Abstract
Purpose: The risk of infectivity of HBV is high among unvaccinated family members of HBsAg +ve patients. The risk among family members of patients with occult HBV remains unknown. The aim of this study was to examine the HCV and HBV serological markers and viral status of immediate family members of HBsAg −ve patients with liver cirrhosis. Methods: 100 HBsAg −ve patients with Child C cirrhosis agreed to provide 4 consenting unvaccinated family members each for testing for markers of HBV and HCV infection, and biochemical and clinical parameters of liver disease. Patients and family members were tested for HBsAg, anti-HBs, anti-HBc, anti-HCV, HCV-RNA by PCR, and had serum HBV-DNA tested using nested PCR by specific primers of surface antigen. Results: Family members were 25 spouses, 268 offsprings and 107 siblings. 86 Patients were +ve for HCV, 53 were HBV-DNA +ve (48 sero+ve and 5 sero-ve) and 17 were anti-HBc +ve and HBV-DNA-ve. Among the 400 family members tested, 122 had antibodies to HCV (30.5%), 49 were HBsAg +ve HBV-DNA +ve (12.25%), 13 (3.25%) had occult hepatitis B (all anti-HBc +ve). HCV +ve patients had 32% of their relatives +ve for HCV vs 21.4% of the relatives of HCV −ve patients (ns), and 13% of their relatives +ve for HBsAg vs 3.6% of the relatives of HCV-ve patients (p = 0.05). Patients with occult hepatitis B had 18.9% of their relatives HBV-DNA +ve vs 11.7% of the relatives of HBV-DNA −ve patients. Patients −ve for HBV and HCV markers had none of their relatives +ve for any HBV markers. HBV markers were not different among siblings, spouses and offsprings (HBsAg +ve in 16.8%, 10.1% and 16% respectively, ns; occult HBV in 6.5%, 1.9% and 4% respectively, ns). Spouses had significantly higher prevalence of HCV (56%) compared to siblings and offsprings (28% and 28.7% respectively). 58 Of 99 relatives +ve for HCV (58.6%) had biochemical and clinical indications of asymptomatic liver disease, vs 25 of 252 HCV negatives (10%) and 12 of 49 with HBsAg +ve(25%). Conclusions: Family members of patients with HBsAg −ve chronic liver disease are at higher risk of being +ve for HCV than HBV. This risk is higher if the patient is HCV +ve than occult hepatitis B +ve, and is highest if both are positive. The routes of infection need be further studied. The high prevalence of HBsAg positivity in relatives vs occult infection is indicative that occult HBV is a stage in the disease progress of HBV infection.
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