.6)
52 (61.9)
Female
7 (8.3)
6 (7.2)
Age group
≤ 20
2 (2.4)
6 (7.1)
21 to 30
9 (10.7)
26 (31.0)
31 to 40
12 (14.3)
23 (27.4)
> 40
3 (3.6)
3 (3.6)
*Significant at p< 0.05
Figures 1 and 2 shows the distribution of liver inflammation and fibrosis respectively. Using METAVIR scoring system, mild inflammation (A1) was observed in 50 (60%) of patients and moderate inflammation (A2) in 12% while the remaining 10 patients (28%) showed no inflammatory activity. Similarly, fibrosis score shows that, 20 patients (24%) had no fibrosis (F0), 8% had portal fibrosis without septa (F1), 24% had portal fibrosis with rare septa (F2) while the remaining majority (44%) had numerous septa (F3). No patient had cirrhosis.
Figure 2. Distribution of liver fibrosis in biopsy indicated patients among treatment naïve subjects with chronic HBV infection.
4. Discussion
Hepatitis B viral infection has the tendency for chronicity with significant morbidity and mortality. Nigeria being in a hyper-endemic region, with a huge burden of CHB patients in its population, robust studies are needed as to identify patients who are eligible for treatment. The eligibility for treatment is defined as individual with HBV DNA count >2000 IU/ml with F2 and/or A2 on liver histology.
4.1. Gender Distribution of the Study Population
Of the 84 CHBV patients with elevated HBV DNA and liver biopsies, 71 patients (84.5%) were males and 13 patients (15.5%) were female, with a mean age of 29.5 6.4 years. This was similar to one of the Iranian studies by Mansour-Ghanaei et al
[8]
Mansour-Ghanaei F, Rafiei R, Joukar F, Naghipour M, Besharati S, Aminian K, et al. Relationship between serum HBV DNA level and liver histology in HBV carriers with normal ALT in Guilan province, Iran. Med Sci Monit. 2010; 16(3): BR97-BR101.
[8]
where male patients was 34 (63%) and female was 20 (37%) but mostly elderly population, mean age of 41.8911.54. Similarly in India study
[13]
Chandra R, Kapoor D, Agarwal SR, Malhotra V, Sakhuja P, Sarin SK. High frequency of biochemical and histological disease in incidentally discovered asymptomatic HBsAg positive carrier: need to change terminology. Hepatology 1999; 30; 10-7.
[13]
, of the 157 patients (M:F =123:34) However, In another Iranian study by Esmaeelzadeh et al
[15]
Esmaeelzadeh A, Saadatnia H, Memar B, Amirmajdi EM, Ganji A, Goshayeshi L et al. Evaluation of serum HBV viral load, transaminases and histological features in chronic HBeAg-negative hepatitis B patients. Gastroenterol Hepatol Bed Bench. 2017; 10(1): 39-43.
[15]
where total of 150 patients were biopsied, female patient slightly dominated, 72 (48%) were male and 78 (52%) were female M;F ratio 1:1.1.
4.2. Liver Histology
The study showed that a significant number of patients (60%) had mild to moderate necro-inflammation. In a similar study done in Netherland by Sonneveld et al
[16]
Sonneveld MJ, Brouwer WP, Hansen BE, Chan HL, Piratvisuth T, Jia JD et al. Very low probability of significant liver inflammation in chronic hepatitis B patients with low ALT levels in the absence of liver fibrosis. Alimentary pharmacology & therapeutics, 2020; 52(8), 1399–1406.
there is significant inflammatory activity (mild to severe) in 83.6% while only 16.4% had no inflammation on liver biopsy. Also, this difference is may likely be due to the predominant genotypes in the Western Europe compared to sub-Saharan Africa.
Also, our study showed that a fairly large number (68%) of biopsied patients had F2 on liver histology. A study done in China by Da Wu et al
[17]
Da Wu Z, Yu Rui L, Jing D, Yue Yong Z, You Bing L, Jing C et al. Serum HBsAg and HBeAg levels are associated with liver pathological stages in the immune clearance phase of hepatitis B virus chronic infection. Mol Med Rep 2015; 11(5): 3465-72.
reported significant fibrosis in a slightly higher number of patients (77.2%) and cirrhosis was seen as compared to our study, this therefore, could explain the slight variation observed in the two studies.
