Seroreactivity of hepatitis B and C in a tertiary care hospital ASCOMS

Background: Hepatitis B and C are globally emerging health problems. Being Hepatitis B and C are parenterally transmitted viruses both resulting in liver cirrhosis and hepatocellular carcinoma. Both accounting for the substantial proportion of hepatic diseases worldwide. Although both are hepatotropic viruses both are sharing common modes of transmission and mostly affect the young population. Prevalence of Hepatitis B in India is 3.7% and Hepatitis C is 1%. Hepatitis B is the second most common cause of acute viral hepatitis in India. Chance of transmission of Hepatitis B by needle stick injury is 30% and of Hepatitis C is 3%. Intravenous drug abusers were found to be most common mode of transmission of Hepatitis C. Aims: As both Hepatits B, and C are parenterally transmitted infections and land up into chronicity. To prevent their complications the present study was done to screen out these cases at the very early stage with the test with high sensitivity and specificity. Materials and Methods: The presence of HBsAg and anti HCV antibodies were studied serologically in patients blood by Electro chemiluminescence immune-assay method. Results: The seroreactivity of positive cases were observed. Conclusion: Henceforth seroreactivity of both the viruses studied among different age groups in both the sexes to initiate the treatment at right time to prevent its long term complications such as chronicity and for good prognosis by highly sensitive and specific test.


Introduction
Hepatitis infection is a serious clinical problem because of its worldwide distribution and potential adverse sequelae. It is particularly important in Asian-Pacific region where the prevalence is high. Hepatitis B and C is most commonly prevalent among those, both are parenterally transmitted. About 350 million people develop the risk of chronic liver diseases like cirrhosis of liver and hepatocellular carcinoma worldwide. Health care workers are also at risk of these infections due to needle stick injury. Although both viruses differing in their nucleic acid sequence pattern but affecting the young population mostly. Hepatitis C infects 3% of world population but in our country its prevalence is 0.8-1.5%. 1 Hepatitis C mostly encountered among intravenous drug abusers and also in patients on long term dialysis. Both Hepatitis B and C are sexually transmitted also. There is a need to formulate a health educational curriculum targeting not only the high risk population but also the general population regarding the modes of transmission of these viruses. Adopting the dual approach of treating the old cases and decreasing the incidence of new cases would help in curtailing the disease and decreasing the related mortality. 2 HCV is known to cause both acute and chronic infection in humans and unlike HBV, 80% of acute HCV infection in adults can lead onto chronic viremia. Of these persons with chronic infection, 30% will develop progressive liver disease culminating in cirrhosis of liver and or hepatocellular carcinoma (HCC). 3 The estimated prevalence of HCV in India is 0.5-1.5%. 4 Despite the low prevalence of HCV, India with its large population accounts for a significant proportion of global HCV burden. 5 Approximately, 12-18 million people are thought to be infected with HCV in India. 6 In the part of the world, majority of HBV infection is acquired perinatally or in early childhood if mother is sero-reactive. The prevalence of Chronic Hepatitis B in India is in the intermediate range with an estimated 40 million people infected. Most adults infected with these viruses recover but 5-10% are unable to clear these viruses and become chronically infected so there is need to evaluate for the underlying cause of hepatitis for the treatment to be initiated at right time to prevent the complications and for prognosis also.

Materials and Methods
A retrospective study was conducted in the department of Microbiology and collaboration with department of Biochemistry on 3500 patients attending the out patient department of Medicine of Acharya Shree Chander College of Medical Sciences & Hospital Jammu for the duration of 1 year from March 2018 to April 2019 after seeking permission from institutional board with signs and symptoms of hepatitis and with deranged liver function tests.

Inclusion criteria
Patients with history of raised bilirubin and deranged liver function tests, patients on dialysis, immunocompromised patients, unhealed ulcers, intravenous drug abusers, patients admitted for surgical procedures.

Exclusion criteria
Normal healthy asymptomatic individuals, patients with hepatitis A and E, chronic liver disorders. 2 ml venous blood sample were withdrawn under aseptic conditions. HBsAg and ant-HCV antibodies were detected by electrochemiluminescense immunoassay and results were expressed as IU/mla new fully automated version of quantification of these viruses. 7 Liver function tests were estimated by Cobas 311 autoanalyser. Statistical analysis was done. Quantitative HBsAg and anti-HCV antibodies are the alternate biomarker for the estimation of these viruses as compared to DNA or RNA quantification and are cheaper method of monitoring these.

Result
Total of 3500 patients with and without clinical presentation of hepatitis were studied for HBsAg and HCV. Both were detected by ECLIA method i.e. electrochemiluminescense method. Out of these 2100 were found to be males and 1400 were females as shown in Table 1. Male-Female ratio was found to be 1.5 in the study group. The percentage of reactive cases of Hepatitis B and Hepatitis C were estimated among these and also in terms of sex ratio was seen as shown in Table 2 and 3 where number and percentage of reactive cases was estimated and sex wise distribution of these cases was seen respectively. 38 cases out of 3500 turned to be HBsAg reactive and malefemale ratio among these is 23:15. The percentage of reactive males and females for HBsAg reactive was also calculated as shown in Table 3. Hepatitis C reactive cases were found to be 89 cases out of 3500. Males were mostly affected ones i.e 77 as shown in Table 2 and 3. Table 4 showed age-wise distribution of reactive cases of HBsAg and HCV and maximum number of reactive cases were seen in the age group of 20-40 years. Seroreactivity of HBsAg and HCV in different places was also compared in Table 4.     hepatocellular carcinoma in the world and accounts for 78% of cases. As both viruses are hepatotropic and causes progressive liver disease resulting in end stage so these should be screened out in each and every case by the method with more specificity and sensitivity so that right measures should be initiated at right time for its cure and to prevent its complications.

Source of Funding
None.