Evaluation of HBV DNA Level Distribution and Related Factors in Chronic Hepatitis B Patients

Abstract

 Background: Hepatitis B is still a major health problem in many parts of the world. In some developing countries the most common cause of chronic hepatitis and liver cirrhosis is hepatitis B virus (HBV). The progression of chronic hepatitis B to cirrhosis and  hepatocellular carcinoma (HCC) include such viral factors as genotype C and high levels of serum HBV DNA in addition to host factors such as older age, male gender, obesity and diabetes. Other factors that influence progression to cirrhosis and HCC are  simultaneous alcohol use, and co-infections with HIV, HDV and HCV. The present study aims to determine the correlations between serum HBV DNA viral load  and related factors. In this study, new HBV DNA and ALT levels that enable better separation between different stages of this disease are presented.

 Materials and Methods: Chronic hepatitis B patients who presented to the Liver Clinic at  Imam Khomeini Hospital in 1388 who were HBsAg positive for more than six months were enrolled in this study. Patients who had previously been treated or those with concurrent HIV, HCV and HDV infections as well as those with autoimmune hepatitis and fatty liver were excluded. Patients' data, HbeAg state, demographics, liver enzymes, HBV DNA  level, smoking history, cirrhosis and disease stage were recorded. In order to better differentiation between non-replicative and reactive chronic hepatitis B patients, statistical analysis was done to distinguish between their HBV DNA levels. Evaluation of  the relationships between HBV DNA level and the above mentioned variables was performed.

  Results: High Levels of HBV DNA correlated with HBeAg positive state, smoking (p=0.005) and elevated  liver enzymes (p=0.002). The cut-off value for ALT level that separated HbeAg-positive group (immunoclearance and immunotolerance phases) was set at 42 U/l on the roc curve(r=0.889 area under curve) with 100% sensitivity and 67.7% specificity. The cut-off value for serum HBV DNA levels that differentiated  between the Hbe Ag-negative group (non-replicative and reactive phases) was set at 3000 IU/ml on the roc curve (r=0.987 area under curve) with 97% sensitivity and  92% specificity.

 Coclusion: The present study determined that  serum HBV DNA at a level of 3000 IU/ml was a better level for classification of HBeAg-negative patients into the non-replicative and reactive groups.