Asymptomatic chronic hepatitis B virus infection in northern India.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.