Chronic hepatitis b associated without/with a delta agent in Kyrgyzstan (epidemiological situation, clinical features)

Abstract

Objective. To compare epidemiological, clinical and laboratory characteristics of chronic hepatitis B (ChHB) associated with/without delta agent (ChHB+DV) study.Materials and methods. The Kyrgyzstan State Reporting Form No. 12 covering 2010–2017 period was examined. For this, 133 and 130 case histories of ChHB and ChHB+DV patients, respectively, were analyzed. The data were statiastically processed by using Microsoft Office Excel software.Results and discussion. Over the 2010–2017 period, prevalence of the “HBV Carrier” (60.4 ) was higher by 20-fold than that one for ChHB [3.8 , 95% CI (2.4–4.0)] and CVHD [3.4 , 95% CI (2.2–3.4)], as the vast majority of patients were not thoroughly examined after detecting HBsAg, and the HBV Carrier was empirically diagnosed at the primary health care units. As a result, routine case definitions for such conditions were revised and an improved system of epidemiological surveillance of viral hepatitis was developed, according to the 2016 WHO recommendations approved by the Ministry of Health of the Kyrgyz Republic (Order No. 524, dated of July 20, 2018). Asthenia was observed in ~60% of patients in both groups, whereas arthralgia — in ~5–10% of patients, more often in those comorbid with ChHB+DV, and myalgia — in as low as ~3% of cases. Impaired central nervous system functions manifested as headache and restless sleep were evenly recorded in about 10–15% of patients, without significant difference between groups. In contrast, dominating dyspeptic manifestations such as poor appetite (72±3.9% vs. 20.6±3.5%, p < 0,05), nausea (23.8±3.7% vs. 7.3±2.3%, p < 0,05), vomiting (12.3±2.6% vs. 3.3±1.5%, p < 0,05) and flatulence (27±3.9% and 13±2.9%, p < 0,05) were revealed in ChHB+DV patients. Pain in the right hypochondrium was noted in 52–56% of patients, insignificantly differed between patient groups. Incidence of yellowness of the sclera and skin layers as well as skin itching were recorded by 2–3 and 8 times, respectively, more frequently in ChHB+DV patients. A more profound cytolysis and signs of altered bilirubin metabolism were also more common in HBV patients comorbid with the delta agent. Thus, a more severe ChHB+DV course requires that all patients with primary HBsAg detection were mandatorily examined for anti-HDV antibodies to ensure early diagnostics and timely organization of the secondary and tertiary preventive measures in the Kyrgyzstan.