4 ACUTE VIRAL HEPATITIS WITH G6PD DEFICIENCY-INCREASED MORBIDITY

Abstract

Background: India is mesoendemic for hepatitis B virus (HBV) infection with a lifetime risk of 0.04% for developing chronic infection among newborns. Hence, differentiating acute hepatitis B (AHB) from chronic hepatitis B with an acute flare (CHB-AF) is difficult in patients presenting with acute hepatitis like picture with no prior history of HBV infection. Aim: To identify the clinical, biochemical, and virological parameters and to differentiate between AHB and CHB-AF. Method: A retrospective study was conducted at a tertiary care center in South Kerala, in patients who presented clinically as HBV-related acute hepatitis. Patients who had a protracted clinical course of >2 months with elevated liver enzymes and positive HBV-DNA (deoxyribonucleic acid), who had undergone liver biopsy were included. The clinical and laboratory profiles were compared between patients with and without biopsy features suggestive of CHB. Statistical analysis was done using SPSS version 20.0, and P value <0.05 was considered statistically significant. Result: Among the 75 patients included in the study, 32 patients had a liver biopsy suggestive of CHB. Among the clinical parameters, presence of prodrome was significantly lower in the CHB-AF group (28.1% vs 55.8%). Among the laboratory parameters, platelet count (2.01 × 105/mm3 vs 2.83 × 105/mm3), aspartate aminotransferase (AST) (609 vs 1460), alanine aminotransferase (ALT) (405 IU/mL vs 1022 IU/mL) and bilirubin (5.3 mg/dL vs 13.2 mg/dL) were lower in CHB-AF group. Among the virological parameters, IgM anti-HBc (40.6% vs 86%) was significantly lower in the CHB-AF group. There was no significant difference in HBV-DNA levels or the presence of hepatitis B e-antigen (HBeAg). On follow-up, loss of hepatitis B surface antigen (HBsAg) was lesser in the CHB-AF group (9.4% vs 76.7%). Conclusion: Presence of prodrome, platelet count, bilirubin, liver enzyme levels and presence of IgM anti-HBc were statistically different between patients with AHB and CHB-AF. On follow-up, immune clearance was seen more in patients with AHB. 4