Several other similar studies had also demonstrated serious association between high level of HBV DNA and Liver histology. Zacharakis et al
[18]
Zacharakis G, Koskinas J, Kotsiou S, Tzara F, Vafeiadis N, Papoutselis M, et al. The role of serial measurement of serum HBV DNA levels in patients with chronic HbeAg (–) hepatitis B infection: association with liver disease progression. A prospective cohort study. J Hepatol, 2008; 49(6): 884–91. Epub 2008 Jul 2. Erratum in: J Hepatol. 2009 May; 50(5): 1065.
reported that liver fibrosis is significantly related HBV DNA level in HBeAg-negative patients. Also, Mommeja-Marin et al
[19]
Mommeja-Marin H, Mondou E, Blum MR, Rousseau F. Serum HBV DNA as a Marker of Efficacy During Therapy for Chronic HBV Infection: Analysis and Review of the Literature. Hepatology, 2003; 37(6): 1309–19.
showed correlation between viral load and histology grading similar to our findings. Additionally, Changjiang and his team performed liver biopsy in 396 patients with CHB infection and the results show significant correlation between HBV DNA level and liver fibrosis and cirrhosis. The serum HBV DNA levels was correlated with mild fibrosis, moderate to severe fibrosis and cirrhosis (P = 0.009, P<0.001, and P<0.001 respectively)
[20]
Liu C, Wang L, Xie H, Zhang L, Wang B, Luo C. The relationship between serum hepatitis B virus DNA level and liver histology in patients with Chronic HBV infection. PLoS ONE 13(11).
[20]
.
However, Martinot-Peignoux et al
[21]
Martinot-Peignoux M, Boyer N, Colombat M, Akremi R, Pham BN, Ollivier S et al: Serum hepatitis B virus DNA levels and liver histology in inactive HBsAg carriers. J Hepatol, 2002; 36(4): 543–46.
study observed that there is no significant correlation between the total histological score, staging or grading and elevated HBV DNA titre. Also Shao et al
[20]
Liu C, Wang L, Xie H, Zhang L, Wang B, Luo C. The relationship between serum hepatitis B virus DNA level and liver histology in patients with Chronic HBV infection. PLoS ONE 13(11).
[20]
studied 178 patients with markedly elevated HBV DNA levels greater than 105 and found that there is no correlation between the HBV DNA and histology grade and stage of the liver disease.This contrary observations might however be due to the difference in the disease pattern and HBV genotype between Africa/Middle East/Far East and Europe-France.
5. Conclusion
Chronic HBV infection is Endemic in our region and the study had shown the importance of adequate evaluation and early treatment necessary to avert the associated high morbidity and mortality. The shows that younger age group are particularly affected by the disease and predominantly the male patients. These findings further confirmed the importance of the CHB infection in contributing to the African economics losses and the resultant sequel.
Furthermore, the significant number of CHB patients with normal ALT levels had fibrosis on liver histology. Thus, patients who have elevated HBV DNA (>2000 IU/ml) but low or normal ALT might be considered for treatment if liver histology result is not available as significant number of them had active histological findings.
Therefore, Liver histology remains an important parameter in the evaluation of patients with CHB, as 57 patients would have missed the opportunity of early treatment.
6. Recommendation
These findings are expected to provide a basis for an informed planning of national CHBV treatment guidelines.
Abbrevations
A1
Mild Inflammation
A2
Moderate Inflammation
AKTH
Aminu Kano Teaching Hospital
CHB
Chronic Hepatitis B
CHBV
Chronic Hepatitis B Virus
CLD
Chronic Liver Disease
DNA
Deoxyribonucleic Acid
F0
No fibrosis
F1
Portal Fibrosis Without Septa
F2
Portal Fibrosis with Rare Septa
F3
Numerous Septa Fibrosis
ELISA
Enzyme-linked Immunosorbent Assay
HbcAg
Hepatitis B Core Antigen
HbcAb
Hepatitis B Core Antibody
HbeAg
Hepatitis B Envelop Antigen
HBeAb
Hepatitis B Envelop Antibody
HBsAg
Hepatitis B Surface Antigen
METAVIR
Meta-Analysis of Histological Data in Viral Hepatitis
SPSS
Statistical Package for the Social Sciences
Acknowledgments
All praise is to Almighty who made it possible for me to complete this work and profound gratitude to Professor MM Borodo and Professor AA Samaila for their guidance and advice. I sincerely appreciate the support of my colleagues and family.
