Acute Hepatitis B Progression to Chronicity - A Prospective Study at Tertiary Care Centre of Northeren India
DOI:
https://doi.org/10.12974/2312-5411.2020.07.4Keywords:
Hepatitis B, Acute hepatitis B, Chronic hepatitis B, Cirrhosis, HbsAg.Abstract
Background: There are limited number of studies providing information regarding the progression of acute hepatitis B virus (HBV) infection to chronic phase.
Aim: To determine the percentage of patients of acute hepatitis B who progressed to chronic hepatitis B stage.
Methods: It was a prospective study over a period of four years in which total 409 confirmed acute hepatitis B patients were enrolled but out of them only three hundred and four, (221 men and 83 women, 06–82 years old) were followed regularly for at least six months or more, thus data pertaining to them was analyzed.
Results: Out of total of 304 acute hepatitis B patients, 279 patients resolved and became Hepatitis B surface antigen (HbsAg) and Hepatitis B virus DNA negative whereas 25 patients went into chronic phase. No differences were found between groups with respect to age and sex. However, Serum Bilirubin, Serum amino transaminases, HbeAg and HBV DNA Quantitative levels were significantly lower in patients who progressed to chronic hepatitis stage.
Conclusions: Around 91.78% of acute hepatitis B patients resolved but 8.22% progressed to Chronic hepatitis B stage The twenty five patients who progressed to chronic infection had mild hepatitis on comparison to 279 patients who resolved, thus suggesting that patients with mild acute hepatitis B infection may have a higher risk of progressing to chronic infection.
References
Lavanchy D. "Hepatitis B virus epidemiology, disease burden, treatment, arid current and emerging prevention and control measures," Journal of Viral Hepatitis, 2004; 11(2): 97- 107. https://doi.org/10.1046/j.1365-2893.2003.00487.x
Yokosuka O, Kurosaki M, Imazeki F et al., "Management of hepatitis B: consensus of the Japan Society of Hepatology 2009," Hepatology Research, 2011; 41(1): 1-21. https://doi.org/10.1111/j.1872-034X.2010.00739.x
Michitaka K, Nishiguchi S, Aoyagi Y, Hiasa Y, Tokumoto Y and Onji M. "Etiology of liver cirrhosis in Japan: a nationwide survey," Journal of Gastroenterology, 2010; 45(1): 86-94. https://doi.org/10.1007/s00535-009-0128-5
McMahon BJ. Natural history of chronic hepatitis B - clinical implications. Medscape J Med. 2008; 10(4): 91.
Yim HJ and Lok AS. "Natural history of chronic hepatitis B virus infection: what we knew in 1981 and what we know in 2005," Hepatology, 2006; 43(S1): S173-S181. https://doi.org/10.1002/hep.20956
Hoofnagle JH, Doo E, Liang TJ, Fleischer R and Lok ASF. "Management of hepatitis B: summary of a clinical research workshop," Hepatology, 2007; 45(4): 1056-1075. https://doi.org/10.1002/hep.21627
Okamoto H, Tsuda F, Sakugawa H et al., "Typing hepatitis B virus by homology in nucleotide sequence: comparison of surface antigen subtypes," Journal of General Virology, 1988; 69(10): 2575-2583. https://doi.org/10.1099/0022-1317-69-10-2575
Kato H, Gish RG, Bzowej N et al., "Eight genotypes (A-H) of hepatitis B virus infecting patients from San Francisco and their demographic, clinical, and virological characteristics," Journal of Medical Virology, 2004; 73(4): 516-521. https://doi.org/10.1002/jmv.20120
Kurbanov F, Tanaka Y and Mizokami M. "Geographical and genetic diversity of the human hepatitis B virus," Hepatology Research, 2010; 40(1): 14-30. https://doi.org/10.1111/j.1872-034X.2009.00601.x
Chu CJ, Keeffe EB, Han SH et al., "Hepatitis B virus genotypes in the United States: results of a nationwide study," Gastroenterology, 2003; 25(2): 444-451. https://doi.org/10.1016/S0016-5085(03)00895-3
Lin CL and Kao JH. "The clinical implications of hepatitis B virus genotype: recent advances," Journal of Gastroenterology and Hepatology, 2011; 26(1): 123-130. https://doi.org/10.1111/j.1440-1746.2010.06541.x
Yano K, Tamada Y, Yatsuhashi H et al., "Dynamic epidemiology of acute viral hepatitis in Japan," Intervirology, 2010; 53(1): 70-75. https://doi.org/10.1159/000252788
Ozasa A, Tanaka Y, Orito E et al., "Influence of genotypes and precore mutations on fulminant or chronic outcome of acute hepatitis B virus infection," Hepatology, 2006; 44(2): 326-334. https://doi.org/10.1002/hep.21249
