Evaluation of association of demographic profiles and sero prevalence of HBV and HCV among the patients presenting with chronic liver disease and its complications: A Tertiary Care Hospital Based Study

Chronic liver disease is one of the common hepatobiliary problems worldwide. A major portion of the cases of chronic liver disease presents as a sequel of hepatotrophic viral infection specially hepatitis B and hepatitis C virus. Hepatitis B virus infects more than 350 million people worldwide and it is a leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma [1]. On the other hand hepatitis C virus infects an estimated 170 million people worldwide and it represents a viral pandemic and mostly causes chronic infection leading to cirrhosis in 15-20% of those [2]. In Bangladesh the prevalence of chronic viral hepatitis [3,4] is quite signifi cant. It has been observed that a large number of people in Bangladesh suffer Abstract

Citation: Gomes  from viral hepatitis every year. Around 10-15% of patients are treated for liver diseases including hepatitis and their sequelae [5][6][7][8][9] in medical units in hospitals of Dhaka city. Hepatitis B virus infection is the major cause of mortality and morbidity related to chronic liver disease and also hepatitis C virus is emerging as another major health problem [3,4]. The patients with chronic liver disease in our hospital usually come with overt clinical manifestations and complications. In our country vast majority of cases are non alcoholic post viral sequelae is the most important cause. Among the etiologically implicated hepatotrophic viruses, hepatitis B virus has been reported most important and hepatitis C virus related especially to chronic infection [9][10][11][12]. Clinically persistent presences of HBsAg and/ or Anti-HCV are correlated with chronic liver disease [9][10][11][12][13]. Most of the patients of chronic liver disease are likely to be the carrier of these viruses and hence persistent viraemia resulting in positive HBsAg and/ or Anti-HCV [14][15][16]. so they are potential source of Hepatitis B (HBV) and hepatitis C (HCV) virus infection for others. This study yet not has been done in our hospitals settings. This study is therefore undertaken to show the pictures of two common and cost effective viral markers like HBsAg and Anti-HCV(for hepatitis B and hepatitis C virus infection respectively) in patients with chronic liver disease and their demographic profi le, clinical presentation, complication profi le and other related fi ndings. The study will try to evaluate demographic profi les of those patients having post viral (HBV & HCV) CLD in our settings.

Materials and methods
This observational, descriptive, longitudinal study was carried out on Medicine units and department of Gastroenterology of Dhaka Medical College Hospital from April, 2016 to September 2018. Total 100 cases, age between 15 to 75 years, including known cases of chronic liver disease with or without complications were selected. Diagnosis was made by analysis of clinical, biochemical, endoscopy of upper GIT and USG of whole abdomen fi ndings. Histopathological examination was done in some selected cases. Collected data's were analyzed with the computer software SPSS.
Inclusion criteria: All cases (including known cases) of chronic liver disease with or without complications will be selected. Diagnosis will be made by analysis of clinical, biochemical and imaging features including evidences of varices on upper GI endoscopy. Histopathological examination will be done in some selected cases. Initial criteria's for selection of cases as chronic liver disease are:  Age between 15 to 75 years, and  Presence of stigmata of chronic liver disease( e.g. spider naevi, palmer erythema, gynaecomastia, testicular atrophy), and/or  Cases having jaundice for more than 6 months, and/or  Clinical and laboratory evidences of portal hypertension.

Discussion
In Bangladesh, Chronic parenchymal liver disease (CLD) is a common hepatobiliary problem. Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are regarded as the most important cause of chronic liver disease in Bangladesh [3,6,7]. A substantial number of hospital admitted CLD patients are likely to be chronic carriers of HBV and HCV. A common serologic marker of HBV infection is HBsAg and HCV infection is Anti-HCV. After fi rst identifi cation of HBsAg by Blumberg, et al. [17], it has been widely used to identify chronic carriers of HBV. The HCV was discovered in 1989 and Anti-HCV antibodies were identifi ed soon after the virus was discovered, and current iterations of these assays enable past exposure to HCV to be determined with high degree of accuracy [1,2,5]. Therefore, these patients constitute a major medical health hazards for medical personnel as well as for other patients by acting as a potential source of HBV and HCV infection. The present study was undertaken to fi nd out the seroprevalence of HBsAg College Hospital. Among them, 10 were excluded from the study. Among the excluded cases, 4 were absconded, 2 were dead before satisfactory diagnosis, 3 refused to give consent and 1 was known case of Wilson's disease. Total numbers of 100 cases were selected and ages of all were 15 years or more.   (Table 1). So, still HBsAg seropositive group has higher prevalence among the patients with CLD and several number of Anti-HCV seropositive cases indicate that chronic liver disease as a result of HCV infection is not uncommon. Co-infection should be also considered in case of chronic liver disease.
HBsAg was positive in 33.3% cases. Similar fi ndings were reported by other workers but it was lower than this study.
HCV infection was present in 25.75% patients with CLD which is similar to my study [16]. 79.41% of total HCV infected cases showed co infection with HBV (past or present infection) [16].
Here co infection was detected by various markers but in this study we had done only one marker that might be the cause of having HBsAg with Anti-HCV positive in 4% cases. The high prevalence of HBsAg among the patients with CLD is not surprising if we consider that the HBsAg prevalence amongst the general population of Bangladesh which is between 7.8 to 8.6 percent [12]. But prevalence of CLD due to HCV infection is not less now a days [12].
High incidence of HBsAg seropositiviry in the patients with CLD ranging from 25 to 60% had been reported from Iraq [21], greece [22], Africa [23] &India [24]. All of these countries have high HBsAg seroprevalence amongst the general population [22,24]. Such association however was rarely observed in patients with CLD in Australia [25] and Great Britain [26]. The age and sex (Tables 2,3) distribution in the present study were similar to other reports [7,8,20,[27][28][29]. Here 75% patients were male and 25% were female with a male to female ratio 3:1. This male preponderance in this hospital based study corresponds to previous studies [6][7][8][27][28][29] and perhaps refl ects social prejudice, male are in high risk of transmission of hepatitis virus and avoidance of hospital admission by females. The study showed more male patients than female were admitted/came to this hospital with a feature of CLD. Among those, males are higher seropositive for HBsAg (75%), Anti-HCV (75%0 and both (100%) which is consistent with another previous study [30]. D Naher, et al. showed 75.3% male and 24.7% female were HBsAg positive among the cases of CLD [3]. Taher Selim Khan, et al. showed 73.3% male and 26.7% female were Anti-HCV positive in Pakistan [15], which is similar to my study.
In my study, age incidence showed young and middle age group of patients were much higher seropositive for HBsAg and Anti-HCV. In 20-50 years group, HBsAg were positive in 68.75% and Anti-HCV positive in 62.5%. 37.5% cases were found Anti-HCV positive in age group more than 51 years.
Similar fi ndings had shown in another previous study [15].
Myanmar and KhinPyoneKy, Myo Aye, et al. showed that the prevalence of Anti-HCV positive cases were more in older age group [31].
The occupational status in patient with CLD (Table 4) showed that the people of various occupations were an unfortunate victim of CLD. Among the CLD cases, 26% were businessman, 24% were service holder. Among the HBsAg positive cases, 25% were service holder and 21, 87% were businessman. Among the Anti-HCV positive cases, 50% were Table 1: Seroprevalence of HBsAg and Anti-HCV in patients with chronic liver disease (CLD) (n= 100).