Hepatitis B virus (HBV) is a major global public health problem. It is a DNA virus transmitted percutaneously, perinatally and sexually. About 400 million people were chronically infected with HBV worldwide.[1] Though most of the people will not develop any serious illness related to this chronic infection, some will develop chronic liver disease, which can lead to liver cirrhosis (LC) or hepatocellular carcinoma (HCC).[2] Serum hepatitis B surface antigen (HBsAg) is a reliable biomarker of apparent hepatitis B virus infection. It is secreted as an subviral particles by infected cells in a larger extent than the infectious virons and may serve as probable mechanism for evading host immune responses. [3-4] Whereas anti-HBs (anti-hepatitis B surface antigen) antibodies give protective immunity. HBsAg loss and anti-HBs antibodies development (HBsAg-seroconversion) were the ultimate goal of anti-viral therapy (EASL 2012). Serum HBsAg titres quantification has been recently standardised by automated quantitative assays leading to an increased interest in the clinical usage. [5] HBsAg level was important for interpretation of the phase of the HBV infection in untreated patients as well as treatment individualisation.[6] In fact, HBV-infection has a complicated and dynamic natural history and was divided into four phases when acquired early in the life, based on evolution of the virus and host immune responses; immune tolerance phase (IT), immune clearance phase (IC), low-replicative phase (LR) and HBeAg negative hepatitis(ENH). All these phases were well characterised with biochemical, virological and demographic characteristics. As HBV DNA levels were different during various phases, HBsAg titres may vary. [7] Besides, perceptive of correlation between these two makers may be useful to understand the natural history of HBV infection and use of HBsAg as a biomarker for treatment response. The main objective of this study was to evaluate serum HBsAg titres during different phases of the natural history of HBV infection and to evaluate the correlation between HBsAg titres and HBV DNA quantitative levels in Indian patients.[8]

This was cross sectional observational study conducted over a 10 months study duration between March 2022 to December 2022 in SSG Hospital, Vadodara, Gujarat, India. Ethical committee approval was obtained from The Institutional Ethics Committee for Human Research-PG Research (IECHR-PGR) to carry out this study. Informed consent were taken before the enrollment of the patients. Expected patients per month was 5 to 10.  Considering 10 month study interval 40 Hepatitis B Positive patients were included in sample size.

Inclusion Criteria

1) All the Subject who was HbsAg Positive aged 18 -60 years attended Medicine Out Patient and inpatient department.

2) Subject who was given consent for study.

Exclusion Criteria

1) Subject who was less than 18 years and more than 60 years of age.

2) Subject who had liver cirrhosis due to any other causes like Nonalcoholic fatty liver disease, Autoimmune Liver Cirrhosis, Hepatitis C.

Table 1: AGE DISTRIBUTION and Mean HBV DNA

Majority of study participants i.e. 50% belonged to 26-40 year age group, followed by 30% patients belonged to 41-55 year age groups, 12.5% patients belonged to >55 year age group. Minimum participants were <25 year age group. Mean HBV was maximum in >55 year group, followed by 26-40 year age group.

TABLE NO 2- MEAN HBV ACCORDING TO SYMPTOMS

In our study the most common symptom was anorexia (95%), followed by nausea ( 72.5%), followed by yellowish discoloration (65%).The least common symptom was altered sensorium. decreased urine output and hemetemesis.  Mean HBV value showed a significant association with symptoms.  Mean HBV value was higher in those who had symptoms except for nausea.

TABLE NO 3- ASSOCIATION OF PAST HISTORY AND MEAN HBV DNA

Past history of blood transfusion was present in 50% cases, followed by surgical history in 7 pts, followed by needle prick history in 6 patients and multiple sexual partner history in 5 pts.  There was non-significant association of past history and MEAN HBV DNA.

TABLE NO 4- GENERAL PHYSICAL EXAMINATION

In general physical examination icterus was most common sign, which was present in 27 patients, followed by pallor, present in 13 patients. In these patients mean HBV was higher.  There is non-significant relation between general physical examination and mean HBV.

The natural road map of hepatitis B virus infection and its outcome is determined by the degree of virus replication and host immune response both. Infection with HBV is limited in developed countries but it is still a serious public health issue in developing countries like India [9]. In our study we had examined the viral load pattern of the patients attending the tertiary care centre. Patients who develop chronic hepatitis B have a similar initial pattern of serological markers with appearance of HBV DNA, HBsAg, HBeAg, and anti-HBc. In these persons, however, viral replication persists and HBsAg, HBeAg, and HBV DNA continue to be detectable in serum, often in high titers[10].

Majority of study participants in our study i.e. 50% belonged to 26-40 year age group, followed by 30% patients belonged to 41-55 year age groups, 12.5% patients belonged to >55 year age group[11]. Minimum participants were <25 year age group. Mean HBV was maximum in >55 year group, followed by 26-40 year age group. It was minimum in <25 year age group. In our study 72.5% were males and their mean HBV DNA was also higher than females i.e. 7432623.45, and mean HBV 27.5% females was 1302027.49.

The observation is same as observed in previous studies by sana et al and Chen et al. The patients included 32.24% (118) numbers of males and 67.75 % (248) numbers of females thus the number of male participant was higher. The distribution of HBsAg positivity among the patients shows increasing trend from the lower age group 0-10 to 21-30 and then a decreasing trend from 31-40 to 81-90 age group. The HBsAg positivity frequency in different age groups shows that lower and higher age groups are less exposed to risk factors as compared to the intermediate age groups. Thus we conclude that positivity is directly proportional to the exposure. The highest positivity is found between age group 21-30 (42.89%) which is the most sexually active age group[12].

In our study the most common symptom was anorexia (95%), followed by nausea ( 72.5%), followed by yellowish discoloration (65%).The least common symptom was altered sensorium .decreased urine output and hemetemesis. Mean HBV value showed a significant association with symptoms .Mean HBV value was higher in those who had symptoms except for nausea.

In our study of 40 patients of Hepatitis B Positive 29(72.5%) were males and 11(27.5%) were females. In our study commonest age group was 26-40. It was 20 (50%). Those patients who had high HBV DNA titre had more chances of having haematological abnormalities in form of Anemia, Thrombocytopenia, Hypoalbuminemia and coagulopathies in form of raised PT and APTT. Past history of blood transfusion was present in 20(50%) cases followed by surgical history 7(17.5%) patients, followed by needle prick history in 6(15%) patients and multiple sexual partner history in 5(12.5%) patients, the chi square statics is not significant.

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