Evaluation of the Immunological Status in Occult Hepatitis B Virus-infected Patients Attending Rivers State University Teaching Hospital

Background: Occult hepatitis B infection (OBI) is a rare form of infection that is characterized by the presence of replication-competent HBV DNA in the liver but without detectable HBsAg in the serum.

Aim: This study aimed to determine the comparative levels of immunological variables particularly CD4 counts and differential white blood cell (WBC) counts in occult hepatitis B and HBsAg positive subjects among prospective blood donors in Port Harcourt Metropolis in Nigeria.

Methods: The CD4 count and total and differential WBC counts were analyzed with automated techniques using BD Fascount and Sysmex XP-300 respectively. Data were analyzed as mean (standard deviation) and significance was assumed at 95% confidence interval using student t-test and one-way ANOVA on GraphPad prism.

Results: The mean values for CD4, WBC, LYM (lymphocyte), MXD (differential mixed cells), and NEU (neutrophils) were 607±286 µ/l, 16±24 /l, 1.8±0.55 %, 0.46±0.15 % and 3.1±1.1 % respectively for occult hepatitis B subjects; 609±222 µ/l, 5.4±1.7 /l, 2.3±1.2 %, 0.54±0.31 % and 2.7±1.2 % respectively for HbsAg positive subjects and 823±256 µ/l, 10±5.4 /l, 2.4±1.6 %, 0.69±0.49 % and 6.4±4.7 % respectively for hepatitis B negative subjects. CD4 levels for male and female occult hepatitis B subjects are 729±309 µ/l and 461±190 µ/l respectively; 582±210 µ/l and 643±250 µ/l respectively for HBsAg positive subjects while that of hepatitis B negative subjects were 824±305 µ/l and 821±199 µ/l respectively. OBI showed a significant negative association between differential mixed cells and lymphocytes (r= -0.89 and p= 0.001) alone signifying that increment in former could reduce the latter. Only the HBsAg positive subjects showed a significant positive correlation of age to differential mixed cells (r=0.94 and p=0.000) which imply as the age increase the level of differential mixed cells will rise. Again, the HBsAg positive subjects showed a significant positive correlation between the differential mixed cells against neutrophil and WBC (r=0.53 and p=0.050), (r=0.56 and 0.036) respectively. Smoking and alcohol consumption caused raised levels of CD4 cells in OBI.

Conclusion: This study revealed a significant decrease in CD4 count, increase in total WBC and neutrophil counts while lymphocyte counts were decreased in occult hepatitis B subjects. Gender difference affect the level of CD4 cells and significant correlation were observed especially with the differential mixed cells.