Hbe-antigen negative chronic hepatitis b: prevalence, viral dna characteristic and clinical profile

Background & Aims: Chronic hepatitis B (CHB) is a disease recognized since 1970. Knowledge regarding its natural history, especially that of HBeAg negative CHB, is still evolving. HBeAg negative CHB is caused by those strains of hepatitis B virus (HBV) which do not produce HBeAg. Previously, HBeAg negative status was considered non replicative phase of HBV infection, but nowadays many of these (about a third) have been found to be in replicative phase. HBeAg negative CHB patients test negative for HBeAg, have persistent or intermittent rise of alanine amino transferase and HBV-DNA in their serum >104copies/ml. This study was aimed to determine the prevalence of e-CHB, mutations associated with e antigen negativity, clinical and biochemical profile of e-antigen negative and positive CHB patients. Most of the works on e-CHB subjects have been done in western countries and very few data are available from India to address this issue.
Method: The study was carried out in the Department of Gastroenterology, Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi. This study was performed during January 2010 to December 2011 on patients with chronic hepatitis B. The patients with e antigen negative chronic hepatitis B were considered as case group and e antigen positive were considered as control groups.
Result: The prevalence of HBeAg negative HBV infection in this study was 42.2%.Nearly half (43%) of 161 CHB patients were e-Antigen negative. Liver disease in e-Antigen negative subjects appears to be less advanced than e-antigen positive subjects as cirrhosis was present in 48.5% in e-Antigen negative as compared to e-Antigen positive subjects (64.5%)(p<0.05). High prevalence (43%) of e-Antigen negative CHB noted in this study is in conformity with the some of the recent reports from India. In our study we did not find any significant difference in mean age of e-Antigen negative and positive subjects, which were 36.4 and 39.0 yrs. respectively.
Conclusion: The results of this study clearly indicate that e-Antigen negative CHB/CLD is quite common and accounts for nearly half of all HBV related chronic liver diseases. Although e-Antigen negative CHB/CLD cases had less severe liver disease and lower DNA level, still the disease was active, progressive and far advanced and presents challenge during routine diagnostic workup as well as therapy.