Yotsuyanagi H, Okuse C, Yasuda K. et al., "Distinct geographic distributions of hepatitis B virus genotypes in patients with acute infection in Japan," Journal of Medical Virology, 2005; 77(1): 39-46. https://doi.org/10.1002/jmv.20411
Suzuki Y, Kobayashi M, Ikeda K et al., "Persistence of acute infection with hepatitis B virus genotype A and treatment in Japan," Journal of Medical Virology, 2005; 76(1): 33-39. https://doi.org/10.1002/jmv.20320
Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis. 1995; 20(4): 992- 100. https://doi.org/10.1093/clinids/20.4.992
Chen Y, Michitaka K, Matsubara H, Yamamoto K, Horiike N and Onji M. "Complete genome sequence of hepatitis B virus (HBV) from a patient with fulminant hepatitis without precore and core promoter mutations: comparison with HBV from a patient with acute hepatitis infected from the same infectious source," Journal of Hepatology, 2003; 38(1): 84-90. https://doi.org/10.1016/S0168-8278(02)00325-2
Yamamoto K, Michitaka K, Miyata T et al., "An adult patient with hepatitis B who progressed to chronic infection," Kanzo, 2002; 43: 406-410. https://doi.org/10.2957/kanzo.43.406
Omata M, Ehata T, Yokosuka O, Hosoda K and Ohto M. "Mutations in the precore region of hepatitis B virus DNA in patients with fulminant and severe hepatitis," The New England Journal of Medicine, 1991; 324(24): 1699-1704. https://doi.org/10.1056/NEJM199106133242404
Sato S, Suzuki K, Akahane Y et al., "Hepatitis B virus strains with mutations in the core promoter in patients with fulminant hepatitis," Annals of Internal Medicine, 1995; 122(4): 241- 248. https://doi.org/10.7326/0003-4819-122-4-199502150-00001
Michitaka K, Horiike N, Chen Y et al., "Infectious source factors affecting the severity of sexually transmitted acute hepatitis due to hepatitis B virus genotype C," Intervirology, 2005; 48(2-3): 112-119. https://doi.org/10.1159/000081737
Chook JB, Ngeow YF, Khang TF, Ng KP, Tiang YP and Mohamed R. "Comparative analysis of viral genomes from acute and chronic hepatitis B reveals novel variants associated with a lower rate of chronicity," Journal of Medical Virology, 2013; 85(3): 419-424. https://doi.org/10.1002/jmv.23500
Yanagimoto S, Yotsuyanagi H, Kikuchi Y et al., "Chronic hepatitis B in patients coinfected with human immunodeficiency virus in Japan: a retrospective multicenter analysis," Journal of Infection and Chemotherapy, 2012; 18(6): 883-890. https://doi.org/10.1007/s10156-012-0433-4
Pol S. "Management of HBV in immunocompromised patients," Liver International, 2013; 33(supplement 1): 182- 187. https://doi.org/10.1111/liv.12055
Mayerat C, Mantegani A and Frei PC. "Does hepatitis B virus (HBV) genotype influence the clinical outcome of HBV infection?" Journal of Viral Hepatitis, 1999; 6(4): 299-304. https://doi.org/10.1046/j.1365-2893.1999.00174.x
Barker LF, Murray R. Acquisition of hepatitis-associated antigen. Clinical features in young adults. JAMA. 1971; 216(12): 1970-6. https://doi.org/10.1001/jama.1971.03180380028006
Hyams KC. Risks of chronicity following acute hepatitis B virus infection: a review. Clin Infect Dis. 1995; 20(4): 992- 1000. https://doi.org/10.1093/clinids/20.4.992
Kim WR, Benson JT, Therneau TM, Torgerson HA, Yawn BP, Melton LJ. Changing epidemiology of hepatitis B in a U.S. community. Hepatology. 2004; 39(3): 811-6. https://doi.org/10.1002/hep.20098
Meffre C, Le Strat Y, Delarocque-Astagneau E, Dubois F, Antona D, Lemasson JM, et al. Prevalence of hepatitis B and hepatitis C virus infections in France in 2004: social factors are important predictors after adjusting for known risk factors. J Med Virol. 2010; 82(4): 546-55. https://doi.org/10.1002/jmv.21734
Taylor BC, Yuan JM, Shamliyan TA, Shaukat A, Kane RL, Wilt TJ. Clinical outcomes in adults with chronic hepatitis B in association with patient and viral characteristics: a systematic review of evidence. Hepatology. 2009; 49(5 Suppl): S85-95. https://doi.org/10.1002/hep.22929
Souza MG, Passos ADC, Machado AA, Figueiredo JFC, Esmeraldino LE. Co-infecção HIV e vírus da hepatite B: prevalência e fatores de risco. Rev Soc Bras Med Trop. 2004; 37(5): 391-5. https://doi.org/10.1590/S0037-86822004000500004
Sherman M. Strategies for managing coinfection with hepatitis B virus and HIV. Cleve Clin J Med. 2009; 76(Suppl 3): S30-3. https://doi.org/10.3949/ccjm.76.s3.07