Muhammad Musa Borodo: Conceptualization, Methodology, Project administration, Supervision, Visualization, Writing – original draft
Conflicts of Interest
The authors declare no conflicts of interest.
References
[1]
Schweitzer A, Horn J, Mikolajczk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systemic review of data published between 1965 and 2013. Lancet 2015; 386: 1546–1555.
[2]
Pyrsopoulos ANT, Katz J. Hepatitis B clinical presentation. Curr Gastroenterol Rep. 2013; 7: 2; 1–9.
[3]
Shimakawa Y, Yan H, Tsuchiya N, Bottomley C, Hall AJ. Association of Early Age at Establishment of Chronic Hepatitis B Infection with Persistent Viral Replication, Liver Cirrhosis and hepatocellular Carcinoma: A systemic Review. PloS One 2013; 8: 7.
[4]
Kiire CF. The epidemiology and prophylaxis of Hepatitis B in sub Saharan Africa: a view from tropical and sub-tropical Africa. Gut 1996; 38(suppl 2): S5-S12.
[5]
Musa BM, Bussell S, Borodo MM, Samaila AA, Femi OL. Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: a systematic review and meta-analysis. Niger J Clin Pract 2015; 18: 163–72.
[6]
Sebastiani G. Non-invasive assessment of liver fibrosis in chronic liver disease : Implementation in clinical practice and decisional algorithms. World J Gastroenterol 2009; 15: 2190–203.
[7]
Cadranel JF, Rufat P, Degos F. Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology. 2000 Sep; 32(3): 477-81.
Mansour-Ghanaei F, Rafiei R, Joukar F, Naghipour M, Besharati S, Aminian K, et al. Relationship between serum HBV DNA level and liver histology in HBV carriers with normal ALT in Guilan province, Iran. Med Sci Monit. 2010; 16(3): BR97-BR101.
[9]
Dragosics B, Ferenci P, Hitchman E, Denk H. Long-term follow-up study of asymptomatic HBsAg-positive voluntary blood donors in Austria: a clinical and histologic evaluation of 242 cases. Hepatology. 1987 Mar-Apr; 7(2): 302-6.
Nguyen MH, Trinh H, Garcia RT, Keefe EG. Significant histologic disease in HBV-infected patients with normal to minimally elevated ALT levels at initial evaluation. Hepatology. 2005: 42; 1; 593.
[13]
Chandra R, Kapoor D, Agarwal SR, Malhotra V, Sakhuja P, Sarin SK. High frequency of biochemical and histological disease in incidentally discovered asymptomatic HBsAg positive carrier: need to change terminology. Hepatology 1999; 30; 10-7.
[14]
Malu AO, Borodo MM, Ndububa DA, Ojo OS, Anomneze EE, Lesi OA et al. Hepatitis B and C treatment guidelines for Nigeria. Nig J Gatroenterol Hepatol 2015; 7; 2; 63-75.
[15]
Esmaeelzadeh A, Saadatnia H, Memar B, Amirmajdi EM, Ganji A, Goshayeshi L et al. Evaluation of serum HBV viral load, transaminases and histological features in chronic HBeAg-negative hepatitis B patients. Gastroenterol Hepatol Bed Bench. 2017; 10(1): 39-43.
[16]
Sonneveld MJ, Brouwer WP, Hansen BE, Chan HL, Piratvisuth T, Jia JD et al. Very low probability of significant liver inflammation in chronic hepatitis B patients with low ALT levels in the absence of liver fibrosis. Alimentary pharmacology & therapeutics, 2020; 52(8), 1399–1406.
Da Wu Z, Yu Rui L, Jing D, Yue Yong Z, You Bing L, Jing C et al. Serum HBsAg and HBeAg levels are associated with liver pathological stages in the immune clearance phase of hepatitis B virus chronic infection. Mol Med Rep 2015; 11(5): 3465-72.
