Evaluation of ALT and Immune-Hematological Parameters as Adjunct Markers to Viral Load in HBV Management in a Resource-Constrained Setting

Abstract

Introduction: In a resource-constrained situation where HBV DNA viral load testing may not be available or be prohibitively expensive, the current study sought to assess the levels of white blood cells, red blood cells, haemoglobin, platelets count and other red cell indices, CD4+ T-cell count and ALT as an adjunct marker to viral load in HBV Management. Methods: A case-control cross-sectional study was conducted among 300 subjects (100 acute HBV patients, 100 chronic HBV patients, and 100 HBV-negative individuals). The haemostatic parameter, absolute CD4+ T-cell count, HBcAb-IgM, alanine aminotransferase (ALT) and HBV-DNA were measured using standard methods.Results: When compared to HBV-negative individuals, the median (interquartile range, IQR) of acute and chronic HBV-infected participants had signi cantly higher total WBC, granulocyte, and monocyte counts, but lower platelet, lymphocyte, and RBC counts. When compared to the HBV-negative group, the median (IQR) of acute and chronic HBV-infected participants had signi cantly lower haemoglobin, haematocrit, mean cell volume, mean cell haemoglobin, and mean cell haemoglobin concentration. ALT levels were highest in acute HBV participants (median 61.0 [IQR: 48.75-72.00]) and lowest in HBV negative controls (median 24.50 [IQR: 20.0-36.75]) (Krustal-Wallis test= 151.2, p <0.0001). HBV negative controls had the highest CD4+ T-cell count levels (median 784.0 [IQR: 548.0-953.8] and lowest in acute HBV infected participants (median 194.5 [IQR: 142.0-308.0]) (Krustal-Wallis test= 193.2, p < 0.0001) Conclusion: Our ndings highlight the impact of HBV infection on iron metabolism and the production of haematological precursor cells. As such these parameters could be used as adjunct markers for viral load in the management of HBV infection in a resource-constrained setting.