Study of histomorphological characteristics and it’s correlation with clinical, biochemical, serological and immunohistochemical parameters in incidentally detected hepatitis B patients

Authors

  • Rakesh Kumar Gupta Chattisgarh Institute of Medical Sciences, Bilaspur (C.G.)
  • Puja Sakhuja G B Pant Institute of Postgraduate Medical Research and Education, New Delhi
  • Shahajad Ali G B Pant Institute of Postgraduate Medical Research and Education, New Delhi
  • Sidharth Srivastava G B Pant Institute of Postgraduate Medical Research and Education, New Delhi
  • Barjesh Chand Sharma G B Pant Institute of Postgraduate Medical Research and Education, New Delhi
  • Amarender Singh Puri G B Pant Institute of Postgraduate Medical Research and Education, New Delhi

Keywords:

Hepatitis B virus, Hepatitis B surface antigen, Hepatitis B e antigen, viral DNA, Alanine transaminase.

Abstract

Background

India lies in intermediate endemicity zone for hepatitis B virus (HBV) infection and constitutes the second largest global pool of HBV infection worldwide. Hepatitis B has a varied clinical presentation ranging from clinically asymptomatic state to cirrhosis and hepatocellular carcinoma. A significant liver injury can occur, without accompanying elevation in alanine transaminase (ALT) and HBV DNA levels, especially in incidentally detected asymptomatic hepatitis B subjects (IDAHS). Hence, a role of liver biopsy to be incorporated with other investigations is debatable, but important to initiate antiviral therapy.

We explored correlation between histomorphological outcomes with various clinical, biochemical, serological and immunohistochemical parameters in IDAHS.

Methods 

Total 113 patients were consecutively selected over a period of 4.5 years. Serological work-up for HBsAg, Anti-HBeAg, Anti-HBeAb, Anti-HBcAb, and HBV DNA levels were done as per resources. A liver biopsy was done in each patient after a written consent. Ishak’s scoring system was used to assess histological parameters. Immunohistochemistry (IHC) was done for HBsAg and HBcAg. Appropriate statistical tests were applied.

Results

The mean age of the patients was 30 years with a male to female ratio of 3:1. A higher necro-inflammatory activity (NIA >3) correlated with high ALT (>40 U/l), HBV DNA (>105 copies/ml) and fibrosis (F ≥2). HBeAg-positive patients had significantly higher NIA and HBV DNA levels. Anti-HBeAb delineated association with ALT (≤40 U/l) and low HBV DNA but more severe fibrosis (F≥2). Steatotic changes were noted in 52.2% biopsies. IHC for HBsAg and HBeAg showed positivity in 82.7% and 39.2% of cases respectively with a significant correlation between membranous pattern of HBsAg staining and serum HBV DNA levels.

Conclusion

IDAHS represent tip of the iceberg of major HBV infection reservoir. A liver biopsy is a useful additional tool with other parameters to further tailor the therapy in such asymptomatic patients.

 

Author Biographies

Rakesh Kumar Gupta, Chattisgarh Institute of Medical Sciences, Bilaspur (C.G.)

Assistant Professor, Department of Pathology

Puja Sakhuja, G B Pant Institute of Postgraduate Medical Research and Education, New Delhi

Professor & Head, Department of Pathology

Shahajad Ali, G B Pant Institute of Postgraduate Medical Research and Education, New Delhi

JRF

Sidharth Srivastava, G B Pant Institute of Postgraduate Medical Research and Education, New Delhi

Assistant Professor, Department of Gastro-enterology

Amarender Singh Puri, G B Pant Institute of Postgraduate Medical Research and Education, New Delhi

Professor & Head, Department of Gastro-enterology

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Published

11-07-2017

How to Cite

1.
Gupta RK, Sakhuja P, Ali S, Srivastava S, Sharma BC, Puri AS. Study of histomorphological characteristics and it’s correlation with clinical, biochemical, serological and immunohistochemical parameters in incidentally detected hepatitis B patients. Ann of Pathol and Lab Med [Internet]. 2017 Jul. 11 [cited 2024 Dec. 26];4(3):A325-331. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm1175

Issue

Vol. 4 No. 3 (2017)

Section

Original Article

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Copyright (c) 2017 Rakesh Kumar Gupta, Puja Sakhuja, Shahajad Ali, Sidharth Srivastava, Barjesh Chand Sharma, Amarender Singh Puri

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