Zacharakis G, Koskinas J, Kotsiou S, Tzara F, Vafeiadis N, Papoutselis M, et al. The role of serial measurement of serum HBV DNA levels in patients with chronic HbeAg (–) hepatitis B infection: association with liver disease progression. A prospective cohort study. J Hepatol, 2008; 49(6): 884–91. Epub 2008 Jul 2. Erratum in: J Hepatol. 2009 May; 50(5): 1065.
Mommeja-Marin H, Mondou E, Blum MR, Rousseau F. Serum HBV DNA as a Marker of Efficacy During Therapy for Chronic HBV Infection: Analysis and Review of the Literature. Hepatology, 2003; 37(6): 1309–19.
Liu C, Wang L, Xie H, Zhang L, Wang B, Luo C. The relationship between serum hepatitis B virus DNA level and liver histology in patients with Chronic HBV infection. PLoS ONE 13(11).
[21]
Martinot-Peignoux M, Boyer N, Colombat M, Akremi R, Pham BN, Ollivier S et al: Serum hepatitis B virus DNA levels and liver histology in inactive HBsAg carriers. J Hepatol, 2002; 36(4): 543–46.
Shao J, Wei L, Wang H, Sun Y, Zhang LF, Li J and Dong JQ. Relationship between hepatitis B virus DNA levels and liver histology in patients with chronic hepatitis B. World J Gastroenterol. 2007; 13(14): 2104-07.
Muhammad, N. O., Abdulkadir, Y. M., Musa, Y., Ibrahim, Y., Samaila, A. A., et al. (2024). Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients. Clinical Medicine Research, 13(6), 101-106. https://doi.org/10.11648/j.cmr.20241306.15
Muhammad, N. O.; Abdulkadir, Y. M.; Musa, Y.; Ibrahim, Y.; Samaila, A. A., et al. Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients. Clin. Med. Res.2024, 13(6), 101-106. doi: 10.11648/j.cmr.20241306.15
Muhammad NO, Abdulkadir YM, Musa Y, Ibrahim Y, Samaila AA, et al. Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients. Clin Med Res. 2024;13(6):101-106. doi: 10.11648/j.cmr.20241306.15
@article{10.11648/j.cmr.20241306.15,
author = {Nurudeen Olalekan Muhammad and Yussuf Maisuna Abdulkadir and Yusuf Musa and Yusuf Ibrahim and Adamu Alhaji Samaila and Muhammad Musa Borodo},
title = {Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients
},
journal = {Clinical Medicine Research},
volume = {13},
number = {6},
pages = {101-106},
doi = {10.11648/j.cmr.20241306.15},
url = {https://doi.org/10.11648/j.cmr.20241306.15},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20241306.15},
abstract = {Introduction: Chronic Hepatitis B viral infection is associated with significant health and financial challenges. An estimated 15-40% of the Chronic Hepatitis B infected patients would develop liver Cirrhosis and a quarter of which may result in Hepatocellular cancer. In Africa, about 65 million people are said to be chronically infected with HBV. Thus, Africa with 12% of the world’s population carries approximately 18% of the global burden of HBV infection. An elevated level of ALT is an important component in the consideration for treatment of CHB, however, the presence of normal level ALT levels with discordantly elevated HBV DNA levels may requires further evaluation with Liver histology. Method: All patients who were newly diagnosed with CHB infection and above 18 years of age were consecutively recruited from December 2019 to October 2020, into the study. Blood samples were taken for the Liver Function Test, HBV immunologic panel and HBV DNA levels. Liver biopsy was performed for 84 patients with variance elevated serum HBV DNA (>2000 IU/mls) and normal serum ALT defined as level Result: The Liver biopsy histology shows, mild inflammation (A1) was observed in 50 (60%), and moderate inflammation (A2) in 12% while the remaining 10 patients (28%) showed no inflammatory. Similarly, 20 patients (24%) had no fibrosis (F0), 8% had portal fibrosis without septa (F1), 24% had portal fibrosis with rare septa (F2) while the remaining majority (44%) had numerous septa (F3). Conclusion: Chronic HBV infection is Endemic in our region and studies had shown the importance of adequate evaluation and early treatment to avert the associated high morbidity and mortality. Also, significant number of patients with normal ALT levels had fibrosis on liver histology. Liver histology remains an important parameter in the evaluation of patients with CHB, as 57 patients would have missed the opportunity of early treatment. These findings are expected to provide a basis for an informed planning of national and International CHBV treatment guidelines.
