Stage of disease in hepatitis B virus infection in Zambian adults is associated with large cell change but not well defined using classic biomarkers

Bright Nsokolo, Anne Kanunga, Edford Sinkala, Kanekwa Zyambo, Dia Kumwenda, David Chama, Gabriel Muyinda, Michael Vinikoor, Samreen Ijaz, Richard Tedder, Ali Khalifa A. Elmdaah, Meleri Jones, Clarence Chiluba, Victor Mudenda, Robert D. Goldin, Graham Foster, Paul Kelly

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Hepatocellular malignancy in young adults is a prominent feature of hepatitis B virus (HBV) infection in southern Africa. Here we report a cross-sectional study of liver pathology correlated with biomarkers in adults with HBV infection in Zambia. Methods: We analysed liver biopsies from Zambian patients with persistent HBV infection. Results: We analysed 104 patients with HBV infection and evidence of liver disease. We obtained liver biopsies from 53 adults; of these, 12 (23%) were hepatitis B e antigen seropositive. The genotype was evenly distributed between A and E. One biopsy showed malignancy. Stage was 3 or more in 11 of 52 (21%) biopsies free of malignancy and lobular inflammation was found in 50 (94%). Neither alanine aminotransferase (ALT) nor the γ-glutamyl transferase:platelet ratio (GPR) were correlated with the stage of disease but were correlated with total Ishak score (p=0.47, p=0.0004 and p=0.33, p=0.02, respectively). Large cell change was observed in 10 of 11 biopsies with fibrosis stage 3 or more and 16 of 41 with early disease (p=0.005). Serum α-fetoprotein was elevated, although still within the normal range, in patients with large cell change (median 3.6 [interquartile range {IQR} 1.6-5.1]) compared with those without (1.7 [IQR 1.0-2.8]; p=0.03). Neither ALT nor GPR predicted large cell change. Conclusions: Large cell change was common in young HBV-infected adults in Zambia. Only serum α-fetoprotein was identified as a biomarker of this phenotype.

Original languageEnglish
Pages (from-to)425-432
Number of pages8
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Volume111
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017

Keywords

  • Africa
  • Hepatitis B
  • Hepatocellular carcinoma
  • Liver biopsy

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