Hidden Burden of Hepatitis B: High Viral Loads among Asymptomatic Carriers in India

Hepatitis B virus (HBV) infection remains a major public health issue in India, with a significant burden of undiagnosed asymptomatic carriers. Identifying such individuals is essential to achieve the World Health Organization's goal of HBV elimination by 2030.

The objectives of this study were to determine the prevalence of hepatitis B surface antigen (HBsAg) and HBV viral load among asymptomatic healthcare workers and patients undergoing elective surgeries and to evaluate the need for universal HBV screening in such populations. This was a hospital-based cross-sectional study conducted at a tertiary care center in Central India. Blood samples from 13,840 asymptomatic individuals were tested for HBsAg, and positives in HBsAg were further tested for hepatitis B e antigen (HBeAg) by enzyme-linked immunosorbent assay. HBV DNA quantification was performed using a real-time polymerase chain reaction-based method on selected samples.

Out of 13,840 individuals screened, 355 (2.57%) tested positive for HBsAg. Among these, 37 (10.42%) were HBeAg-positive, all of whom had HBV DNA levels > 2000 IU/ml. Notably, 48.64% of HBeAg-negative individuals also had significant viral loads. The average age of HBsAg-positive individuals was higher than negatives (42.38 ± 16.58 vs. 37.52 ± 18.92; P = 0.008). Males were more frequently infected (P < 0.001).

The study highlights a significant proportion of asymptomatic individuals with elevated HBV viral loads, particularly among HBeAg-negative cases. These findings support the implementation of universal HBV screening in preoperative and occupational health settings as a vital strategy for early detection, treatment initiation, and achieving national and global HBV elimination targets.