},
year = {2024}
}
TY - JOUR
T1 - Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients
AU - Nurudeen Olalekan Muhammad
AU - Yussuf Maisuna Abdulkadir
AU - Yusuf Musa
AU - Yusuf Ibrahim
AU - Adamu Alhaji Samaila
AU - Muhammad Musa Borodo
Y1 - 2024/12/30
PY - 2024
N1 - https://doi.org/10.11648/j.cmr.20241306.15
DO - 10.11648/j.cmr.20241306.15
T2 - Clinical Medicine Research
JF - Clinical Medicine Research
JO - Clinical Medicine Research
SP - 101
EP - 106
PB - Science Publishing Group
SN - 2326-9057
UR - https://doi.org/10.11648/j.cmr.20241306.15
AB - Introduction: Chronic Hepatitis B viral infection is associated with significant health and financial challenges. An estimated 15-40% of the Chronic Hepatitis B infected patients would develop liver Cirrhosis and a quarter of which may result in Hepatocellular cancer. In Africa, about 65 million people are said to be chronically infected with HBV. Thus, Africa with 12% of the world’s population carries approximately 18% of the global burden of HBV infection. An elevated level of ALT is an important component in the consideration for treatment of CHB, however, the presence of normal level ALT levels with discordantly elevated HBV DNA levels may requires further evaluation with Liver histology. Method: All patients who were newly diagnosed with CHB infection and above 18 years of age were consecutively recruited from December 2019 to October 2020, into the study. Blood samples were taken for the Liver Function Test, HBV immunologic panel and HBV DNA levels. Liver biopsy was performed for 84 patients with variance elevated serum HBV DNA (>2000 IU/mls) and normal serum ALT defined as level Result: The Liver biopsy histology shows, mild inflammation (A1) was observed in 50 (60%), and moderate inflammation (A2) in 12% while the remaining 10 patients (28%) showed no inflammatory. Similarly, 20 patients (24%) had no fibrosis (F0), 8% had portal fibrosis without septa (F1), 24% had portal fibrosis with rare septa (F2) while the remaining majority (44%) had numerous septa (F3). Conclusion: Chronic HBV infection is Endemic in our region and studies had shown the importance of adequate evaluation and early treatment to avert the associated high morbidity and mortality. Also, significant number of patients with normal ALT levels had fibrosis on liver histology. Liver histology remains an important parameter in the evaluation of patients with CHB, as 57 patients would have missed the opportunity of early treatment. These findings are expected to provide a basis for an informed planning of national and International CHBV treatment guidelines.
VL - 13
IS - 6
ER -
Muhammad, N. O., Abdulkadir, Y. M., Musa, Y., Ibrahim, Y., Samaila, A. A., et al. (2024). Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients. Clinical Medicine Research, 13(6), 101-106. https://doi.org/10.11648/j.cmr.20241306.15
Muhammad, N. O.; Abdulkadir, Y. M.; Musa, Y.; Ibrahim, Y.; Samaila, A. A., et al. Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients. Clin. Med. Res.2024, 13(6), 101-106. doi: 10.11648/j.cmr.20241306.15
Muhammad NO, Abdulkadir YM, Musa Y, Ibrahim Y, Samaila AA, et al. Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients. Clin Med Res. 2024;13(6):101-106. doi: 10.11648/j.cmr.20241306.15
@article{10.11648/j.cmr.20241306.15,
author = {Nurudeen Olalekan Muhammad and Yussuf Maisuna Abdulkadir and Yusuf Musa and Yusuf Ibrahim and Adamu Alhaji Samaila and Muhammad Musa Borodo},
title = {Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients
},
journal = {Clinical Medicine Research},
volume = {13},
number = {6},
pages = {101-106},
doi = {10.11648/j.cmr.20241306.15},
url = {https://doi.org/10.11648/j.cmr.20241306.15},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20241306.15},
