Serum levels of inflammatory markers in hepatitis b virus infection

Currently, the drugs used in the management of chronic hepatitis B virus (HBV) infection do not have anti-inflammatory properties. Hence, this study was relevant to establish the presence of liver inflammation in drug naive HBV infected persons in Ghana to support the proposal for the inclusion of anti-inflammatory drugs in the management of the infection to reduce the risk of liver fibrosis which may occur due to the chronic liver inflammatory process. A total of 210 participants were recruited for this cross-sectional study, comprising of 146 HBV infected persons (males: 74.7% and females: 25.3%) and 64 controls (males: 79.7% and females: 20.3%). The HBV infected persons and healthy controls were recruited from the clients visiting the Medilab Diagnostics Services Limited and Regional Blood Transfusion Centre, Kumasi respectively. Ethical clearance was obtained from the Committee on Human Research, Publications and Ethics (CHRPE), School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi. Each participant gave a written informed consent to take part in the study after verbal and written explanation of the methods and risks involved had been given. Information on socio-demographic characteristics and medical history were obtained with standardised questionnaires which was administered to them. Venous blood samples were collected from the participants and assayed for haematological parameters (haemoglobin, WBC, lymphocytes neutrophils and platelets), biochemical parameters (AST, ALT, ALP, GGT and albumin) and inflammatory makers (CRP and IL-6). Some non-invasive markers of liver fibrosis (AAR, APRI and FIB-4) were also calculated. Further, anti-HBc IgM and anti-HBc was estimated qualitatively in the HBV infected persons to determine the presence of acute and chronic HBV infection. Also, HBeAg was estimated qualitatively to determine the presence of active and inactive HBV infection among the participants. The data obtained was analysed using the Statistical Package for Social Scientist (SPSS) Statistical Software (version 16.0, SPSS Inc., Chicago, IL, USA). The mean age of the HBV infected individuals (38.17±0.78 years) was not significantly different (p=0.115) from those of the control group (36.13±0.76 years). Out of the 146 HBV infected participants, 81.5% (CI: 74.2 - 87.4) were having acute infection whereas 18.5% (CI: 12.6 - 25.8) were having chronic infection. Overall, the chronic HBV infected individuals with active infection was 5.5% (CI: 2.4 - 10.5). The levels of CRP in the HBV infected individuals were significantly (p<0.001) increased as compared to the control group. This suggests an increased in liver inflammation as the HBV infection progressed in the HBV infected individuals. The levels of IL-6 pattern in the participants showed consistency with the CRP levels. The levels of AST ix (p<0.001) and ALT (p<0.001) in the HBV infected persons were markedly increased as compared to the control group, signifying an increase in liver injury as the infection progressed in the HBV infected persons. Further, the non-invasive markers of liver fibrosis scores in the HBV infected persons were significantly (p<0.001) increased as compared to the control group, suggestive of an increase in liver fibrosis as the infection progressed in the HBV infected persons. The haematological assays revealed significant (p<0.001) anaemia and leucocytosis in HBV infected persons compared to the control group, confirming some degree of anaemia and leucocytosis in the HBV infected persons. The levels of AST (r=0.856), ALT (r=0.909) and IL-6 (r=0.959) showed positive significant (p<0.001) associations with the levels of CRP in the chronic HBV infected persons. Similarly, levels of AST (r=0.799) and ALT (r=0.855) showed positive significant (p<0.001) associations with the levels of IL-6 in the chronic HBV infected individuals. The findings of this study support the assertion that chronic liver inflammation in HBV infected individuals is aggravated by increases in viral activities. The increase in the viral activities causes the release of IL-6 which in turn triggers the synthesis of CRP, and the damaged hepatocytes result in the leakage of transaminases into the bloodstream causing the serum levels of these markers to rise as observed in the study. The chronic liver inflammation, if left untreated, may lead to liver fibrosis. Therefore, the inclusion of antiinflammatory drugs in the management of HBV infection may be relevant to suppress the chronic liver inflammatory process and improve liver function

Source: KNUST