does transaminase elevation truly reflect necroinflammatory activity due to chronic viral hepatitis...
TRANSCRIPT
ABSTRACTS 22ND ANNUAL CONFERENCE–2014
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DOES TRANSAMINASE ELEVATION TRULYREFLECT NECROINFLAMMATORY ACTIVITYDUE TO CHRONIC VIRAL HEPATITIS B?
Varghese Thomas, Rajany Antony
Department of Medical Gastroenterology, Government MedicalCollege, Calicut, Kerala, India
Background: Initiation of antiviral therapy in chronicHBV infection is often based on combination of elevatedtransaminase levels, HBV DNA levels and or histologicalactivity. Aminotransferases are sensitive but relativelynonspecific indicators of liver cell injury. Alcohol andNAFLD are common confounding variables in such pa-tients.Aim: To analyze the confounding factors causing transam-inase elevation in a patient cohort with chronic HBV infec-tion.Methods: Chronic HBV patients with transaminase eleva-tion (ALT>1.5 ULN) and elevated HBV DNA levels wereenrolled from September 2011 to December2013. All pa-tients had detailed clinical assessment, hematological,biochemical evaluation and ultrasound scan of theabdomen. HBV DNA quantification was done using realtime PCR and expressed in IU/mL. The grading and stag-ing of liver disease (modified HAI) as well as the degreeof steatosis was estimated by liver biopsy.Results: Fifty-six chronic HBV patients were studied. Male:Female ratio was 6.8:1. Sixteen patients (28.57%) wereHBeAg positive. Mean HBV DNA level was 1.17x 109 IU/mL. Forty patients (71.4%) had alcohol intake of which9(22.5%) had alcohol consumption >20 g/day. Twenty pa-tients (35.7%) had dyslipidemia. Eight patients (14.28%)had concomitant complimentary or alternative medicationintake and one patient had diabetes. Forty-one patients(73.2%) had HAI $4 on liver biopsy and the mean ALTwas 74.26 IU/mL. Fifteen patients (26.7%) with transami-nase elevation (mean ALT-61.66 IU/mL) and HAI < 4. Liverbiopsy showed steatosis in 64.5% (n = 36) of which 77.7%had HAI $4 and 22.2% had HAI < 4. Mean age of patientswith steatosis was 34.54 years while it was 28.05 in thosewithout steatosis and it was statistically significant (P =0.025). Mean BMI in the steatosis group was 24.23 kg/m3. Patients with steatosis had a higher BMI (24.23 vs21.44; P < 0.01). Twenty-seven patients (48.2%) had fattyliver on ultrasound scan of which 88.9% (n = 24) had stea-tosis on biopsy. Fatty liver was more in patients with signif-icant alcohol intake compared to non alcoholics (P =0.001). Eleven patients (40.74%) with normal ultrasonogra-phy had evidence of steatosis on liver biopsy.Conclusions: Transaminase elevation in patients withchronic HBV infection may not always reflect necroinflam-matory activity. Steatosis is the most common cause of
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transaminase elevation in those without significant nec-roinflammatory activity. This emphasizes the importanceof liver biopsy at least in a subgroup of patients withchronic viral heptitis B. The confounding factors identifiedwere concomitant alcohol intake, obesity and complemen-tary or alternative medicine intake.
Corresponding author: Varghese Thomas.Email: [email protected]
HEPATITIS B VIRUS (HBV) INFECTION INPATIENTS WITH END STAGE RENALDISEASE: A DEMOGRAPHIC ANALYSIS FROMA TERTIARY CARE CENTRE IN INDIA
Naresh Bansal*, Ashish Kumar*, Pakaj Tyagi*,Praveen Sharma*, Vikas Singla*, Manish Maliky,Anil Arora*
*Department of Gastroenterology, Hepatology, Sir Ganga RamHospital, New Delhi, India, and yDepartment of Nephrology, SirGanga Ram Hospital, New Delhi, India
Background: Hepatitis B Virus (HBV) infection in end-stage renal disease (ESRD) patients is an important causeof liver disease. Limited data exist about demography ofHBV in ESRD patients from India.Methods: Records of consecutive patients of HBV infec-tion with ESRD on hemodialysis or with history of renaltransplantation, who presented to Sir Ganga RamHospitalfrom Jan 2009 to June 2013 were analyzed. The diagnosisof HBV was based on positivity of HBsAg and positiveHBV DNA.Results: A total of 56 patients (median age 42 years [range18 to 66],65% males) were included in the study. Majorityof the patients (60%) belonged to the age-group of 41-60years. Six patients had co-infections: Five with HCV andanother with HIV.Most (39, 70%) patients were asymptom-atic for liver disease and HBV was identified either onroutine screening or during investigation for raised liverenzymes. Remaining 17(30%) were symptomatic for liverdisease either in the form of clinical jaundice alone or de-compensated liver disease, most common being ascites.Median time between initiation of hemodialysis andHBV detection was 48(range 0-124) months. Twelve(22%) patients had received renal transplantation, amongthem 2 had more than one renal transplantation.Conclusion: HBV infection is usually asymptomatic in pa-tients with ESRD, however, it may lead to jaundice and de-compensated liver disease. Most of the patients have highviral load whichmay lead to rapid progression of liver disease.
Corresponding author: Naresh Bansal.Email: [email protected]
© 2014, INASL