Impact of Viral Load on Liver Damage in Bangladesh

Abstract

AIM: In general, it is revealed that patients with chronic hepatitis B virus (HBV) infection with high viral load exhibit increased liver damages. More than 80% chronic HBV carriers live in the developing nations of the world, but little is known about relationship between HBV viral load and extent of liver damages in these countries. In this study, we addressed this issue to provide insights into this. METHODS: A total of 306 chronic hepatitis B (CHB) patients from our pool of 561 Bangladeshi CHB patients were included. Viral load in CHB was measured by polymerase chain reaction (PCR) and all patients underwent per-cutaneous liver biopsy. A few were however evaluated for genotype due to economical constrains. RESULTS: About 90% patients had high HBV DNA load. Of them 45% CHB patients with high HBV DNA load had non-significant hepatic necro-inflammation (HAI-NI <7). On the other hand, non-significant hepatic fibrosis (HAI-HF <3) was observed in 76% patient with high viral load. The study found no significant correlation between the high viral load and hepatic damage and also between serum alanine aminotransferase (ALT) and hepatic activity index (index for hepatic damage on the basis of cytopathology). The study found good correlation between the two hepatic activity index score (r=0.47, p< 0.001). DISCUSSION: It is generally assumed that CHB patients with high viral load develop more severe liver disease and the current guidelines also emphasize on reduction of viral load. However this may not be the case as has been suggested in a number of studies. It is therefore important to look for other viral as well as host factors that may influence the course and outcome in CHB patients. CONCLUSION: This study shows that a correlation could not be established between viral load and liver damage in patients with CHB in Bangladesh. A significant percentage of patients with CHB with high HBV DNA in Bangladesh do not have significant hepatic necro-inflammation and fibrosis.