CLINICAL PHASES OF CHRONIC HEPATITIS B AMONG GEORGIAN PATIENTS.

Hepatitis B virus infection remains one of the major healthcare problems in Georgia with an exposure prevalence of 25.9% (Positive Anti-HBc) and chronic HBV infection (Positive HBsAg) 2.9%. Determination of clinical phase of chronic HBV infection is crucial for evaluation prognosis and accordingly, initiation of antiviral treatment, which might be lifelong. The specific aim of our study was to collect data on clinical characteristics of HBV-infected patients and determine the clinical phases of chronic HBV infection in the Georgian population. We randomly selected 111 chronic HBV-infected patients from the database of the medical center Mrcheveli. Liver fibrosis was assessed by Fibroscan, and viral load data were computed by the Real Time polymerase chain reaction (PCR) methodology. Liver fibrosis results were available for 74 of the patients (67%), and a majority of patients (72 of the 74, 97%) had no signs of advanced liver fibrosis. Viral load data were available for 94 patients, of whom 70 (74.5%) had an HBV-DNA level less than 2000 IU/ml, while 18 (19.1%) had an HBV-DNA level between 2000 and 20000 IU/ml and 6 (6.4%) were higher than 20000 IU/ml. Data for the assessment of the clinical phase of chronic HBV infection were available for 54% of patients (60 of the 111). Only 3.3% (2/60) of patients had undetectable HBV-DNA and 75% (45/60) had a viral load <2000 IU/ml. Two patients were HBeAg-positive, one of them with hepatitis and another with normal ALT. A few patients classified as HBeAg-negative with chronic hepatitis given normal ALT criteria: 3/60 (5%) by EASL and 6/50 (10%) patients by AASLD. In summary, 11/60 (18.5%) and 8/60 (13.5%) patients had HBV-DNA >2000 IU/ml but a normal ALT. Given the small number of patients, we cautiously conclude that most patients (75%) had HBeAg-positive or -negative chronic HBV infection without hepatitis. However, up to 19% of patients were not possible to classify in any of the internationally recognized phases of HBV infection. Patients within this indeterminate grey area, should be evaluated cautiously and management needs to be individualized. It will be interesting to evaluate the reason high viral load in HBeAg negative patients with normal ALT and long-term outcome among these patients (liver fibroses and/or HCC development).

DISTRIBUTION OF HBV GENOTYPES AMONG GEORGIAN PATIENTS OF DIFFERENT AGE GROUPS.

Hepatitis B virus (HBV) infection is one of the major healthcare problems in Georgia with a prevalence of 2.9% in the adult population. There is no published data on HBV genotype distribution among different age groups in the country. The study aims to evaluate genotype distribution in Georgian HBV-infected patients among different age groups. Data was extracted from the clinical database of Mrcheveli medical center. Genotyping was performed using INNO-LiPA methodology. Statistical analysis was done using the statistical software SPSS 23.0. The total number of patients enrolled in the study was 84, of which 52 (62.1%) were males. Participants were mostly from Tbillisi (63.2%, N=53). Even though HBV genotype D was more predominant (found in 57.1% (N=48) of study participants), than genotype A (found in 42.9% (N=36) of the study population). Age was significantly associated with genotype distribution. The majority of the participants (58.3%, N=49) were 35 years old or younger. Genotype D was predominant in 71.4% of the study participants older than 35 years old, versus 46.9% of individuals 35 or younger with genotype D (p<0.001). Genotype A, among those <35 and >= 35 was presented in 53.1% and 28.6% of cases, respectively. Our data suggests that HBV genotype D is most prevalent among older Georgian patients chronically infected with hepatitis B. More than half of younger patients (35 years old or younger) have Genotype A.