abstract = {Introduction: Chronic Hepatitis B viral infection is associated with significant health and financial challenges. An estimated 15-40% of the Chronic Hepatitis B infected patients would develop liver Cirrhosis and a quarter of which may result in Hepatocellular cancer. In Africa, about 65 million people are said to be chronically infected with HBV. Thus, Africa with 12% of the world’s population carries approximately 18% of the global burden of HBV infection. An elevated level of ALT is an important component in the consideration for treatment of CHB, however, the presence of normal level ALT levels with discordantly elevated HBV DNA levels may requires further evaluation with Liver histology. Method: All patients who were newly diagnosed with CHB infection and above 18 years of age were consecutively recruited from December 2019 to October 2020, into the study. Blood samples were taken for the Liver Function Test, HBV immunologic panel and HBV DNA levels. Liver biopsy was performed for 84 patients with variance elevated serum HBV DNA (>2000 IU/mls) and normal serum ALT defined as level Result: The Liver biopsy histology shows, mild inflammation (A1) was observed in 50 (60%), and moderate inflammation (A2) in 12% while the remaining 10 patients (28%) showed no inflammatory. Similarly, 20 patients (24%) had no fibrosis (F0), 8% had portal fibrosis without septa (F1), 24% had portal fibrosis with rare septa (F2) while the remaining majority (44%) had numerous septa (F3). Conclusion: Chronic HBV infection is Endemic in our region and studies had shown the importance of adequate evaluation and early treatment to avert the associated high morbidity and mortality. Also, significant number of patients with normal ALT levels had fibrosis on liver histology. Liver histology remains an important parameter in the evaluation of patients with CHB, as 57 patients would have missed the opportunity of early treatment. These findings are expected to provide a basis for an informed planning of national and International CHBV treatment guidelines.
},
year = {2024}
}
TY - JOUR
T1 - Analysing Liver Histology in Relation to Elevated HBV DNA Levels in Immuno-Tolerant Phase of Chronic Hepatitis B Viral Infection Patients
AU - Nurudeen Olalekan Muhammad
AU - Yussuf Maisuna Abdulkadir
AU - Yusuf Musa
AU - Yusuf Ibrahim
AU - Adamu Alhaji Samaila
AU - Muhammad Musa Borodo
Y1 - 2024/12/30
PY - 2024
N1 - https://doi.org/10.11648/j.cmr.20241306.15
DO - 10.11648/j.cmr.20241306.15
T2 - Clinical Medicine Research
JF - Clinical Medicine Research
JO - Clinical Medicine Research
SP - 101
EP - 106
PB - Science Publishing Group
SN - 2326-9057
UR - https://doi.org/10.11648/j.cmr.20241306.15
AB - Introduction: Chronic Hepatitis B viral infection is associated with significant health and financial challenges. An estimated 15-40% of the Chronic Hepatitis B infected patients would develop liver Cirrhosis and a quarter of which may result in Hepatocellular cancer. In Africa, about 65 million people are said to be chronically infected with HBV. Thus, Africa with 12% of the world’s population carries approximately 18% of the global burden of HBV infection. An elevated level of ALT is an important component in the consideration for treatment of CHB, however, the presence of normal level ALT levels with discordantly elevated HBV DNA levels may requires further evaluation with Liver histology. Method: All patients who were newly diagnosed with CHB infection and above 18 years of age were consecutively recruited from December 2019 to October 2020, into the study. Blood samples were taken for the Liver Function Test, HBV immunologic panel and HBV DNA levels. Liver biopsy was performed for 84 patients with variance elevated serum HBV DNA (>2000 IU/mls) and normal serum ALT defined as level Result: The Liver biopsy histology shows, mild inflammation (A1) was observed in 50 (60%), and moderate inflammation (A2) in 12% while the remaining 10 patients (28%) showed no inflammatory. Similarly, 20 patients (24%) had no fibrosis (F0), 8% had portal fibrosis without septa (F1), 24% had portal fibrosis with rare septa (F2) while the remaining majority (44%) had numerous septa (F3). Conclusion: Chronic HBV infection is Endemic in our region and studies had shown the importance of adequate evaluation and early treatment to avert the associated high morbidity and mortality. Also, significant number of patients with normal ALT levels had fibrosis on liver histology. Liver histology remains an important parameter in the evaluation of patients with CHB, as 57 patients would have missed the opportunity of early treatment. These findings are expected to provide a basis for an informed planning of national and International CHBV treatment guidelines.
VL - 13
IS - 6
ER -
,
Yussuf Maisuna Abdulkadir*
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