Asymptomatic chronic hepatitis B virus infection in northern India

Chronic infection with hepatitis B virus (HBV) causes a spectrum of diseases ranging from asymptomatic infective state to cirrhosis and hepato-cellular carcinoma. The asymptomatic state has highly variable characteristics.

Sixty-one incidentally detected asymptomatic HBsAg-positive subjects (IDAHS), in whom HBsAg positivity persisted for > 6 months, were studied for liver biochemistry, HBeAg, anti HBe and HBV DNA levels (in HBeAg-negative subjects). Liver biopsy was done in 29 subjects and scored for histological activity index (HAI) and fibrosis using modified Knodell score.

Thirteen (21%) subjects were HBeAg positive. The remaining 48 (79%) were positive for anti HBe, with HBV DNA level of> 105 copies/mL in 15 (31.2%). Transaminase elevation was more frequent in HBeAg-positive subjects (69%; p< 0.05) and in HBV DNA-positive (93%) than in non-replicative (27%) infection. Seroconverted (anti HBe-positive) individuals were a decade older than HBeAg-positive ones and most (93.7%) of them were> 20 years of age. Fifteen of 29 (51.3%) had HAI> 3, more frequently in those with raised ALT (68.4%; p< 0.05) than with normal ALT (20%), but there was no difference in relation to HBeAg status.

Seroconversion to anti HBe was noted in individuals aged 20 years or more. Ongoing liver disease was noted in approximately half of IDAHS, suggesting that a considerable proportion of IDAHS have active infection. In HBeAg-negative subjects, transaminase estimation may be sufficient in planning therapy.