Observational Study
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World J Hepatol. Aug 27, 2014; 6(8): 621-625
Published online Aug 27, 2014. doi: 10.4254/wjh.v6.i8.621
Early termination of immune tolerance state of hepatitis B virus infection explains liver damage
Mamun-Al-Mahtab, Sheikh Mohammad Fazle Akbar, Helal Uddin, Sakirul Islam Khan, Salimur Rahman
Mamun-Al-Mahtab, Salimur Rahman, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh
Sheikh Mohammad Fazle Akbar, Department of Medical Sciences, Toshiba General Hospital, Tokyo140-0013, Japan
Helal Uddin, Clinical Research Organization, Dhaka 1213, Bangladesh
Sakirul Islam Khan, Department of Anatomy and Embryology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
Author contributions: All authors contributed to this paper.
Correspondence to: Dr. Mamun-Al-Mahtab, Associate Professor of Hepatology, Bangabandhu Sheikh Mujib Medical University, Shahbagh Rd, Dhaka 1000, Bangladesh. shwapnil@agni.com
Telephone: +880-171-1567275
Received: February 22, 2014
Revised: April 24, 2014
Accepted: June 10, 2014
Published online: August 27, 2014

AIM: To assess an early termination of immune tolerance state of chronic hepatitis B virus infection in Bangladesh and its clinical significance.

METHODS: From a series of 167 treatment-naive chronic hepatitis B patients aged between 12 to 20 years (mean ± SD; 17.5 ± 2.8 years), percutaneous liver biopsies of 89 patients who were all hepatitis B e antigen negative at presentation were done. Of them, 81 were included in the study. They had persistently normal or raised serum alanine aminotransferase (ALT) values. A precore mutation (PCM) study was accomplished in 8 patients who were randomly selected.

RESULTS: Forty-four (53.7%) patients had significant necroinflammation (HAI-NI > 7), while significant fibrosis (HAI-F ≥ 3) was seen in 15 (18.5%) patients. Serum ALT (cut off 42 U/L) was raised in 29 (35.8%) patients, while low HBV DNA load (< 105 copies/mL) was observed in 57 (70.4%) patients. PCM was negative in all 8 patients.

CONCLUSION: This study indicates that the current concept of age-related immune tolerance state of HBV infection deserves further analyses in different population groups.

Keywords: Chronic hepatitis B, Immune tolerance, Early termination

Core tip: Immune tolerance phase usually prevails for up to 20-25 years in subjects with chronic hepatitis B virus (HBV) infection. However, the present study showed that considerable numbers of chronic HBV-infected patients of Bangladesh lost hepatitis B e antigen and developed anti-HBe. Early termination of immune tolerance phase of these young patients was also associated with elevated alanine aminotransferase, hepatic necroinflammation and considerable hepatic fibrosis in some patients. Treatment guidelines are warranted for these patients as there is a paucity of information about their entity.